Determinants of Post-Stroke Depressive Phenomenon: A Retrospective Cohort Inquiry in a Tertiary Care Hospital in Pakistan

Abstract

Background: Post-stroke depression (PSD) is a common neuropsychiatric complication that adversely affects quality of life, particularly in low- and middle-income countries such as Pakistan, where comorbid conditions, including diabetes and hypertension, are highly prevalent. This study aimed to determine the prevalence and predictors of PSD.

Methodology: A retrospective study was conducted from July to December 2023 at Liaquat National Hospital, Karachi, following approval from the Institutional Ethical Review Committee. Using non-probability consecutive sampling, 372 patients within five years of stroke onset were enrolled during the subacute phase, defined as one-month post-stroke. The Patient Health Questionnaire-9 (PHQ-9) was administered at one month and reassessed at six months. Patients identified with PSD received antidepressant therapy. Data were collected using a semi-structured questionnaire and analyzed through descriptive statistics and inferential tests, including confidence intervals and p-values to determine statistical significance.

Results: Among the 372 participants, 35.5% exhibited symptoms of PSD; 90.9% of affected individuals received antidepressants, and 80% of these reported improved mood by six months. No significant association was observed between PSD and National Institute of Health Stroke Scale (NIHSS) scores. Ischemic stroke was strongly associated with higher odds of PSD in both unadjusted and adjusted analyses. Patients younger than 50 years also demonstrated greater susceptibility to depressive symptoms. Hypertension emerged as a significant predictor of PSD, with markedly elevated odds in both models. Overall, 26.9% of patients demonstrated moderate depressive severity on the PHQ-9.

Conclusion: Younger age, ischemic stroke subtype, and hypertension were significant predictors of PSD. Antidepressant treatment was widely administered and associated with clinical improvement at six-month follow-up.