The Natural History of Depression up to

15 Years After Stroke

The South London Stroke Register
Luis Ayerbe, MSc; Salma Ayis, PhD; Siobhan Crichton, MSc;
Charles D.A. Wolfe, FFPH; Anthony G. Rudd, FRCP
Background and PurposeEvidence on the natural history of depression after stroke is still insufficient to inform prognosis
and treatment strategies. This study estimates the incidence, cumulative incidence, prevalence, time of onset, duration,
and recurrence rate of depression up to 15 years after stroke.
MethodsData from patients registered in the South London Stroke Register between 1995 and 2009 were used (N=4022
at registration. Maximum number of participants for these analyses n=1233). Depression was assessed in all patients with
the Hospital Anxiety and Depression Scale (scores >7=depression) 3 months after stroke, 1 year after stroke, and annually
thereafter up to 15 years after stroke. Inverse probability weighting was used to calculate the estimates accounting for
missing data.
ResultsThe poststroke incidence of depression ranged from 7% to 21% in the 15 years after a stroke, with cumulative
incidence of 55% and prevalence ranging from 29% to 39%. Most episodes of depression started within a year of stroke,
with 33% of the cases starting in the 3 months after a stroke, and none from year 10 onward. Fifty percent of the patients
with depression at 3 months had recovered 1 year after stroke. The proportion of recurrent episodes of depression after
stroke increased gradually from 38% in year 2 to 100% in years 14 and 15.
ConclusionsThe natural history of depression after stroke is dynamic. Depression affects most of the stroke patients with
episodes that have a short duration but a high risk of recurrence in the long term.(Stroke. 2013;44:1105-1110.)
Key Words: cohort studies

depression

lthough depression is a recognized outcome of stroke,1

most studies investigating depression after stroke have
limitations, including selection bias, short follow-up, and
small sample size.2,3 The prevalence of depression in the first
few years after stroke has been reported in several studies.2
Nonetheless, evidence is poor or lacking on other estimates of
the long-term natural history of depression, such as the poststroke incidence, cumulative incidence, time of onset, duration, and recurrence rate.2 Interventions for depression after
stroke only show limited effect. Whether these interventions
had been started at the right time after stroke and given for an
adequate length of time to obtain maximal sustained response
has been questioned.4
In this article, the poststroke incidence, cumulative incidence, prevalence, time of onset, duration, and recurrence rate
of depression up to 15 years after stroke are estimated in a
population-based study.

incidence

natural history

prevalence

stroke

Methods
First in a lifetime stroke patients were recruited from the South
London Stroke Register (SLSR), a prospective population-based
stroke register covering an inner-city population of 271817.5 Data
from patients, registered in the SLSR between January 1, 1995, and
December 31, 2009, and followed up between April 1, 1995 (first 3
months of follow-up assessments), and August 31, 2010, were used
(patients at registration, N=4022).
Patients were registered during the acute phase of stroke and were
then followed up for 3 months after stroke, 1 year after stroke, and annually thereafter. The World Health Organization definition of stroke
was used.6 Follow-up was by postal questionnaire or interview, depending on the capacity of patient to fill in the questionnaire. Such
capacity was judged by the patient, the next of kin, or the field worker
in a preceding follow-up assessment. Patients unable to complete
the follow-up questionnaire, and those not returning them by post,
were telephoned to arrange face-to-face interviews or have another
follow-up questionnaire posted. Patients who could not be followed
up at one time point remained registered and were contacted again
for the following annual assessment. At follow-up, patients were

Received October 4, 2012; final revision received December 21, 2012; accepted December 28, 2012.
From the Division of Health and Social Care Research, Kings College London, London, United Kingdom (L.A., S.A., S.C., C.D.A.W., A.G.R.);
National Institute for Health Research (NIHR) Biomedical Research Centre, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
(C.D.A.W.); and Stroke Unit, Guys and St. Thomas NHS Foundation Trust, St. Thomas Hospital, London, United Kingdom (A.G.R.).
The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl/doi:10.1161/STROKEAHA.
111.679340/-/DC1.
Correspondence to Luis Ayerbe, 7th Floor, Capital House, 42 Weston Street, London SE1 3QD, United Kingdom. E-mail luis.ayerbe_garcia-mozon@
kcl.ac.uk
2013 American Heart Association, Inc.
Stroke is available at http://stroke.ahajournals.org

