在南伦敦中风登记中，中风后10年抑郁的长期结果：一项基于人群的研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2025-05-15 DOI:10.1016/j.lanepe.2025.101324

Lu Liu , Iain J. Marshall , Xianqi Li , Ajay Bhalla , Lidan Liu , Ruonan Pei , Charles D.A. Wolfe , Matthew D.L. O'Connell , Yanzhong Wang

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引用次数: 0

摘要

目前关于脑卒中后抑郁（PSD）长期预后的证据有限，大多数研究依赖于短期随访和横断面设计。我们的目标是检查(1)3个月时抑郁与长期预后（包括死亡率、卒中复发、功能能力和生活质量）至10年之间的关系；(2)抑郁恢复和发病时间对这些关联的影响。方法数据来自南伦敦卒中登记（1997年1月1日-2023年4月20日）。抑郁症的定义是在医院焦虑和抑郁量表上得分为7分。身体残疾采用Barthel指数测定；日常生活工具活动（IADL）使用法国活动指数；和使用Short Form-12的生活质量，它提供了身体和心理健康的总结分数。结果每年评估一次，持续10年。Cox比例风险模型估计PSD与死亡率和卒中复发之间的关系，而广义估计方程用于身体残疾和IADL，线性混合模型用于生活质量，调整协变量。在2581名中风幸存者中，918名（35.6%）表现出抑郁症状。在10年随访中，3个月时PSD与较高的死亡风险相关（aHR 1.18, 95% CI[1.03-1.36]），但与卒中复发无关（0.85[0.64-1.14]）。分析与肢体残疾、IADL和生活质量相关性的患者分别为1388例、1167例和1292例。PSD还与身体残疾（aOR 2.94, 95% CI[2.12-4.09]）、IADL障碍（2.89[2.13-3.92]）和较低的身体（β = - 5.93, 95% CI[- 7.26至- 4.60]）和精神生活质量（- 7.56[- 8.99至- 6.13]）评分相关。与PSD患者在3个月和1年的死亡率相比，1年康复患者的死亡率相似（0.95[0.76-1.16]），但卒中复发率（0.47[0.25-0.92]），身体残疾（0.55[0.36-0.85]）和IADL功能障碍（0.56[0.36-0.89]）的发生率较低，身体（3.55[1.30-5.80]）和精神（10.91[8.56-13.25]）生活质量得到改善。1年或5年的PSD还与死亡率增加（1年：1.33[1.15-1.53]，5年：1.37[1.10-1.71]）、身体残疾风险增加（1年：2.20[1.77-2.74]，5年：2.42[1.39-4.22]）和IADL功能障碍（1年：3.00[2.22-4.06]）相关；5年：2.69[1.76-4.11])和更低的物理(1年：−6.49[−7.60至−5.38]；5年：−6.78[−8.30至−1.24])和精神生活质量（1年：−12.04[−13.25至−10.83]）；5年得分：−6.76[−8.81至−4.72])。解释psd对中风恢复有持久的影响，在急性期之后显著延长。由于抑郁症在1年内恢复与改善健康结果相关，因此需要进一步研究开发有效的PSD干预措施并提高卒中的长期预后。国家卫生与保健研究所（NIHR202339）。

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Long-term outcomes of depression up to 10-years after stroke in the South London Stroke Register: a population-based study

Background

Current evidence on the long-term outcomes of post-stroke depression (PSD) is limited, with most studies relying on short follow-ups and cross-sectional designs. We aim to examine (1) associations between depression at 3-months and long-term outcomes-including mortality, stroke recurrence, functional ability and quality of life (QoL)- up to 10-years; (2) the impact of depression recovery and timing of onset on these associations.

Methods

Data were from the South London Stroke Register (1-January-1997–20-April-2023). Depression was defined as a score >7 on the Hospital Anxiety and Depression Scale. Physical disability was measured using Barthel Index; instrumental activity of daily living (IADL) using the Frenchay Activities Index; and QoL using the Short Form-12, which provides physical and mental health summary scores. Outcomes were assessed annually up to 10-years. Cox proportional hazards models estimated the associations between PSD and mortality and stroke recurrence, while generalized estimating equation was used for physical disability and IADL and linear mixed models for QoL, adjusting for covariates.

Findings

Among 2581 stroke survivors assessed at 3-months, 918 (35.6%) exhibited depression symptom. PSD at 3-month was associated with higher mortality risk (aHR 1.18, 95% CI [1.03–1.36]), but not with stroke recurrence (0.85 [0.64–1.14]) over a 10-year follow-up. The number of patients in analysing the association with physical disability, IADL and QoL was 1388, 1167, and 1292 respectively. PSD was also linked to increased odds of physical disability (aOR 2.94, 95% CI [2.12–4.09]), IADL impairment (2.89 [2.13–3.92]) and lower physical (β = −5.93, 95% CI [−7.26 to −4.60]) and mental QoL (−7.56 [−8.99 to −6.13]) scores. Compared to patients with PSD at both 3-months and 1-year, those recovered by 1-year had similar mortality risk (0.95 [0.76–1.16]), but lower stroke recurrence (0.47 [0.25–0.92]), lower occurrence of physical disability (0.55 [0.36–0.85]) and IADL impairment (0.56 [0.36–0.89]), and improved physical (3.55 [1.30–5.80]) and mental (10.91 [8.56–13.25]) QoL. PSD at 1-year or 5-years was also associated with increased mortality (1-year: 1.33 [1.15–1.53], 5-year: 1.37 [1.10–1.71]), increased risks of physical disability (1-year: 2.20 [1.77–2.74], 5-year: 2.42 [1.39–4.22]) and IADL impairment (1-year: 3.00 [2.22–4.06]; 5-year: 2.69 [1.76–4.11]) and lower physical (1-year: −6.49 [−7.60 to −5.38]; 5-year: −6.78 [−8.30 to −1.24]) and mental QoL (1-year: −12.04 [−13.25 to −10.83]; 5-year: −6.76 [−8.81 to −4.72]) scores.

Interpretation

PSD had lasting impact on stroke recovery, extending significantly beyond the acute phase. As recovery from depression within 1-year is associated with improved health outcomes, further research is needed to develop effective PSD interventions and enhance long-term stroke prognosis.

Funding

National Institute for Health and Care Research (NIHR202339).

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.