The course of depressive symptoms in the first 12 months post-stroke and its association with unmet needs

Abstract

Aim

To describe the course of depressive symptoms during the first 12 months post-stroke and its association with unmet needs.

Methods

A prospective cohort study among stroke patients admitted to inpatient rehabilitation. Depressive symptoms were assessed 3, 6, and 12 months post-stroke using the Hospital Anxiety and Depression Scale, and categorized into three trajectories: no (all times <8), non-consistent (one or two times ≥8), or persistent (all times ≥8) depressive symptoms. Unmet needs were assessed using the Longer-Term Unmet Needs questionnaire. Multivariable logistic regression analyses were used to investigate the association between depressive symptoms and unmet needs.

Results

One hundred and fifty-one patients were included, of whom 95 (62.9%), 38 (25.2%), and 18 (11.9%) had no, non-consistent, or persistent depressive symptoms, respectively. Depressive symptoms three months post-stroke persisted in 43.9% and recurred in 19.5% of patients during the first 12 months post-stroke. Depressive symptoms were significantly associated with the occurrence and number of unmet needs (odds ratio 6.49; p = 0.003 and odds ratio 1.28; p = 0.005, respectively).

Conclusions

Depressive symptoms three months post-stroke were likely to persist or recur during the first 12 months post-stroke. Depressive symptoms are associated with unmet needs. These results suggest that routine monitoring of depressive symptoms and unmet needs should be considered post-stroke.

Implications for rehabilitation

• Patients with depressive symptoms three months post-stroke have a high risk of developing persistent or recurrent depressive symptoms during the first 12 months post-stroke.

• Unmet needs are associated with both non-consistent and persistent depressive symptoms post-stroke.

• These results suggest that health professionals should routinely screen for depressive symptoms and health care needs around three months post-stroke.

• In patients with depressive symptoms at three months post-stroke early treatment of depressive symptoms and addressing unmet needs should be considered and depressive symptoms should be routinely monitored during the first 12 months post-stroke.

Keywords:

• Stroke
• depression
• depressive
• monitoring
• health services needs and demand
• unmet needs

Acknowledgements

We thank Betsy Nieuwhof, Inke van Braak, and Winke Pont for collecting the data.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

We are grateful to the Stichting Kwaliteitsgelden Medisch Specialisten for funding the study (Medical Specialist Quality Fund; the Netherlands, Project No. 328534072014).