Cognitive dysfunction and functional limitations are associated with major depression in stroke survivors attending rehabilitation in Nigeria

Abstract

Background: The frequency and predictors of post-stroke depression diagnosed according to codified criteria remain unknown in Nigeria.

Objectives: We report on the predictors of post-stroke major depressive disorder (MDD) in Nigeria using standardized assessment methods.

Method: Using a case-control design, we consecutively recruited 260 participants. Among them were 130 stroke survivors attending rehabilitation. Along with historical details, an exploration for MDD meeting criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders was carried out using a semi-structured interview. Cognition was assessed using both the Mini Mental State Examination and the modified Indiana University Token test, while disability was assessed using the modified Rankin Scale. Associations were explored using univariate and multivariate analyses.

Results: The diagnosis of MDD was more frequently present in the stroke survivors (41.5%, p < 0.001). It was strongly associated with female gender (p < 0.001, O.R = 3.77, 95% C.I = 1.78-8.00), disability (p = 0.001, O.R = 3.27, 95% C.I = 1.57-6.83), and cognitive dysfunction (p < 0.001, O.R = 5.28, 95% C.I = 2.25-12.41). Female gender (p = 0.037, O.R = 2.65, 95% C.I = 1.06-6.62) and cognitive dysfunction (P = 0.03, O.R = 4.58, 95% C.I = 1.68-12.46) were independent predictors of post-stroke MDD.

Conclusion: Post stroke MDD is common in Nigerian survivors attending rehabilitation. The high rates reported in this population may be the result of factors affecting the efficient management of stroke in developing countries.

Keywords: DSM IV; Stroke; cognition; depression; disability; rehabilitation; survivors.