J Stroke.  2021 May;23(2):263-272. 10.5853/jos.2020.04637.

Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger

• Kwon B
• Lee EJ
• Park S
• Lee JS
• Lee MH
• Jeong D
• Lee D
• Kwon HS
• Chang DI
• Park JH
• Cha JK
• Heo JH
• Sohn SI
• Kim DE
• Choi-Kwon S
• Kim JS

• KMID: 2516415
• DOI: http://doi.org/10.5853/jos.2020.04637

Abstract

Background and Purpose
Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied.
Methods
This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim’s criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP.
Results
A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP.
Conclusions
The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.

Keyword

Ischemic stroke; Depression; Emotions; Anger

Figure

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  Figure 1. Study profile. EMOTION, Efficacy of Early Administration of Escitalopram on Depressive and Emotional Symptoms and Neurologic Dysfunction After Stroke; IRB, Institutional Review Board.

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  Figure 2. (A) Median modified Rankin Scale (mRS) with interquartile range. (B) Prevalence of post-stroke depression (PSD) and mean Montgomery-Åsberg depression rating scale (MADRS) with 95% confidence interval (CI). (C) Prevalence of post-stroke emotional incontinence. Follow-up time is shown in month. (D) Mean anger score with 95% CI. LTP, long-term period.

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  Figure 3. Correlation test results between Montgomery-Åsberg depression rating scale (MADRS) at long-term period (LTP) and enhancing recovery in coronary heart disease (ENRICHD) Social Support Instrument (ESSI), and between anger score at LTP and ESSI.

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