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Stroke Research and Treatment
Volume 2013 (2013), Article ID 862978, 11 pages
http://dx.doi.org/10.1155/2013/862978
Review Article

Depression after Stroke and Risk of Mortality: A Systematic Review and Meta-Analysis

1Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, 20900 Monza, Italy
2Stroke Unit, Neurology Department, Azienda Ospedaliera Niguarda Cà Granda, 20162 Milan, Italy
3Department of Mental Health, Azienda Ospedaliera San Gerardo, 20900 Monza, Italy
4Department of Mental Health Sciences, University College London, London W1W 7EJ, UK

Received 12 October 2012; Revised 21 December 2012; Accepted 25 January 2013

Academic Editor: Caroline L. Watkins

Copyright © 2013 Francesco Bartoli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Depression after stroke may have great burden on the likelihood of functional recovery and long-term outcomes. Objective. To estimate the association between depression after stroke and subsequent mortality. Methods. A systematic search of articles using PubMed and Web of Science databases was performed. Odds ratios (ORs) and hazard ratios (HRs) were used as association measures for pooled analyses, based on random-effects models. Results. Thirteen studies, involving 59,598 subjects suffering from stroke (6,052 with and 53,546 without depression), had data suitable for meta-analysis. The pooled OR for mortality at followup in people suffering from depression after stroke was 1.22 (1.02–1.47). Subgroups analyses highlighted that only studies with medium-term followup (2–5 years) showed a statistically significant association between depression and risk of death. Four studies had data suitable for further analysis of pooled HR. The meta-analysis revealed a HR for mortality of 1.52 (1.02–2.26) among people with depression after stroke. Conclusions. Despite some limitations, this paper confirms the potential role of depression on post stroke mortality. The relationship between depression and mortality after stroke seems to be related to the followup duration. Further research is needed to clarify the nature of the association between depression after stroke and mortality.