Influencing Factors and Longitudinal Analysis of Post-Stroke Depression in the Elderly Based on GDS-15

doi:10.3969/j.issn.1673-5765.2025.09.008

Abstract

Abstract: Objective To evaluate the influencing factors of post-stroke depression (PSD) in the elderly based on the geriatric depression scale 15 (GDS-15) and to longitudinally analyze the changes in depressive status.
Methods A retrospective analysis was performed on the clinical data of elderly patients with first-episode acute ischemic stroke (AIS) admitted to the Third People’s Hospital of Hefei from January 2019 to December 2021. All patients completed the GDS-15 questionnaire at discharge to evaluate the occurrence of PSD. Patients with a GDS-15 score>10 were included in the PSD group, while those with a score≤10 were included in the non-PSD group. Clinical data were compared between the two groups, and multivariate logistic regression analysis was used to assess the risk factors for PSD in elderly patients with AIS. Longitudinal analysis of GDS-15 scores was performed for patients with a follow-up period of ≥12 months after discharge.
Results A total of 168 elderly AIS patients were enrolled, including 57 patients in the PSD group and 111 patients in the non-PSD group. The proportion of patients with an education level of junior college or above in the PSD group was lower than that in the non-PSD group (P=0.042). The proportions of patients with an admission NIHSS score>4 points (P=0.007), an admission modified Barthel index (MBI) score<60 points (P=0.003), and an admission geriatric nutritional risk index (GNRI)≤98 (P=0.021) were higher in the PSD group than in the non-PSD group. Multivariate logistic regression analysis showed that an admission NIHSS score>4 points (OR 2.489, 95%CI 0.017～0.995, P<0.05), an admission MBI score<60 points (OR 3.357, 95%CI 1.883～5.986, P<0.05), and an admission GNRI≤98 (OR 2.818, 95%CI 1.537～5.165, P<0.05) were risk factors for PSD in elderly patients with AIS, while an education level of junior college or above was a protective factor (OR 0.519, 95%CI 0.017～0.995, P<0.05). Among the 168 elderly patients with AIS, 69 patients had a follow-up period of≥12 months after discharge. At 12 months after discharge, GDS-15 score, MBI score, and GNRI were higher than those at discharge (P all<0.01), while NIHSS score was lower than that at discharge (P<0.01).
Conclusions Depressive levels in elderly patients with AIS may increase after discharge. Those with severe neurological impairment, significant limitations in activities of daily living, and poor nutritional status at admission are more likely to develop PSD, whereas those with an education level of junior college or above have a low risk of PSD.

Key words: Ischemic stroke; Elderly; Post-stroke depression; Geriatric depression scale 15

摘要： 目的基于简版老年抑郁量表（geriatric depression scale 15，GDS-15）评估老年卒中后抑郁（post-stroke depression，PSD）的影响因素，并纵向分析其抑郁状态的变化情况。
方法回顾性分析2019年1月—2021年12月合肥市第三人民医院收治的老年首发急性缺血性卒中（acute ischemic stroke，AIS）患者的临床资料，记录患者出院时的GDS-15评分以评估PSD发生情况。将GDS-15评分＞10分的患者纳入PSD组，≤10分的患者纳入非PSD组。比较两组临床资料，使用多因素logistic回归分析评估老年AIS患者发生PSD的危险因素，并对出院后随访时间≥12个月患者的GDS-15评分进行纵向分析。
结果共纳入168例老年AIS患者，其中PSD组57例，非PSD组111例。PSD组大专及以上学历患者的占比低于非PSD组（P=0.042），入院时NIHSS评分＞4分（P=0.007）、入院时改良巴塞尔指数（modified Barthel index，mBI）评分＜60分（P=0.003）及入院时老年营养风险指数（geriatric nutritional risk index，GNRI）≤98（P=0.021）的占比高于非PSD组。多因素logistic回归分析显示，入院时NIHSS评分＞4分（OR 2.489，95%CI 0.017～0.995，P＜0.05）、入院时mBI评分＜60分（OR 3.357，95%CI 1.883～5.986，P＜0.05）及入院时GNRI≤98（OR 2.818，95%CI 1.537～5.165，P＜0.05）是老年AIS患者发生PSD的危险因素，而大专及以上学历是老年AIS患者发生PSD的保护因素（OR 0.519，95%CI 0.017～0.995，P＜0.05）。168例老年AIS患者中，有69例出院后随访时间≥12个月，出院后12个月GDS-15评分、mBI评分及GNRI高于出院时（P均＜0.01），而NIHSS评分低于出院时（P＜0.01）。
结论老年AIS患者出院后抑郁水平较高，入院时神经功能损伤严重、日常活动能力受限明显及营养状态不佳的患者，更易发生PSD；而大专及以上学历的老年AIS患者PSD发生风险较低。

