review · PLoS ONE
A systematic review and meta-analysis of eighty prospective studies examined how depression influences recovery and long-term outcomes following a stroke. The evidence demonstrates that post-stroke depression has significant adverse effects on physical functioning, overall quality of life, the ability to return to employment, and survival rates. Meta-analytic findings indicate that individuals with depression face a substantially higher likelihood of premature mortality and experience worse functional abilities compared to those without depressive symptoms. Conversely, the link between depression and cognitive impairment remains inconclusive across the evaluated literature. The findings also highlight a notable shortage of prospective evidence originating from low-income settings. Consequently, there is an urgent need to establish timely diagnostic practices and targeted interventions for depression to improve comprehensive post-stroke health outcomes and survival.
Mental health plays a critical role in physical recovery after serious medical events. Because depression after a stroke substantially increases the risk of premature death and impairs everyday physical functioning, recognising mental health symptoms early is vital. Ensuring timely diagnosis and emotional support helps clinicians and families improve survival rates, enhance recovery trajectories, and support individuals in returning to daily activities and work.
The evidence supports the development and deployment of early diagnostic screening tools and targeted intervention programmes for post-stroke depression. Potential users include hospital rehabilitation units, primary care providers, and community health services. Because this research synthesises existing clinical evidence rather than presenting a finished product, technical solutions or care pathways based on these findings represent early-stage conceptual development that requires translation into validated clinical workflows.
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BACKGROUND: Depression may negatively affect stroke outcomes and the progress of recovery. However, there is a lack of updated comprehensive evidence to inform clinical practice and directions of future studies. In this review, we report the multidimensional impact of depression on stroke outcomes. METHODS: Data sources. PubMed, PsycINFO, EMBASE, and Global Index Medicus were searched from the date of inception. Eligibility criteria. Prospective studies which investigated the impact of depression on stroke outcomes (cognition, returning to work, quality of life, functioning, and survival) were included. Data extraction. Two authors extracted data independently and solved the difference with a third reviewer using an extraction tool developed prior. The extraction tool included sample size, measurement, duration of follow-up, stroke outcomes, statistical analysis, and predictors outcomes. Risk of bias. We used Effective Public Health Practice Project (EPHPP) to assess the quality of the included studies. RESULTS: Eighty prospective studies were included in the review. These studies investigated the impact of depression on the ability to return to work (n = 4), quality of life (n = 12), cognitive impairment (n = 5), functioning (n = 43), and mortality (n = 24) where a study may report on more than one outcome. Though there were inconsistencies, the evidence reported that depression had negative consequences on returning to work, functioning, quality of life, and mortality rate. However, the impact on cognition was not conclusive. In the meta-analysis, depression was associated with premature mortality (HR: 1.61 (95% CI; 1.33, 1.96)), and worse functioning (OR: 1.64 (95% CI; 1.36, 1.99)). CONCLUSION: Depression affects many aspects of stroke outcomes including survival The evidence is not conclusive on cognition and there was a lack of evidence in low-income settings. The results showed the need for early diagnosis and intervention of depression after stroke. The protocol was pre-registered on the International Prospective Register of Systematic Review (PROSPERO) (CRD42021230579).
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DOI: 10.1371/journal.pone.0294668
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