Early functional recovery and clinical risk profiles predict distinct trajectories of post-stroke depression: a one-year longitudinal analysis.

backgroundStudies often investigated risk factors for post-stroke depression (PSD) at a single timepoint, neglecting its dynamic nature. We aimed to identify distinct trajectories of depressive symptoms over the first-year post-stroke and explore their early predictors.

methodsWe conducted a prospective cohort study at a stroke center in China from 2022 to 2024. Stroke patients with HAMD assessments at 3-, 6-, and 12-months were included. We identified trajectories using group-based trajectory modeling. The optimal number was determined by statistical criteria and interpretability. To explore predictors of trajectory membership, we conducted two separate binary logistic regression analyses, adjusted for covariates, to differentiate subtypes within favorable (Resilient vs. Recovering) and unfavorable (Fluctuating vs. Worsening) outcome clusters. We also conducted a separate analysis to identify predictors for developing any form of post-stroke depression (Recovering, Fluctuating, or Worsening) versus remaining in the Resilient group.

findingsThe analysis comprised 634 participants. We identified four distinct trajectories: Resilient (50.8%, n = 322), Recovering (9.6%, n = 61), Fluctuating (18.8%, n = 119), and Worsening (20.8%, n = 132). Compared to Recovering, Resilient patients were less likely to be smokers (OR = 0.48, 95% CI: 0.25-0.93) and have hypertension (OR = 0.40, 95% CI: 0.17-0.92), and had lower nutritional risk. Comparing unfavorable trajectories, smoking (OR = 4.17, 95% CI: 1.75-9.96) and hyperlipidemia (OR = 3.83, 95% CI: 1.97-7.47) predicted the Fluctuating group versus Worsening. Functional improvement pace was also significantly associated. A subsequent analysis of overall risk, conducted on 553 participants with complete data, found that male sex was the only significant independent predictor, and was strongly associated with a reduced likelihood of developing any form of PSD (OR = 0.35, 95% CI: 0.17-0.73).

interpretationThe course of PSD is heterogeneous and classifiable into four trajectories. Our primary analysis identified male sex as a strong protective factor against any form of PSD. Concurrently, secondary analyses suggest that early modifiable factors, particularly smoking and metabolic status, are significant predictors differentiating unfavorable subtypes. The novel association observed with VTE risk scores should be considered exploratory and requires further validation. These findings highlight the value of using clinically accessible markers for early risk stratification, though underscore the complexity of PSD prediction. This study was limited to a single center.