Published online Jun 19, 2026. doi: 10.5498/wjp.v16.i6.114616
Revised: November 25, 2025
Accepted: February 2, 2026
Published online: June 19, 2026
Processing time: 216 Days and 1.8 Hours
Among stroke patients, post-stroke depression (PSD) represents a frequent complication that substantially impacts neurological rehabilitation and quality of life. While vascular risk factor clustering might serve as a crucial predictor for PSD development, the specific mechanisms underlying its influence remain incompletely understood.
To examine how vascular risk factor clustering affects PSD development.
This retrospective study investigation enrolled 110 patients with acute cerebral infarction who were admitted to our hospital’s neurology department between January 2022 and December 2024. Based on vascular risk factor clustering severity, participants were categorized into: Low-risk cohort (≤ 2 risk factors, n = 52) and high-risk cohort (≥ 3 risk factors, n = 58). The cutoff threshold of ≥ 3 vascular risk factors was determined through receiver operating characteristic curve analysis, which demonstrated an optimal balance between sensitivity (71.1%) and specificity (73.6%) for predicting PSD (Youden index = 0.447, area-under-curve = 0.753). The evaluated vascular risk factors encompassed hyper
The study included 110 patients with acute cerebral infarction (average age 67.3 ± 10.2 years, 58.2% males). PSD developed in 38 patients (34.5%) within the 3-month observation period, demonstrating significantly elevated mean HAMD-17 scores vs non-depressed individuals (20.3 ± 3.2 points vs 8.9 ± 2.8 points, P < 0.001). Two independent PSD risk factors were identified through multivariate logistic regression: Vascular risk factor clustering (≥ 3 factors) (odds ratio = 3.42, 95% confidence interval: 1.45-8.06, P = 0.005) and severe neurological impairment (National Institutes of Health Stroke Scale score ≥ 8) (odds ratio = 2.91, 95% confidence interval: 1.38-6.13, P = 0.005). The analysis revealed a clear dose-response association between accumulated vascular risk factors and depression severity (Spearman r = 0.418, P < 0.001), showing PSD incidence escalation from 14.3% among patients with 0-1 risk factors to 66.7% in those with ≥ 5 risk factors (P for trend < 0.001). At the 3-month assessment, the low-risk cohort demonstrated superior functional recovery, achieving favorable outcomes (Modified Rankin Scale: 0-2) in 73.1% compared to 51.7% in the high-risk cohort (P = 0.021). The prediction model exhibited strong discriminatory performance (C-statistic = 0.753), with sensitivity analyses validating the stability of these relationships across various diagnostic thresholds and patient subsets.
Multiple vascular risk factor clustering constitutes an independent predictor of PSD development. Individuals presenting with numerous vascular risk factors (≥ 3) demonstrate markedly elevated PSD risk relative to those with limited risk factors (≤ 2).
Core Tip: Post-stroke depression is a common neuropsychiatric complication that seriously affects recovery and quality of life in stroke survivors. This study demonstrates that clustering of multiple vascular risk factors, rather than individual factors, is an independent predictor of post-stroke depression. A clear dose-response relationship was observed, with depression risk rising progressively as the number of vascular risk factors increased. These findings highlight the importance of comprehensive vascular risk factor assessment in routine stroke care to enable early identification and timely intervention for high-risk patients.