Introduction: Depression is prevalent after ischemic stroke and is associated with increased morbidity. No studies have described subsequent changes in depressive symptoms detected during the acute stage of stroke.
Hypothesis: We sought to assess changes in depressive symptoms from hospitalization to clinic follow-up and to explore variables associated with worsening depressive symptoms at clinic follow-up.
Methods: Ischemic strokes (7/14- 7 /15) were identified from the stroke prevention clinic registry. Prior to hospital discharge, patients are screened for depressive symptoms using Patient Health Questionnaire 9 (PHQ-9; range 0 - 27) and then re-assessed in clinic. Higher scores reflect more severe symptoms. Univariate and multivariable linear regression analyses were used to evaluate associations between change in PHQ-9 and age, sex, race, baseline NIHSS, mRS, and antidepressant use.
Results: Among 160 ischemic stroke patients, 82 had both baseline and follow-up PHQ-9 scores. Median time to follow-up was 41.5 days (IQR 35-50). Mean age was 60.7 (SD 14.5) and 40.2% were female. Median PHQ-9 scores were 2 (IQR 0, 5) and 5.5 (IQR 1, 10) for inpatient and clinic, respectively. During inpatient stay, 67% of patients had 0 to minimal depressive symptoms; 31.7% mild to moderate; and 1.3% moderately severe to severe. At follow-up 43.9% had 0 to minimal symptoms; 46.3% mild to moderate; and 9.7% moderately severe to severe symptoms. There was a statistically significant increase in PHQ-9 at follow-up [mean change 2.79 (SD 5.7); paired t-test p < 0.001] and a significant difference in depression category (Wilcoxon rank-sum test, p < 0.0001). Neither age, sex, race, marital status, admission NIHSS, baseline or clinic mRS, nor antidepressant treatment were associated with change in depressive symptoms.
Conclusions: Depressive symptoms were more severe at clinic follow-up for ischemic stroke patients who were initially screened during hospitalization. Depression screening should be repeated at clinic follow-up.