DOI: 10.1161/STROKEAHA.111.679340

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by guest on August 23, 2015
1105

1106StrokeApril 2013
assessed for depression using the Hospital Anxiety and Depression
Scale (HADS).7 Scores >7 in the HADS depression subscale were
considered depression. HADS has been validated in stroke patients
showing a good performance both when it is used in a face-to-face
interview and when it is self-administered8 (Cronbachs alpha > 0.80;
optimum performance when HADS subscales scores >7 are used to
identify depression, sensitivity: 73.1, and specificity: 81.6).7 Despite
its good performance, HADS is not a diagnostic scale but a screening
tool that indicates risk of depression. However, the term depression
will be used in this article for succinctness in patients with scores >7.
HADS was routinely collected between 1997 and 2010. Patients registered in 1995 (n=299) and 1996 (n=350) received their first HADS
assessment in 1997. Data on HADS were, therefore, not included
from these patients in the respective estimates for early rates of depression. Because HADS cannot be answered by proxy, all information was collected directly from patients. Although patients with
some degree of cognitive or communication impairment can respond
to HADS, no data could be collected from patients with severe cognitive or communication impairment that the field worker, or the patients next of kin in case of postal questionnaire, judged would give
invalid responses.

Statistical Methods
The poststroke incidence of depression was calculated among patients assessed at each time point who were also assessed and not
depressed in the previous follow-up. Poststroke incidence of depression 3 months after stroke was not calculated because there were no
depression assessments before that point. The cumulative incidence
of depression was calculated among patients assessed for depression
at any time point. The prevalence of depression was calculated among
survivors assessed at each time point. The proportion of patients who
became depressed for the first time at each assessment, between 3
months and 15 years after stroke, was calculated among patients with
complete follow-up until each time point. The proportion of patients
depressed at 3 months who recovered each year was calculated among
patients with complete follow-up until each time point. Finally, to estimate recurrence rate, the proportion of patients not depressed at one
time point, becoming depressed in the following one and having a previous episode of depression reported, was calculated among patients
who had 3 follow-up assessments. Sociodemographic and clinical
characteristics of survivors completing and not completing HADS
were compared using 2 test because these variables were categorical.
As a first step, all estimates were obtained only from patients with
complete data (ie, complete case [CC] analysis). However, estimates
obtained from CC analysis may be biased if the excluded individuals are systematically different from those included. Therefore, in
a second step, estimates were calculated using inverse probability
weighting (IPW).9 Using IPW, cases were weighted by the inverse
of their probability of being a CC. To weight the probability of being
complete, a variable of completeness was created for each estimate.
For example, prevalence of depression at 3 months is 1=observed and
0=missing. A logistic regression model was built to identify predictors of completeness. Variables included in the models were those
considered to be associated with completeness: age, sex, ethnicity,
stroke severity measures (Glasgow Coma Scale, incontinence, and
paresis), and disability at baseline. The inverse of the probability of
being a CC was calculated and applied to individuals with available
data. Finally, estimates were calculated on weighted data. Weighted
and CC estimates are presented. For cases with weight >25, only CC
estimates are presented because IPW can also introduce error when
weights are very large.9 IPW was not used to estimate rate of recurrences because the number of patients available each year was too
low, between 1 and 68, to allow for a stable model of completeness
to be built.10
Some estimates, particularly those obtained with small number of
patients toward the end of the follow-up, had confidence intervals
with values >1 or <0. In these cases, the arcsine correction was used.11
When this correction was used, IPW was not possible; therefore, only
CC estimates were reported.

Ethics
Patients or their relatives gave written informed consent. The study
was approved by the ethics committees of Guys and St Thomas
Hospital NHS Foundation Trust, Kings College Hospital Foundation,
National Hospital for Neurology and Neurosurgery, Queens Square
Hospital, St Georges Hospital, and Chelsea and Westminster
Hospital.

