While women are more likely to have a history of depression at the time of a stroke compared with men, women are significantly less likely to have depression at 90 days following a first-time stroke event, according to a study in Neurology.
The study included 786 patients (mean age [±standard deviation], 65.4 ± 11.1 years) with first-ever stroke from the Brain Attack Surveillance in Corpus Christi project (2011–2016), an ongoing south Texas population-based stroke surveillance study with community residents ≥45 years of age.
Depression at 90 days after the first-stroke event comprised the primary outcome. Depressive symptoms were assessed with the 8-item Patient Health Questionnaire, whereas self-reported history and medication use were examined to identify pre-stroke depression status. The association between sex and post-stroke depression was examined in a logistic regression analysis.
Compared with men, a significantly higher proportion of women (P <.001 for both) had a history of depression (12.9% vs 19.4%, respectively) and were on medication for depression at the time of stroke (11.4% vs 24.9%). At 90 days, the prevalence of depression was 28.2% for men (95% CI, 23.7%–32.8%) vs 32.7% for women (95% CI, 27.8%–37.5%), with no significant difference between the 2 sexes (P =.187). Women reported significantly higher levels of fatigue (39.5% [95% CI, 34.4–44.6] vs 29.9% [95% CI, 25.3–34.4]; P =.005) and appetite changes (20.2% [95% CI, 15.9–24.5] vs 13.9% [95% CI, 10.4–17.3]; P =.021) compared with men at 90 days following the stroke event.
In an analysis that compared women with men, the age-adjusted odds ratio (OR) of poststroke depression was 1.34 (95% CI, 0.97–1.85). This was fully attenuated toward the null following additional adjustment for sociodemographic, stroke, and pre-stroke characteristics. Among the group of patients who were on medication for depression at the time of their stroke, women were less likely to have depression at 90 days following stroke than men (OR, 0.39; 95% CI, 0.16–0.96; P =.038). There were no other significant differences between the sexes in patients with vs without a history of depression.
Limitations of this study included the self-reported nature of pre-stroke depression status, the reliance on self-reported symptoms for the identification of poststroke depression, and the use of a bi-ethnic population from south Texas, which may reduce the generalizability of the results.
The investigators concluded that poststroke depression prevention interventions “are needed, particularly among those with pre-stroke depression but not undergoing treatment for depression at stroke onset.”
Dong L, Sánchez BN, Skolarus LE, Stulberg E, Morgenstern LB, Lisabeth LD. Sex difference in prevalence of depression after stroke. Neurology. 2020;94(19):e1973-e1983.