Abstract
Post-stroke depression (PSD) is a frequent problem in stroke rehabilitation. Several studies have evaluated association between the lesion location and the risk of depression. Different conclusions and contradictory findings have been published. The aim of the present study was to perform a systematic meta-analysis to evaluate the relationship between PSD and lesion location. We researched PubMed, ISI Web of Science, EMBASE, and systematically reviewed available publications reporting investigations on stroke location and risk of PSD. Subgroup analyses were performed according to the time since stroke onset to assessment for PSD or the source of patients. Odds ratios (ORs) and 95 % confidence intervals (CIs) were used for pooled analyses. Heterogeneity was assessed with Cochran’s Q test and I 2 test. Begg’s funnel plot and Egger’s test were used to examine the publication bias. A total of 43 studies involving 5,507 patients suffering from stroke were included in this meta-analysis. The pooled OR with 95 % CI for the overall association of stroke location and depression risk was 0.99 (0.88–1.11). Subgroups analyses highlighted that only studies with subacute post-stroke group (1–6 months) showed a statistical association between right hemisphere stroke and risk of depression (OR = 0.79, 95 % CI 0.66–0.93). This systematic review offered no support for the hypothesis that lesion of the left hemisphere was associated with an increased risk of depression after stroke. We only find significant association between right hemisphere stroke and incidence of depression for studies within subacute post-stroke phase.
Similar content being viewed by others
References
Cully JA, Gfeller JD, Heise RA, Ross MJ, Teal CR, Kunik ME (2005) Geriatric depression, medical diagnosis, and functional recovery during acute rehabilitation. Arch Phys Med Rehabil 86:2256–2260
Gillen R, Tennen H, McKee TE, Gernert-Dott P, Affleck G (2001) Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients. Arch Phys Med Rehabil 82:1645–1649
Williams LS, Ghose SS, Swindle RW (2004) Depression and other mental health diagnoses increase mortality risk after ischemic stroke. Am J Psychiatry 161:1090–1095
Ayerbe L, Ayis S, Rudd AG, Heuschmann PU, Wolfe CD (2011) Natural history, predictors, and associations of depression 5 years after stroke: the South London Stroke Register. Stroke J Cereb Circ 42:1907–1911
Hackett ML, Yapa C, Parag V, Anderson CS (2005) Frequency of depression after stroke: a systematic review of observational studies. Stroke J Cereb Circ 36:1330–1340
Robinson RG, Shoemaker WJ, Schlumpf M, Valk T, Bloom FE (1975) Effect of experimental cerebral infarction in rat brain on catecholamines and behaviour. Nature 255:332–334
Robinson RG, Kubos KL, Starr LB, Rao K, Price TR (1983) Mood changes in stroke patients: relationship to lesion location. Compr Psychiatry 24:555–566
Robinson RG, Kubos KL, Starr LB, Rao K, Price TR (1984) Mood disorders in stroke patients. Importance of location of lesion. Brain J Neurol 107(Pt 1):81–93
Parikh RM, Lipsey JR, Robinson RG, Price TR (1987) Two-year longitudinal study of post-stroke mood disorders: dynamic changes in correlates of depression at one and two years. Stroke J Cereb Circ 18:579–584
MacHale SM, O’Rourke SJ, Wardlaw JM, Dennis MS (1998) Depression and its relation to lesion location after stroke. J Neurol Neurosurg Psychiatry 64:371–374
Carson AJ, MacHale S, Allen K, Lawrie SM, Dennis M, House A, Sharpe M (2000) Depression after stroke and lesion location: a systematic review. Lancet 356:122–126
Hadidi N, Treat-Jacobson DJ, Lindquist R (2009) Poststroke depression and functional outcome: a critical review of literature. Heart lung J Crit Care 38:151–162
Bhogal SK, Teasell R, Foley N, Speechley M (2004) Lesion location and poststroke depression: systematic review of the methodological limitations in the literature. Stroke J Cereb Circ 35:794–802
Yu L, Liu CK, Chen JW, Wang SY, Wu YH, Yu SH (2004) Relationship between post-stroke depression and lesion location: a meta-analysis. Kaohsiung J Med Sci 20:372–380
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634 (clinical research ed)