Results
Between 1995 and 2009, the SLSR registered 4022 patients.
When the follow-up period finished in August 2010, the follow-up time for survivors ranged from 3 months to 15 years.
The number of patients registered in each period, assessed
for depression or lost to follow-up, at each time point, is
presented in the online-only Data Supplement I. The maximum number of participants available for analysis was 1233,
1 year after stroke. Few differences were observed between
sociodemographic characteristics of patients who were and
those who were not assessed for depression (online-only Data
Supplement II). Up to 10 years after stroke, those who had had
more severe strokes were less likely to be assessed (onlineonly Data Supplement III).
The poststroke incidence of depression after stroke ranged
between 7% and 21% per year during the 15-year follow-up
(Table 1; online-only Data Supplement III). The proportion
of patients depressed at 3 months, first cases after stroke,
was 33%. The prevalence of depression ranged from 29% to
39% during the follow-up period (Table 2; online-only Data
Supplement IV). Cumulative incidence of depression was
55.4% (53.3%57.5%) on CC analysis and 58.2% (52.9%
60.5%) using IPW. Thirty-three percent of the assessed
patients had their first detected episode of poststroke depression 3 months after the acute event, and this proportion gradually decreased to 4% in year 9. There were no observations of
patients having their first episode of depression from year 10
onward (Table 3). Half of the patients who were depressed at
3 months had recovered from depression at 1 year. The other
half recovered gradually between years 2 and 9. No cases of
depression at 3 months recovering after year 9 were observed
(Table 4). The proportion of recurrent cases rose from 38% in
year 2 to 100% in years 14 and 15 (Table 5).
Weighted and CC estimates of prevalence, poststroke incidence, cumulative incidence, time of onset, and duration were
consistent at all time points.

Discussion
These analyses and estimates show that the natural history of
depression after stroke is dynamic. Depression affects more
than half of all stroke patients at some point, with a stable
prevalence of ~30% up to 15 years after stroke, with most
patients recovering from depression after a few years and having a significant risk of recurrent episodes in the long term.
This study shows a prevalence of depression similar to the
one previously reported in other studies, although the follow-up
is substantially longer.2,3 Poststroke incidence is an estimate
of natural history that has been scarcely investigated.2,12,13
The prevalence and poststroke incidence observed in this
study, which are largely stable throughout the follow-up, are
estimates suggesting a persisting risk of depression among

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Ayerbe et al Natural History of Depression After Stroke 1107

Table 1. Poststroke Incidence of Depression up to 15 Years After Stroke
Follow-up, y

Patient at Risk

Depression

Poststroke Incidence (95% CI)

Weighted Poststroke Incidence (95% CI)

518

85

16.4 (13.219.6)

17.8 (14.021.6)

488

93

19.1 (15.622.6)

20.5 (16.624.5)

423

69

16.3 (12.819.8)

16.9 (13.020.8)

498

85

17.1 (13.720.4)

17.5 (13.721.2)

356

58

16.3 (12.420.1)

18.5 (13.823.1)

281

42

14.9 (10.719.1)

14.11 (9.518.7)

268

52

19.4 (14.624.2)

22.3 (16.128.6)

205

27

13.2 (8.517.8)

15.2 (9.421.1)

159

27

17.0 (11.122.9)

17.9 (11.024.9)

10

113

22

19.5 (12.026.9)

21.6 (11.931.2)

11

94

15

15.9 (8.423.5)

NR

12

66

12

18.2 (8.627.7)

NR

13

43

20.9 (8.333.6)

NR

14

15

6.7 (0.226.4)*

NR

15

14.3 (0.350.1)*

NR

Because patients who were lost to follow-up for 1 year remained registered and were contacted again the following year, the number of patients at risk may be higher
than the number of patients at risk, minus the number of incident cases, in the previous assessment. CI indicates confidence interval; and NR, not reported.
*Proportions calculated using arcsine correction.
Weights >25 were considered too high.
Estimate not reported as arcsine correction cannot be used, and weighted estimates included CIs with values >1 or <0.

