A Correlative Study Of Psychosocial Risk Factors And Psychophysiological Mechanisms Of Depression After Ischemic Stroke

Objective: This study used a case-control method to investigate the occurrence rate, clinical features, imaging features, cognitive function, behavior type and the levels of serum brain-derived neurotrophic factor, high sensitive C-reactive protein and homocysteine and the related mechanisms of the depression after ischemic stroke, analyze the correlation between psychosocial risk factors and post stroke depression, to explore the psychological mediating mechanisms, and provide the basis for early diagnosis and comprehensive intervention in post stroke depression.Methods: We collected 190 cases of patients with acute ischemic stroke admitted to Neurology department of First Hospital Affiliated to Soochow University from June 2014 to July 2015, all were followed up for 6 months, the relevant indicator variables were recorded in 2W, March and June, according to the diagnostic and Statistical Manual of mental disorders Fifth Edition(DSM-V) diagnostic criteria for depression and Hamilton depression table(HAMD-17), stroke patients were divided into stroke depression group(PSD group)(n=87) and non post stroke depression group(NPSD group)(n=103), and we regarded them who have first depression episode at 2W as early onset PSD group(EPSD group)(n=65), the follow-up as late onset PSD group(LPSD group)(n=22); collected healthy control group(NC group)(n=31). We completed the general clinical information questionnaire, the National Institutes of Health Stroke Scale(NIHSS), modified Rankin scale(m RS), Barthel index(BI), imaging index, Mini Mental State Examination(MMSE) and Type A Behavior Scale(TABP), life event scale(LES), social support scale(SSS); detect the level serum of brain-derived neurotrophic factor(BDNF), high sensitive C-reactive protein(hs-CRP) and homocysteine(HCY), analyze psychosomatic mediating mechanisms between psychosocial risk factors and PSD.Results:1. The clinical features and related psychosocial risk factors of PSD:(1) Prevalence and HAMD score: the prevalence of PSD was 45.79%, including mild depression 22.11%, moderate depression 18.95%, and severe depression 4.74%, factor scores of HAMD was highest for anxiety/somatization disorder(7.84±3.01); early-onset PSD was 34.21%, late-onset PSD was 11.58%;(2)The correlation between HAMD and nerve function and psychosocial risk factors: the total score of HAMD was positively related to admission NIHSS, 2W NIHSS, 2W m RS and 6m m RS score(r=0.380, 0.385, 0.375, 0.412, P<0.01), was negatively related to admission BI and 2W BI score(r=-0.365,-0.331, r=-0.487,-0.483, P<0.01); the total score of HAMD was positively related to CH factor and TABP(r=0.396, 0.386, P<0.01);(3) Comparison between EPSD group and LPSD group: MMSE score of LPSD group was significantly lower than EPSD group[(20.05±5.22) &(23.28±4.09), P<0.05];(4) Logistic regression analysis: lower 2w nerve function recovery, basal ganglia and internal capsule infarction, high A behavior and negative life events, low cognitive function and social support is independent risk factors for ischemic PSD.2. Biological indicators and correlation analysis of PSD:(1) Analysis of serum BDNF, hs-CRP and HCY: the serum level of BDNF [689.34(459.53,1480.37)] in PSD group was significantly lower than NPSD and NC group, the level of serum hs-CRP [5.63(1.34,10.10)] was significantly higher than NPSD and NC group(P<0.01); the serum level of HCY is no statistical significance between PSD and NPSD group(P>0.05), but the two groups were significantly higher than NC group(P<0.01);(2) The correlation between A behavior and serum hs-CRP: the TH, CH and TABP scores were positively related to serum hs-CRP(r=0.207, 0.416, 0.381, P<0.01);(3)The variables of factor HAMD score, 2W NIHSS, CH and serum hs-CRP were eventually included in the multiple regression equation.Conclusion:1. The prevalence of PSD is high, mainly in the early stage of stroke, with mild to moderate depression, anxiety and somatization symptoms were most significant;2. lower nerve function, basal ganglia and internal capsule infarction, more serious cognitive impairment, high A behavior, higher stimulation of negative life events and lower social support, are more susceptible to PSD; cognitive impairment of late-onset PSD is more serious;3. There are biological indicators disorder in patients with PSD, BDNF decreased significantly, inflammatory response was obvious; competition hostility(CH) was related to the degree of inflammation response, the serious degree of depression in PSD patients was related to neurological deficits and CH factors, hostility and excessive competition is the psychological and social risk of PSD factor;4. The occuring of PSD including psychosocial and neurophysiological risk factors, the PSD patients should be used by the bio-psycho-social comprehensive intervention to treat.