Risk of Depression Significantly Higher after Stroke vs Heart Attack

Stroke patients are approximately 50% more likely than heart attack patients to develop depression, and women have a higher risk of developing depression after a stroke than men. The findings come from 2 preliminary studies by the same research group that will be presented at the virtual American Stroke Association’s International Stroke Conference 2021, March 17-19, 2021.

“Depression following stroke is almost three times as common as it is in the general population and may affect up to a third of stroke patients. Patients with post-stroke depression also experience poorer quality of life and outcomes,” said lead author Laura K. Stein, MD, MPH, assistant professor of neurology, Icahn School of Medicine, Mount Sinai, New York City, New York, in a press release from the American Heart Association.

In what Stein and colleagues described as one of the largest studies of post-stroke depression to date, they conducted 2 investigations using the same US Medicare dataset of patients aged ≥65 years who were hospitalized for ischemic stroke or heart attack from July 2016 to December 31, 2017.

Of the >11 million Medicare beneficiaries who were admitted during the study period, 174 901 were admitted for ischemic stroke and 193 418 admitted for heart attack. Patients were followed for 1.5 years, and those with a history of depression in the 6 months before their stroke or heart attack were excluded.

Results from the first study (Presentation 22) include:

• The risk of depression was approximately 50% more likely among stroke patients (174 901) vs heart attack patients (193 418).
• History of anxiety was found in 10.3% of ischemic stroke patients and 11.8% of heart attack patients; Ischemic stroke patients with a history of anxiety were 1.7-times more likely to develop depression vs patients without anxiety.
• History of anxiety was the strongest predictor of post-stroke depression, while being discharged home resulted in less depression.
• White patients were 1.33-times more likely to be diagnosed with post-stroke depression.
• Patients aged ≥75 years were 0.79-times less likely to be diagnosed with post-stroke depression.

“We did not expect that the cumulative risk of depression would remain so persistently elevated. This finding supports that post-stroke depression is not simply a transient consequence of difficulties adjusting to life after stroke,” said Stein who is also an attending neurologist at Mount Sinai and Mount Sinai Queens Stroke Centers.

In the second study (Presentation 21), Stein and colleagues specifically examined the sex differences in risk of post-stroke depression in ischemic stroke patients over the same 1.5 years of follow-up.

The results showed that female stroke patients (n=90 474) had a 20% higher risk of developing depression vs male stroke patients (n=84 427).

“Our current findings highlight the need for active screening and treatment for depression in the time period immediately and well after the stroke and the importance of screening all stroke patients for post-stroke depression, including women and those with a history of mental illness,” concluded Stein in the press release.