关键词: 缺血性卒中; 老年; 卒中后抑郁; 老年抑郁量表

CLC Number:

MIAO Lianhai, CHEN Jiqun, SONG Shitao, YANG Zhiyong, ZHAO Hui. Influencing Factors and Longitudinal Analysis of Post-Stroke Depression in the Elderly Based on GDS-15[J]. Chinese Journal of Stroke, 2025, 20(9): 1131-1136.

苗连海, 陈继群, 宋诗涛, 杨志勇, 赵辉. 基于GDS-15评价老年卒中后抑郁状态的影响因素及其纵向分析[J]. 中国卒中杂志, 2025, 20(9): 1131-1136.

References

[1] CHEN Y P，REN J L，YANG N P，et al. Eosinophil-to-monocyte ratio is a potential predictor of prognosis in acute ischemic stroke patients after intravenous thrombolysis[J/OL]. Clin Interv Aging，2021，16：853-862[2025-03-12]. https://doi.org/10.2147/CIA.S309923.
[2] ZHANG K，CUI G W，GAO Y，et al. Does acupuncture combined with antidepressants have a better therapeutic effect on post-stroke depression？A systematic review and meta-analysis[J]. Acupunct Med，2021，39（5）：432-440.
[3] WANG C X，LUO B Y，WU J，et al. Diagnosis and treatment of post-stroke depression in China：a cross-sectional survey of 350 senior clinicians in neurology，geriatrics，and rehabilitation departments[J]. Int Psychogeriatr，2020，32（1）：151-153.
[4] 张少军，刘杨，杨海，等. 绵竹地区后遗症期脑卒中患者抑郁状况的调查分析[J]. 中华物理医学与康复杂志，2022，44（2）：171-175.
ZHANG S J，LIU Y，YANG H，et al. Investigation and analysis of depression in post-stroke patients with sequelae in Mianzhu region[J]. Chin J Phys Med Rehabil，2022，44（2）：171-175.
[5] 唐丹. 简版老年抑郁量表（GDS-15）在中国老年人中的使用[J]. 中国临床心理学杂志，2013，21（3）：402-405.
TANG D. Application of short form geriatric depression scale（GDS-15）in Chinese elderly[J]. Chinese Journal of Clnical Psychology，2013，21（3）：402-405.
[6] 中国卒中学会中国脑血管病临床管理指南撰写工作委员会. 中国脑血管病临床管理指南（第2版）（节选）——第4章缺血性脑血管病临床管理推荐意见[J]. 中国卒中杂志，2023，18（8）：910-933.
The Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases. Chinese Stroke Association guidelines for clinical management of cerebrovascular diseases（second edition）（excerpt）—chapter four clinical management of ischaemic cerebrovascular diseases[J]. Chin J Stroke，2023，18（8）：910-933.
[7] 中国医师协会神经内科医师分会神经心理与情感障碍专业委员会. 卒中后抑郁临床实践的中国专家共识[J]. 中国卒中杂志，2016，11（8）：685-693.
Neuropsychology and Affective Disorders Committee of the Neurology Branch，Chinese Medical Doctor Association. Chinese expert consensus on clinical practice for post-stroke depression[J]. Chin J Stroke，2016，11（8）：685-693.
[8] 路雅宁，吴跃华，林黎明. NIHSS评分对急性脑梗死的评估效力研究[J]. 国际老年医学杂志，2017，38（3）：131-132，封3.
LU Y N，WU Y H，LIN L M. Efficacy of the National Institutes of Health stroke scale in evaluation of acute ischemic stroke patients[J]. Int J Geriatr，2017，38（3）：131-132，inside back cover 3.
[9] 闵瑜，吴媛媛，燕铁斌. 改良Barthel指数（简体中文版）量表评定脑卒中患者日常生活活动能力的效度和信度研究[J]. 中华物理医学与康复杂志，2008，30（3）：185-188.
MIN Y，WU Y Y，YAN T B. Validity and reliability of the simplified Chinese version of modified Barthel index for Chinese stroke patients[J]. Chin J Phys Med Rehabil，2008，30（3）：185-188.
[10] TAKAHASHI H，INOUE K，SHIMIZU K，et al. Comparison of nutritional risk scores for predicting mortality in Japanese chronic hemodialysis patients[J]. J Ren Nutr，2017，27（3）：201-206.
[11] LI G，JING P，CHEN G H，et al. Development and validation of 3-month major post-stroke depression prediction nomogram after acute ischemic stroke onset[J/OL]. Clin Interv Aging，2021，16：1439-1447[2025-03-12]. https://doi.org/10.2147/CIA.S318857.
