Effects of Stroke Rehabilitation on Incidence of Poststroke Depression: A Population-Based Cohort Study

Huey-Wen Liang¹,  Ching-lin Hsieh²,  Chieh-Yi Hou³, Pei-Jyun Wun⁴,  Chung-Yi Li^5,*

¹  Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei
²  School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei
³  Department of Physical Medicine and Rehabilitation, E-Da Hospital, Yan-Chau District, Kaohsiung
⁴  Department of Dentistry, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi City
⁵  Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan

Poststroke depression may increase morbidity and mortality in stroke survivors. We conducted a cohort study to investigate whether receipt of rehabilitation intervention in 3 months of stroke onset may reduce the risk of post-stroke depression. The rehabilitation group included 1,285 stroke patients who received a rehabilitation regimen within the first 3 months of stroke admission in 2000-2005. The control group was consisted of 6,392 patients without such early rehabilitation. By the end of 2009, 75 (5.8%) patients with rehabilitation and 566 (8.7%) controls developed PSD, representing an incidence rate of 11.3 and 18.5 per 1,000 person-years, respectively. After controlling for potential confounders, rehabilitation was found to significantly reduce the risk of PSD with a hazard ratio (HR) of 0.57 (95% confidence interval (CI)=0.45-0.73). The effect was greater for men (HR=0.52) than for women (HR=0.69).This study provides evidence that best supports the protective effect of stroke rehabilitation intervention on depression incidence.