Person-Centered Approaches for Identifying Subgroups of Post-Stroke Depression: A Systematic Review of Observational Studies

Background: Current management for post-stroke depression (PSD) mainly relies on the severity of depression, insufficiently capturing PSD's clinical heterogeneity. No previous systematic review has jointly synthesized cross-sectional and longitudinal observational studies using person-centered approaches to identify PSD subgroups. This systematic review synthesizes evidence from these studies employing person-centered approaches to characterize PSD subgroups. Methods: Comprehensive searches were conducted in nine databases from the inception to September 2025. Observational studies using person-centered approaches to subgroup PSD were included. Two reviewers independently performed data extraction and study quality assessment using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Eleven articles (9 unique cohorts; N = 6729) were included. Cross-sectional studies (4 studies; N = 1400) identified four symptom-based subgroups: low depressive symptoms (46.6%), emotional depressive symptoms (9.4%), atypical depressive symptoms (23.2%), and widespread depressive symptoms (20.8%). Longitudinal studies (5 studies; N = 5329) revealed four trajectory-based subgroups: low and stable/decreasing (59.7%), low but increasing (17.8%), high and stable/increasing (13.6%), and initially high/moderate but declining (8.9%). Latent transition analysis (2 studies; N = 886) showed greater subgroup fluidity within 6-month post-stroke, followed by increasing stability. Predictors of more severe/persistent subgroups included social-demographic, clinical and physiological factors. One study found that all non-low-stable trajectories were associated with significantly increased 10-year mortality (hazard ratios: 1.38-2.62). Conclusion: Person-centered approaches can effectively delineate latent subgroups of PSD characterized by distinct symptom manifestations and trajectories. Findings of this review support a shift away from one-size-fits-all, total-score-based management toward a more nuanced, symptom- and trajectory-informed framework for PSD. Systematic Review Registration: CRD420251273568.