Factors associated with post-stroke depression one month after discharge among older patients based on Health Ecology Theory: a retrospective cross-sectional study of consecutive cases

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Objective This study aimed to examine multidimensional factors associated with post-stroke depression one month after discharge among older patients within the framework of Health Ecology Theory. Methods This retrospective cross-sectional study consecutively included 482 older stroke patients (aged ≥ 65 years) who were hospitalized at a tertiary hospital in Jingzhou, China, between January and December 2025. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate the level of depressive symptoms at one month after discharge, with a score of ≥10 used as the study-defined criterion for PSD. Potential factors were systematically categorized into five dimensions according to Health Ecology Theory: personal characteristics (sex, age, body mass index [BMI], comorbidities, acute treatment, functional disability via the modified Rankin Scale [mRS], and early cognitive impairment assessed using the Eight-item Ascertain Dementia questionnaire [AD8]); behavioral lifestyles (smoking, drinking, sleep disorders, and physical activity); interpersonal networks (marital status, living alone, primary caregiver and social activities); living/working conditions (education level and residence type); and policy environment (pension). Univariate analyses and multivariable logistic regression were performed to identify factors independently associated with PSD. Results Among the 482 participants, 162 (33.6%) presented with depressive symptoms, as indicated by a PHQ-9 score ≥ 10. In the multivariable analysis, factors significantly associated with PSD were identified from three ecological dimensions: personal characteristics, behavioral lifestyles, and interpersonal networks. Specifically, physical disability (mRS score > 2; OR = 4.383, 95% CI = 2.028–9.474, p < 0.001), cognitive impairment (AD8 score > 1; OR = 6.033, 95% CI = 3.411–10.669, p < 0.001), sleep disorders (OR = 6.756, 95% CI = 3.737–12.215, p < 0.001), and living alone (OR = 4.417, 95% CI = 1.240–15.741, p = 0.022) were associated with higher odds of PSD, whereas regular physical activity (> twice per week; OR = 0.064, 95% CI = 0.020–0.203, p < 0.001) and frequent participation in social activities (OR = 0.236, 95% CI = 0.092–0.603, p = 0.003) were associated with lower odds of PSD. Conclusion PSD in older stroke patients was associated with factors across the personal, behavioral, and interpersonal dimensions of Health Ecology Theory. These findings suggest that comprehensive care may be considered to address functional and cognitive rehabilitation, sleep management, promotion of physical activity, and strengthened social support.

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