Trajectory Classes of Post-Stroke Depression Severity and Their Baseline Predictors: A Multi-Cohort Replication Study

Post-stroke depression (PSD) affects approximately one-third of stroke survivors and is associated with poorer rehabilitation outcomes, increased disability, and higher mortality. Despite its clinical importance, PSD is often studied as a binary outcome, obscuring heterogeneity in symptom trajectories over time. This study aimed to identify replicable longitudinal trajectories of PSD across independent cohorts and examine baseline predictors of trajectory membership. Data were analysed from three cohorts of the Stroke and Cognition Consortium (STROKOG; n=750). Depression was measured using the Geriatric Depression Scale (GDS-15) and the Hamilton Depression Rating Scale (HAMD-17). Latent class growth analysis was conducted within cohorts and in pooled GDS-15 and HAMD-17 datasets. Across six analyses, a consistent three-class solution emerged. The majority of participants (58–83%) showed no clinically significant depressive symptoms (No Depression). A second class (14–29%) displayed mild symptoms that generally remitted over time (Mild Remitting). A smaller subgroup (4–13%) exhibited symptoms in the moderate-severity range throughout follow-up, with trajectory direction varying across analyses. Baseline global cognitive impairment predicted Mild Remitting class membership across both pooled analyses. In pooled HAMD-17 analyses, female sex predicted membership in the Moderate Improving class, characterised by moderately severe symptoms that gradually resolved over time. In pooled GDS-15 analyses, older age, hypertension, and diabetes predicted membership in the Moderate Stable class. PSD follows a robust three-trajectory structure across independent cohorts, countries, and instruments. Early clinical factors, particularly cognitive impairment, sex, and vascular risk factors, may identify stroke survivors at risk for persistent depression, enabling earlier targeted intervention.