Title : Beyond physical recovery: Depression among stroke survivors at three-month follow-up in tertiary care Indian hospital

Background: Stroke recovery extends beyond neurological and physical impairment, with emotional and psychological complications playing an important role in long-term disability and quality of life. Post-stroke depression (PSD) is common but may remain under-recognized, particularly in resource-limited settings. Depression can adversely affect participation in rehabilitation, activities of daily living (ADLs), functional independence, and overall well-being. This study aimed to determine the prevalence of depression among stroke survivors at three months after stroke and to examine its association with functional independence and quality of life.

Method: A cross-sectional study was conducted among stroke survivors attending a three-month follow-up at a tertiary care hospital. Of 56 participants initially enrolled, 48 completed the three-month follow-up assessment. Participants with clinically and/or radiologically confirmed stroke who provided informed consent were included. Depression was assessed using the 17-item Hamilton Depression Rating Scale (HDRS). Functional independence in ADLs was evaluated using the Barthel Index, while quality of life was assessed using the WHO Quality of Life scale. Sociodemographic and clinical information was collected through structured interviews and medical-record review. Descriptive statistics were used to summarize participant characteristics and clinical outcomes. Pearson’s correlation analysis was performed to assess relationships between depression severity, age, and functional independence.

Result: The mean age of participants was 61.4 ± 10.1 years, and 56% were male. At three months following stroke, 83.3% of participants had post-stroke depression, demonstrating a substantial psychological burden among survivors. Depression severity showed a statistically significant negative correlation with Barthel Index scores (Pearson’s r = −0.292, p = 0.044), indicating that greater depressive symptoms were associated with lower functional independence. Age was positively correlated with HDRS scores (r = 0.316, p = 0.028), suggesting a greater burden of depressive symptoms among older stroke survivors. Educational status was significantly associated with depression (p = 0.027), whereas gender and marital status were not significantly associated. Depression was also significantly associated with greater dependence in ADLs (p = 0.003). Among quality-of-life domains, psychological health was the most adversely affected, while social relationships were comparatively better.

Conclusion: Post-stroke depression was highly prevalent among survivors three months after stroke and was significantly associated with reduced functional independence and greater dependence in daily activities. These findings emphasize that successful stroke recovery should address psychological health alongside physical rehabilitation. Routine depression screening during stroke follow-up, early psychological intervention, caregiver counselling, and integration of mental health support into rehabilitation services may promote greater independence and improve quality of life. Particular attention should be given to older and socially vulnerable survivors. Larger longitudinal and multicenter studies are needed to further evaluate the impact of depression on long-term stroke recovery and to develop integrated models of post-stroke care.

Dr. Shria Datta holds an MBBS degree from AIIMS Patna and is passionate about Neurology. Dr. Datta also has 
•    Clinical Experience in US Health care system in Internal Medicine department of UTHealth Houston and UC Irvine School of Medicine. She has completed her USMLE Step 1 & Step 2 CK exams.
•    Completed clerkships in 12+ core specialties including Internal Medicine, Surgery, Neurology, etc.  
•    Keen interest in research and has published multiple papers. Made multiple oral presentations at international and domestic conferences 
•    Been awarded scholarships for doing research and has also won several medical quizzes.