The prevalence of post stroke depression is 43.4 %. Factors contributing to increased risk of depression after stroke include age between 45 and 64 and shorter duration after the diagnosis of strokes (less than 3 months and between 3 to 6 months).
The prevalence of depression in this study is very high when compared to studies done in Ethiopia, among the general population, 2.2% (17) and 9.1% (15). The range is very wide when it comes to prevalence of PSD in studies done worldwide (20–65%)(16). This can be attributed to the difference in study setting, screening tools, sample size, severity of stroke and other list of factors. The result in this study is comparable with studies conducted in other developing countries, Uganda (31.5%) (17), Nigeria (40.1%)(18) and Pakistan (35%)(19).
Out of the depressed 43.3% of patients, 62.3% of them reported to have extreme difficulty, while 26.1% found it very difficult to perform their daily activities. Only one patient (1.5%) had reported no difficulty on performing daily activities. This highlights some of the devastating effects of PSD clearly.
Most of the study participants lie above the age of 45. This result is comparable with the studies done at SPHMMC Ethiopia (13) and Ayder referral hospital in Ethiopia(20), but different from a study done at Tikur Anbessa hospital in Addis Ababa where a quarter of patients were under 34years(21).
The mean age of patients with stroke in this study was 58.4 (S.D ± 13.7) years, which is also comparable with the study done at SPHMMC on which the reported mean age was 57.53 ± 15.8 years (13). Age between 45 and 64 showed significant association in the multiple logistic regression analysis.
In this study we found that amongst the 159 patients selected for the study, 57.9% were male and 42.1% were females. It is in accordance with the results presented by previous study conducted at SPHMMC(13). Significant association was not observed on gender. A systematic review of 24 studies of stroke patients reported that gender was not a significant risk factor for PSD in 13 out of 21 studies that examined this association. However, one-third of these studies identified female sex as a risk factor for PSD (35). Other socioeconomic and demographic factors like residency status, marital educational status, employment status and average monthly income did not show association.
The other variable which showed a strong significant association with PSD is a shorter duration from the diagnosis of stroke, specifically less than 3 months and 3 months up to 6 months. Which has also been reported by most other researches ( 29,30). Overall the prevalence of post stroke depression reduces over time with improvements in activities of daily living if treatment is initiated early.
In this study out of the selected 159 participants, 56 % of them were having hemorrhagic stroke which goes in line with most other studies done in Ethiopia(13, 22, 23, 24). Type of stroke had no statistically significant association with PSD. Most literatures reported that ischemic stroke is more associated with PSD (25, 26, 27). On the other hand, recent systematic reviews argue against an association between PSD and the type (i.e., ischemic or hemorrhagic)(28) .
No association was found between stroke lateralization and prevalence of PSD. Lesion location has been extensively investigated as a risk factor for PSD. With this regard, literatures show contradictory results. Some show strong association between left side stroke and PSD (25, 31, 32), while others report in contrary(33, 34). This can be explained by difference in severity of the stroke, size of the lesion, level of disability and other factors.
This study has potential limitations. Being a cross sectional study, it is difficult to test the temporal relation and to establish causal relationship between exposure and outcome. We used a screening tool (PHQ-9) which could further inflate the prevalence of PSD. This study was institutional based, limited to a single hospital and had small number of sample size, which might be biased in stroke type, stroke severity and demographic characteristics of the patients. The study does not control common comorbidities like hypertension, cardiovascular disorders, diabetes mellitus, neurocognitive impairment, and concomitant medications taken, which can pose a higher burden of depression independently. Therefore, it affects the generalizability of the results to all stroke patients. Despite its limitations the study has significant importance in showing the prevalence of PSD, its impact on daily life and contributes to early detection and management.