Association between high serum total bilirubin and post‐stroke depression

Aim High serum bilirubin predicts depression in non‐stroke subjects, but it is unknown whether it also predicts post‐stroke depression ( PSD ). This study examined the association between the risk of PSD and bilirubin level. Methods Six hundred and thirty‐five patients with acute ischemic stroke in H ong K ong were recruited. Serum total bilirubin, alanine transaminase and alkaline phosphatase levels were measured in all patients during their hospital stay. A psychiatrist gave the S tructured C linical I nterview for DSM‐IV to all patients 3 months after the index stroke, with 61 patients diagnosed with PSD : 27 with major depression, 24 with minor depression and 10 with dysthymia. Results In the full sample, the 25%, 50% and 75% percentile bilirubin levels were 7.0, 10.0 and 14.0 μmol/L, respectively. Significant differences were found between the PSD and non‐ PSD groups in terms of bilirubin level ( P  = 0.006). In post‐hoc comparisons, the proportion of patients with bilirubin ≥14.1 μmol/L was significantly higher in the PSD group (37.7% vs 19.7%, P  = 0.001). In the final regression model, bilirubin level (≥14.1 μmol/L) remained a significant independent predictor of PSD , with an odds ratio of 2.4. Conclusions High bilirubin level is associated with PSD . Further investigations are needed to clarify the underlying pathophysiological link between bilirubin level and PSD .