There is a high risk of developing depression in the "first year" of stroke, and more so among younger male patients than older female patients.
Three researchers at Samsung Medical Center – Professor Shin Dong-wook of the Family Medicine Department, Clinical Lecturer Choi Hye-rim, and Professor Jeon Hong-jin of the Neuropsychiatry Department – said Monday that stroke patients are more than five times or likelier to develop depression than the control group in the first year.
The researchers analyzed 207,678 people who suffered from a stroke from 2010 to 2018 based on the national health insurance data and compared them with the matched cohort group of 294,506 ordinary people, considering their age and sex.
Stroke patients had a 5.02 times greater risk of developing depression in the first year than the control group, and the worse the disability, the greater the risk, which soared to 9.29 times among people left with severe disability.
Considering the risk tended to decline as time passed, it is necessary to take care of the patient’s mental health from the early stage of treating stroke, they said.
The study also confirmed the difference in the incidence of depression by age and gender -- the more severe the aftereffects of the stroke, the higher the risk of depression. And that was more noticeable among people under 65 or men.
Among stroke patients left with severe disability, people under 65 showed a 5.39 times higher risk of depression than the control group, but the difference narrowed to 2.62 times among people 65 and older.
Under the same condition, men showed a 3.78 times higher risk of depression than the control group, but women showed a smaller gap, with 2.92 times.
The researchers attributed such differences to the combination of social pressure and physiological changes caused by stroke. In other words, the patients were adversely affected by frustration resulting from aftereffects when they were supposed to be most active socially.
“Stroke patients in more socially active age and gender might have experienced depression more amid social and economic pressure,” Professor Shin, the corresponding author, said. “We must look closely at these patients in the treatment process.”
The research team believed that changes in the brain also increased the risk of developing depression. This is because stroke reduces monoamine associated with depression while increasing glutamate, a neurotransmitter that causes excitotoxicity.
Also, they presumed that the reduction of the brain’s grey substance due to brain damage, which affects emotional and cognitive functions, might also have served as a factor that increased the risk of depression in stroke patients.
“Stroke reduces cognitive function and causes disability in the limb movement, making it difficult to maintain vocational and social functions. The addition of depression makes patients avoid people and stay at home,” Professor Jeon, the co-corresponding author, said. “We should pay more interest and attention to stroke patients to prevent their depression and keep them from falling into deep despair.”
The research result was published in the latest International Journal of Environmental Research and Public Health issue.