Long-term changes in post-stroke depression, emotional incontinence, and anger

Boseong Kwon, Eun Jae Lee, Seongho Park, Ji Sung Lee, Min Hwan Lee, Daeun Jeong, Dongwhane Lee, Hyuk Sung Kwon, Dae Il Chang, Jong Ho Park, Jae Kwan Cha, Ji Hoe Heo, Sung Il Sohn, Dong Eog Kim, Smi Choi-Kwon, Jong S. Kim

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


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. Methods 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. Results 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. Conclusions 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.

Original languageEnglish
Pages (from-to)263-272
Number of pages10
JournalJournal of Stroke
Issue number2
Publication statusPublished - 2021 May

Bibliographical note

Funding Information:
This work was supported by grants from Dong-A Pharmaceutical Company, who had no role in the design, analysis, interpretation, or publication of this study.

Publisher Copyright:
© 2021 Korean Stroke Society.

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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