A Longitudinal Study on Post-stroke Depression and Its Associated Factors in Hong Kong (Chinese version)_Chinese Journal of Evidence-Based Medicine

Authors：

 Janet W Sit ¹ , Thomas KS Wong ¹ , Leonard SW Li ²

1. School of Nursing, The Hong Kong Polytechnic University, HongKong 2. Tung Wah Hospital, Hong Kong Hospital Authority, HongKong;

Corresponding?author：

Janet W Sit, Email: hsjsit@inet.polyu.edu.hk

Keywords：

Post-stroke Depression; Social support; Functional disability

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Objective 　Depression is a common consequence after stroke and has become a significant issue in clinical practice and research. The aim of this study was to explore associated factors of post-stroke depression among first-ever stroke patients in Hong Kong.
Methods 　A longitudinal study was conducted to collect data in face-to-face interviews and by physical assessment at two time points: T1, within 48 hours of admission to a rehabilitation hospital; and T2, 6 months after the first interview. T2 interviews and assessments were conducted in the participant’s current place of residence. Participants were first-ever stroke patients in Hong Kong. Post-stroke depression was measured using the Center of Epidemiological Study-Depression (CES-D) Scale. Backward linear regression analysis was performed to examine factors associated with level of post-stroke depression at T2.
Results 　Our findings showed that 69% of participants exhibited clinically relevant levels of depressive symptoms at T1 and 48% at T2. Regression analysis revealed complex relationships between the level of depressive symptoms, demographic characteristics and variations in perceived levels of social support. Five variables were found to explain 55% of the variance in depressive symptoms at T2. The variables with significant standardized regression coefficients (β) were: companionship (P=0.001), informational support (P=0.025), baseline level of depressive symptoms (P lt;0.001), ADL dependence level (P lt;0.001) and being a homemaker before the stroke (P=0.039).
Conclusions 　We have followed a group of stroke patients over a 6-month period. Our findings suggest that when screening for post-stroke depression, health professionals must take into consideration of the clinical, socio-personal characteristics that might increase a stroke patient’s vulnerability to develop depression after stroke.

Citation： Janet W Sit,Thomas KS Wong,Leonard SW Li. A Longitudinal Study on Post-stroke Depression and Its Associated Factors in Hong Kong (Chinese version). Chinese Journal of Evidence-Based Medicine, 2006, 06(4): 243-248. doi: Copy

