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Prevalence of pre-stroke depression and its association with post-stroke depression: a systematic review and meta-analysis

Published online by Cambridge University Press:  15 August 2018

Martin Taylor-Rowan ,
Oyiza Momoh ,
Luis Ayerbe ,
Jonathan J. Evans ,
David J. Stott  and
Terence J. Quinn
Martin Taylor-Rowan*
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Oyiza Momoh
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Luis Ayerbe
Affiliation:
Centre of Primary Care and Public Health, Queen Mary University of London, London, UK
Jonathan J. Evans
Affiliation:
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
David J. Stott
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Terence J. Quinn
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
*
Author for correspondence: Martin Taylor-Rowan, E-mail: m.taylor-rowan.1@research.gla.ac.uk
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Abstract

Background

Depression is a common post-stroke complication. Pre-stroke depression may be an important contributor, however the epidemiology of pre-stroke depression is poorly understood. Using systematic review and meta-analysis, we described the prevalence of pre-stroke depression and its association with post-stroke depression.

Methods

We searched multiple cross-disciplinary databases from inception to July 2017 and extracted data on the prevalence of pre-stroke depression and its association with post-stroke depression. We assessed the risk of bias (RoB) using validated tools. We described summary estimates of prevalence and summary odds ratio (OR) for association with post-stroke depression, using random-effects models. We performed subgroup analysis describing the effect of depression assessment method. We used a funnel plot to describe potential publication bias. The strength of evidence presented in this review was summarised via ‘GRADE’.

Results

Of 11 884 studies identified, 29 were included (total participants n = 164 993). Pre-stroke depression pooled prevalence was 11.6% [95% confidence interval (CI) 9.2–14.7]; range: 0.4–24% (I2 95.8). Prevalence of pre-stroke depression varied by assessment method (p = 0.02) with clinical interview suggesting greater pre-stroke depression prevalence (~17%) than case-note review (9%) or self-report (11%). Pre-stroke depression was associated with increased odds of post-stroke depression; summary OR 3.0 (95% CI 2.3–4.0). All studies were judged to be at RoB: 59% of included studies had an uncertain RoB in stroke assessment; 83% had high or uncertain RoB for pre-stroke depression assessment. Funnel plot indicated no risk of publication bias. The strength of evidence based on GRADE was ‘very low’.

Conclusions

One in six stroke patients have had pre-stroke depression. Reported rates may be routinely underestimated due to limitations around assessment. Pre-stroke depression significantly increases odds of post-stroke depression.

Protocol identifier

PROSPERO identifier: CRD42017065544

Keywords

Post-stroke depressionpre-stroke depressionprevalenceriskstroke
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 4 , March 2019 , pp. 685 - 696
Copyright
Copyright © Cambridge University Press 2018 

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