Establishment Of Post-stroke Depression Risk Assessment Model In Non-Acute Phase

Background: Post-stroke Depression is a common and serious complication after stroke.It directly impairs rehabilitation and functional outcomes of patients,reduces the enthusiasm for rehabilitation of patients,prolongs the recovery process,and further aggravates the economic burden on families and society.The risk factors for post-stroke depression at different time periods are complex and diverse,including pathophysiological changes and psychological effects in patients.Therefore,it is important to accurately assess the risk of post-stroke depression,and it is important to take active preventive measures and reduce the incidence of post-stroke depression.However,there is still a lack of effective assessment methods for non-acute post-stroke depression.Objective: The purpose of this study was to investigate the risk factors of depressive symptoms in the post-stroke rehabilitation phase and to establish a model for assessing the risk of post-stroke depression in order to provide guidance for clinical assessment of post-stroke depression risk factors.Methods: Firstly: searching literature on post-stroke depression related factors at home and abroad and extracting information,includes: title,date,journal name,author.Further reading abstracts and full-text information,data extracted include: number of cases,gender,stage of illness,types of stroke,and risk factors.Secondly: establishment of post-stroke depression risk assessment model,cross-sectional surveys were used in stroke rehabilitation patients.A total of 31 related factors were collected,including: demographic factors,type and location of stroke,pain scores and sleep scores,blood lipids,underlying diseases,duration of illness,aphasia,social support,and so on.Depressive symptoms self-rating scale was used to evaluate depressive symptoms.Single factor analysis was used to determine statistically significant risk factors.Logistic regression analysis was used to establish an evaluation model.Diagnostic tests and ROC curves were used to determine the model's assessment threshold.Results:(1)Literature research results: 215 articles were eventually included,including 119 in English and 96 in Chinese;With the passage of time,the number of documents was on an upward trend;A total of 28 countries were involved;A total of 139 articles(64.65%)were published in China,of which 43(30.94%)were published in foreign journals.The total number of foreign literatures were 776(35.35%).A total of 5,4347 stroke patients were included in the literature,including 32,158 in China and 22,189 in foreign countries,stroke patients in the acute phase received the most attention;The incidence of post-stroke depression fluctuates,ranging from 5.40% to 72.41%.All risk factors were eventually divided into 51 areas,the top three were: stroke severity(133,21.66%),incidence(52,8.47%),gender(42 Times,6.84%).(2)Risk assessment model establishment results: patient's gender,pain score,Barthel score,NIHSS score,PSQI score,FSS score,SSRS score,parietal lobe lesions,lesions in two or more parts of the brain,income,occupation,and type of major care provider affected the development of post-stroke depression in the rehabilitation stage with statistically significant differences(P<0.05);The Logistic regression analysis: National Institute of Health stroke scale score(OR=1.53,P=0.00,95% CI: 1.23~1.90),Pittsburgh Sleep Quality Index score(OR=1.25,P=0.00,95% CI: 1.07~1.45),Pain score(OR=1.84,P=0.02,95% CI: 1.11~3.05),income(OR=6.36,P=0.01,95% CI: 1.67~24.25),caregiver(OR=5.27,P=0.02,95% CI: 1.38~20.06),which were independent risk factors for depression in stroke patients;Establishment of post-stroke depression risk assessment model: Logistic P = 8.93+ 0.43 × NIHSS score +0.22 × PSQI score+ 0.61 ×pain score+1.85 × income(0 = sufficient,1 = insufficient)+1.66 ×caregiver(0 = family,1 = Vocational nursing);Evaluation model threshold: The evaluation threshold of the model is 17.783 points,that is,when the patient evaluation result is greater than or equal to 17.78 points,it shows that it has a high risk of PSD.The YI of the model was 0.82,the sensitivity was 0.94,the specificity was 0.88,the AUC was 0.96,P=0.00,95% CI: 0.93~0.99,indicating that the model's assessment results had high accuracy.Conclusion: Post-stroke depression is still a hot topic at home and abroad.The study of related factors involves the field of biology and social psychology.Stroke patients at the non-acute stage were less studied;The post-stroke rehabilitation risk assessment model and its evaluation threshold can provide convenience and basis for the evaluation of depressive symptoms.Among them,the patient's income,primary caregiver type,pain score,PSQI score,and NIHSS score are the key risk factors.