Supplementary Material for: White Matter Hyperintensity as a Factor Associated with Delayed Mood Disorders in Patients with Acute Ischemic Stroke

Background: Mood disorder is a frequent complication of stroke. Comorbid depressive and anxiety disorders are very common, indicating that it is advisable to assess both disorders at the same time. The aim of the present study was to examine the prevalence of post-stroke depression (PSD) and poststroke anxiety (PSA) at baseline and to evaluate factors related to delayed PSD and PSA at 3 months after stroke onset. Methods: This was a prospectively registered and retrospectively analyzed study of patients with acute ischemic stroke between January 2009 and March 2010. Patients included in this study were interviewed in order to evaluate their Hospital Anxiety and Depression Scale (HADS) scores. In this study, each depression and anxiety score was dichotomized into ‘nondepressive and nonanxious’ (HADS-D and HADS-A ≤7) and ‘depressive and anxious’ (HADS-D and HADS-A >7). Multiple logistic regression analysis was used to evaluate the independent factors of depressive and anxious symptoms 3 months after stroke onset. Results: Of the 133 patients, 47.4% were ‘depressive’ and 56.4% were ‘anxious’ at baseline. The depressive and anxious groups had a significantly higher frequency of severe white matter hyperintensity (WMH) than the nondepressive and nonanxious groups (p < 0.05). The independent factors of PSD and PSA at 3 months were deep white matter hyperintensities (DWMH) and modified Rankin scale 0 to 1 at 3 months. Conclusion: In conclusions, the results of our study demonstrated that delayed depression and anxiety after ischemic stroke were related to the severity of DWMH and unfavorable outcomes at 3 months, regardless of anti-anxiety treatment. Our results suggested that WMH might be associated with pathomechanism of delayed depression and anxiety.

背景：心境障碍是脑卒中常见并发症之一。共病抑郁与焦虑障碍的情况十分普遍，提示临床应同时对两类障碍进行评估。本研究旨在评估脑卒中后抑郁（post-stroke depression, PSD）与脑卒中后焦虑（post-stroke anxiety, PSA）在基线时的患病率，并分析卒中发病3个月后迟发性PSD与PSA的相关危险因素。
方法：本研究为一项前瞻性注册、回顾性分析的研究，纳入2009年1月至2010年3月期间收治的急性缺血性脑卒中患者。本研究对入组患者进行访谈，以评估其医院焦虑抑郁量表（Hospital Anxiety and Depression Scale, HADS）得分。本研究将抑郁与焦虑得分分别进行二分类：「无抑郁、无焦虑」组（HADS抑郁分量表得分HADS-D与HADS焦虑分量表得分HADS-A均≤7）与「有抑郁、有焦虑」组（HADS-D与HADS-A均>7）。采用多因素logistic回归分析，探讨卒中发病3个月后抑郁与焦虑症状的独立危险因素。
结果：133例患者中，基线时有47.4%存在抑郁症状，56.4%存在焦虑症状。有抑郁与焦虑症状的患者组，其重度脑白质高信号（white matter hyperintensity, WMH）的检出率显著高于无抑郁、无焦虑症状组（p<0.05）。卒中发病3个月时，迟发性PSD与PSA的独立危险因素为脑深部白质高信号（deep white matter hyperintensities, DWMH）以及3个月时改良Rankin量表评分为0~1分。
结论：综上，本研究结果显示，缺血性脑卒中后迟发性抑郁与焦虑症状与DWMH的严重程度及3个月时的不良预后相关，且该关联不受抗焦虑治疗的影响。本研究结果提示，脑白质高信号可能与迟发性抑郁及焦虑的发病机制存在关联。