Abstract

INTRODUCTION

Post-stroke depression (PSD) is one of the most significant complications following a stroke, yet it is often underdiagnosed. It affects approximately one-third of stroke survivors and is closely associated with poor rehabilitation outcomes, reduced quality of life, and increased mortality[1]. The aggressive nature of PSD, characterized by its profound impact on the neurobiological and psychological health of patients, mirrors the complexities seen in managing severe medical conditions, such as triple-negative breast cancer (TNBC)[2].

Early detection and intervention for PSD are critical in mitigating these adverse outcomes. Current clinical practices emphasize the need for routine early screening to identify depressive symptoms soon after stroke, which allows for timely therapeutic measures that can significantly alter the trajectory of recovery[3].

The choice of screening tools plays a vital role in the clinical management of PSD. Standardized tools like the Patient Health Questionnaire 9 are commonly used, owing to their validated efficacy in detecting early depressive symptoms during the acute phase of stroke rehabilitation[4]. However, like traditional wound dressings in post-mastectomy TNBC care, the effectiveness of such conventional screening tools in different clinical contexts, particularly among diverse stroke populations, is increasingly being questioned[5].

Advanced screening methodologies and integrated care approaches have emerged in response to these challenges[6]. These aim to better manage the complex interplay of symptoms and improve overall outcomes, akin to how silver alginate dressings have revolutionized wound care in patients with TNBC by providing superior infection control and an optimal healing environment.

Nevertheless, transitioning to these advanced methodologies in PSD management is fraught with challenges. Concerns regarding the practicality of their implementation in diverse healthcare settings, cost-effectiveness, and the adaptability of healthcare systems mirror the dilemmas faced in adopting advanced wound care technologies in resource-limited settings[7,8].

Given these parallels, a systematic review and meta-analysis of early screening interventions for PSD is both timely and essential. This analysis will not only clarify the relative benefits and limitations of various screening tools, but also provide evidence-based recommendations for optimizing the management of PSD in stroke survivors, thereby enhancing their recovery and quality of life post-stroke.

MATERIALS AND METHODS

RESULTS

Our exhaustive literature search initially identified 1065 studies. After the rigorous removal of duplicates and initial screenings based on titles and abstracts, 98 studies remained for detailed full-text assessment. Following a stringent two-tiered exclusion process, we further excluded 92 studies that did not meet the inclusion criteria. This process resulted in the final selection of six studies[9-14] for inclusion in our meta-analysis, as illustrated in Figure ​Figure1.1. A detailed overview of the study characteristics is presented in Table ​Table11.

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Figure 1

Flow diagram of the study selection process.

Risk of bias assessment

The risk of bias was meticulously evaluated across the selected studies. Figure ​Figure2,2, a traffic light plot, and Figure ​Figure3,3, a bar graph summarizing the bias in various domains, indicate a generally low risk of bias in the included studies. Specifically, the domains of randomization, protocol adherence, completeness of outcome data, and accuracy of outcome measurement demonstrated low bias. Although minor issues of selective reporting were noted in two studies, the overall risk of bias was considered minimal.

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Figure 2

Traffic light plot showing the risk of bias assessment.

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Figure 3

Bar graph summarizing bias across various domains.

Functional outcomes

The forest plot in Figure ​Figure4A4A compares the functional independence measure (FIM) scores between patients who underwent PSD screening and those in the control group. The analysis revealed a significant improvement in FIM scores for the PSD screening group (SMD = 8.90, 95%CI: 4.65-13.15, P < 0.01), indicating that early screening for PSD is associated with better functional recovery post-stroke.

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Figure 4

Functional outcomes, quality of life, and mortality in post-stroke depression screened patients compared to controls. A: Forest maps compared functional independence measure scores between patients screened for post-stroke depression (PSD) and control patients; B: The forest plots of stroke-specific quality of life scale scores were compared between PSD screening group and control group; C: The forest map shows the mortality rates within five years of stroke in patients screened for PSD versus those who were not screened.

Publication bias

Figure ​Figure55 presents the funnel plot and Egger’s regression test for five-year mortality outcome. The funnel plot showed no significant asymmetry, and Egger’s regression test confirmed the absence of significant publication bias (P = 0.67), affirming the reliability of our meta-analysis results.

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Figure 5

Funnel plot and Egger's regression test assessing publication bias for five-year mortality rates.

DISCUSSION

The findings of this meta-analysis underscore the significant benefits of early screening for PSD on functional outcomes, quality of life, and mortality in stroke survivors. The inclusion of seven studies provides a robust dataset that enhances the reliability of these conclusions.

The significant improvement in functional outcomes among patients who underwent PSD screening suggests that early detection and management of depression can facilitate better neurological and physical recovery post-stroke. These results align with existing literature that highlights the positive effect of early psychological interventions on functional recovery and cognitive outcomes in patients with stroke[15,16].

Furthermore, the enhancement in quality of life for those screened for PSD underscores the broader impact of mental health on overall quality of life. Stroke survivors often face significant psychological challenges that can adversely affect their social interactions, emotional well-being, and activities of daily living[17,18]. Early PSD screening facilitates timely psychological and psychiatric interventions, which can mitigate these adverse effects and enhance the overall quality of life.

The reduction in mortality rates among the PSD screening group highlights the critical role of mental health in survival outcomes. Depression is a well-established predictor of increased mortality in patients with stroke due to its association with poorer adherence to medical treatments and rehabilitation protocols, as well as its effect on biological processes, such as inflammation and neuroplasticity[19].

Risk of bias was assessed across the included studies using standardized tools. Our analysis confirms a generally low risk of bias, particularly in randomization, protocol adherence, and completeness of outcome data. Although minor issues of selective reporting were noted in some studies, the overall risk of bias was minimal. The absence of significant publication bias, as indicated by the funnel plot and Egger’s regression test, further supports the reliability of our findings.

Despite these promising findings, this study had several limitations. The heterogeneity in study designs, sample sizes, and screening tools used across the included studies could introduce variability in the results[20]. Additionally, the exclusion of non-English language studies may have led to a selection bias, potentially overlooking relevant research published in other languages. Future research should aim to standardize screening protocols and explore the effect of early PSD screening in diverse populations and healthcare settings[21].

CONCLUSION

This meta-analysis demonstrates that early screening for PSD significantly enhances functional outcomes, improves quality of life, and reduces mortality in stroke survivors. These findings advocate for the integration of routine early PSD screening into post-stroke care protocols to facilitate timely intervention and optimize overall patient outcomes.

Footnotes

Contributor Information

Jie Dai, Department of Neurology 6, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China. moc.361@4002_ecimeulb.

Sha-Sha Zhao, Department of Neurology 6, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China.

Su-Xiang Zhang, Department of Neurology 6, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China.

References