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Prevalence and Factors Influencing Depression in Patients with Stroke IJCRR Section: Healthcare Sci International Journal of Current Research and Review Original Article DOI: 10.7324/IJCRR.2017.1031 Prevalence and Factors Influencing Depression in Patients with Stroke IJCRR Section: Healthcare Sci. Journal Attending a Tertiary Care Teaching Impact Factor 4.016 ICV: 71.54 Hospital, a Cross Sectional Study Shaik Afsar Pasha1, Pavan Kumar TV2, Chaitanya CH3 1Associate Professor, Department of Neurology, NRI Medical college and General Hospital, Chinakakani, Guntur District, Andhra Pradesh, India 522503; 2Associate Professor, Department of Psychiatry, NRI Medical college and General Hospital, Chinakakani, Guntur District, Andhra Pradesh, India 522503; 3Senior Resident, Department of Psychiatry, NRI Medical college and General Hospital, Chinakakani, Guntur District, Andhra Pradesh, India 522503. ABSTRACT Background: Stroke is a major public health problem contributing to significant morbidity and mortality across the globe. In spite of many reviews documenting a strong association between stroke and depression, it is the most ignored aspect in many developing countries including India, due to paucity of studies on the subject. Hence the current study was conducted with an objective of assessing the prevalence of depression among the stroke patients and factors influencing it in a tertiary care teach- ing hospital Materials & Methods: This cross sectional study was conducted in the department of Neurology and the department of Psychia- try in NRI General Hospital. The study had included 56 eligible stroke patients and evaluated them for depression using DSM-IV TR Diagnostic criteria and Hamilton Depression Rating Scale (HAM-D). Results: The prevalence of depression in study population was 46.4%, out of which 21.4% had minor depression and 25% had major depression. The demographic factors which have shown increased risk of depression were female gender, primary school educational status, middle socioeconomic class and living in an extended nuclear family or joint family. But none of the associations had shown statistical significance. The disease related factors associated with increased risk of stroke were pres- ence of aphasia, severe limitation of and presence of stressful life event. Out of these only severe limitation of ADL has shown statistically significant association. Conclusions: The prevalence of depression is very high in patients affected by stroke. The major factors which were associated with increased risk of depression were female gender, presence of aphasia, severe limitation of ADL and presence of stressful life events. Key Words: Depression, Stroke, Aphasia, Stressful life events INTRODUCTION dia. Currently, the stroke incidence in India is much higher than Western industrialized countries. The reported age ad- Stroke is a major public health problem accounting for 5.5 justed prevalence rate of stroke ranges from, 84 to 262 per million deaths worldwide annually, with 44 million disabili- 100,000 among rural population. It ranges from 334 to 424 1 ty-adjusted life-years lost. A systematic review of 56 popula- per 100,000 among urban population. The incidence rate is tion based studies found a 42% decrease in stroke incidence 119-145/100,000 based on the recent population based stud- in high income countries while in low income countries, the ies”.3-5 In India, the overall morbidity as assessed by DALYs 2 stroke incidence more than doubled in recent years. Stroke was 795.57 per 100,000 person-years.6 is one of the leading causes of death and disability in In- Corresponding Author: Dr T.V. Pavan Kumar, Associate Professor of Psychiatry, Department of Psychiatry, NRI Medical College and General Hospital, Chinakakani, Guntur – 522503, Andhrapradesh, India; Mob: 09849220263; Email: [email protected] ISSN: 2231-2196 (Print) ISSN: 0975-5241 (Online) Received: 18.12.2017 Revised: 02.01.2018 Accepted: 18.01.2018 Int J Cur Res Rev | Vol 10 • Issue 3 • February 2018 1 Pasha et.al.: Depression in stroke patients Considering the devastating consequences of stroke at per- ing (IADL) was applied to assess the degree of physical im- sonal and family level, it is likely that stroke may have seri- pairment. Mini Mental Status Examination (MMSE) was ap- ous negative impact on psychological health of the affected plied to assess cognitive impairment. Presumptive Stressful person. Depression is reported to be one of the common se- Life Event Scale (PSLES) was administered to find the role quelae of stroke. Recent systematic reviews have reported a of stressful life events in post stroke depression. pooled estimate of depression in stroke patients to be about 33%.7Though it was presumed that left hemisphere strokes Inclusion Criteria: increase the risk for post-stroke depression (PSD), a recent 1. All adult patients with the diagnosis of Ischemic systematic reviews did not support the hypothesis.8,9The de- stroke made by a neurologist both clinically and with pression in stroke patients is reported to be the strong predic- CT/ MRI scan belonging