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The Italian multicenter observational study on post–stroke depression (DESTRO)

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Abstract

Despite growing information, questions still surround various aspects of post–stroke depression (PSD). The Italian multicenter observational study Destro was designed to help clarify in a large sample the frequency and clinical impact of PSD. A total of 53 centers consecutively admitted 1064 patients with ischemic or hemorrhagic stroke, assessing them periodically in the first 9 months after the event. Patients with depression were followed for two years. Depression was diagnosed on clinical examination, verbal (Beck Depression Inventory) and non–verbal rating systems (Visual Analog Mood Scale), identifying the nosographic condition attributable to the mental state. The patient’s clinical history, residual independence, and post–ictus quality of life were also taken into account. PSD was detected in 383 patients (36 %), most of whom had minor depression (80.17 %), with dysthymia, rather than major depression and adaptation disorder. About 80% developed depression within three months of the stroke. Cases with later onset tended to have less severe symptoms. Risk factors were a history of depression, severe disability, previous stroke and female sex, but not the type and site of the vascular lesion. PSD was not correlated with any increase in mortality or cerebrovascular recurrences, but these patients had lower autonomy and quality of life ratings. In conclusion, patients should be close observed in the first few weeks after a stroke in order to check for depression,which is more likely in those with clear risk factors and may spoil their quality of life.

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References

  1. Chemerinski E, Robinson RG (2000) The neuropsychiatry of stroke. Psychosomatics 41:5–14

    PubMed  CAS  Google Scholar 

  2. Gustafson Y, Nilsson I, Mattsson M, Astrom M, Bucht G (1995) Epidemiology and treatment of post–stroke depression. Drugs Aging 7:298–309

    Article  PubMed  CAS  Google Scholar 

  3. Whyte EM, Mulsant BH (2002) Post stroke depression: epidemiology, pathophysiology, and biological treatment. Biol Psychiatry 52:253–264

    Article  PubMed  Google Scholar 

  4. Robinson RG (2003) Poststroke depression: prevalence, diagnosis, treatment, and disease progression. Biol Psychiatry 54:376–387

    Article  PubMed  Google Scholar 

  5. Turner–Stokes L, Hassan N (2002) Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway. Part 1: Diagnosis, frequency and impact. Clin Rehabil 16:231–247

    Article  PubMed  Google Scholar 

  6. Provinciali L, Coccia M (2002) Poststroke and vascular depression: a critical review. Neurol Sci 22:417–428

    Article  PubMed  CAS  Google Scholar 

  7. Bhogal SK, Teasell R, Foley N, Speechley M (2004) Lesion location and poststroke depression: systematic review of the methodological limitations in the literature. Stroke 35:794–802

    Article  PubMed  Google Scholar 

  8. Andersen G, Vestergaard K, Riis J, Lauritzen L (1994) Incidence of poststroke depression during the first year in a large unselected stroke population determined using a valid standardized rating scale. Acta Psychiatr Scand 90:190–195

    PubMed  CAS  Google Scholar 

  9. Aben I, Verhey F, Strik J, Lousberg R, Lodder J, Honig A (2003) A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction. J Neurol Neurosurg Psychiatry 74:581–585

    Article  PubMed  CAS  Google Scholar 

  10. Paolucci S, Gandolfo C, Provinciali L, Torta R, Sommacal S (on behalf of DESTRO Study Group) Toso V (2005) Quantification of the risk of poststroke depression: the Italian multicenter observational study DESTRO (“Depression in Stroke”). Acta Psychiatr Scand 112:272–278

    Article  PubMed  CAS  Google Scholar 

  11. Rankin J (1957) Cerebral vascular accidents in patients over the age of 60, II: prognosis. Scott Med J 2:200–215

    PubMed  CAS  Google Scholar 

  12. Arruda JE, Stern RA, Somerville JA (1999) Measurement of mood states in stroke patients: validation of the visual analog mood scales. Arch Phys Med Rehabil 80:676–680

    Article  PubMed  CAS  Google Scholar 

  13. Toso V, Gandolfo C, Paolucci S, Provinciali L, Torta R, Grassivaro N (2004) Post–stroke depression: research methodology of a large multicentre observational study (DESTRO). Neurol Sci 25:138–144

