In previous chapters we have demonstrated the relationship between poststroke depression and stroke-related factors, such as lesion location, severity of physical, or cognitive impairment and social support. Although social support might be argued to be a premorbid risk factor for depression, the dynamic relationship between depression and social functioning makes this an interactive variable with poststroke depression which has already been covered in Chapter 16. In the present chapter, we will focus on both physical and psychological factors that appear to be in existence before the acute stroke event.

It is clear from the discussion in the prior chapters, that stroke-related consequences may play a significant role in poststroke depression but do not explain all of the variants. For example, the meta-analysis of relationship between distances of anterior border of the lesion from the frontal pole and the left hemisphere and severity of depression (Chapter 10, Table 10.3) found a pooled correlation coefficient of -0.53 on the fixed model and -0.59 on the random model. Based on the sample size of 163, these are highly significant correlations. They would explain, however, only about 25–30% of the variance in severity of depression. Similarly, the correlation between depression and severity of impairment in activities of daily living showed a pooled mean correlation coefficient of 0.32.