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Sex differences in trajectories of depression symptoms and associations with 10-year mortality in stroke patients: The south london stroke register

Research output: Contribution to journalArticle

Salma A Ayis, Anthony G Rudd, Luis Ayerbe, Charles D A Wolfe

Original languageEnglish
JournalEuropean Journal of Neurology
Early online date7 Jan 2019
DOIs
StateE-pub ahead of print - 7 Jan 2019

King's Authors

Abstract

Background
Depression is a common neuropsychiatric consequence of stroke. We identified trajectories of depression symptoms in men and women and examined their associations with 10‐year all‐cause mortality.

Methods
Data were obtained from the South London Stroke Register (1998‐2016). Socio‐demographic, stroke severity and clinical measures were collected during the acute phase. The Hospital Anxiety and Depression Scale (HADS) was used to screen for depression at 3 months after stroke then annually. We used Group Based Trajectory Models (GBTMs) to identify trajectories of depression, and Cox proportional hazards models to study the risk of mortality in these.

Results
We studied 1275 men and 1038 women. Three trajectories of depression symptoms were identified in men: I‐M (42.12%) low and stable symptoms, II‐M (46.51%) moderate increasing, and III‐M (11.37%) severe persistent. In women four trajectories were identified (I‐F to IV‐F); 29.09% with low symptoms, 49.81% moderate, 16.28% severe, and 4.82% with very severe symptoms. Ten‐year mortality hazard ratios (HRs) in men were: 1.68 (95% CI:1.38‐2.04) and 2.62 (1.97‐3.48) for the trajectories II‐M, and III‐M respectively, compared to I‐M. In women these were: 1.38 (1.09 – 1.75), 1.65 (1.23 – 2.20) and 2.81 (1.90 – 4.16), for trajectories II‐F, III‐F, and IV‐F respectively compared to I‐F.

Conclusions
Depression trajectories varied independent of sex. Severe symptoms in women are double these in men. Moderate symptoms in men get worse overtime. Increased symptoms of depression are associated with higher mortality rates. Data on symptoms progression may help a better long‐term management of stroke patients.

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