The journal of nutrition, health & aging

, Volume 14, Issue 6, pp 488–493

A one-year follow-up study into the course of depression after stroke

  • A. Bour
  • S. Rasquin
  • I. Aben
  • A. Boreas
  • M. Limburg
  • F. Verhey
A One-Year Follow-Up Study into the Course of Depression after Stroke



Stroke patients commonly suffer from neuropsychiatric disorders, such as depression, that negatively influence stroke outcome. Diagnosis, treatment and prevention of post-stroke psychiatric disorders including depression are under debate.


To study the course of depression after stroke.


One hundred and ninety first-ever stroke patients were screened for depressive symptoms at 1, 3, 6, 9, and 12 months after stroke. Diagnosis of depression was made according to the DSM-IV criteria of major and minor depression.


Follow-up was completed in 138 patients. The cumulative incidence of post-stroke depression (PSD) in 1 year was 36.2%. One month after stroke the prevalence of PSD was 18.8%. Thirty percent of patients who were depressed in the first three months did not reach cut-off levels on depression screening instruments at the following assessments. In 44% of these patients symptoms recurred. Recurrent cases were older than patients with limited disease. In 40% of PSD patients depression persisted for at least two consecutive following follow-up visits. Persistent cases were more disabled and suffered more often from major depression.


Half of PSD patients become depressed within the first month after stroke. Although most patients recover, a clinician has to be aware that symptoms can recur especially in older patients and that in patients with major depression symptoms may be persistent. In these patients treatment should be considered, whereas in patients with limited disease an observational approach may suffice.