stroke patients and a dynamic natural history of depression

in the long term after stroke. The cumulative incidence of
depression in stroke cohorts has been so rarely reported in
previous studies that the overall importance of depression
among stroke patients has probably been underestimated.2,3
The duration of the episodes of depression is relatively
short. Other studies following stroke patients for up to 3
years published similar results.1214 The increase in recurrent
episodes observed during the 15-year follow-up explains

why depression starting shortly after stroke and having short

duration has a stable prevalence.
The SLSR does not have a control arm, therefore it was
not possible to know whether estimates of depression were
different from the ones in general population. Two previous
studies observed that significantly more stroke survivors
were depressed than controls.15,16 Studies observing general
population report lower frequency of depression than that
observed among stroke patients with a cumulative incidence

Table 2. Prevalence of Depression up to 15 Years After Stroke

Follow-up

Patients Assessed at
Each Time Point

Prevalence (95% CI)

Weighted Prevalence (95% CI)

3m

1101

Patients Depressed
361

32.8 (30.035.6)

33.2 (30.036.4)

1, y

1233

357

28.9 (26.431.5)

30.6 (27.733.5)

2, y

901

266

29.5 (26.532.5)

30.7 (27.434.0)

3, y

1100

340

30.9 (28.233.6)

31.6 (28.734.5)

4, y

890

268

30.1 (27.133.1)

31.0 (27.834.2)

5, y

658

194

29.5 (26.033.0)

30.4 (26.734.1)

6, y

600

179

29.8 (26.233.5)

29.5 (25.633.4)

7, y

475

151

31.8 (27.636.0)

32.1 (27.636.5)

8, y

392

113

28.8 (24.333.3)

29.8 (25.034.6)

9, y

296

106

35.8 (30.341.3)

37.6 (31.743.4)

10, y

234

81

34.6 (28.540.1)

34.4 (28.040.7)

11, y

183

54

29.5 (22.836.2)

30.5 (23.537.6)

12, y

116

37

31.9 (23.340.5)

31.5 (22.640.5)

13, y

72

28

38.9 (27.350.4)

35.9 (24.047.9)

14, y

46

14

30.4 (16.644.2)

34.4 (18.550.3)

15, y

16

31.2 (5.756.8)

32.3 (2.262.4)

CI indicates confidence interval.

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1108StrokeApril 2013
Table 3. Proportion of Patients (With Complete Follow-up) With New Cases of Depression Annually

Follow-up

Patients With Complete

Follow-up and
Depression First Detected

Number of Patients With Complete

Follow-up to Each Time Point

Proportion of Patients With

Complete Follow-up and
Depression First Detected

Weighted Proportion of Patients

With Complete Follow-up
and Depression First Detected

3 mo

1101

361

32.8 (30.035.6)

33.2 (30.036.4)

1, y

750

85

11.3 (9.013.6)

12.0 (9.414.7)

2, y

450

40

8.9 (6.211.5)

9.4 (6.412.3)

3, y

329

17

5.2 (2.87.6)

5.6 (2.88.3)

4, y

249

16

6.4 (3.39.5)

5.2 (2.58.0)

5, y

154

1.9 (0.44.9)*

NR

6, y

87

NR

7, y

44

8.3 (0.216.4)

NR

8, y

36

NR

9, y

27

3.7 (0.0915.4)*

NR

10, y

14

NR

11, y

11

NR

12, y

NR

13, y

No observations

14, y

No observations

15, y

No observations

NR indicates not reported.

*Proportions calculated using arcsine correction.
Weights >25 were considered too high.
Estimate not reported as arcsine correction cannot be used, and weighted estimates included confidence intervals with values >1 or <0.
No patients had complete follow-up from registration to >12 years.

of depression between 13% and 17% during patients lifetime

and incidence between 5% and 10%.1719
It has been reported that medical illness, not only stroke,
increases the risk of depression.20 The World Health

Organization World Health Survey reported from observations

in 60 countries that up to 23% of patients with chronic physical
diseases had comorbid depression.21 Life-threatening illness,
unpleasant treatments, and drugs causing depression as a side

Table 4. Recovery After Depression After Stroke

Recovery Time, y

Patients With
Depression at 3 mo With
Complete Follow-up

Patients With
Depression at 3 mo
Recovered for the First Time

Proportion of Patients
Depressed at 3 mo Recovered
for the First Time (95% CI)

Weighted Proportion of
Patients Depressed at 3 mo
Recovered for the First Time (95% CI)

232

116

50.0 (43.556.5)

50.3 (43.157.6)

139

19

13.7 (7.919.4)

13.9 (7.320.4)

92

7.6 (2.113.1)

8.1 (1.614.7)

74

4.0 (0.910.1)*

NR

41

2.4 (0.0610.3)*

NR

26

3.8 (0.115.9)*

NR

12

NR

NR

14.3 (0.350.1)*

NR

10

NR

11

NR

12

NR||

13

14

15

CI indicates confidence interval; and NR, not reported.

