Recovery of Daily Life Autonomy J Clin Med Res • 2010;2(1):39-43 Figure 1. Incidence of hypertension according to gender and severity of depression. W: women; M: men. P = 0.02. sex and parental status, if any, of the caregiver. With regard to the anamnestic characteristics, location and type of the lesion, the only variable showing a statistical- ly significant association with the attribution of the patient to the HDRS class was hypertension. Indeed, patients with hy- pertension were more frequently included in the HDRS se- vere class than the non-hypertensive ones (Fig. 1). The sub- sequent stratification by gender showed that the association was statistically significant in the female gender but not in the male gender, although within the male patients emerged also an asymmetrical distribution with a higher frequency of hypertension among subjects included in the major depres- sion class. Finally, among our patients, attribution to the mild/mod- erate or, alternatively, severe HDRS class did not seem to af- fect the outcome of treatment, since there were no statistical- ly significant differences between the Barthel index means after stratifying by class the results of the patients assessed at the beginning and at the end of the period of treatment. Discussion The onset of depressive symptoms is a frequent complication of stroke, associated with a worse functional prognosis and limited success of rehabilitation treatment. Given the high prevalence of this disorder and its consequences on the out- come, it is important to study the predictive factors and the variables that may influence its development and implica- tions. The Hamilton scale used in the study for the assess- ment of depression proved to be extremely sensitive in high- lighting even small deflections of mood so that virtually all patients in the post-stroke period were somewhat affected by depression. This finding led us to compare patients with mild depression vs. patients with severe depression and this may have weakened some of the associations under study. It is well known that the participation of the family plays a key role in the overall management of the home care patient with “sequelae” of stroke. In our study however the analysis of age, sex and parental status of the caregiver showed no association with the severity of depression after stroke. Sim- ilarly, no statistically significant association emerged from the analysis of the socio-economic condition of the patients (age, marital status, instruction level, former occupation). Likewise, most of the comorbilities, the patient’s cognitive status and the aetiology of stroke showed no association with depression. In previous studies, a controversial issue has been the possible influence of the site of brain damage on the later development of depression. Systematic reviews did not sup- port this hypothesis and in our study we also observed no differences in the frequency of mild/moderate or severe de- pression in relation to the location of brain damage [14, 15]. Our study has shown a highly significant association between hypertension and severe depression. Several stud- ies [16-20] have shown a higher prevalence of clinical de- pression and severe depressive symptoms in patients with chronic diseases including hypertension. Moreover, a recent meta-analysis that analyzed the association between chronic illnesses and depression evidenced an association between hypertension and depression although the correlation was not highly significant [21]. It seems appropriate, here, to briefly recall the biochemical mechanisms responsible for depression and their link with hypertension. Particularly in- Articles © The authors, Journal compilation © J Clin Med Res and Elmer Press™, www.jocmr.org 41