Sex differences in trajectories of depression symptoms and associations with 10-year mortality in patients with stroke: the South London Stroke Register.
BACKGROUND AND PURPOSE
Depression is a common neuropsychiatric consequence of stroke. We identified trajectories of depression symptoms in men and women and examined their associations with 10-year all-cause mortality.


METHODS
Data were obtained from the South London Stroke Register (1998-2016). Socio-demographic, stroke severity and clinical measures were collected during the acute phase. The Hospital Anxiety and Depression Scale was used to screen for depression at 3 months after stroke and then annually. We used group-based trajectory models to identify trajectories of depression and Cox proportional hazards models to study the risk of mortality in them.


RESULTS
We studied 1275 men and 1038 women. Three trajectories of depression symptoms were identified in men: I-M (42.12%), low and stable symptoms; II-M (46.51%), moderate increasing symptoms; and III-M (11.37%), severe persistent symptoms. Four trajectories were identified in women; I-F (29.09%), low symptoms; II-F (49.81%), moderate symptoms; III-F (16.28%), severe symptoms; and IV-F (4.82%), very severe symptoms, all with stable symptoms. The 10-year adjusted mortality hazard ratios in men were: 1.68 [95% confidence interval (CI), 1.38-2.04] and 2.62 (95% CI, 1.97-3.48) for trajectories II-M and III-M, respectively, compared with I-M. In women these were: 1.38 (95% CI, 1.09-1.75), 1.65 (95% CI, 1.23-2.20) and 2.81 (95% CI, 1.90-4.16) for trajectories II-F, III-F and IV-F, respectively, compared with I-F.


CONCLUSIONS
Depression trajectories varied independent of sex. Severe symptoms in women were double those in men. Moderate symptoms in men became worse over time. Increased symptoms of depression were associated with higher mortality rates. Data on symptom progression may help a better long-term management of patients with stroke.
['Ayis|S A|SA|0000-0002-0449-869X', 'Rudd|A G|AG|', 'Ayerbe|L|L|', 'Wolfe|C D A|CDA|']
D000368:Aged D003863:Depression D018450:Disease Progression D005260:Female D006801:Humans D008131:London D008297:Male D008875:Middle Aged D012042:Registries D012307:Risk Factors D020521:Stroke D015996:Survival Rate
sex depression mortality stroke Hospital Anxiety and Depression Scale group-based trajectory modelling