*Proportions calculated using arcsine correction.
Weights >25 were considered too high.
Estimate not reported as arcsine correction cannot be used, and weighted estimates included CIs with values >1 or <0.
||Number of observations too low to build a model of completeness.

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Ayerbe et al Natural History of Depression After Stroke 1109

Table 5. Proportion of Recurrent Cases of Depression After Stroke

Follow-up, y

No. of Incident
Cases With 3
Assessments

No. of Cases With

1 Previous Episode
of Depression

Proportion of
Recurrent Cases

65

25

38.5 (26.350.6)

57

26

45.6 (32.358.9)

68

29

42.6 (30.654.7)

54

31

57.4 (43.871.0)

40

27

67.5 (52.382.7)

51

31

60.7 (46.974.6)

26

20

76.9 (59.694.3)

27

17

63.0 (43.582.4)

10

22

17

77.3 (58.296.3)

11

15

12

80.0 (55.0100.0)*

12

12

10

83.3 (56.7100.0)*

13

87.5 (54.999.7)*

14

100

15

100

*Proportions calculated using arcsine correction.

effect may explain this association.20 Most of these apply to

stroke patients. However, the increased prevalence of depression specifically among stroke patients may also be attributable to other causes, including the following: (1) depression
is a risk factor for stroke, therefore the proportion of patients
at risk of depression may be increased among stroke patients;
(2) depression and stroke have risk factors in common, such
as sedentary lifestyle; (3) depression is a secondary psychological reaction to stroke; (4) depression is secondary to other
outcomes of stroke, such as cognitive impairment; and (5)
stroke has a direct pathophysiological effect on the brain (eg,
increase of cytokine levels).22
As in almost all cohort studies, there are some missing data
in this study. This was not only attributable to the difficulty
in following up patients for so long but also to the difficulty
of some patients in responding to the HADS. The exclusion
of patients with cognitive and communication impairment
is a limitation affecting most studies of depression in stroke
cohorts.2 Nonetheless, missing data were handled using IPW,
and to obtain maximum robustness, both the results of IPW
and CC analysis are presented. Although IPW adjusts for
differences in characteristics of patients with complete and
incomplete follow-up, it cannot adjust for unmeasured factors, which may result in some patients being more likely to
have incomplete follow-up. However, it should be acknowledged that weighted and CC estimates were always consistent. This suggests that although part of the sociodemographic
groups are more likely to be missing than others, this had little
impact on the estimates of the natural history of depression
after stroke. Therefore, the validity of results from CC analysis should be considered.
To assess the natural history of depression, it would have
been ideal to followup patients more frequently because the
average duration of episodes of depression is shorter than 1
year.19 It would have also been better to assess depression
with a diagnostic tool as well, such as the Diagnostic and
Statistical Manual of Mental Disorders-IV criteria.23 However,

these limitations are common in large epidemiology studies,

such as the SLSR. The HADS shows a good performance
detecting depression in patients with no psychiatric conditions
according to a systematic review.7 The SLSR is probably the
largest population-based cohort of stroke patients followed up
for so long. It provides the least biased sampling frame and
good statistical power in the analyses of data collected in the
long term after stroke, in contrast with previous studies.2 A
capturerecapture analysis conducted with the data on incident strokes registered in the SLSR concluded that 88% of
the strokes occurring in the study area were being registered.24
Clinicians should acknowledge that depression remains a
frequent active problem long after stroke, even when stroke
seems to be completely settled and many other medical issues
may have presented. With the exception of those patients who
do not become depressed shortly after stroke, who seem to
be at lower risk, depression requires periodic clinical attention in the long term. The high rate of recurrence of depression should be noted. Assuming that a patient recovering from
depression is a closed case could lead to a late diagnosis or an
overlooking of a further episode.

