Cognitive ability, education and socioeconomic status in childhood and risk of post-stroke depression in later life: A systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Depression after stroke is common and is associated with poorer recovery. Risk factors such as gender, age and stroke severity are established, but it is unclear whether factors from earlier in life might also contribute. METHODS: We searched MEDLINE, PsycINFO, EMBASE and meta-analysed all available evidence on childhood (premorbid) IQ, socioeconomic status (SES), education and stroke in adulthood. We included all studies reporting data on >50 patients, calculating overall odds ratios (OR), mean difference, correlation, 95% confidence intervals (CI) and 95% predictive intervals (PI) using random effects methods. We quality assessed all studies, performed sensitivity analyses, assessed heterogeneity and publication bias. RESULTS: We identified 33 studies including 2,664 participants with post-stroke depression and 5,460 without (314 participants not classified). Low education (< = 8 years) was associated with post-stroke depression in studies which defined depression as score of mild and above on a depression rating scale (OR 1.47 95% CI 1.10-1.97, p<0.01) but not in studies where depression was defined as severe depressive symptoms or a clinical diagnosis of major depression (OR 1.04 95% CI 0.90-1.31, p = 0.60). Low education was not associated with an increased risk for post-stroke depression in studies that adjusted for age and sex (OR 0.86 95% CI 0.50-1.48 p = 0.58). Those with post-stroke depression had fewer years of education than those without post-stroke depression (MD 0.68 95% CI 0.05-1.31 p = 0.04). Few studies adjusted for vascular risk factors or stroke severity. Heterogeneity between studies was moderate and was partly explained by severity of depression. In the one study identified premorbid IQ did not differ between those with post-stroke depression (mean IQ 10.1.8 SD 9.8) vs those without (mean IQ 104 SD 10.1). There were no studies that examined childhood socioeconomic status and risk of post-stroke depression. CONCLUSIONS: Having less education is associated with an increased risk of post-stroke depressive symptoms but with large confidence intervals and heterogeneity. Future studies should explore the relationship between early and late life risk factors to improve risk identification and to target prevention and treatment strategies.
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Low levels of education have been shown to be linked to post-stroke depression (but not severe or clinical depression outcomes).
“In a study, part of the findings showed that low levels of education have been shown to be linked to post-stroke depression (but not severe or clinical depression outcomes) [299].”
From Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature (2021) · cites this paper as [299]
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- Authors
- Backhouse, E. V., McHutchison, C. A., Cvoro, V., Shenkin, S. D., & Wardlaw, J. M.
- Affiliations
- University of Edinburgh (GB)
- UK Dementia Research Institute (GB)
- Corresponding author
- Backhouse, Ellen V.
- McHutchison, Caroline A.
- Cvoro, Vera
- Shenkin, Susan D.
- Wardlaw, Joanna M.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-07-16
- Volume
- 13
- Issue
- 7
- Pages
- e0200525
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6047794
- OpenAlex
- W2883057433
- Cited by
- 58
- References
- 53
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 9 · 2023: 7 · 2022: 8 · 2021: 12 · 2020: 8 · 2019: 4
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- Dr. Mortimer and Theresa Sackler Foundation
- Chest, Heart and Stroke Association Scotland (R14/A157)
- Horizon 2020 Framework Programme (666881)
- NHS Research Scotland
- Fondation Leducq (16 CVD 05)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- post-stroke depression, stroke, educational attainment, socioeconomic status, premorbid intelligence, children's cognitive abilities, risk factors for depression, depressive symptoms, stroke severity, vascular risk factors, mental health in later life, child IQ
- MeSH terms
- Child, Child Development, Child, Preschool, Cognition, Depression, Female, Humans, Male, Sex Factors, Socioeconomic Factors, Stroke
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