Prevalence and Associated Factors of Post-stroke Depression among Stroke Survivors in Sri Lanka: A Multicenter Cross-Sectional Study

Background: Stroke and its resulting disabilities are increasingly prevalent in low- and middle-income countries, underscoring the need to investigate post-stroke complications such as post-stroke depression (PSD). PSD is a common sequela of stroke, significantly impairing quality of life. This study aimed to determine the prevalence of PSD and identify its associated factors among stroke survivors in the Sri Lankan context. 
Methods: A descriptive cross-sectional study was conducted, enrolling consecutively selected 322 stroke survivors who attended follow-up clinics three months after their stroke onset. Depression was measured using the validated Sinhala version of the Patient Health Questionnaire (PHQ-9). Associated factors were assessed through a pre-tested, interviewer-administered questionnaire and cognitive function was evaluated using the validated Sinhala version of the Mini-Mental State Examination (MMSE). Data were analysed using relevant descriptive statistics and inferential statistics.  
Results: The mean age of the participants was 60.82 (SD ± 11.91) years, with 59.6% males and 40.4% females. Ischemic stroke was the predominant type, affecting 84.5 % (n=271) of patients. Moderately severe depression was detected in 25.5% (n=82) of the patients, and severe depression was detected in 8.7% (n=28). Multiple linear regression analysis revealed that lower cognitive function (β = -0.27, p < 0.001), older age (β = 0.16, p = 0.005), having hemiplegia (β = -0.15, p = 0.004), perceived satisfaction on family support (β = 0.14, p = 0.008), longer hospitalization (β = 0.12, p = 0.008), and stroke type (β = -0.11, p = 0.022) were significantly associated with the PSD. The model explained 35% of the variance in PHQ-9 scores (adjusted R² = 0.35, p = 0.011).  
Conclusions: PSD was relatively prevalent among stroke survivors, with more than one-third experiencing moderately severe to severe depressive symptoms. Cognitive impairment emerged as the strongest independent predictor of depression, while older age, stroke-related disabilities, prolonged hospitalization, and family support were also significant contributors.