Are Younger Age and Subjective Stress Risk Factors for Depression after Stroke?

Background and Purpose: Approximately 800,000 strokes occur in the United States (U.S.) each year. Stroke survivors can face an array of physical and mental health challenges including experiencing at least three times the rate of depression found in the general population. Although studies suggest that overall stroke incidence in the U.S. is declining, the number of strokes among persons aged 20-54 has actually increased in recent years (i.e., from 11.7% of all cases in 1993 to 20.5% of all cases in 2005, p = 0.002). Given the myriad of unique stressors that can stem from experiencing stroke at a younger age (e.g., financial stress from lost employment, family stress from parenting demands, health-related stress from having a disease commonly associated with later life), there is a critical need to better understand age differences in rates of depression after stroke, as well as the role of subjective stressors in this process, in order to determine whether younger survivors may be at greater risk. We hypothesized that younger age would be a significant risk factor for depression after stroke and that financial, family, and health-related stress would moderate the impact of age, with younger survivors who report higher stress being at the greatest risk for depression.      

Methods: Surveys were conducted at baseline and 3-months post-stroke with 460 participants enrolled in a population-based study of ischemic stroke in the Cincinnati region in 2005. Financial, family, and health-related stress were assessed with three individual items. Depression was assessed with the 10-item CES-D using a cutoff of 10 or greater to classify clinical depression. Rates of depression were compared between four age groups (i.e., 25-54 years, 55-65 years, 65-74 years, 75+ years). Logistic regression was used to identify risk factors for clinical depression, including potential interactions between age and subjective stress variables.

Results: At 3 months post stroke, among the 460 participants originally enrolled, data for 322 survivors were available for analysis. Depression was the most prevalent among survivors aged 25-54 (47%) and the least prevalent among those aged 65-74 (27%). Logistic analyses indicated that survivors aged 25-54 were 3.07 times more likely to experience depression than their older counterparts (OR=3.07, 95%CI 1.46-6.45). Survivors who reported having “trouble paying bills” were 2.23 times more likely to experience depression than those who did not (OR=2.23, 95%CI 1.22-4.09). Survivors reporting family and health-related stress were also slightly more likely to experience depression (OR1.20, 95%CI 1.10-1.32; OR1.17, 95%CI 1.09-1.27, respectively). No statistically significant interactions between age and subjective stress were found.       

Conclusions and Implications: This study suggests that younger survivors, as well as those experiencing financial and other stress, are at significantly higher risk for depression. These findings are important considering that the onset of psychiatric illness at a younger age contributes to increased illness burden, more years of lost or reduced productivity, and greater cumulative care-related costs. Social work practitioners should be aware that younger survivors may need additional support in order maintain positive mental health in the face of the challenges brought about by stroke.