Post-stroke depression risk higher in women than men

The risk of depression following a stroke may be greater in women than men, according to a retrospective study from the US presented at ISC 2021.

The researchers used Medicare data to identify individuals aged ≥65 years (90,474 female and 84,427 male) who were hospitalized for ischaemic stroke between July 2016 and December 2017. Patients were followed up for a diagnosis of depression up to 1.5 years post-stroke.

Female patients were 20 percent more likely to be diagnosed with post-stroke depression than male patients. [ISC 2021, presentation 22]

The cumulative risk of post-stroke depression was consistently higher in female than male patients over the 1.5-year follow up period (Kaplan-Meier cumulative risk, 0.2055 vs 0.1690; p<0.0001; hazard ratio, 1.20, 95 percent confidence interval, 1.17–1.23; p<0.0001).

Depression risk higher after stroke than MI

Another retrospective study of the same Medicare dataset of patients aged ≥65 years suggested that the risk of depression was higher following a stroke than a myocardial infarction (MI). [ISC 2021, presentation 21]

This study involved 174,901 patients who had been hospitalized for an ischaemic stroke and 193,418 patients who had been hospitalized for an MI between July 2016 and December 2017.

Over the 1.5-year follow-up period, patients hospitalized for a stroke had a 50 percent increased likelihood of developing depression than those hospitalized for an MI (Kaplan-Meier cumulative risk, 0.1596 vs 0.0973; p<0.0001).

In this cohort, 10.3 percent of the patients with ischaemic stroke and 11.8 percent of those with an MI had a history of anxiety. A history of anxiety was associated with a 1.7-fold risk of developing post-stroke depression, the strongest predictor in this cohort.

Female patients were also at an increased risk of depression and White patients had a 1.33-fold risk. On the other hand, patients aged ≥75 years were 0.79 times less likely to develop post-stroke depression. Discharge home had the greatest protective effect against post-stroke depression.

Screening for depression a must post-stroke

“Depression following stroke is almost three times as common as it is in the general population and may affect up to a third of stroke patients. Patients with post-stroke depression also experience poorer quality of life and outcomes,” said lead author Assistant Professor Laura Stein from the Icahn School of Medicine at Mount Sinai, New York City, New York, US.

“We did not expect that the cumulative risk of depression would remain so persistently elevated. This finding supports that post-stroke depression is not simply a transient consequence of difficulties adjusting to life after stroke,” she continued.

“Our current findings highlight the need for active screening and treatment for depression in the time period immediately and well after the stroke and the importance of screening all stroke patients for post-stroke depression, including women and those with a history of mental illness,” she concluded.