Key words

Depression stroke 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Angelelli P, Paolucci S, Bivona U, et al: Development of neuropsychiatric symptoms in poststroke patients: a cross-sectional study. Acta Psychiatr Scand 2004; 110:55–63CrossRefPubMedGoogle Scholar
  2. 2.
    Robinson RG: Poststroke depression: prevalence, diagnosis, treatment, and disease progression. Biol Psychiatry 2003; 54:376–387CrossRefPubMedGoogle Scholar
  3. 3.
    Morrison V, Pollard B, Johnston M, et al: Anxiety and depression 3 years following stroke: Demographic, clinical, and psychological predictors. Journal of psychosomatic research 2005; 59:209–213CrossRefPubMedGoogle Scholar
  4. 4.
    Sharpe M, Hawton K, Seagroatt V, et al: Depressive disorders in long-term survivors of stroke. Associations with demographic and social factors, functional status, and brain lesion volume. British Journal of Psychiatry 1994; 164:380–386CrossRefPubMedGoogle Scholar
  5. 5.
    Pohjasvaara T, Vataja R, Leppavuori A, et al: Depression is an independent predictor of poor long-term functional outcome post-stroke. Eur J Neurol 2001; 8:315–319CrossRefPubMedGoogle Scholar
  6. 6.
    Astrom M, Adolfsson R, Asplund K: Major depression in stroke patients. A 3-year longitudinal study. Stroke; a journal of cerebral circulation 1993; 24:976–982PubMedGoogle Scholar
  7. 7.
    Carota A, Berney A, Aybek S, et al: A prospective study of predictors of poststroke depression. Neurology 2005; 64:428–433PubMedGoogle Scholar
  8. 8.
    Berg A, Palomaki H, Lehtihalmes M, et al: Poststroke depression: an 18-month follow-up. Stroke; a journal of cerebral circulation 2003; 34:138–143PubMedGoogle Scholar
  9. 9.
    Andersen G, Vestergaard K, Ingemann-Nielsen M, et al: Risk factors for post-stroke-depression. Acta Psychiatr Scand 1995; 92:193–198CrossRefPubMedGoogle Scholar
  10. 10.
    Gaete JM, Bogousslavsky J: Post-stroke depression. Expert review of neurotherapeutics 2008; 8:75–92CrossRefPubMedGoogle Scholar
  11. 11.
    Carson AJ, MacHale S, Allen K, et al: Depression after stroke and lesion location: a systematic review. Lancet 2000; 356:122–126CrossRefPubMedGoogle Scholar
  12. 12.
    Vataja R, Pohjasvaara T, Leppavuori A, et al: Magnetic resonance imaging correlates of depression after ischemic stroke. Archives of general psychiatry 2001; 58:925–931.CrossRefPubMedGoogle Scholar
  13. 13.
    Tateno A, Kimura M, Robinson RG: Phenomenological characteristics of poststroke depression: early- versus late-onset. Am J Geriatr Psychiatry 2002; 10:575–582PubMedGoogle Scholar
  14. 14.
    Hackett M: Frequency of depression after stroke. Stroke; a journal of cerebral circulation 2005; 36:1330–1340PubMedGoogle Scholar
  15. 15.
    Whyte EM, Mulsant BH, Vanderbilt J, et al: Depression after stroke: a prospective epidemiological study. Journal of the American Geriatrics Society 2004; 52:774–778CrossRefPubMedGoogle Scholar
  16. 16.
    Narushima K, Robinson RG: The effect of early versus late antidepressant treatment on physical impairment associated with poststroke depression: is there a time-related therapeutic window? J Nerv Ment Dis 2003; 191:645–652CrossRefPubMedGoogle Scholar
  17. 17.
    Paranthaman R, Baldwin RC: Treatment of psychiatric syndromes due to cerebrovascular disease. International review of psychiatry (Abingdon, England) The effect of early versus late antidepressant treatment on physical impairment associated with poststroke depression: is there a time-related therapeutic window 2006; 18:453–470Google Scholar
  18. 18.
    Aben I, Verhey F, Strik J, et al: A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction. Journal of neurology, neurosurgery, and psychiatry 2003; 74:581–585CrossRefPubMedGoogle Scholar
  19. 19.
    Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. Stroke; a journal of cerebral circulation 1990; 21:637–676Google Scholar
  20. 20.
    Boon A, Lodder J, Heuts-van Raak L, et al: Silent brain infarcts in 755 consecutive patients with a first-ever supratentorial ischemic stroke. Relationship with index-stroke subtype, vascular risk factors, and mortality. Stroke; a journal of cerebral circulation 1994; 25:2384–2390PubMedGoogle Scholar
  21. 21.
    Hamilton M: A rating scale for depression. Journal of neurology, neurosurgery and psychiatry 1960; 23:56–62CrossRefGoogle Scholar
  22. 22.
    Beck AT, Ward CH, Mendelson M, et al: An Inventory for measuring depression. Archives of general psychiatry 1961; 4:561–571PubMedGoogle Scholar
  23. 23.
    Derogatis LR, Lipman RS, Covi L: SCL-90: an outpatient psychiatric rating scale—preliminary report. Psychopharmacol Bull 1973; 9:13–28PubMedGoogle Scholar
  24. 24.
    Zigmond AS, Snaith RP: The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 1983; 67:361–370CrossRefPubMedGoogle Scholar
  25. 25.
    Aben I, Verhey F, Lousberg R, et al: Validity of the beck depression inventory, hospital anxiety and depression scale, SCL-90, and hamilton depression rating scale as screening instruments for depression in stroke patients. Psychosomatics 2002; 43:386–393CrossRefPubMedGoogle Scholar
  26. 26.
    Costa PT, Jr., McCrae RR: The NEO Personality Inventory Manual, Odessa, Florida, Psychological Assessment Resources Inc., 1985Google Scholar
  27. 27.
    Hoekstra HA, Ormel J, De Fruyt F: NEO Personality Questionnaires NEO-PI-R, NEO-FFI, Manual, Lisse, Swets & Zeitlinger B.V., 1996Google Scholar
  28. 28.
    Enns MW, Cox BJ: Personality dimensions and depression: Review and commentary. Canadian Journal of Psychiatry 1997; 42:274–284Google Scholar
  29. 29.
    Morris PL, Robinson RG, Raphael B: Prevalence and course of depressive disorders in hospitalized stroke patients. International journal of psychiatry in medicine 1990; 20:349–364PubMedGoogle Scholar
  30. 30.
    Robinson RG, Bolduc PL, Price TR: Two-year longitudinal study of poststroke mood disorders: diagnosis and outcome at one and two years. Stroke; a journal of cerebral circulation 1987; 18:837–843PubMedGoogle Scholar
  31. 31.
    Burvill PW, Johnson GA, Jamrozik KD, et al: Prevalence of depression after stroke: the Perth Community Stroke Study. Br J Psychiatry 1995; 166:320–327CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2010

Authors and Affiliations

  • A. Bour
    • 1
  • S. Rasquin
    • 2
  • I. Aben
    • 3
  • A. Boreas
    • 4
  • M. Limburg
    • 4
  • F. Verhey
    • 5
  1. 1.Dpt. NeurologyMaastricht University Medical CenterMaastrichtThe Netherlands
  2. 2.Stichting Revalidatie LimburgHoensbroekThe Netherlands
  3. 3.Dpt. PsychiatryMondriaan ZorggroepHeerlenThe Netherlands
  4. 4.Maastricht University Medical CenterMaastrichtThe Netherlands
  5. 5.Dpt. Neuropsychology and PsychiatryMaastricht University Medical CenterMaastrichtThe Netherlands

Personalised recommendations