Persistent depression after transient ischemic attack predicts death
Depression was common after transient ischemic attack and persistent symptoms strongly predicted worse long-term outcomes.
*Prospective population-based cohort; Level 1b (OCEBM).

Citation

McColl AJ, Luengo-Fernandez R, Vaughan-Fowler E-R, et al. Prevalence, Predictors, and Prognosis of Depression After Transient Ischemic Attack: A Population-Based Study. Stroke. 2026;57:125–133. doi:10.1161/STROKEAHA.125.052251.

Background

Depression after stroke is common and linked to higher death rates, but less is known after transient ischemic attack. This study measured how often depression occurs after transient ischemic attack, what predicts it, and whether it relates to later health outcomes.

Patients

519 adults with a first-in-study transient ischemic attack in a defined United Kingdom population (2014–2020).

Intervention

Screening for depression at 1 and 12 months using a validated questionnaire; analysis of predictors and prognosis.

Control

Patients without depression.

Outcome

Depression prevalence/predictors; 5-year death, disability, nursing/residential home placement, and quality of life.

Follow-up Period

Depression at 1 and 12 months; outcomes up to 5 years.

Results

Depression affected 24.3% within 12 months (20.7% at 1 month; 14.9% at 12 months). Depression was not linked to an acute brain lesion on imaging, but persistent depression was strongly linked to worse outcomes.
Finding (adjusted) Effect size
Predictors of depression within 12 months: low mood at first visit Odds ratio 4.06 (95% CI, 2.31–7.15)
Predictors of depression within 12 months: pre-event disability Odds ratio 3.53 (95% CI, 1.89–6.59)
All-cause death (any depression within 12 months) Hazard ratio 2.27 (95% CI, 1.21–4.27)
All-cause death (persistent depression at 1 and 12 months) Hazard ratio 4.58 (95% CI, 2.07–10.13)
Disability within 5 years (persistent depression) Odds ratio 12.10 (95% CI, 6.18–23.7)
Nursing/residential home placement within 5 years (persistent depression) Hazard ratio 5.83 (95% CI, 1.84–18.50)
Most analyses adjusted for age, sex, health conditions, social factors, and pre-event disability.

Limitations

Depression was screened, not diagnosed clinically; some follow-up was missing; single-region study; few recurrent events limited some analyses; pandemic-era follow-up could affect mood reporting.

Funding

National Institute for Health research and major charities; potential consultant conflict noted.

Clinical Application

Screen for depression after transient ischemic attack, especially at 1 month, and re-check at 12 months; persistent symptoms signal high risk and warrant active treatment and follow-up.