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Meta-Analysis
. 2023 Mar 28;20(3):e1004200.
doi: 10.1371/journal.pmed.1004200. eCollection 2023 Mar.

Prevalence and natural history of depression after stroke: A systematic review and meta-analysis of observational studies

Lu Liu  1 , Min Xu  1 , Iain J Marshall  1   2 , Charles DA Wolfe  1   2   3 , Yanzhong Wang  1   2   3 , Matthew Dl O'Connell  1
Affiliations
Meta-Analysis

Prevalence and natural history of depression after stroke: A systematic review and meta-analysis of observational studies

Lu Liu et al. PLoS Med. .

Abstract

Background: Depression is the most frequent psychiatric condition after stroke and is associated with negative health outcomes. We aim to undertake a systematic review and meta-analysis of the prevalence and natural history of depression after stroke.

Methods and findings: Studies published up to 4 November 2022 on Medline, Embase, PsycINFO, and Web of Science Core Collection were searched. We included studies of adults with stroke, where depression was assessed at a prespecified time point. Studies excluding people with aphasia and history of depression are excluded. Critical Appraisal Skills Programme(CASP) cohort study tool was used to assess risk of bias. A total of 77 studies were included in the pooled estimates of the prevalence of poststroke depression (PSD). The overall prevalence of depression was 27% (95% CI 25 to 30). Prevalence of depression was 24% (95% CI 21 to 28) by clinical interview and 29% (95% CI 25 to 32) by rating scales. Twenty-four studies with more than one assessment time point reported the natural history of PSD. Among people who were depressed within 3 months of stroke, 53% (95% CI 47 to 59) experienced persistent depression, while 44% (95% CI 38 to 50) recovered. The incidence of later depression (3 to 12 months after stroke) was 9% (95% CI 7 to 12). The cumulative incidence during 1 year after stroke was 38% (95% CI 33 to 43), and the majority (71% (95% CI 65 to 76)) of depression had onset within 3 months after stroke. The main limitation of the present study is that excluding people in source studies with severe impairments may produce imprecise estimates of the prevalence of PSD.

Conclusions: In this study, we observed that stroke survivors with early-onset depression (within 3 months after stroke) are at high risks for remaining depressed and make up two-thirds of the incident cases during 1 year after stroke. This highlights the need for ongoing clinical monitoring of patients depressed shortly after stroke.

Trial registration: PROSPERO CRD42022314146.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests:YW is a paid statistical consultant on PLOS Medicine’s statistical board.

Figures

Fig 1
Fig 1. PRISMA flow diagram of literature search.
Fig 2
Fig 2. Prevalence of depression stratified by assessment criteria.
Fig 3
Fig 3. Proportion of persistent depression within 1 year among people who are depressed within 3 months.
Fig 4
Fig 4. Proportion of recovered patients within 1 year among people who are depressed within 3 months after stroke.
Fig 5
Fig 5. Proportion of incident cases of depression between 3 months and 1 year after stroke.
Fig 6
Fig 6. Cumulative incidence of depression within 1 year after stroke.
Fig 7
Fig 7. Proportion of early-onset depression (within 3 months after stroke) among all incident cases during 1 year after stroke.
See this image and copyright information in PMC

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