Rest-Activity Rhythm Characteristics Associated With Depression Symptoms in Stroke Survivors

Sarah T. Stahl, Elizabeth Skidmore, Emily Kringle, Minmei Shih, Carolyn Baum, Joy Hammel, Robert Krafty, Naima Covassin, Jingen Li, Stephen F. Smagula

Research output: Contribution to journalArticlepeer-review


Objective: To examine which 24-hour rest-activity rhythm (RAR) characteristics are associated with depression symptoms in stroke survivors. Design: Cross-sectional observational study examining associations of RAR characteristics with the presence of depression symptoms adjusting for age, sex, race, and medical comorbidity. Setting: Community setting. Participants: Stroke survivors: (1) recruited locally (N women=35, N men=28) and (2) a nationally representative probability sample (the National Health and Nutrition Examination Survey [NHANES]; N women=156, N men=124). Interventions: None. Measurements: Objective RAR characteristics derived from accelerometer recordings including activity onset/offset times and non-parametric measures of RAR strength (relative amplitude), stability (interdaily stability), and fragmentation (intradaily variability). The presence of depression symptoms was categorized using Patient Health Questionnaire scores. Results: In both samples, the only RAR characteristic associated with depression symptoms was intradaily variability (fragmentation): local sample, odds ratio=1.96 [95% confidence interval=1.05-3.63]; NHANES sample, odds ratio=1.34, [95% confidence interval=1.01-1.78]). In the NHANES sample, which included both mild and moderate/severe depression, the association between 24-hour sleep-wake fragmentation and depression symptoms was driven by moderate-to-severe cases. Conclusions: Stroke survivors with higher levels of RAR fragmentation were more likely to have depression symptoms in both samples. These findings have implications, given prior studies in general samples linking RAR fragmentation with future depression and dementia risk. Research is needed to establish the potential consequences, mechanisms, and modifiability of RAR fragmentation in stroke survivors.

Original languageEnglish (US)
Pages (from-to)1203-1208
Number of pages6
JournalArchives of Physical Medicine and Rehabilitation
Issue number8
StatePublished - Aug 2023


  • Actigraphy
  • Depression
  • Rehabilitation
  • Sleep
  • Stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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