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Depression after Stroke in Sub-Saharan Africa: A Systematic Review and Meta-Analysis 时间:2017-07-31 11:55   来源:未知   作者:admin   点击: 次 Abstract:Objective. We aimed to conduct a systematic review and meta-analysis of prevalence and characteristics of poststroke depression (PSD) in sub-Saharan Africa (SSA). Methods. We searched Medline, PsycINFO, and African Journals OnLine using keywords for stroke and depression and the .mp. operator for all 54 SSA countries/regions. Further information was retrieved through a manual search of references from relevant published and unpublished articles. We included only peer-reviewed original studies with epidemiological or experimental designs, conducted random-effect meta-analysis, and identified the most commonly associated factors by weight (inverse of variance method). Results. Seventeen studies, comprising 1483 stroke survivors, met the criteria for syntheses. The pooled frequency of clinically diagnosed PSD was 31% (95% CI = 26%–36%), versus 13.9% in healthy control pairs. Prevalence did not vary much across healthcare settings but was affected by methods of depression ascertainment. PSD was significantly associated with low education, cognitive impairment, physical disability, poor quality of life, and divorced marital status. Conclusion. Almost 1 in 3 individuals with stroke in SSA has clinical depression. Despite limitations around quality of identified studies, results of the present systematic review overlap with findings in the global literature and highlight useful targets for the design and trial of tailored intervention for PSD in SSA.
1. Introduction
There is an escalating burden of stroke in sub-Saharan Africa (SSA), which is now among the leading causes of disease and disability in the region [1]. A key complication of stroke is depression, which while being associated with tremendous poststroke morbidity is frequently under-recognized and undertreated, especially in SSA, where resources are relatively limited and the issues of mental health are underappreciated.
A recently published scientific statement on poststroke depression (PSD) by the American Heart Association/American Stroke Association (AHA/ASA) [2] highlighted the current state of evidence regarding scientific knowledge and clinical practice of PSD. However, there was only one study from SSA [3] out of a combined total of 236 citations in the five systematic reviews [4–8] in the AHA/ASA statement.
The limited data on PSD in SSA in the AHA/ASA scientific statement was likely due to the publication of African studies in typically less visible and less accessible media, such as databases of African literature. Yet, extrapolating results derived from a global pool of studies to SSA may mask the true state of burden of depression in stroke survivors living in the subregion.
  The objective of this study was to conduct a systematic review and meta-analysis of PSD studies among patients in SSA to arrive at a pooled estimate of prevalence and to identify the qualitative and quantitative relationships of key clinical characteristics with occurrence of PSD.
2. Methods
  This review followed conventional recommendations for the methodology and reporting of systematic reviews [9, 10].
2.1. Search Strategy
  The search strategy aimed to find both published and unpublished studies. An initial search of the African Journal OnLine (12 February 2017; repeated 14 May 2017), Medline (Ovid SP 1946—15 February 2017; repeated 14 May 2017), and PsycINFO (Ovid SP 1806—16 February 2017) databases was conducted using the following keywords with the “explode” operator: stroke OR poststroke OR “cerebrovascular accident” OR “Cerebrovascular disorder” OR “stroke survivors” AND depression OR “major depression” OR “major depressive disorder” OR “depressive symptoms” OR “poststroke emotional disorders” OR “emotional response” AND epidemiology OR frequency OR prevalence OR incidence OR factors OR “risk factors” OR “associated factors” OR “precipitating factors” OR “predisposing factors” OR outcome OR mortality. We next used the .mp. operator to search each of the 54 SSA countries or regions by name.