1.	WU ML,CHENG GY,TAI SC. Primary analysis of post stroke depression in 20 patients. Zhong Guo Shen Jing Ji Bing Za Zhi. 1994; 20(2), 109-110.
2.	Collaboration. Self-reported depression and use of antidepressants after stroke: a national survey.Stroke, 2004; 35(4): 936-941.
3.	鄔夢龍，陳國義，態生才.20例腦卒中抑郁狀態初步分析。中國神經精神疾病雜志, 1994; 20(2), 109-110.
4.	Robinson RG, Starr LB, Lipsey JR, et al. A two-year longitudinal study of post-stroke mood disorders: dynamic changes in associated variables over the first six months of follow-up.Stroke, 1984; 15(3): 510-7.
5.	Herrmann M, Bartels C, Schumacher M, et al. Poststroke depression. Is there a pathoanatomic correlate for depression in the postacute stage of stroke? Stroke, 1995; 26(5): 850-856.
6.	Morris PL, Robinson RG, de Carvalho ML, et al. Lesion characteristics and depressed mood in the stroke data bank study. J Neuropsychiatry Clin Neurosci, 1996; 8(2): 153-159.
7.	MacHale SM, O’Rourke SJ, Wardlaw JM, et al. Depression and its relation to lesion location after stroke. J Neurol Neurosurg Psychiatry, 1998, 64(3): 371-374.
8.	Eriksson M, Asplund K, Glader EL, et al. Riks-Stroke.
9.	Bhogal SK, Teasell R, Foley N, et al. Lesion location and poststroke depression: systematic review of the methodological limitations in the literature. Stroke, 2004; 35(3): 794-802.
10.	Jorgensen HS, Nakayama H, Raaschou HO, et al. Outcome and time course of recovery in stroke. Part II: Time course of recovery. The Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995; 76(5): 406-412.
11.	American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (4th ed). 2000.
12.	De Coster L, Leentjens AF, Lodder J, et al. The sensitivity of somatic symptoms in post-stroke depression: a discriminant analytic approach. Int J Geriatr Psychiatry, 2005; 20(4): 358-362.
13.	Radloff LS.The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1977; 3 (1); 385-401.
14.	Chi I, Boey KW.A mental health and social support study of the old-old in Hong Kong (Resource paper series No.22). Hong Kong: University of Hong Kong Department of Social Work and Social Administration. 1994.
15.	Kuo WH. Prevalence of depression among Asian-Americans. J Nerv Ment Dis, 1984; 172(8): 449-457.
16.	Ramasubbu R, Robinson RG, Flint AJ, et al. Functional impairment associated with acute poststroke depression: the Stroke Data Bank Study. J Neuropsychiatry Clin Neurosci, 1998; 10(1): 26-33.
17.	Shinar D, Gross CR, Price TR, et al. Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiologic Studies Depression Scale. Stroke, 1986; 17(2): 241-245.
18.	Parikh RM, Eden DT, Price TR, et al. The sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale in screening for post-stroke depression. Int J Psychiatry Med, 1988; 18(2): 169-181.
19.	MCDOWELL I, Newell C. Measuring Health. A Guide to Rating Scales and Questionnaires (2nd ed). New York: Oxford University Press. 1996.
20.	Wade DT, Hewer RL. Functional disabilities after stroke: Measuring natural history and prognosis. Journal of Neurology, Neurosurgery and Psychiatry, 1987; 50: 177-182.
21.	Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol, 1989; 42(8): 703-709.
22.	Wityk RJ, Pessin MS, Kaplan RF, et al. Serial assessment of acute stroke using the NIH Stroke Scale. Stroke, 1994; 25(2): 362-365.
23.	Suurmeijer TP, Doeglas DM, Briancon S, et al. The measurement of social support in the ’European Research on Incapacitating Diseases and Social Support’: the development of the Social Support Questionnaire for Transactions (SSQT). Soc Sci Med, 1995; 40(9): 1221-1229.
24.	Sit JW, Wong TK, Clinton M, et al. Stroke care in the home: the impact of social support on the general health of family caregivers. J Clin Nurs, 2004; 13(7): 816-824.
25.	Fuh JL, Liu HC, Wang SJ, et al. Poststroke depression among the Chinese elderly in a rural community. Stroke, 1997 Jun;28(6):1126-1129.
26.	ZHANG, Q. A correlative study on post-stroke depression and CT, physical, psychological and social parameters. Zhonghua Shen Jing Jing Shen Ke Za Zhi. 1992; 25(4): 203-207, 252. Chinese.
27.	Tang WK, Chan SS, Chiu HF, et al. Can the Geriatric Depression Scale detect poststroke depression in Chinese elderly? J Affect Disord, 2004; 81(2): 153-156.
28.	House A. Mood disorders after stroke: A review of the evidence. International Journal of Geriatric Psychiatry, 1987; 2: 211-221.
29.	House A, Dennis M, Hawton K, et al. Methods of identifying mood disorders in stroke patients: experience in the Oxfordshire Community Stroke Project. Age Ageing, 1989; 18(6): 371-379.
30.	House A, Dennis M, Warlow C, et al. Mood disorders after stroke and their relation to lesion location. A CT scan study. Brain, 1990; 113 ( Pt 4): 1113-1129.
31.	Morris PL, Raphael B, Robinson RG. Clinical depression is associated with impaired recovery from stroke. Med J Aust, 1992; 157(4): 239-242.
32.	Herrmann N, Black SE, Lawrence J, et al. The Sunnybrook Stroke Study: a prospective study of depressive symptoms and functional outcome. Stroke, 1998; 29(3): 618-624.
33.	Cassidy EM, O’connor R, O’eane V. Prevalence of post-stroke depression in an Irish participant and its relationship with disability and outcome following inpatient rehabilitation. Disability and Rehabilitation, 2004; 26: 71-77.
34.	Wade DT, Legh-Smith J, Hewer RA. Depressed mood after stroke. A community study of its frequency. Br J Psychiatry; 1987; 151: 200-205.
35.	Carod-Artal J, Egido JA, Gonzalez JL, et al. Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit. Stroke, 2000; 31(12): 2 995-3 000.
36.	Chou KL, Chi I. Reciprocal relationship between social support and depressive symptoms among Chinese elderly. Aging Ment Health, 2003; 7(3): 224-231.
37.	Chou KL, Chi I. Chronic illness and depressive symptoms among Chinese older adults: a longitudinal study. Int J Aging Hum Dev, 2002;54(2):159-171.

