The relationship between post-stroke depression and physical recovery

• Published in: Journal of affective disorders Vol. 176; pp. 56 - 60
• Main Authors: Matsuzaki, Shiho, Hashimoto, Mamoru, Yuki, Seiji, Koyama, Asuka, Hirata, Yoshifumi, Ikeda, Manabu
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.05.2015
• Subjects: Adaptation, Psychological; Aged; Aged, 80 and over; Apathy; Depression; Depression - diagnosis; Depression - epidemiology; Depression - psychology; Disability Evaluation; Female; Humans; Japan - epidemiology; Male; Middle Aged; Personality Inventory - statistics & numerical data; Physical recovery; Post-stroke depression; Prevalence; Prospective Studies; Psychiatry; Recovery of Function; Rehabilitation; Stroke - epidemiology; Stroke - psychology; Japan; PSD; SDS; NPI-NH; Zung Self-Rating Depression Scale; Depression; MADRS; FIM; Montgomery–Åsberg Depression Rating Scale; Neuropsychiatric Inventory-Nursing Home; Functional Independence Measurement; Apathy; Physical recovery; AS; post-stroke depression; MMSE; Apathy Scale; Rehabilitation; Mini-Mental State Examination; Post-stroke depression
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2015.01.020

Abstract Background Post-stroke depression (PSD) is a serious and common complication of stroke. In this prospective study on the relationship between clinical PSD and physical recovery, we focused on (1) distinguishing between depression and apathy, (2) issues in assessment of PSD, and (3) timing of assessment. Methods Japanese stroke patients ( n =117) were studied. We used self-rating scales [Zung Self-Rating Depression Scale (SDS) for depression; Apathy Scale (AS) for apathy] and observer-rating scales [Montgomery–Åsberg Depression Rating Scale (MADRS) for depression; Neuropsychiatric Inventory-Nursing Home (NPI-NH) for apathy] to assess psychological state. We assessed physical disability using the Functional Independence Measurement (FIM). Two-way analysis of covariance was used to determine effects of depression and apathy on functional outcome. We evaluated PSD twice, within 10 days after hospitalization and four weeks later. Results Objective scales gave higher prevalence than subjective scales for both depression and apathy. A significant effect of apathy on FIM recovery was seen with objective scale assessment during hospitalization; there was a marginal effect of depression at the same time. Limitations We did not consider the stroke size and location. In addition, we excluded patients with severe comprehension deficits or with a history of stroke. Conclusions Our findings indicate that depression and apathy could occur independently after stroke and could individually influence functional recovery. We obtained more accurate estimates of functional recovery using objective measures. Furthermore, our findings suggest that depression and apathy should be assessed not only at admission but also during hospitalization to estimate and enhance the functional recovery of stroke patients.