    Article  PubMed  CAS  Google Scholar 

  14. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337:1521–1526

    Article  PubMed  CAS  Google Scholar 

  15. Beck AT, Ward CH, Mendelson M, Mock JE, Erbaugh JK (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    PubMed  CAS  Google Scholar 

  16. American Psychiatric Association: DSM–IV. Diagnostic and statistical manual of mental disorders. Fourth ed. Washington DC, American Psychiatric Press Inc, 1994

  17. World Health Organization: Classification of dysthymia and related conditions in neurological disorders: recommendations for the clinical descriptions and criteria for research: version for field trials. Geneva, World Health Organization 1997

  18. Gordon WA, Hibbard MR (1997) Poststroke depression: an examination of the literature. Arch Phys Med Rehabil 78:658–663

    Article  PubMed  CAS  Google Scholar 

  19. Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–389

    Article  PubMed  CAS  Google Scholar 

  20. Mahoney F, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65

    PubMed  CAS  Google Scholar 

  21. de Haan RJ (2002) Measuring quality of life after stroke using the SF–36. Stroke 33:1176–1177

    Article  PubMed  Google Scholar 

  22. Cohen J (1988) Statistical power analysis for the behavioral sciences. 2nd ed. ed. Hillsdale, NJ, Lawrence Earlbaum Associates

  23. Carson AJ, MacHale S, Allen K, Lawrie SM, Dennis M, House A, Sharpe M (2000) Depression after stroke and lesion location: a systematic review. Lancet 356:122–126

    Article  PubMed  CAS  Google Scholar 

  24. Benaim C, Cailly B, Perennou D, Pelissier J (2004) Validation of the aphasic depression rating scale. Stroke 35:1692–1696

    Article  PubMed  Google Scholar 

  25. Kotila M, Numminen H, Waltimo O, Kaste M (1998) Depression after stroke: results of the FINNSTROKE Study. Stroke 29:368–372

    PubMed  CAS  Google Scholar 

  26. Schubert DS, Taylor C, Lee S, Mentari A, Tamaklo W (1992) Detection of depression in the stroke patient. Psychosomatics 33:290–294

    PubMed  CAS  Google Scholar 

  27. Aben I, Verhey F, Lousberg R, Lodder J, Honig A (2002) Validity of the Beck Depression Inventory, Hospital Anxiety and Depression Scale, SCL–90, and Hamilton Depression Rating Scale as Screening Instruments for Depression in Stroke Patients. Psychosomatics 43:386–393

    Article  PubMed  Google Scholar 

  28. Verdelho A, Henon H, Lebert F, Pasquier F, Leys D (2004) Depressive symptoms after stroke and relationship with dementia: A three–year follow– up study. Neurology 62:905–911

    PubMed  CAS  Google Scholar 

  29. Andersen G, Vestergaard K, Ingemann– Nielsen M, Lauritzen L (1995) Risk factors for post–stroke depression. Acta Psychiatr Scand 92:193–198

    PubMed  CAS  Google Scholar 

  30. Paolucci S, Antonucci G, Pratesi L, Traballesi M, Grasso MG, Lubich S (1999) Poststroke depression and its role in rehabilitation of inpatients. Arch Phys Med Rehabil 80:985–990

    Article  PubMed  CAS  Google Scholar 

  31. Herrmann N, Black SE, Lawrence J, Szekely C, Szalai JP (1998) The Sunnybrook Stroke Study: a prospective study of depressive symptoms and functional outcome. Stroke 29:618–624

    PubMed  CAS  Google Scholar 

  32. Ng KC, Chan KL, Straughan PT (1995) A study of post–stroke depression in a rehabilitative center. Acta Psychiatr Scand 92:75–79

    PubMed  CAS  Google Scholar 

  33. Singh A, Black SE, Herrmann N, Leibovitch FS, Ebert PL, Lawrence J, Szalai JP (2000) Functional and neuroanatomic correlations in poststroke depression: the Sunnybrook Stroke Study. Stroke 31:637–644

    PubMed  CAS  Google Scholar 

  34. Ramasubbu R, Robinson RG, Flint AJ, Kosier T, Price TR (1998) Functional impairment associated with acute poststroke depression: the Stroke Data Bank Study. J Neuropsychiatry Clin Neurosci 10:26–33

