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The vast majority of post-stroke depression (87.9%) occurred within the first 5 years after a stroke, suggesting a benefit for screening within that timeframe, according to a prospective study from the U.K.

During an 18-year study period, the cumulative incidence of post-stroke depression was 59.4%, with 33.4% of cases occurring within 3 months and 54.6% occurring within 1 year, Lu Liu, PhD, of King's College London, and colleagues reported in .

Given that the majority of cases occurred within 5 years, the findings suggest that routine screening for depression "should be provided to all stroke survivors within 5 years after stroke," the researchers wrote, noting, however, that depression can begin as early as the first 3 to 6 months following a stroke.

Among stroke patients with depression 3 months later, 46.6% first recovered at 1 year and 20.3% did so at 2 years. However, the cumulative recurrence rate was high, at 66.7% -- of which the majority (94.4%) occurred within 5 years of recovery.

"Depression has a high recurrence in the long-term, which means patients with depression at one time-point are at high risk for remaining depressed," Liu told MedPage Today in an email, noting that the cumulative recurrence rate for depression in the general population is about 42%.

Liu and colleagues noted that there's a dearth of evidence on the long-term course of depression in stroke survivors, and that the natural history has rarely been compared between early- and late-onset depression as well as mild and severe depression.

To fill in those gaps, Liu and colleagues analyzed data from the South London Stroke Register on 3,864 stroke survivors who had any assessment for depression from January 1995 through July 2019. The patient population was 55.4% male, 62.5% white, and the median age was 68. The number of patients assessed for depression ranged from 2,293 at 1 year to 145 at 18 years. Depression was measured on the Hospital Anxiety and Depression Scale.

Liu and colleagues found a similar frequency of mild and severe depression, but severe depression occurred earlier after stroke, had a longer duration, and was quicker to recur than mild depression, they wrote.

For instance, those with severe depression at 3 months post-stroke had a significantly lower likelihood of recovery at 1 year compared with those with mild depression (OR 0.43, 95% CI 0.29-0.63). In addition, the recurrence rate 1 year after recovery was higher in patients with severe depression compared with mild depression (52.9% vs 23.5%, P=0.003), indicating "patients with severe depression had a higher risk of having persistent depression," they wrote.

"Patients with a high level of depression on initial assessment tended to have longer duration and faster recurrence than those with milder symptoms," Liu said. "As such, these patients may be more likely to benefit from closer follow-up and longer-term care of their depressive symptoms."

The study was limited by challenges with patient follow-up, and by the fact that it was more likely to include patients with mild and moderate stroke because those with severe stroke were less likely to participate in the depression assessment. Also, the number of patients included in the analysis beyond 10 years was small due to high mortality in stroke patients.

Jacob Ballon, MD, MPH, of Stanford University in California, who wasn't involved in the study, told MedPage Today that getting data on long-term depression outcomes in stroke survivors is hard, as studies will typically only have a 6- to 24-month follow-up period.

"This paper adds nicely to longer term information; 18 years is a long time," Ballon said, adding that the results can help inform decisions about how mental health resources can be deployed in this patient population.

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