Post-Stroke Depression and its Impact on Mortality and Functional Outcomes: A Systematic Review and Meta-Analysis.

Abstract

BackgroundPost-stroke depression (PSD) affects 25-50% of stroke survivors, yet its prognostic impact on mortality, functional disability, cognition, and health-related quality of life (HRQoL) remains incompletely characterised.ObjectivesTo review evidence published from 2016 to 2026 on PSD and clinical outcomes in stroke survivors and to perform meta-analysis where compatible data existed.MethodsPubMed was searched from January 2016 to April 2026. Cohort studies enrolling adult stroke survivors with validated PSD assessments were eligible. Two reviewers independently extracted data and assessed quality using the Newcastle-Ottawa Scale. Random-effects meta-analysis (DerSimonian-Laird) was performed where compatible; otherwise SWiM narrative synthesis was applied.ResultsSeven cohort studies (N = 10,643), all published between 2016 and 2019, were included; six (86%) were high quality. Meta-analysis of functional disability (k = 2, n = 836) yielded pooled OR = 3.46 (95% CI 2.04-5.87; I 2 = 0.0%), and an exploratory meta-analysis of continuous functional outcomes (k = 2, n = 294) yielded pooled SMD = 0.338 (95% CI 0.127-0.548), providing directional support for a small-to-moderate effect. PSD was independently associated with cognitive impairment (HR 3.68; 95% CI 1.03-13.21) and reduced HRQoL. Mortality findings were divergent and could not be pooled.ConclusionsPSD is a consistent prognostic marker for worse functional outcomes, cognitive impairment, and reduced HRQoL, with pooled analyses supporting a 3.5-fold increase in disability odds independent of stroke severity. Validated PSD screening should be embedded into post-stroke neurorehabilitation pathways. As all included studies were published between 2016 and 2019, findings should be confirmed in a future multi-database review capturing more recent evidence.