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

Taylor-Rowan, M. , Momoh, O., Ayerbe, L., Evans, J. J. , Stott, D. J. and Quinn, T. J. (2019) Prevalence of pre-stroke depression and its association with post-stroke depression: a systematic review and meta-analysis. Psychological Medicine, 49(4), pp. 685-696. (doi: 10.1017/S0033291718002003) (PMID:30107864)

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.

• Item Type: Articles
• Additional Information: MT is part funded by Chest Heart and Stroke Scotland; this work is part of the APPLE programme of work funded by the Stroke Association and Chief Scientist Office Scotland. TQ is supported by a Stroke Association, Chief Scientist Office Senior Lectureship.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Taylor-Rowan, Dr Martin and Evans, Professor Jonathan and Stott J, Professor David and Quinn, Professor Terry
• Authors: Taylor-Rowan, M., Momoh, O., Ayerbe, L., Evans, J. J., Stott, D. J., and Quinn, T. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Journal Name: Psychological Medicine
• Publisher: Cambridge University Press
• ISSN: 0033-2917
• ISSN (Online): 1469-8978
• Published Online: 15 August 2018
• Copyright Holders: Copyright © 2018 Cambridge University Press
• First Published: First published in Psychological Medicine 49(4):685-696
• Publisher Policy: Reproduced in accordance with the publisher copyright policy