Prevalence of pre-stroke depression and its association with post-stroke depression: a systematic review and meta-analysis. Issue 4 (15th August 2018)

• Record Type: Journal Article
• Authors: Taylor-Rowan, Martin; Momoh, Oyiza; Ayerbe, Luis; Evans, Jonathan J.; Stott, David J.; Quinn, Terence J.
• Is Part Of: Psychological medicine. Volume 49:Issue 4(2019)
• Page Start: 685
• Page End: 696
• Publication Date: 2018-08-15
• Subjects: Post-stroke depression, -- pre-stroke depression, -- prevalence, -- risk, -- stroke; Psychiatry -- Periodicals; Medicine and psychology -- Periodicals; Clinical psychology -- Periodicals; 616.89
• DOI: 10.1017/S0033291718002003
• Languages: English
• ISSNs: 0033-2917

Abstract

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% ( I 2 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