Acknowledgments
We thank all patients and healthcare professionals involved. Particular
thanks to field workers and the team working since 1995 for the South
London Stroke Register and the Stroke Research Team at Kings
College London.

Sources of Funding
The study was funded by Guys and St Thomas Hospital Charity,
The Stroke Association, Department of Health HQIP grant,
UK, National Institute for Health Research Program Grant (RPPG-0407-10184). Charles D.A. Wolfe acknowledges financial support from the Department of Health via the National Institute for
Health Research (NIHR) Biomedical Research Center award to Guys
and St Thomas NHS Foundation Trust in partnership with Kings
College London.

Disclosure
Charles D.A. Wolfe is an NIHR Senior Investigator. This article presents independent research commissioned by the National Institute
for Health Research (NIHR) under its Program Grants for Applied
Research funding scheme (RP-PG-0407-10184). The views expressed in this article are those of the authors and not necessarily
those of the National Health Service, the NIHR, or the Department of
Health. The other authors have no conflicts to report.

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SUPPLEMENTAL MATERIAL
Follow up time

Registration period

since stroke

3 months

Dead <3m=1064 LTF=1015 FU=1943 # HADS=1101** (37.2%)

1995-2009 N=4022

1 year

Dead<1y=1541

1995-2009 N=3957

2 year

Dead<2y=1523

LTF=954

FU=1263

HADS=901

(40.6%)

1995-2008 N=3740

3 year

Dead<3y =1652

LTF=556

FU=1316

HADS=1100 (58.8%)

1995-2007 N=3524

4 year

Dead <4y=1695

LTF=498

FU=1094

HADS=890 (55.9%)

1995-2006 N=3287

5 year

Dead <5y=1728

LTF=517

FU=820

HADS=658 (49.2%)

1995-2005 N=3065

6 year

Dead <6y=1702

LTF=395

FU=710

HADS=600 (54.3%)

1995-2004 N=2807

7 year

Dead <7y=1664

LTF=330

FU=568

HADS=475 (52.9%)

1995-2003 N=2562

8 year

Dead <8y=1563

LTF=251

FU=474

HADS=392 (54.1%)

1995-2002 N=2288

9 year

Dead <9y= 1451

LTF=211

FU=356

HADS=296 (52.2%)

1995-2001N=2018

10 year

Dead <10y=1297

LTF=167

FU=262

HADS=234 (54.5%)

1995-2000 N=1726

11 year

Dead <11y=1165

LTF=134

FU=203

HADS=183 (54.3%)

1995-1999 N=1502

12 year

Dead <12y=966

LTF=99

FU=128

HADS=116 (51.1%)

1995-1998 N=1193

13 year

Dead <13y=704

LTF=63

FU=96

HADS=72 (45.3%)

1995-1997 N=863

14 year

Dead <14y=451

LTF=40

FU=51

HADS=46 (47.4%)

1995-1996 N=542

15 year

Dead<15y =172

LTF=16

FU=16

HADS=16 (50.0%)

1995-1996 N=204

LTF=558

FU=1858

HADS=1233## (51.0%)

Supplement 1. Number of participants included in the analysis at each follow up time point
N= number of patients registered.

HADS=number of patients completing the depression scale.

FU= Number of patients followed up at each time point.
LTF=Number of patients lost to follow up at each time point.
# Note that some patients who were followed up could not be assessed with HADS due to
cognitive or communication impairment.
**The 649 patients registered in 1995 and 1996 were not assessed for depression at this point
as HADs was routinely collected from 1997.
Proportion of patients assessed with HADS over the total patients followed up and lost to
follow up
##The 299 patients registered in 1995 were not assessed for depression at this time point as
HADs was routinely collected from 1997.

