Prevalence and factors associated with post-stroke depression: a cross-sectional analysis of a prospectively assembled cohort in Eastern Saudi Arabia.
To estimate the prevalence and severity of post-stroke depression (PSD) and identify factors independently associated with PSD among stroke survivors.
This cross-sectional analysis was conducted within a prospectively assembled hospital-based cohort at King Fahd University Hospital between January 2021 and November 2025. Adults with ischemic stroke, transient ischemic attack, intracerebral hemorrhage, or cerebral venous sinus thrombosis (CVST) underwent PSD assessment at least 3 months after the index event. PSD was established through structured clinical assessment based on DSM-5-TR and ICD-11 criteria together with the clinician-administered 17-item Hamilton Depression Rating Scale. Factors associated with PSD were evaluated using forced-entry multivariable logistic regression.
Among 403 participants, the mean age was 57.3 ± 13.8 years, and 69.2% were male. PSD was identified in 172 participants (42.7%): 71 (17.6%) had mild, 61 (15.1%) moderate, and 40 (9.9%) severe or very severe depression. The complete-case multivariable analysis included 398 participants. Higher NIHSS score was independently associated with PSD [adjusted odds ratio (aOR) per 1-point increase, 1.35; 95% CI, 1.22-1.49; p < 0.001], as was unfavorable functional status at discharge (mRS 3-5 vs. 0-2: aOR, 6.51; 95% CI, 3.19-13.29; p < 0.001). The overall stroke-subtype test was nonsignificant (p = 0.067), although the category-specific CVST coefficient indicated higher odds of PSD (aOR, 5.73; 95% CI, 1.34-24.50; p = 0.018). The model demonstrated excellent apparent discrimination (AUC, 0.89; bootstrap 95% CI, 0.86-0.92), with 72.5% sensitivity and 90.5% specificity at a cutoff of 0.50.
PSD affected approximately two-fifths of participants and was most consistently associated with neurological severity and functional disability. Standardized depression screening should be integrated into post-stroke care, particularly for patients with greater neurological impairment or functional dependence. The CVST finding was exploratory and requires confirmation.
This cross-sectional analysis was conducted within a prospectively assembled hospital-based cohort at King Fahd University Hospital between January 2021 and November 2025. Adults with ischemic stroke, transient ischemic attack, intracerebral hemorrhage, or cerebral venous sinus thrombosis (CVST) underwent PSD assessment at least 3 months after the index event. PSD was established through structured clinical assessment based on DSM-5-TR and ICD-11 criteria together with the clinician-administered 17-item Hamilton Depression Rating Scale. Factors associated with PSD were evaluated using forced-entry multivariable logistic regression.
Among 403 participants, the mean age was 57.3 ± 13.8 years, and 69.2% were male. PSD was identified in 172 participants (42.7%): 71 (17.6%) had mild, 61 (15.1%) moderate, and 40 (9.9%) severe or very severe depression. The complete-case multivariable analysis included 398 participants. Higher NIHSS score was independently associated with PSD [adjusted odds ratio (aOR) per 1-point increase, 1.35; 95% CI, 1.22-1.49; p < 0.001], as was unfavorable functional status at discharge (mRS 3-5 vs. 0-2: aOR, 6.51; 95% CI, 3.19-13.29; p < 0.001). The overall stroke-subtype test was nonsignificant (p = 0.067), although the category-specific CVST coefficient indicated higher odds of PSD (aOR, 5.73; 95% CI, 1.34-24.50; p = 0.018). The model demonstrated excellent apparent discrimination (AUC, 0.89; bootstrap 95% CI, 0.86-0.92), with 72.5% sensitivity and 90.5% specificity at a cutoff of 0.50.
PSD affected approximately two-fifths of participants and was most consistently associated with neurological severity and functional disability. Standardized depression screening should be integrated into post-stroke care, particularly for patients with greater neurological impairment or functional dependence. The CVST finding was exploratory and requires confirmation.
Authors
Albakr Albakr, Alqarni Alqarni, Alhashim Alhashim, Albakr Albakr, Yasawy Yasawy, Al Ghamdi Al Ghamdi, Sharif Sharif, Shahid Shahid, Zafar Zafar, Nazish Nazish, Almunassir Alqahtani Almunassir Alqahtani, Aljamea Aljamea, Aldamigh Aldamigh, AlDawsari AlDawsari, Al Ghannam Al Ghannam
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