Folstein MF, Maiberger R, McHugh PR (1977) Mood disorder as a specific complication of stroke. J Neurol Neurosurg Psychiatry 40:1018–1020
Eastwood MR, Rifat SL, Nobbs H, Ruderman J (1989) Mood disorder following cerebrovascular accident. Br J Psychiatry J Mental Sci 154:195–200
Morris PL, Robinson RG, Raphael B (1990) Prevalence and course of depressive disorders in hospitalized stroke patients. Int J Psychiatry Med 20:349–364
House A, Dennis M, Warlow C, Hawton K, Molyneux A (1990) Mood disorders after stroke and their relation to lesion location. A CT scan study. Brain J Neurol 113(Pt 4):1113–1129
Sharpe M, Hawton K, House A, Molyneux A, Sandercock P, Bamford J, Warlow C (1990) Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume. Psychol Med 20:815–828
Starkstein SE, Bryer JB, Berthier ML, Cohen B, Price TR, Robinson RG (1991) Depression after stroke: the importance of cerebral hemisphere asymmetries. J Neuropsychiatry Clin Neurosci 3:276–285
Schwartz JA, Speed NM, Brunberg JA, Brewer TL, Brown M, Greden JF (1993) Depression in stroke rehabilitation. Biol Psychiatry 33:694–699
Astrom M, Adolfsson R, Asplund K (1993) Major depression in stroke patients. A 3-year longitudinal study. Stroke J Cereb Circ 24:976–982
Loong CK, Kenneth NK, Paulin ST (1995) Post-stroke depression: outcome following rehabilitation. Aust NZ J Psychiatry 29:609–614
Gonzalez-Torrecillas JL, Mendlewicz J, Lobo A (1995) Effects of early treatment of poststroke depression on neuropsychological rehabilitation. Int Psychogeriatr/IPA 7:547–560
Andersen G, Vestergaard K, Ingemann-Nielsen M, Lauritzen L (1995) Risk factors for post-stroke depression. Acta Psychiatr Scand 92:193–198
Herrmann M, Bartels C, Schumacher M, Wallesch CW (1995) Poststroke depression. Is there a pathoanatomic correlate for depression in the postacute stage of stroke? Stroke J Cereb Circ 26:850–856
Iacoboni M, Padovani A, Di Piero V, Lenzi GL (1995) Post-stroke depression: relationships with morphological damage and cognition over time. Ital J Neurol Sci 16:209–216
Bjerg Bendsen B, Bjerg Bendsen E, Lauritzen L, Vilmar T, Bech P (1997) Post-stroke patients in rehabilitation. The relationship between biological impairment (CT scanning), physical disability and clinical depression. Eur Psychiatry 12:399–404
Pohjasvaara T, Leppavuori A, Siira I, Vataja R, Kaste M, Erkinjuntti T (1998) Frequency and clinical determinants of poststroke depression. Stroke J Cereb Circ 29:2311–2317
Kase CS, Wolf PA, Kelly-Hayes M, Kannel WB, Beiser A, D’Agostino RB (1998) Intellectual decline after stroke: the Framingham Study. Stroke J Cereb Circ 29:805–812
Paolucci S, Antonucci G, Pratesi L, Traballesi M, Grasso MG, Lubich S (1999) Poststroke depression and its role in rehabilitation of inpatients. Arch Phys Med Rehabil 80:985–990
Gainotti G, Antonucci G, Marra C, Paolucci S (2001) Relation between depression after stroke, antidepressant therapy, and functional recovery. J Neurol Neurosurg Psychiatry 71:258–261
Shimoda K, Robinson RG (1999) The relationship between poststroke depression and lesion location in long-term follow-up. Biol Psychiatry 45:187–192
Singh A, Black SE, Herrmann N, Leibovitch FS, Ebert PL, Lawrence J, Szalai JP (2000) Functional and neuroanatomic correlations in poststroke depression: the Sunnybrook Stroke Study. Stroke J Cereb Circ 31:637–644
Berg A, Palomaki H, Lehtihalmes M, Lonnqvist J, Kaste M (2001) Poststroke depression in acute phase after stroke. Cerebrovasc Dis 12:14–20
Desmond DW, Remien RH, Moroney JT, Stern Y, Sano M, Williams JB (2003) Ischemic stroke and depression. J Int Neuropsychol Soc JINS 9:429–439
Hsieh LP, Kao HJ (2005) Depressive symptoms following ischemic stroke: a study of 207 patients. Acta Neurol Taiwanica 14:187–190
Spalletta G, Ripa A, Caltagirone C (2005) Symptom profile of DSM-IV major and minor depressive disorders in first-ever stroke patients. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry 13:108–115
Nys GM, van Zandvoort MJ, van der Worp HB, de Haan EH, de Kort PL, Kappelle LJ (2005) Early depressive symptoms after stroke: neuropsychological correlates and lesion characteristics. J Neurol Sci 228:27–33
