Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis.

BACKGROUND Depression after stroke is a distressing problem that may be associated with other negative health outcomes. AIMS To estimate the natural history, predictors and outcomes of depression after stroke. METHOD Studies published up to 31 August 2011 were searched and reviewed according to accepted criteria. RESULTS Out of 13 558 references initially found, 50 studies were included. Prevalence of depression was 29% (95% CI 25-32), and remains stable up to 10 years after stroke, with a cumulative incidence of 39-52% within 5 years of stroke. The rate of recovery from depression among patients depressed a few months after stroke ranged from 15 to 57% 1 year after stroke. Major predictors of depression are disability, depression pre-stroke, cognitive impairment, stroke severity and anxiety. Lower quality of life, mortality and disability are independent outcomes of depression after stroke. CONCLUSION Interventions for depression and its potential outcomes are required.