to both genders tor of adherence to treatment, quality of life of the affected 2. Conscious and cooperative and accompanied by at patients.10 Hence, many of the recent studies have empha- least one informant. sized the importance of focusing on the psychological as- 3. The stroke should be of first episode. pects apart from (neuro) biological factors, to achieve bet- Exclusion Criteria: ter treatment outcomes and quality of life in stroke affected 1. Patients with past history of psychiatric illness. patients.11,12 2. Patients with neuro radiological evidence of hemor- In India, post-stroke depression is an ignored or highly un- rhage. der-diagnosed condition, hence poorly addressed. Studies 3. Patients with duration of less than 3 months and more documenting the burden and factors influencing depression than 12 months from the stroke episode. can draw the attention of all relevant stakeholders including 4. Patients who could not communicate or severely apha- patients, their family members, health care providers at dif- sic. ferent levels. Hence there is a strong need for studies on the Study procedure: After obtaining informed consent, special subject. proforma was prepared for collecting the socio-demographic profile. This consisted of socio demo graphic data, history of Objectives: present illness, history of past medical and psychiatric illness 1. To assess the prevalence of depression among the and detailed neurological examination, CT scan and other stroke patients presenting to a tertiary care teaching important investigations. Patients meeting the criteria for de- hospital in south India pressive disorder due to general medical condition based on 2. To analyse factors associated with depression in the DSM-IV TR criteria were administered the following tools. study population This study had cleared the institutional ethical committee re- quirements. MATERIALS AND METHODS Statistical Methods Study site: This study was conducted in the department of IBM SPSS statistical software version 21 was used for sta- Neurology and the department of Psychiatry in NRI General tistical analysis. Socio demographic variables like age and Hospital, which is a tertiary care teaching hospital located in gender, religion, education, occupation, socioeconomic sta- the state of Andhra Pradesh, South India. tus, type of family etc. were taken as explanatory param- eters. Presence of depression as assessed by HAM depres- Study population: The study population included all the sion score was considered as primary outcome. Descriptive adult patients diagnosed with ischemic stroke by clinical ex- analysis of all the explanatory and outcome parameters was amination and confirmed by appropriate imaging (CT scan/ done. All the categorical variables were presented in fre- MRI Brain) and were attending follow up visits in neurology quencies and percentages. The numerical variables presented OPD 3 to 12 months after stroke in means and standard deviations. The association between Sample size and sampling method: A group of 56 eligible various explanatory variables and depression was assessed and consenting participants were included in the study se- by univariate binary logistic regression in the first step. Un- quentially by convenient sampling. adjusted odds ratios along with 95% CI were presented. Vari- ables showing statistically significant association in univari- Data collection tools: ate analysis were included in the multivariate binary logistic DSM-IV TR Diagnostic criteria was followed to screen for regression analysis, to identify the independent predictors of Depression. Hamilton Depression Rating Scale (HAM-D) depression. IBM SPSS statistical software version 21 was 13 was used to assess the severity of depression in the study used for statistical analysis. group. Lawton scale of Instrumental Activities of Daily Liv- Int J Cur Res Rev | Vol 10 • Issue 3 • February 2018 2 Pasha et.al.: Depression in stroke patients RESULTS Table 2: Distribution of disease related parameters in study population (n=56) A total of 56 stroke patients, who satisfied inclusion criteria were included in the study. History Frequency Percent Following Table 1 illustrates the distribution of sociodemo- I. Side of lesion graphic parameters in the study population. Left 32 57.1 Right 24 42.9 Table 1: Distribution of Socio demographic param- eters in study population (N=56) II. Cranial nerve involvement Parameter Frequency Percent None 37 66.1 I. Sex UMN facial palsy 19 33.9 Male 38 67.9 III. Speech defects Female 18 32.1 Normal 36 64.3 Aphasia 20 35.7 II. Religion IV.CT Findings Hindu 45 80.4 Fronto parietal infarct 19 33.9 Christian 8 14.3 Capsulo ganglionic infarct 15 26.8 Muslim 3 5.4 Frontoparieto temporal in- 8 14.3 III. Education farct Illiterate 40 71.4 Frontal infarct 6 10.7 Primary 12 21.4 Parieto temporal infarct 6 10.8 Secondary education anhigher 4 5.2 Occipital infarct 2 3.6 IV. Socio economic status V. Instrumental activities of daily living scale Low 23 41.1 Normal 19 33.9 Middle 29 51.8 Mild 19 33.9 Moderate 8 14.3 High 4 7.1 Severe 10 17.9 V. Type of family VI.
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