افسردگی پس از سکته مغزی در اردن: مقادیر و پیش بینی های شیوع Post-Stroke Depression in Jordan: Prevalence Correlates and Predictors

Introduction Globally, stroke and ischemic heart disease were the foremost 2 causes of death and premature mortality in 2015.1,2 The recent improvements in medical health care increase life expectancy and decrease stroke mortality. Worldwide, mortality rates associated with stroke were decreased by 21.0%, since 2005.2 However, they increase the number of stroke survivors who live with the consequences of stroke such as disabilities that affect their quality of life and put increased demands on healthcare systems.3 It has been well acknowledged that stroke is one of the largest causes of serious long-term mental and physical disabilities.1 Depression ranks first among all illnesses that cause disability.4 In particular, post-stroke depression (PSD) is among the most frequent neuropsychiatric complications of stroke, with a reported prevalence varying widely and ranging from 25% to 79%, either in the early or in the late stage following stroke.5,6 This percentage was found to be higher in developing countries, compared with the developed ones, which bear a disproportionate larger burden of stroke while owning fewer resources.7 Lack of modern treatment and rehabilitation facilities may play an important role in increasing the frequency of depression in developing countries.8-10 Besides its high prevalence, PSD has been associated with a poor prognosis. Depressive symptoms increased the risk of stroke morbidity and mortality.11 Patients with depression have more severe deficits in activities of daily living, a worse functional outcome, and more severe cognitive deficits.12,13 Depression is considered as the strongest predictor of quality of life in stroke survivors and is associated with a significant increase in total healthcare expenditure.14,15 Furthermore, high depressive symptoms have been associated with increased risk of stroke.16 Identifying factors that predict PSD rates and categories is vital. Studies revealed that depression levels were stable during the 18 months after first-ever stroke.17 However, depression scores were significantly higher among patients who had lower physical functioning in the acute phase, disability after stroke, history of depression before stroke, cognitive impairment, lack of social or family support, suffering anxiety, and unemployment of patients at the time of stroke. Specific patient characteristics, like age and gender, were not shown to predict depression. In addition, there were no associations between depression and other variables like the stroke subtype, lesion location, or laterality.5,9,18,19 Antidepressant medication may not always be suitable to treat depression after stroke, because of drug interactions, side effects, and poor compliance. Therefore, psychological treatments should be considered.13 Physicians and other healthcare providers are usually aware of the emotional constituents of their stroke patients’ illnesses, but the emotional and psychosocial dimensions of patients’ illness are usually ignored because of physicians’ lack of time to effectively asses and manage these aspects.