Predictors of cerebrovascular event reoccurrence in patients with depression:: a retrospective cohort study

Wa Cai; Christoph Mueller; Hitesh Shetty; Gayan Surendrajith Perera; Robert James Stewart

Predictors of cerebrovascular event reoccurrence in patients with depression: a retrospective cohort study

Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
SLaM South London and Maudsley NHS Foundation Trust

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Abstract

Objectives: To identify predictors of recurrent cerebrovascular morbidity in a cohort of patients with depression and a cerebrovascular disease (CBVD) history.
Methods: We identified patients with previously hospitalised depressive disorder and CBVD ascertained between 2008 and 2017 using data from the Maudsley Biomedical Research Centre Case Register linked to national hospitalisation. Using depression diagnosis as the index date we followed patients until first hospitalised CBVD recurrence. Sociodemographic data, symptom and functioning scores of Health of the Nation Outcome Scales (HoNOS), medications and comorbidities were extracted and modelled in multivariate survival analyses to identify predictors of CBVD re-occurrence.
Results: Of 1292 patients with depression and CBVD (mean age 75.6 years; 56.6% female), 264 (20.4%) experienced fatal/non-fatal CBVD recurrence during a median follow-up duration of 1.66 years. In multivariate Cox regression models, a higher risk of CBVD recurrence was predicted by older age (HR, 1.02; 95 % CI, 1.01-1.04) (P=0.002), physical health problems (moderate – severe HR, 2.47; 95 % CI, 1.45-4.19) (P=0.001), anticoagulant (HR, 1.40; 95 % CI, 1.01-1.93) (P=0.041) and antipsychotic medication (HR, 0.66; 95 % CI 0.44-0.99) (P=0.047). Neither depression severity, mental health symptoms, functional status, nor antidepressant prescribing were significantly associated with CBVD recurrence.
Conclusions: Approximately one in five patients with depression and CBVD experienced a CBVD recurrence over a median follow-up time of twenty months. Risk of CBVD recurrence was largely dependent on age and physical health rather than on severity of depressive symptoms, co-morbid mental health or functional problems, or psychotropic prescribing.

Original language	English
Journal	BMJ Open
Publication status	Accepted/In press - 25 Nov 2019

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

depression
cerebrovascular disease recurrence
retrospective
cohort study

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manuscript_R3_201119[224] - 副本Accepted author manuscript, 130 KB

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@article{2f6b5f9fcba0462ca2eb9f4929c62d0d,

title = "Predictors of cerebrovascular event reoccurrence in patients with depression:: a retrospective cohort study",

abstract = "Objectives: To identify predictors of recurrent cerebrovascular morbidity in a cohort of patients with depression and a cerebrovascular disease (CBVD) history. Methods: We identified patients with previously hospitalised depressive disorder and CBVD ascertained between 2008 and 2017 using data from the Maudsley Biomedical Research Centre Case Register linked to national hospitalisation. Using depression diagnosis as the index date we followed patients until first hospitalised CBVD recurrence. Sociodemographic data, symptom and functioning scores of Health of the Nation Outcome Scales (HoNOS), medications and comorbidities were extracted and modelled in multivariate survival analyses to identify predictors of CBVD re-occurrence. Results: Of 1292 patients with depression and CBVD (mean age 75.6 years; 56.6\% female), 264 (20.4\%) experienced fatal/non-fatal CBVD recurrence during a median follow-up duration of 1.66 years. In multivariate Cox regression models, a higher risk of CBVD recurrence was predicted by older age (HR, 1.02; 95 \% CI, 1.01-1.04) (P=0.002), physical health problems (moderate – severe HR, 2.47; 95 \% CI, 1.45-4.19) (P=0.001), anticoagulant (HR, 1.40; 95 \% CI, 1.01-1.93) (P=0.041) and antipsychotic medication (HR, 0.66; 95 \% CI 0.44-0.99) (P=0.047). Neither depression severity, mental health symptoms, functional status, nor antidepressant prescribing were significantly associated with CBVD recurrence. Conclusions: Approximately one in five patients with depression and CBVD experienced a CBVD recurrence over a median follow-up time of twenty months. Risk of CBVD recurrence was largely dependent on age and physical health rather than on severity of depressive symptoms, co-morbid mental health or functional problems, or psychotropic prescribing. ",

keywords = "depression, cerebrovascular disease recurrence, retrospective, cohort study",

author = "Wa Cai and Christoph Mueller and Hitesh Shetty and Perera, \{Gayan Surendrajith\} and Stewart, \{Robert James\}",

year = "2019",

month = nov,

day = "25",

language = "English",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Predictors of cerebrovascular event reoccurrence in patients with depression:

