# Association between early depressive symptoms after stroke and trajectories of functional recovery among patients with acute ischemic stroke: a longitudinal study

## TL;DR

This study shows that early depressive symptoms after stroke are linked to worse recovery outcomes in patients with acute ischemic stroke.

## Contribution

The study identifies specific functional recovery patterns and their association with early depressive symptoms in AIS patients.

## Key findings

- Three mRS and five BI recovery trajectories were identified among AIS patients.
- Early depressive symptoms increased the likelihood of moderate and severe recovery trajectories.
- Depressive symptoms were linked to a rapid decline in functional independence.

## Abstract

Depressive symptoms are very common in the acute phase of stroke; however, its impact on distinct functional recovery trajectories in acute ischemic stroke (AIS) patients remains unclear. Our study aimed to depict the functional recovery trajectories within 6 months after stroke and explore the association of early depressive symptoms with these recovery patterns among AIS patients.

A total of 219 eligible patients were enrolled at the stroke centers of two tertiary hospitals in Xuzhou, China from April 2023 to June 2024. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive symptoms during the acute hospitalization. The Group-based trajectory model was conducted to identify distinct trajectories of functional recovery, as measured by modified Rankin Scale (mRS) and Barthel Index (BI) at baseline, 3 months, and 6 months. A series of multinomial logistic regression models were performed to examine the relationship between early depressive symptoms and dynamic recovery patterns.

We identified 3 mRS trajectories (mild, moderate, and severe) and 5 BI trajectories (low-rapid rise, moderate low-stable, moderate-progressive rise, moderate high-rapid decline, and high-stable), respectively. After full adjustments, patients with early depressive symptoms were at increased likelihood of being in the moderate (OR 8.22, 95% CI 2.77–24.39) and severe (OR 24.41, 95% CI 5.33–111.90) trajectory group for mRS trajectories, and of the moderate high-rapid decline (OR 12.93, 95% CI 1.49–112.42) trajectory group for BI trajectories ( p < 0.05).

Early depressive symptoms were associated with unfavorable functional recovery trajectories within 6 months following acute stroke in AIS patients.