title: Depression Status Is Associated with Functional Decline Over 1-Year Following Acute Stroke.
abstract: BACKGROUND
  We investigated the independent association of depression status at 3 and 12 months after stroke and functional decline.
  
  
  METHODS
  Data were obtained as part of the multicenter Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry. Depression was assessed with the Patient Health Questionnaire-8 (depression, PHQ-8 ≥ 10), and functional status was assessed with the modified Rankin score (mRS) at 3 and 12 months following hospitalization for ischemic stroke. We used logistic regression analyses to evaluate the independent association between the change in depression rating and the change in mRS.
  
  
  RESULTS
  Among 1444 patients, 75% did not have depression at either time point, 9.2% had persistent depression, 8.7% had resolving depression, and 7% had incident depression at 12 months. After covariate adjustment, depression status at 3 and 12 months remained associated with worsening mRS (P = .01). Compared with patients without depression, those with resolving depression were less likely to have a worsening mRS (odds ratio [OR] = .49, 95% confidence interval [CI]: .29-0.83). There was no difference in functional decline between those with no depression and those with persistent depression; however, those with persistent depression had worse mRS at both time points (median mRS: 2.5 [Q1-Q3: 2-3] at 3 months; 2 [2-3] at 12 months) than those with no depression (mRS: 1 [0-2] at both 3 and 12 months), P < .0001.
  
  
  CONCLUSIONS
  Patients with resolving depression in the first year after stroke were less likely to have functional deterioration than those without depression. Greater functional impairment was present in the setting of depression.
authors.affiliation: Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, North Carolina; Department of Neurology, Duke University Medical Center, Durham, North Carolina. Electronic address: nelhusse@wakehealth.edu.
authors.forename: Nada
authors.initials: N
authors.lastname: El Husseini
authors.affiliation: Department of Neurology, University of Kentucky, Lexington, Kentucky.
authors.forename: Larry B
authors.initials: LB
authors.lastname: Goldstein
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Neurology, UT Southwestern, Dallas, Texas.
authors.forename: DaiWai M
authors.initials: DM
authors.lastname: Olson
authors.affiliation: Department of Medicine, Durham Veterans Affairs, Durham, North Carolina.
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
authors.affiliation: Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, North Carolina.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bushnell
authors.affiliation: Department of Neurology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Laskowitz
mesh_terms: D000368:Aged; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Depression after stroke; functional decline; functional recovery; stroke