Frequency of depression after stroke - A systematic review of observational studies

Background and Purpose - Although depression is an important sequelae of stroke, there is uncertainty regarding its frequency and outcome. Methods - We undertook a systematic review of all published nonexperimental studies ( to June 2004) with prospective consecutive patient recruitment and quantification of depressive symptoms/illness after stroke. Results - Data were available from 51 studies ( reported in 96 publications) conducted between 1977 and 2002. Although frequencies varied considerably across studies, the pooled estimate was 33% (95% confidence interval, 29% to 36%) of all stroke survivors experiencing depression. Differences in case mix and method of mood assessment could explain some of the variation in estimates across studies. The data also suggest that depression resolves spontaneously within several months of onset in the majority of stroke survivors, with few receiving any specific antidepressant therapy or active management. Conclusions - Depression is common among stroke patients, with the risks of occurrence being similar for the early, medium, and late stages of stroke recovery. There is a pressing need for further research to improve clinical practice in this area of stroke care.