Journal CME September 2025, Clinical impact of a poststroke depression screening program-PM R - 2025 - Chan - Clinical impact of a poststroke depression screening program

PM R - 2025 - Chan - Clinical impact of a poststroke depression screening program

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This study evaluated the clinical impact of a routine poststroke depression (PSD) screening and intervention program, Effective Mood Management After Stroke (EMMAS), implemented at a tertiary hospital inpatient rehabilitation setting. PSD is common among stroke survivors and negatively affects long-term outcomes such as mortality, disability, and quality of life, but the effect of proactive PSD screening and early treatment on long-term outcomes was unclear.<br /><br />Researchers conducted a cross-sectional, case-control study using propensity-score matching to compare outcomes between patients who underwent stroke rehabilitation before and after EMMAS implementation. The composite poor long-term outcome was defined as death, institutionalization, requiring a full-time caregiver, or screening positive for depression at 5 years poststroke. The study included 493 patients (366 post-EMMAS and 127 pre-EMMAS), matched on demographics, stroke characteristics, and severity.<br /><br />Results showed that about 60% of stroke survivors experienced poor outcomes after 5 years. After matching, patients exposed to the EMMAS program had significantly lower odds of poor long-term outcomes (adjusted odds ratio 0.37; 95% CI: 0.20–0.65; p<0.001), indicating a 63% reduction in risk compared to pre-EMMAS controls. This benefit appeared irrespective of PSD diagnosis, suggesting that routine in-hospital PSD screening combined with timely psychiatric interventions can improve long-term functional and psychological outcomes in stroke survivors.<br /><br />The study’s strengths included comprehensive baseline clinical data and use of real-world clinical populations. Limitations involved potential recruitment bias, lack of matching on baseline depression and antidepressant use, and absence of survival analysis due to missing intermediate follow-up data. Despite this, findings support integrating systematic PSD screening and early intervention into stroke care pathways to enhance recovery and quality of life.<br /><br />In conclusion, routine PSD screening and early management through programs like EMMAS may improve long-term survival, functional independence, and mood outcomes after stroke. Further cost-effectiveness studies are needed before widespread adoption into standard clinical practice.

Keywords

poststroke depression

PSD screening

stroke rehabilitation

Effective Mood Management After Stroke

EMMAS program

long-term stroke outcomes

psychiatric intervention

functional independence after stroke

stroke survivor quality of life

stroke care pathways