J Stroke.  2021 May;23(2):263-272. 10.5853/jos.2020.04637.

Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger

  • 1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Korea
  • 3Clinical Research Center, Asan Medical Center, Seoul, Korea
  • 4Department of Neurology, Veterans Health Service Medical Center, Seoul, Korea
  • 5Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
  • 6Department of Neurology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
  • 7Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
  • 8Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
  • 9Department of Neurology, Dong-A University Hospital, Busan, Korea
  • 10Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 11Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
  • 12Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
  • 13College of Nursing, Seoul National University, Seoul, Korea


Background and Purpose
Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied.
This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim’s criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP.
A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP.
The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.


Ischemic stroke; Depression; Emotions; Anger
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