[12] 朱宁，段燕燕，王娜，等. 理情行为疗法对卒中后抑郁患者睡眠及情绪的影响研究[J]. 中国全科医学，2022，25（12）：1481-1486.
ZHU N，DUAN Y Y，WANG N，et al. Impact of rational emotive behavior therapy on sleep and mood in patients with post-stroke depression[J]. Chinese General Practice，2022，25（12）：1481-1486.
[13] 田智斌，赵掌权，王战英，等. 抗抑郁药物对脑卒中后抑郁患者的疗效及其依从性的影响[J]. 国际精神病学杂志，2020，47（3）：533-535.
TIAN Z B，ZHAO Z Q，WANG Z Y，et al. The influence of antidepressant on the treatment effect and compliance of patients with post-stroke depression[J]. Journal of International Psychiatry，2020，47（3）：533-535.
[14] 钟小路，郝巧蓉，汪应瑞，等. 老年脑卒中后抑郁状况评估及其相关因素分析[J]. 现代预防医学，2020，47（3）：474-478.
ZHONG X L，HAO Q R，WANG Y R，et al. The evaluation and influencing factors of post-stroke depression in the elder patients[J]. Modern Preventive Medicine，2020，47（3）：474-478.
[15] MENG M，HU G Y，YANG K，et al. Tuina plus acupuncture for post-stroke depression：a protocol for systematic review and meta-analysis[J/OL]. Medicine（Baltimore），2021，100（20）：e26013[2025-03-12]. https://doi.org/10.1097/MD.0000000000026013.
[16] MORSUND Å H，ELLEKJÆR H，GRAMSTAD A，et al. Factors influencing employment after minor stroke and NSTEMI[J/OL]. J Stroke Cerebrovasc Dis，2020，29（9）：105036[2025-03-12]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105036.
[17] 王珺婷，丁玎，冯洁，等. 大连市贫困家庭老人的抑郁及相关因素现况[J]. 中国心理卫生杂志，2021，35（6）：461-465.
WANG J T，DING D，FENG J，et al. Carrent situation of depression and related factors of elderly people from poor families in Dalian[J]. Chinese Mental Health Journal，2021，35（6）：461-465.
[18] NIU Y L，SHENG S Y，CHEN Y，et al. The efficacy of group acceptance and commitment therapy for preventing post-stroke depression：a randomized controlled trial[J/OL]. J Stroke Cerebrovasc Dis，2022，31（2）：106225[2025-03-12]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106225.
[19] 石名菲，李英华，刘莹钰，等. 我国老年人慢性病防治素养水平与慢性病患病状况相关性分析[J]. 中国健康教育，2020，36（5）：387-391，417.
SHI M F，LI Y H，LIU Y Y，et al. Study on the relationship between chronic diseases literacy and health status of Chinese residents aged 60-69 years[J]. Chinese Journal of Health Education，2020，36（5）：387-391，417.
[20] 朱岩，朱利芳，泮燕红. 社会支持在老年急性脑梗死与梗死后抑郁之间的调节效应分析[J]. 神经疾病与精神卫生，2023，23（1）：56-59.
ZHU Y，ZHU L F，PAN Y H. The moderating effect of social support on the relationship between acute cerebral infarction and depression after infarction in the elderly[J]. Journal of Neuroscience and Mental Health，2023，23（1）：56-59.
[21] 宋扬，韩珂，贾王平，等. 海南省百岁老人营养状况与抑郁症的关联研究[J]. 中华医学杂志，2022，102（2）：114-118.
SONG Y，HAN K，JIA W P，et al. Association between nutritional status and depression among centenarians in Hainan province[J]. Natl Med J China，2022，102（2）：114-118.
[22] KWON B，LEE E J，PARK S，et al. Long-term changes in post-stroke depression，emotional incontinence，and anger[J]. J Stroke，2021，23（2）：263-272.
[23] CHAU J P C，LO S H S，ZHAO J，et al. Factors associated with post-stroke depression in Chinese stroke survivors[J]. J Stroke Cerebrovasc Dis，2021，30（11）：106076[2025-03-12]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106076.