Tang WK, Chan SS, Chiu HF, Ungvari GS, Wong KS, Kwok TC, Mok V, Wong KT, Richards PS, Ahuja AT (2005) Poststroke depression in Chinese patients: frequency, psychosocial, clinical, and radiological determinants. J Geriatr Psychiatry Neurol 18:45–51
Glodzik-Sobanska L, Slowik A, McHugh P, Sobiecka B, Kozub J, Rich KE, Urbanik A, Szczudlik A (2006) Single voxel proton magnetic resonance spectroscopy in post-stroke depression. Psychiatry Res Neuroimaging 148:111–120
Caeiro L, Ferro JM, Santos CO, Figueira ML (2006) Depression in acute stroke. J Psychiatry Neurosci JPN 31:377–383
Brodaty H, Withall A, Altendorf A, Sachdev PS (2007) Rates of depression at 3 and 15 months post stroke and their relationship with cognitive decline: the Sydney Stroke Study. Am J Geriatr Psychiatry 15:477–486
Provinciali L, Paolucci S, Torta R, Toso V, Gobbi B, Gandolfo C (2008) Depression after first-ever ischemic stroke: the prognostic role of neuroanatomic subtypes in clinical practice. Cerebrovasc Dis 26:592–599
Oladiji JO, Akinbo SR, Aina OF, Aiyejusunle CB (2009) Risk factors of post-stroke depression among stroke survivors in Lagos, Nigeria. Afr J Psychiatry 12:47–51
Fuentes B, Ortiz X, Sanjose B, Frank A, Diez-Tejedor E (2009) Post-stroke depression: can we predict its development from the acute stroke phase? Acta Neurol Scand 120:150–156
Snaphaan L, van der Werf S, Kanselaar K, de Leeuw FE (2009) Post-stroke depressive symptoms are associated with post-stroke characteristics. Cerebrovasc Dis 28:551–557
Nidhinandana S, Sithinamsuwan P, Chinvarun Y, Wongmek W, Supakasem S, Suwantamee J (2010) Prevalence of poststroke depression in Thai stroke survivors studied in Phramongkutklao Hospital. J Med Assoc Thail Chotmaihet Thangphaet 93(Suppl 6):S60–S64
Nishiyama Y, Komaba Y, Ueda M, Nagayama H, Amemiya S, Katayama Y (2010) Early depressive symptoms after ischemic stroke are associated with a left lenticulocapsular area lesion. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 19:184–189
Bour A, Rasquin S, Aben I, Boreas A, Limburg M, Verhey F (2010) A one-year follow-up study into the course of depression after stroke. J Nutr Health Aging 14:488–493
Tennen G, Herrmann N, Black SE, Levy KS, Cappell J, Li A, Lanctot KL (2011) Are vascular risk factors associated with post-stroke depressive symptoms? J Geriatr Psychiatry Neurol 24:215–221
Altieri M, Maestrini I, Mercurio A, Troisi P, Sgarlata E, Rea V, Di Piero V, Lenzi GL (2012) Depression after minor stroke: prevalence and predictors. Eur J Neurol Off J Eur Fed Neurol Soc 19:517–521
Choi-Kwon S, Han K, Choi S, Suh M, Kim YJ, Song H, Cho KH, Nah HW, Kwon SU, Kang DW, Kim JS (2012) Poststroke depression and emotional incontinence: factors related to acute and subacute stages. Neurology 78:1130–1137
Zhang WN, Pan YH, Wang XY, Zhao Y (2013) A prospective study of the incidence and correlated factors of post-stroke depression in China. PLoS One 8:e78981
Rajashekaran P, Pai K, Thunga R, Unnikrishnan B (2013) Post-stroke depression and lesion location: a hospital based cross-sectional study. Indian J Psychiatry 55:343–348
Meader N, Moe-Byrne T, Llewellyn A, Mitchell AJ (2014) Screening for poststroke major depression: a meta-analysis of diagnostic validity studies. J Neurol Neurosurg Psychiatry 85:198–206
Santos M, Kovari E, Gold G, Bozikas VP, Hof PR, Bouras C, Giannakopoulos P (2009) The neuroanatomical model of post-stroke depression: towards a change of focus? J Neurol Sci 283:158–162
Acknowledgments
This work was supported by National Natural Science Foundation of China (81301165 to Jin H), Natural Science Fund of Hubei Province (2012FFB03706 to Jin H) and China Postdoctoral Science Foundation (2014M552047 to Jin H).
Conflicts of interest
The authors declare that there is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
N. Wei and W. Yong contributed equally to this work.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Wei, N., Yong, W., Li, X. et al. Post-stroke depression and lesion location: a systematic review. J Neurol 262, 81–90 (2015). https://doi.org/10.1007/s00415-014-7534-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-014-7534-1