Depression Risk in Post-Stroke Aphasia Patients: A Nationwide Population-Based Cohort Study

Introduction: Depression and aphasia impair the quality of life after a stroke. Studies linking depression risk to post-stroke aphasia (PSA) lacked confirmation using a large database. Methods: Using Taiwan's National Health Insurance claims data, we identified ≥18-year-old patients hospitalized for stroke from 2005 to 2009, and those diagnosed with aphasia during hospitalization or within 3 months after discharge were selected to form the aphasic group. We estimated depression incidence by December 31, 2018, and used the Cox proportional hazards model to estimate aphasia group to non-aphasia group hazard ratios (HRs). Results: With a median follow-up period of 7.91 and 8.62 years for aphasia (n = 26,754) and non-aphasia groups (n = 139,102), respectively, the incidence of depression was higher in the aphasia group than in the non-aphasia group (9.02 vs. 8.13 per 1,000 person-years), with an adjusted HR (95% confidence intervals [CI]) of 1.21 (1.15-1.29) for depression. The adjusted HRs (95% CI) of depression were homogenous for females, 1.26 (1.15-1.37); for males, 1.18 (1.09-1.27); for hemorrhagic stroke, 1.22 (1.09-1.37); and for ischemic stroke, 1.21 (1.13-1.30). Results in analyzing 25,939 propensity score-matched pairs demonstrated an equivalent effect. Conclusion: Patients with PSA are at an increased risk of developing depression, regardless of sex or stroke type.