    PubMed  CAS  Google Scholar 

  35. Astrom M, Adolfsson R, Asplund K (1993) Major depression in stroke patients. A 3–year longitudinal study. Stroke 24:976–982

    PubMed  CAS  Google Scholar 

  36. Aben I, Denollet J, Lousberg R, Verhey F, Wojciechowski F, Honig A (2002) Personality and Vulnerability to Depression in Stroke Patients: A 1–Year Prospective Follow–Up Study. Stroke 33:2391–2395

    Article  PubMed  Google Scholar 

  37. Gainotti G, Azzoni A, Gasparini F, Marra C, Razzano C (1997) Relation of lesion location to verbal and nonverbal mood measures in stroke patients. Stroke 28:2145–2149

    PubMed  CAS  Google Scholar 

  38. Angeleri F, Angeleri VA, Foschi N, Giaquinto S, Nolfe G, Saginario A, Signorino M (1997) Depression after stroke: an investigation through catamnesis. J Clin Psychiatry 58:261–265

    PubMed  CAS  Google Scholar 

  39. Vataja R, Leppavuori A, Pohjasvaara T, Mantyla R, Aronen HJ, Salonen O, Kaste M, Erkinjuntti T (2004) Poststroke depression and lesion location revisited. J Neuropsychiatry Clin Neurosci 16:156–162

    PubMed  CAS  Google Scholar 

  40. House A, Knapp P, Bamford J, Vail A (2001) Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke 32:696–701

    Google Scholar 

  41. Morris PL, Robinson RG, Andrzejewski P, Samuels J, Price TR (1993) Association of depression with 10–year poststroke mortality. Am J Psychiatry 150:124–129

    PubMed  CAS  Google Scholar 

  42. Jorge RE, Robinson RG, Arndt S, Starkstein S (2003) Mortality and poststroke depression: a placebo–controlled trial of antidepressants. Am J Psychiatry 160:1823–1829

    Article  PubMed  Google Scholar 

  43. Sinyor D, Amato P, Kaloupek DG, Becker R, Goldenberg M, Coopersmith H (1986) Post–stroke depression: relationships to functional impairment, coping strategies, and rehabilitation outcome. Stroke 17:1102–1107

    PubMed  CAS  Google Scholar 

  44. van de Weg FB, Kuik DJ, Lankhorst GJ (1999) Post–stroke depression and functional outcome: a cohort study investigating the influence of depression on functional recovery from stroke. Clin Rehabil 13:268–272

    Article  PubMed  CAS  Google Scholar 

  45. Paolucci S, Antonucci G, Grasso MG, Morelli D, Troisi E, Coiro P, De Angelis D, Rizzi F, Bragoni M (2001) Poststroke depression, antidepressant treatment and rehabilitation results. A case–control study. Cerebrovasc Dis 12:264–271

    Article  PubMed  CAS  Google Scholar 

  46. Kim P, Warren S, Madill H, Hadley M (1999) Quality of life of stroke survivors. Qual Life Res 8:293–301

    Article  PubMed  CAS  Google Scholar 

  47. King RB (1996) Quality of life after stroke. Stroke 27:1467–1472

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. S. Lucia Foundation—I.R.C.C.S., Via Ardeatina 306, 00179, Rome, Italy

    St. Paolucci M.D.

  2. Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Genoa, Italy

    C. Gandolfo M.D.

  3. Neurological Clinic, Azienda Ospedali Riuniti, Ancona, Italy

    L. Provinciali M.D.

  4. SCDU Psycho-oncology, Department of Neurosciences and Oncology, University of Turin, Turin, Italy

    R. Torta M.D.

  5. Division of Neurology, S. Bortolo Hospital, Vicenza, Italy

    V. Toso M.D.

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  1. St. Paolucci M.D.
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  2. C. Gandolfo M.D.
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  3. L. Provinciali M.D.
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  4. R. Torta M.D.
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  5. V. Toso M.D.
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on the behalf of the DESTRO Study Group

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Correspondence to St. Paolucci M.D..

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Paolucci, S., Gandolfo, C., Provinciali, L. et al. The Italian multicenter observational study on post–stroke depression (DESTRO). J Neurol 253, 556–562 (2006). https://doi.org/10.1007/s00415-006-0058-6

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  • DOI: https://doi.org/10.1007/s00415-006-0058-6

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