A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 74; no. 5; pp. 581 - 585
• Main Authors: Aben, I, Verhey, F, Strik, J, Lousberg, R, Lodder, J, Honig, A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-05-2003; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: 4th edition; 90 item symptom checklist; Aged; Aphasia; BDI; Beck depression inventory; Biological and medical sciences; Cardiology. Vascular system; Cohort Studies; Comorbidity; Coronary heart disease; Dementia; depression; Depression, Mental; Depressive Disorder - epidemiology; Depressive Disorder - etiology; Depressive Disorder - physiopathology; Diagnostic and Statistical Manual of Mental Disorders; Disability Evaluation; Disease; DSM-IV; Family medical history; FAST; Female; Follow-Up Studies; Frenchay aphasia screening test; HADS; HAM-D; Hamilton depression rating scale; hazard ratio; Heart; Heart attacks; hospital anxiety and depression scale; Hospitals; Humans; Hypotheses; Incidence; Interviews; Longitudinal Studies; Male; Medical imaging; Medical sciences; Mental depression; Methodology; Middle Aged; mini-mental state examination; MMSE; myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - epidemiology; Myocardial Infarction - physiopathology; Neurology; NMR; Nuclear magnetic resonance; Pathogenesis; Patients; Personality traits; Psychological Tests; SCID-I-R; SCL-90; Severity of Illness Index; Stroke; Stroke (Disease); Stroke - complications; Stroke - epidemiology; Stroke - physiopathology; structured clinical interview from DSM-IV; Studies; Survival analysis; Time Factors; Vascular diseases and vascular malformations of the nervous system; Netherlands; Europe; Mood disorder; Human; Nervous system diseases; Stroke; Infarct; Cardiovascular disease; Depression; Coronary heart disease; Myocardial disease; Epidemiology; Long term; Cerebral disorder; Incidence; Vascular disease; Central nervous system disease; Complication; Cerebrovascular disease; Public health; Comparative study
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.74.5.581

Background: The high incidence of post-stroke depression has been claimed to reflect a specific, stroke related pathogenesis in which lesion location plays an important role. To substantiate this claim, post-stroke depression should occur more often than depression after another acute, life threatening, disabling disease that does not involve cerebrovascular damage. Objectives: To compare the cumulative one year incidence of depression after stroke and after myocardial infarction, taking into consideration differences in age, sex, and the level of handicap. Methods: In a longitudinal design, 190 first ever stroke patients and 200 first ever myocardial infarction patients were followed up for one year. Depression self rating scales were used as a screening instrument to detect patients with depressive symptoms. Major and minor depression was assessed at one, three, six, nine, and 12 months after stroke or myocardial infarction according to DSM-IV criteria, using the structured clinical interview from DSM-IV. The severity of depressive symptoms was measured with the Hamilton depression rating scale. Level of disability and handicap was rated with the Rankin handicap scale. Results: The cumulative one year incidence of major and minor depression was 37.8% in stroke patients and 25% in patients with myocardial infarction (hazard ratio 1.6; p = 0.06). This difference disappeared after controlling for sex, age, and level of handicap. In addition, no differences were found in the severity of depressive symptoms or in the time of onset of the depressive episode after stroke or myocardial infarction. Conclusions: Depression occurs equally often during the first year after stroke and after myocardial infarction when non-specific factors such as sex, age, and level of handicap are taken into account. Thus the relatively high incidence of post-stroke depression seems not to reflect a specific pathogenic mechanism. Further research is needed to investigate whether vascular factors play a common role in the development of depression after stroke and myocardial infarction.