Exclusion: MRI. Alcoholism. Method of Memory Research Unit, Department of Neurology (University of Helsinki) and. Exclusion: Severe aphasia

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1 Study, year, and country Study type Patient type PSD Stroke Inclusion or exclusion Kauhanen ML and others, 1999 Prospective Consecutive patients admitted DSM-III-R: Finland (33) to the stroke unit Major or minor of the Oulu University depressive s: Hospital Minor depression was used for dysthymic s, ignoring the 2-year definition Pohjasvaara T Prospective Cohort from and others, 1998 Helsinki Stroke Helsinki, Aging Memory Finland (34) (SAM) study DSM-III-R: ICD10: : single or recurrent bipolar (depression) organic mood (depression) dementia with depressed mood Minor depressive : adjustment CT MRI Method of Memory Research Unit, Department of Neurology (University of Helsinki) and National Stroke Data Bank Type of stroke: Toast Transient ischemic attack Previous psychiatric illnesses Central nervous system s Alcoholism Severe aphasia Decreased level of consciousness Severe hearing impairment Refusal: to be examined, to participate Absence of Magnetic Resonance Imaging (MRI) Impossible to perform psychiatric examination Mean (SD) age or age range in years Mean: 65.8 (11.9) Range: 19 to 82 Range: 55 to 85 Patients registered 106 registered 101 at 3 months 92 at 12 months 486 registered 277 assessed at 3 months Psychosocial risk factors Dysphasia: Western Aphasia Battery Age: older Sex Dependency: ADL scales if daily assistance, home attendant help, admission to nursing home. History of past depression: Hospital charts Severity of physical handicap: Barthel Index Age, Sex Living conditions: dysthymic major depressive in partial remission Stroke-related major depressive : When there was no other recent psychological stress alone or with someone Cognitive impairment: Mini Mental State Examination Dementia: DSM- III-R Aphasia: Acute Aphasia Screening Protocol (AASP) file:///f /Publications/CJP/2001/November01/Layout/html/Frame_59.htm (1 of 2) [11/23/2001 9:29:56 AM]

2 Study, year, and country Astrom Mand others, 1993 Sweden (37) Study type Patient type PSD Stroke Inclusion or exclusion Prospective Population-based cohort admitted to stroke unit Department of Medicine Umca University Hospital (Sweden) DSM-III: Admitted to Stroke Unit Diagnosis: cerebral infarct 79% Intracerebral hemorrhage 5% Transient Ischemic Attack 16% CT: Blind to clinical assessment Acute stroke of no more than one week duration Death Congenital mental problem Refusal Unable to assess psychiatrically (could not reliably give affirmative or negative answers) Moved Recurrent stroke Mean age or age range to 100 Patients registered 98 registered 76 initially 73 at 3 months 68 1 year 57 2 years 49 3 years Psychosocial risk factors In-hospital: Living alone before admission 3 months, few social : Questionnaire on social network. Dependency Index of ADL: not at onset (hospital) but after reflecting poorer outcome (severity rather than risk factor) 1 year: few social 2 years: few social 3 years: few social In-hospital age sex past psychiatric history Dependency: capacity for activies of daily living (Index of ADL) 3 months, living alone is not anymore same as in hospital: 1 year: few social 2 years: few social 3 years: few social file:///f /Publications/CJP/2001/November01/Layout/html/Frame_68.htm (1 of 2) [11/23/2001 9:31:37 AM]

3 Study, year, and country Paradiso S, Robinson RG, 1998 USA (35) Morris PL, Robinson RG, 1995 Australia (30) Same patients as: (31) (32) Study type Patient type PSD Stroke Inclusion or exclusion Prospective 301 consecutive admissions to University of Maryland (Baltimore) for treatment of cerebrovascular disease ( ) Prospective Patients in Rehabilitation Royal New Castle Hospital and Wall send District Hospital of the University of New Castle, New South Wales Australia HRDS severity PSE: symptoms used to derive diagnosis of DSM-IV: Minor depressive Nondepressed CIDI: symptoms at least 2 weeks DSM-III: Minor: dysthymic without 2 year duration MADRS G HQ Admitted for treatment of cerebro- vascular disease CT Stroke patients admitted to rehabilitation But same cohort of patients for (31)/(32) where were: WHO Clinical definition of intracerebral hemorrhage infarction Exclusions: Moderator severe comprehension deficits Markedly decreased level of consciousness Unable to examine because of impaired consciousness or aphasia Refusal: to complete assessment after consenting To be re-interviewed. Death Mean (SD) age or age range in years : Men: 57 (12.1) Women: 50.9 (14.4) Nondepressed Men: 59.6 (2.3) Women: 60.9 (14.2) Patients registered (10) 100 registered 94: 2 months 64: 15 months Psychosocial risk factors Sex : Women: men (2:1) Age (younger: men) Lower social-economic status (class IV-V) Past psychiatry history These factors, and others, were then considered for severity of depression, for each, in acute period poststroke not onset of depression Personality neuroticism Eysenck s Personality Inventory (EPI) Extroversion Unable to locate Moved: overseas, interstate Morris, PI and others, 1992, US (31) Same patients as (30)/(32) Prospective See study #30 See study #30 WHO: (1978) Clinical definition of intracerebral hemorrhage infarction provide informed consent be able to be interviewed reliably: For example, answer consistently on 2 occasions during the interview the depression subscale of the GHQ 703 ( 10.3) 99 potential 88 included Any type of depression: past psychiatric history personal; familial affective; anxiety Age (older) Sex (male) Either clinically depressed or have no psychiatric at the time of interview. Physical disability: Barthel Index Major depression: file:///f /Publications/CJP/2001/November01/Layout/html/Frame_69.htm (1 of 2) [11/23/2001 9:32:25 AM]

