Post-stroke depression affected approximately two-fifths of participants and was most consistently associated with neurological severity and functional disability, suggesting standardized depression screening should be integrated into post-stroke care.
Key Findings
Results
Post-stroke depression (PSD) was identified in 42.7% of stroke survivors assessed at least 3 months after the index event.
Among 403 participants, 172 were identified as having PSD.
Severity breakdown: 71 participants (17.6%) had mild depression, 61 (15.1%) had moderate depression, and 40 (9.9%) had severe or very severe depression.
Mean participant age was 57.3 ± 13.8 years; 69.2% were male.
Assessment was conducted using DSM-5-TR and ICD-11 criteria together with the clinician-administered 17-item Hamilton Depression Rating Scale.
The cohort was hospital-based at King Fahd University Hospital, Eastern Saudi Arabia, between January 2021 and November 2025.
Results
Higher NIHSS (neurological severity) score was independently associated with increased odds of post-stroke depression.
Adjusted odds ratio per 1-point increase in NIHSS score: aOR 1.35 (95% CI, 1.22–1.49; p < 0.001).
This association was identified through forced-entry multivariable logistic regression.
The complete-case multivariable analysis included 398 of the 403 participants.
NIHSS score reflects neurological impairment at time of stroke assessment.
Results
Unfavorable functional status at discharge was independently associated with markedly higher odds of post-stroke depression.
Modified Rankin Scale (mRS) score 3–5 versus 0–2 at discharge: aOR 6.51 (95% CI, 3.19–13.29; p < 0.001).
mRS 3–5 indicates moderate-to-severe disability or dependence.
This was the strongest single predictor identified in the multivariable model.
Functional status was assessed at discharge from the index hospitalization.
Results
Cerebral venous sinus thrombosis (CVST) as a stroke subtype showed higher odds of post-stroke depression compared to reference stroke subtypes, though the overall stroke-subtype test was nonsignificant.
The overall stroke-subtype omnibus test was nonsignificant (p = 0.067).
The authors characterized the CVST finding as exploratory, requiring confirmation in future studies.
Stroke subtypes included ischemic stroke, transient ischemic attack, intracerebral hemorrhage, and CVST.
Results
The multivariable logistic regression model demonstrated excellent discrimination for predicting post-stroke depression.
Area under the curve (AUC): 0.89 (bootstrap 95% CI, 0.86–0.92).
At a cutoff of 0.50, the model achieved 72.5% sensitivity and 90.5% specificity.
A forced-entry approach was used for multivariable logistic regression.
Bootstrap resampling was used to estimate confidence intervals for model performance.
Methods
The study population consisted predominantly of male participants drawn from a hospital-based cohort in Eastern Saudi Arabia.
403 participants total; 69.2% were male.
Mean age was 57.3 ± 13.8 years.
Participants underwent PSD assessment at least 3 months after the index cerebrovascular event.
Eligible stroke types included ischemic stroke, TIA, intracerebral hemorrhage, and CVST.
Data collection spanned January 2021 to November 2025 at King Fahd University Hospital.
What This Means
This research examined how common depression is among stroke survivors in Eastern Saudi Arabia, and what factors make it more likely to occur. The study followed 403 adults who had experienced various types of stroke or related brain events, assessing them for depression at least three months after their stroke using standardized clinical tools. The researchers found that roughly two out of five stroke survivors (42.7%) developed post-stroke depression, with severity ranging from mild to very severe. The most important risk factors were how severe the neurological damage from the stroke was and how dependent on others a person was when they left the hospital — patients with greater disability were over six times more likely to develop depression than those with milder impairment.
The study also found a potentially notable association between a specific, less common type of stroke called cerebral venous sinus thrombosis (CVST) and higher rates of depression, though the researchers caution this finding is preliminary and needs to be confirmed by future studies. The statistical model built from these factors was highly accurate at predicting who would develop depression, correctly identifying about 90% of those who did not develop it and about 73% of those who did.
This research suggests that depression after stroke is very common and is closely tied to how badly the stroke affected the brain and the person's ability to function independently. The findings highlight a practical need for routine depression screening to be built into standard post-stroke medical care, especially for patients who have more severe neurological damage or greater difficulty caring for themselves. Early identification of depression in these high-risk patients could create opportunities for timely treatment and support.
Albakr A, Alqarni M, Alhashim A, Albakr D, Yasawy Z, Al Ghamdi O, et al.. (2026). Prevalence and factors associated with post-stroke depression: a cross-sectional analysis of a prospectively assembled cohort in Eastern Saudi Arabia.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1863484