HADS completed / HADS not completed

Age>65(%)

Female gender (%)

White ethnicity (%)

Black ethnicity (%)

3m

64.3/64.9

46.0/47.4

71.1/70.1

22.7/23.2

1y

61.0/65.3

44.6/46.2

71.1/68.3

22.7/24.8

2y

59.3/59.5

44.9/44.1

66.7/69.3

26.1/24.0

3y

57.4/55.6

42.6/45.2

70.5/62.8

23.4/27.7

4y

54.0/55.4

45.6/40.7

68.6/62.6

24.7/28.2

5y

49.8/55.3

41.6/43.8

68.3/64.5

23.8/27.3

6y

50.7/50.7

43.8/42.4

69.2/61.5

24.2/29.4

7y

49.3/48.2

42.5/40.7

68.9/59.9

25.2/31.7

8y

44.1/47.2

38.8/44.2

64.2/63.8

29.4/28.0

9y

38.8/46.9

41.2/39.8

67.9/60.3

25.6/30.7

10y

37.6/44.4

41.4/41.8

67.9/58.1

24.8/33.5

11y

44.8/35.7

38.8/42.2

69.6/61.4

23.8/30.7

12y

39.7/35.1

36.2/43.2

70.7/56.0

22.4/38.5

13y

33.3/40.2

36.1/44.8

68.1/61.2

27.8/30.6

14y

37.0/39.1

39.1/37.0

66.7/63.0

31.1/30.4

15y

43.7/50

56.2/25.0

66.7/56.2

26.7/37.5

Supplement 2 Comparison of sociodemographic characteristics of the survivors assessed, and

not assessed, with the HADS at each time point
p<0.05
p<0.01
Survivors who did not complete the HADS were either lost to follow up or unable
complete the HADS due to cognitive or communication impairment

HAD completed / HADS not completed

GCS>12

Urine

continence No paresis

Barthel

Index=20

(%)

(%)

(%)

(%)

3m

90.0/84.3

73.3/64.0

26.8/24.9

32.5/29.1

1y

90.7/84.1

75.0/65.2

30.2/22.3

37.8/26.3

2y

89.5/86.8

77.2/68.6

30.7/24.5

41.2/28.7

3y

88.7/86.5

75.3/68.2

28.9/26.0

37.0/32.7

4y

90.6/86.3

76.6/69.1

30.8/25.4

40.6/33.7

5y

89.7/88.4

78.7/71.3

33.1/25.4

41.9/36.9

6y

90.6/85.8

81.8/69.3

32.2/25.7

44.4/34.3

7y

90.2/86.1

80.0/72.6

33.9/25.6

43.1/36.3

8y

90.1/85.7

79.9/72.8

32.9/28.3

42.1/38.0

9y

89.4/87.1

83.0/71.1

33.6/27.6

46.4/32.4

10y

87.9/87.8

80.2/72.2

33.5/27.4

44.3/32.9

11y

88.9/85.2

79.8/67.6

33.7/29.3

41.0/28.2

12y

85.1/86.2

74.3/71.3

27.8/28.2

38.2/29.9

13y

81.7/88.4

70.4/71.8

18.1/25.6

25.7/35.8

14y

87.0/91.3

73.9/78.3

17.4/19.6

31.8/35.6

15y

93.7/93.7

81.2/75.0

18.7/18.7

40.0/56.2

Supplement 3. Comparison of the stroke clinical characteristics of survivors assessed, and not
assessed, with HADS at each time point
p<0.05
p<0.01
Survivors who did not complete the HADS were either lost to follow up or unable
complete the HADS due to cognitive or communication impairment.

60

50

40

30

Post stroke
Incidence (%)

20

10

9
Time (years)

Supplement 4. Incidence of Depression up to 15 years after stroke

12

15

60

50

40

30

Prevalence %

20

10

6 Time (years)

Supplement 5. Prevalence of Depression up to 15 years after stroke

12

15

The Natural History of Depression up to 15 Years After Stroke: The South London Stroke
Register
Luis Ayerbe, Salma Ayis, Siobhan Crichton, Charles D.A. Wolfe and Anthony G. Rudd
Stroke. 2013;44:1105-1110; originally published online February 12, 2013;
doi: 10.1161/STROKEAHA.111.679340
Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231
Copyright 2013 American Heart Association, Inc. All rights reserved.
Print ISSN: 0039-2499. Online ISSN: 1524-4628

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World Wide Web at:
http://stroke.ahajournals.org/content/44/4/1105

Data Supplement (unedited) at:

http://stroke.ahajournals.org/content/suppl/2013/02/14/STROKEAHA.111.679340.DC1.html

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