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Comparison of Treatment Rates of Depression After Stroke Versus Myocardial Infarction

A Systematic Review and Meta-Analysis of Observational Data

Ladwig, Simon, MSc; Zhou, Zien, MD; Xu, Ying, MD; Wang, Xia, PhD; Chow, Clara K., PhD; Werheid, Katja, PhD; Hackett, Maree L., PhD

doi: 10.1097/PSY.0000000000000632

Objective Depression after stroke and myocardial infarction (MI) is common but often assumed to be undertreated without reliable evidence being available. Thus, we aimed to determine treatment rates and investigate the application of guidelines in these conditions.

Methods Databases MEDLINE, EMBASE, PsycInfo, Web of Science, CINAHL, and Scopus were systematically searched without language restriction from inception to June 30, 2017. Prospective observational studies with consecutive recruitment reporting any antidepressant treatment in adults with depression after stroke or MI were included. Random-effects models were used to calculate pooled estimates of treatment rates.

Results Fifty-five studies reported 32 stroke cohorts (n = 8938; pooled frequency of depression = 34%, 95% confidence interval [CI] = 29%–38%) and 17 MI cohorts (n = 10,767; pooled frequency of depression = 24%, 95% CI = 20%–28%). In 29 stroke cohorts, 24% (95% CI = 20%–27%) of 2280 depressed people used antidepressant medication. In 15 MI cohorts, 14% (95% CI = 8%–19%) of 2381 depressed people used antidepressant medication indicating a lower treatment rate than in stroke. Two studies reported use of psychosocial interventions, indicating that less than 10% of participants were treated.

Conclusions Despite the high frequency of depression after stroke and MI and the existence of efficacious treatment strategies, people often remain untreated. Innovative strategies are needed to increase the use of effective antidepressive interventions in patients with cardiovascular disease.

From the Department of Psychology, University of Potsdam, Germany (Ladwig); Department of Neurology, Ernst von Bergmann Hospital, Potsdam, Germany (Ladwig, Werheid); Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China (Zhou); Mental Health, The George Institute for Global Health, The University of New South Wales, Sydney, Australia (Zhou, Xu, Wang, Hackett); Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia (Xu); Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Australia (Chow); Department of Cardiology, Westmead Hospital, Sydney, Australia (Chow); Cardiovascular Division, The George Institute for Global Health, The University of New South Wales, Sydney, Australia (Chow); Department of Psychology, Humboldt University, Berlin, Germany (Werheid); Sydney Medical School, The University of Sydney, New South Wales, Australia (Hackett); and The Faculty of Health and Wellbeing, The University of Central Lancashire, Preston, United Kingdom (Hackett).

Address correspondence to Simon Ladwig, MSc, Klinikum Ernst von Bergmann, Klinik fuer Neurologie, Charlottenstrasse 72, 14467 Potsdam, Germany. E-mail:

Received for publication February 12, 2018; revision received July 23, 2018.

Copyright © 2018 by American Psychosomatic Society
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