T2 - a retrospective cohort study

AU - Cai, Wa

AU - Mueller, Christoph

AU - Shetty, Hitesh

AU - Perera, Gayan Surendrajith

AU - Stewart, Robert James

PY - 2019/11/25

Y1 - 2019/11/25

N2 - Objectives: To identify predictors of recurrent cerebrovascular morbidity in a cohort of patients with depression and a cerebrovascular disease (CBVD) history. Methods: We identified patients with previously hospitalised depressive disorder and CBVD ascertained between 2008 and 2017 using data from the Maudsley Biomedical Research Centre Case Register linked to national hospitalisation. Using depression diagnosis as the index date we followed patients until first hospitalised CBVD recurrence. Sociodemographic data, symptom and functioning scores of Health of the Nation Outcome Scales (HoNOS), medications and comorbidities were extracted and modelled in multivariate survival analyses to identify predictors of CBVD re-occurrence. Results: Of 1292 patients with depression and CBVD (mean age 75.6 years; 56.6% female), 264 (20.4%) experienced fatal/non-fatal CBVD recurrence during a median follow-up duration of 1.66 years. In multivariate Cox regression models, a higher risk of CBVD recurrence was predicted by older age (HR, 1.02; 95 % CI, 1.01-1.04) (P=0.002), physical health problems (moderate – severe HR, 2.47; 95 % CI, 1.45-4.19) (P=0.001), anticoagulant (HR, 1.40; 95 % CI, 1.01-1.93) (P=0.041) and antipsychotic medication (HR, 0.66; 95 % CI 0.44-0.99) (P=0.047). Neither depression severity, mental health symptoms, functional status, nor antidepressant prescribing were significantly associated with CBVD recurrence. Conclusions: Approximately one in five patients with depression and CBVD experienced a CBVD recurrence over a median follow-up time of twenty months. Risk of CBVD recurrence was largely dependent on age and physical health rather than on severity of depressive symptoms, co-morbid mental health or functional problems, or psychotropic prescribing.

AB - Objectives: To identify predictors of recurrent cerebrovascular morbidity in a cohort of patients with depression and a cerebrovascular disease (CBVD) history. Methods: We identified patients with previously hospitalised depressive disorder and CBVD ascertained between 2008 and 2017 using data from the Maudsley Biomedical Research Centre Case Register linked to national hospitalisation. Using depression diagnosis as the index date we followed patients until first hospitalised CBVD recurrence. Sociodemographic data, symptom and functioning scores of Health of the Nation Outcome Scales (HoNOS), medications and comorbidities were extracted and modelled in multivariate survival analyses to identify predictors of CBVD re-occurrence. Results: Of 1292 patients with depression and CBVD (mean age 75.6 years; 56.6% female), 264 (20.4%) experienced fatal/non-fatal CBVD recurrence during a median follow-up duration of 1.66 years. In multivariate Cox regression models, a higher risk of CBVD recurrence was predicted by older age (HR, 1.02; 95 % CI, 1.01-1.04) (P=0.002), physical health problems (moderate – severe HR, 2.47; 95 % CI, 1.45-4.19) (P=0.001), anticoagulant (HR, 1.40; 95 % CI, 1.01-1.93) (P=0.041) and antipsychotic medication (HR, 0.66; 95 % CI 0.44-0.99) (P=0.047). Neither depression severity, mental health symptoms, functional status, nor antidepressant prescribing were significantly associated with CBVD recurrence. Conclusions: Approximately one in five patients with depression and CBVD experienced a CBVD recurrence over a median follow-up time of twenty months. Risk of CBVD recurrence was largely dependent on age and physical health rather than on severity of depressive symptoms, co-morbid mental health or functional problems, or psychotropic prescribing.

KW - depression

KW - cerebrovascular disease recurrence

KW - retrospective

KW - cohort study

M3 - Article

SN - 2044-6055

JO - BMJ Open

JF - BMJ Open

ER -