4 Study, year, and country Morris Pl and others, 1991, US (32) Same patients as studies (30)/(31) Study type Patient type PSD Stroke Prospective See study #30 See study #30 See study #30 Inclusion or exclusion Nominate a person to whom they could turn for support following stroke (who was usually the primary caregiver) Able to be interviewed reliably: answer consistently the 7 item depression subscale of GHQ on 2 occasions during the interview process. Mean age or age range Patients registered 99 registered 76 included 14 months 44 reinterviewed Psychosocial risk factors Sex (men) But men differed from women in terms of: age marital status attachment figure Perceived adequacy of social supports: modified version of Interview Schedule for Social Interaction (ISSI) Either clinically depressed following stroke or have no psychiatric other than depression at time of interview. Informed consent = Psychosocial risk factors: positive correlation for development of PSD. = Psychosocial risk factors: negative correlation for development of PSD. file:///f /Publications/CJP/2001/November01/Layout/html/Frame_70.htm [11/23/2001 9:33:10 AM]

5 Not have been depressed immediately prior to their stroke (within 2 years) Past personal history Age (older) Marital status Cognitive impairments: Mini-mental state Examination (MMSE) Negative life events 12-item list of threatening negative experiences = Psychosocial risk factors: positive correlation for development of PSD. = Psychosocial risk factors: negative correlation for development of PSD. CIDI = Composite International Diagnostic Interview; GHQ = General Health Questionnaire; MADRS = Montgomery-Asberg Depression Rating Scale Continued on next page file:///f /Publications/CJP/2001/November01/Layout/html/Frame_69.htm (2 of 2) [11/23/2001 9:32:25 AM]

6 Cognitive impairment: Mini-Mental State Examination (MMSE) Ng KC and prospective Patient referred to others, 1995 rehabitilation center of Singapore (36) Tan Tock Seng hospital DSM-III-R: depression: Mild Moderate Severe Stroke admission: CT (lesions) Exclusions: Aphasia Drowsy, delirious, demented registered 52 included 51 completed Sex (women) past history of depression functionnal impairment: Barthel Index (1 in the 52) Intellectual impairment: MMSE = Psychosocial risk factors: positive correlation for development of PSD. = Psychosocial risk factors: negative correlation for development of PSD. Continued on next page file:///f /Publications/CJP/2001/November01/Layout/html/Frame_68.htm (2 of 2) [11/23/2001 9:31:37 AM]

7 Anderson G and Prospective Unselected others, 1995 cohort of Denmark (11) consecutive stroke patients referred to hospital or outpatient department (OPD) FarsØ Hospital Aalborg Hospital Aalborg OPD Hamilton Rating Scale for Depression (HRDS) And 14 days of consistent symptoms 13 = depressed (minor) 18 = major depressive WHO modified first ever and recurrent stroke Subarachnoid hemorrage Biswanger Previous degenerative or expansive nervous system disease Previous history of mental illness except depression more than 1 year early Inability to do interview Decrease conciousness Dementia Aphasia Range: 25 to 80 median : before exclusion 259 included year follow up Death Unable to communicate Sex (female) Living alone Social distress 6 months prior to stroke: social loss Social activities: Few Decrease: Social Activities Index Greater Intellectual Impairment at 1 month: Brief Cognitive Rating Scale (BCRS) History of Previous Depression Age Social Class:? Education:? Housing? Performance: Mattis dementia Rating scale (MDRS) Barthel Index = Psychosocial risk factors: positive correlation for development of PSD. = Psychosocial risk factors: negative correlation for development of PSD. Continued on next page file:///f /Publications/CJP/2001/November01/Layout/html/Frame_59.htm (2 of 2) [11/23/2001 9:29:56 AM]

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