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

Table 1

Articles suitable for meta-analysis.

Study	Country	Participants	Recruitment	Depression after stroke assessment	Followup	Reported results on mortality
Almeida and Xiao, 2007 [8]	Australia	574; males 55%	Patients with first-ever diagnosis of stroke from January to December 1990	First diagnosis of ICD-9 and ICD-10 depressive disorders recorded during the 24 months following the stroke	10 years	RR: 1.72 (0.98–3.01); HR: 1.26 (0.71–2.23); (depression versus control without mental disorder)
Ellis et al., 2010 [9]	USA	124; males 48%	Participants between 25 and 74 years with stroke diagnosis from NHANES I Epidemiologic Followup Study (NHEFS) interviewed in 1982	Center for Epidemiologic Studies Depression Scale (CES-D) ≥ 16	8 years	Mortality rate (per 1000): 105.1 versus 84.7; (depression versus no depression)
House et al., 2001 [10]	UK	448; males 54%	Patients with definite clinical diagnosis of stroke (not; subarachnoid hemorrhage) from a randomized controlled trial	ICD-10 major depression at 1 month after stroke, according to Present State Examination	12 and 24 months	OR at 12 months: 1.3 (0.65–2.7); (major depression); OR at 24 months: 1.7 (0.95–3.0); (major depression)
Jia et al., 2006 [11]	USA	5825; males 98%	Patients with stroke diagnosis between October 2000 and September 2001 from a cohort of veterans, who survived 60 days or more after stroke, and with an index length of stay less than 365 days	Depression (primary or secondary diagnosis) according to ICD-9 codes and antidepressant medication dispensing within 12 months of the index stroke	12 months	Crude death rate: 11.0% versus 12.0%; (depression versus no depression)
Jorge et al., 2003; [12]	USA	104; males	Patients between ages 25 and 89 years with acute stroke within the previous 6 months, between June 1991; and June 1997 and from double-blind, placebo-controlled trial	DSM-IV depression due to stroke, with “major depressive-like episode” or “minor depressive disorder,” according to the Present State Examination and Hamilton Depression Rating Scale	9 years	Prevalence of mortality: 25/56 (45%) versus 25/48 (52%); (depression versus no depression)
Kemper et al., 2011 [13]	Germany	977; males 71%	Patients aged 50 years and older with first ischemic stroke in 2005, without previous aphasia, dementia, depression, or nursing care dependency	Diagnosis of depression within the year after stroke, according to ICD-10 codes	12 months after stroke	Adjusted OR: 0.91 (0.55–1.52); (depression versus no depression)
Morris et al., 1993a [14]	Australia	84; males 54%	Patients with stroke undergoing rehabilitation consecutively enrolled from 1986 to 1987 examined approximately two months after stroke (mean 7.6 weeks)	DSM-III major depression approximately 2 weeks after stroke according to Composite International Diagnostic Interview (CIDI) and Montgomery and Asberg Depression Rating Scale; (MADRS)	15 months after the initial evaluation (mean 59 weeks)	Prevalence of mortality: 3/13 (23%) versus 1/48 (2%); (major depression versus no depression)
Morris et al., 1993b [15]	USA	91; males: 59%	Patients consecutively admitted to a university hospital stroke unit between 1979 and 1981 with either thromboembolic cerebral infarction or intracerebral hemorrhage	DSM-III major depression 1–3 weeks after stroke according to Present State Examination and Hamilton Depression Rating Scale	10 years	Prevalence of mortality: 26/37 (70%) versus 22/54 (41%); (major depression versus no depression)
Naess et al., 2010 [16]	Norway	771; (376 returning questionnaire); males 60%	Patients with acute stroke consecutively admitted to the Stroke Unit, Haukeland University Hospital, Norway, from February 2006 to November 2008	Hospital Anxiety and Depression Scale (HADS-D) ≥ 11 (at least 6 months after stroke)	Mean followup: 382 days (range 185–756)	HR: 4.4 (𝑃=0.002); (depression versus no depression)
Paolucci et al., 2006 [17]	Italy	1064; males 60%	Patients with ischemic or hemorrhagic stroke (first or subsequent event) confirmed by neuroimaging (CT or MRI), consecutively admitted to one of the study centers between June 2000 and July 2001 (DESTRO study)	Depression within the first 9 months after the stroke according to a Beck Depression Inventory (BDI) ≥ 10	2 years	Prevalence of mortality: 5.48 % versus 4.85%; (depression versus no depression)
Ried et al., 2011 [18]	USA	790; males 98%	Patients with a stroke diagnosis between July 2000 and September 2001, from a cohort of veterans	Major depressive disorder or depressive disorder NOS according to ICD-9 codes during the 12 months after stroke	7-year follow-up period (maximum follow-up time: 2465 days)	HR: 1.28 (0.96 to 1.71); (depression versus no depression)
Willey et al., 2010 [19]	USA	340; males 42%	Patients with first-ever ischemic stroke between July 1993 and July 1997, aged >39 years (data deriving from the Northern Manhattan Stroke Study (NOMASS))	First question on the Hamilton Depression; Rating Scale regarding their mood in the week after the onset of the stroke (assessment within 30 days of their stroke)	5 years from initial stroke	Adjusted HR: 1.15 (0.76–1.75); (depression versus no depression)
Williams et al., 2004 [20]	USA	51119; males 98%	Patients with a first ischemic stroke from a cohort of veterans who survived beyond 30 days afterward, from October 1990 to September 1998	Diagnosis of depression in the first 3 years after stroke according to ICD-9 codes	3 years after stroke	Adjusted HR: 1.13 (1.06–1.21); (depression versus no depression)