1. WU ML,CHENG GY,TAI SC. Primary analysis of post stroke depression in 20 patients. Zhong Guo Shen Jing Ji Bing Za Zhi. 1994; 20(2), 109-110.
2. Collaboration. Self-reported depression and use of antidepressants after stroke: a national survey.Stroke, 2004; 35(4): 936-941.
3. 鄔夢龍，陳國義，態生才.20例腦卒中抑郁狀態初步分析。中國神經精神疾病雜志, 1994; 20(2), 109-110.
4. Robinson RG, Starr LB, Lipsey JR, et al. A two-year longitudinal study of post-stroke mood disorders: dynamic changes in associated variables over the first six months of follow-up.Stroke, 1984; 15(3): 510-7.
5. Herrmann M, Bartels C, Schumacher M, et al. Poststroke depression. Is there a pathoanatomic correlate for depression in the postacute stage of stroke? Stroke, 1995; 26(5): 850-856.
6. Morris PL, Robinson RG, de Carvalho ML, et al. Lesion characteristics and depressed mood in the stroke data bank study. J Neuropsychiatry Clin Neurosci, 1996; 8(2): 153-159.
7. MacHale SM, O’Rourke SJ, Wardlaw JM, et al. Depression and its relation to lesion location after stroke. J Neurol Neurosurg Psychiatry, 1998, 64(3): 371-374.
8. Eriksson M, Asplund K, Glader EL, et al. Riks-Stroke.
9. Bhogal SK, Teasell R, Foley N, et al. Lesion location and poststroke depression: systematic review of the methodological limitations in the literature. Stroke, 2004; 35(3): 794-802.
10. Jorgensen HS, Nakayama H, Raaschou HO, et al. Outcome and time course of recovery in stroke. Part II: Time course of recovery. The Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995; 76(5): 406-412.
11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (4th ed). 2000.
12. De Coster L, Leentjens AF, Lodder J, et al. The sensitivity of somatic symptoms in post-stroke depression: a discriminant analytic approach. Int J Geriatr Psychiatry, 2005; 20(4): 358-362.
13. Radloff LS.The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1977; 3 (1); 385-401.
14. Chi I, Boey KW.A mental health and social support study of the old-old in Hong Kong (Resource paper series No.22). Hong Kong: University of Hong Kong Department of Social Work and Social Administration. 1994.
15. Kuo WH. Prevalence of depression among Asian-Americans. J Nerv Ment Dis, 1984; 172(8): 449-457.
16. Ramasubbu R, Robinson RG, Flint AJ, et al. Functional impairment associated with acute poststroke depression: the Stroke Data Bank Study. J Neuropsychiatry Clin Neurosci, 1998; 10(1): 26-33.
17. Shinar D, Gross CR, Price TR, et al. Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiologic Studies Depression Scale. Stroke, 1986; 17(2): 241-245.
18. Parikh RM, Eden DT, Price TR, et al. The sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale in screening for post-stroke depression. Int J Psychiatry Med, 1988; 18(2): 169-181.
19. MCDOWELL I, Newell C. Measuring Health. A Guide to Rating Scales and Questionnaires (2nd ed). New York: Oxford University Press. 1996.
20. Wade DT, Hewer RL. Functional disabilities after stroke: Measuring natural history and prognosis. Journal of Neurology, Neurosurgery and Psychiatry, 1987; 50: 177-182.
21. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol, 1989; 42(8): 703-709.
22. Wityk RJ, Pessin MS, Kaplan RF, et al. Serial assessment of acute stroke using the NIH Stroke Scale. Stroke, 1994; 25(2): 362-365.
23. Suurmeijer TP, Doeglas DM, Briancon S, et al. The measurement of social support in the ’European Research on Incapacitating Diseases and Social Support’: the development of the Social Support Questionnaire for Transactions (SSQT). Soc Sci Med, 1995; 40(9): 1221-1229.
24. Sit JW, Wong TK, Clinton M, et al. Stroke care in the home: the impact of social support on the general health of family caregivers. J Clin Nurs, 2004; 13(7): 816-824.
25. Fuh JL, Liu HC, Wang SJ, et al. Poststroke depression among the Chinese elderly in a rural community. Stroke, 1997 Jun;28(6):1126-1129.
26. ZHANG, Q. A correlative study on post-stroke depression and CT, physical, psychological and social parameters. Zhonghua Shen Jing Jing Shen Ke Za Zhi. 1992; 25(4): 203-207, 252. Chinese.
27. Tang WK, Chan SS, Chiu HF, et al. Can the Geriatric Depression Scale detect poststroke depression in Chinese elderly? J Affect Disord, 2004; 81(2): 153-156.
28. House A. Mood disorders after stroke: A review of the evidence. International Journal of Geriatric Psychiatry, 1987; 2: 211-221.
29. House A, Dennis M, Hawton K, et al. Methods of identifying mood disorders in stroke patients: experience in the Oxfordshire Community Stroke Project. Age Ageing, 1989; 18(6): 371-379.
30. House A, Dennis M, Warlow C, et al. Mood disorders after stroke and their relation to lesion location. A CT scan study. Brain, 1990; 113 ( Pt 4): 1113-1129.
31. Morris PL, Raphael B, Robinson RG. Clinical depression is associated with impaired recovery from stroke. Med J Aust, 1992; 157(4): 239-242.
32. Herrmann N, Black SE, Lawrence J, et al. The Sunnybrook Stroke Study: a prospective study of depressive symptoms and functional outcome. Stroke, 1998; 29(3): 618-624.
33. Cassidy EM, O’connor R, O’eane V. Prevalence of post-stroke depression in an Irish participant and its relationship with disability and outcome following inpatient rehabilitation. Disability and Rehabilitation, 2004; 26: 71-77.
34. Wade DT, Legh-Smith J, Hewer RA. Depressed mood after stroke. A community study of its frequency. Br J Psychiatry; 1987; 151: 200-205.
35. Carod-Artal J, Egido JA, Gonzalez JL, et al. Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit. Stroke, 2000; 31(12): 2 995-3 000.
36. Chou KL, Chi I. Reciprocal relationship between social support and depressive symptoms among Chinese elderly. Aging Ment Health, 2003; 7(3): 224-231.
37. Chou KL, Chi I. Chronic illness and depressive symptoms among Chinese older adults: a longitudinal study. Int J Aging Hum Dev, 2002;54(2):159-171.

Chinese Journal of Evidence-Based Medicine

A Longitudinal Study on Post-stroke Depression and Its Associated Factors in Hong Kong (Chinese version)

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