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Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis

  • Luis Ayerbe (a1), Salma Ayis (a2), Charles D. A. Wolfe (a3) and Anthony G. Rudd (a3)

Depression after stroke is a distressing problem that may be associated with other negative health outcomes.


To estimate the natural history, predictors and outcomes of depression after stroke.


Studies published up to 31 August 2011 were searched and reviewed according to accepted criteria.


Out of 13 558 references initially found, 50 studies were included. Prevalence of depression was 29% (95% CI 25-32), and remains stable up to 10 years after stroke, with acumulative incidence of 39-52% within 5 years of stroke. The rate of recovery from depression among patients depressed a few months after stroke ranged from 15 to 57% 1 year after stroke. Major predictors of depression are disability, depression pre-stroke, cognitive impairment, stroke severity and anxiety. Lower quality of life, mortality and disability are independent outcomes of depression after stroke.


Interventions for depression and its potential outcomes are required.

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Corresponding author
Luis Ayerbe, 7th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK. Email:
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Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis

  • Luis Ayerbe (a1), Salma Ayis (a2), Charles D. A. Wolfe (a3) and Anthony G. Rudd (a3)
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Natural history, predictors and outcomes of depression after stroke

13 February 2013

The review article by Ayerbe et al. is an important review of predictors of depression after stroke. There are however some more factorsin addition to the mentioned ones which predict the depression after stroke. They include social support, low physical activity levels and social isolation (1),psycho-emotional factors and level of dependency (2),personality and coping style, severity of depression (worse in minor type)(3), low Barthel index score and post stroke depression and its treatment and probably, site of lesion ( left cortical and subcortical)(3). The vascular factors e.g. younger age, past history of stroke and type of medication used to treat hypertension (i.e. beta blockers, calcium channel blockers and sedatives) are also important factors (4).

References:1. Ayerbe L, Ayis S, Rudd A G, Heuschmann P U, Wolfe C D A. Natural histoory, predictors and association of depression 5 years after stroke. Stroke 2011; 42:1907-1911.2. Lee A C K, Tang S W, Yu G K K, Cheung R T F. Incidence and predictors of depression after stroke(DAS). Int. J Psychiatry in Clin Practice 2007, v11 n.3, p 200-205.3. Chemerinski E, Robinson R G.The neuropsychiatry of stroke. Psychosomatics 2000; 41(1):5-14.4. Bhatia M S, Chandra R. Vascular risk factors for stroke and depression.Br. J Psychiatry 2001; 179: 464-465.

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