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Forster SD, Gauggel S, Loevenich R, Völzke V, Petershofer A, Zimmermann P, Privou C, Bonnert J, Mainz V. A Microanalysis of Mood and Self-Reported Functionality in Stroke Patients Using Ecological Momentary Assessment. Front Neurol 2022; 13:854777. [PMID: 35665036 PMCID: PMC9160229 DOI: 10.3389/fneur.2022.854777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/15/2022] [Indexed: 12/02/2022] Open
Abstract
Post-stroke depression has been repeatedly associated with the degree of functional and cognitive impairment. The present study aimed to conduct a microanalysis on this association and examined the association between mood and self-reported functionality in 20 stroke patients (6 females, age: M = 59.9, SD = 5.2) using ecological momentary assessments (EMA), a structured diary method capturing moment-to-moment variations. Mood and self-reported functionality were recorded via a smartphone-app eight times a day for seven consecutive days during inpatient rehabilitation care. The patients answered on average to 73.2% of the received prompts. Variability in patients' responses was caused by differences both between and within patients. Multilevel regression analyses revealed that mood and self-reported functionality were significantly associated at the same point in time, but only patients' mood predicted their self-reported functionality at the next assessment point in time-lagged analyses. These results remained stable after controlling for between-person differences as patients' age, staff-ratings of their awareness of illness, and their degree of functional independence. Patients' mood appeared to affect their future ratings of their functionality but not the other way around.
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Affiliation(s)
- Saskia D. Forster
- Institute for Medical Psychology and Medical Sociology, University Hospital of the RWTH Aachen, Aachen, Germany
- *Correspondence: Saskia D. Forster
| | - Siegfried Gauggel
- Institute for Medical Psychology and Medical Sociology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Rebecca Loevenich
- Institute for Medical Psychology and Medical Sociology, University Hospital of the RWTH Aachen, Aachen, Germany
| | | | | | | | | | - Jürgen Bonnert
- MediClin Klinik Reichshof, Reichshof-Eckenhagen, Germany
| | - Verena Mainz
- Institute for Medical Psychology and Medical Sociology, University Hospital of the RWTH Aachen, Aachen, Germany
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Yaow CYL, Teoh SE, Lim WS, Wang RSQ, Han MX, Pek PP, Tan BYQ, Ong MEH, Ng QX, Ho AFW. Prevalence of anxiety, depression, and post-traumatic stress disorder after cardiac arrest: A systematic review and meta-analysis. Resuscitation 2021; 170:82-91. [PMID: 34826580 DOI: 10.1016/j.resuscitation.2021.11.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022]
Abstract
AIM Quality of life after surviving out-of-hospital cardiac arrest (OHCA) is poorly understood, and the risk to mental health is not well understood. We aimed to estimate the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) following OHCA. METHODS In this systematic review and meta-analysis, databases (MEDLINE, EMBASE, and PsycINFO) were searched from inception to July 3, 2021, for studies reporting the prevalence of depression, anxiety, and PTSD among OHCA survivors. Data abstraction and quality assessment were conducted by two authors independently, and a third resolved discrepancies. A single-arm meta-analysis of proportions was conducted to pool the proportion of patients with these conditions at the earliest follow-up time point in each study and at predefined time points. Meta-regression was performed to identify significant moderators that contributed to between-study heterogeneity. RESULTS The search yielded 15,366 articles. 13 articles were included for analysis, which comprised 186,160 patients. The pooled overall prevalence at the earliest time point of follow-up was 19.0% (11 studies; 95% confidence interval [CI] = 11.0-30.0%) for depression, 26.0% (nine studies; 95% CI = 16.0-39.0%) for anxiety, and 20.0% (three studies; 95% CI = 3.0-65.0%) for PTSD. Meta-regression showed that the age of patients and proportion of female sex were non-significant moderators. CONCLUSION The burden of mental health disorders is high among survivors of OHCA. There is an urgent need to understand the predisposing risk factors and develop preventive strategies.
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Affiliation(s)
- Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Seth En Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Wei Shyann Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Renaeta Shi Qi Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Ming Xuan Han
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia, Building H McMahons Road, Frankston, Vic 3199, Australia
| | - Pin Pin Pek
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, 8 College Rd, Singapore 169857, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services & Systems Research, Singapore, 1 Outram Rd, Singapore 169608, Singapore; Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Qin Xiang Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore, 91 Ubi Ave 4, Singapore 408827, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, 1 Outram Rd, Singapore 169608, Singapore; Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
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Lee EJ, Kim JS, Chang DI, Park JH, Ahn SH, Cha JK, Heo JH, Sohn SI, Lee BC, Kim DE, Kim HY, Kim S, Kwon DY, Kim J, Seo WK, Lee J, Park SW, Koh SH, Kim JY, Choi-Kwon S, Kim MS, Lee JS. Post-Stroke Depressive Symptoms: Varying Responses to Escitalopram by Individual Symptoms and Lesion Location. J Geriatr Psychiatry Neurol 2021; 34:565-573. [PMID: 32912058 DOI: 10.1177/0891988720957108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The efficacy of antidepressants in post-stroke depressive symptoms (PSD) varies. We aimed to examine whether the effect of escitalopram on PSD differs according to individual depressive symptoms and stroke lesion location. METHODS This is a post hoc analysis of EMOTION (ClinicalTrials.gov, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram on depression in acute stroke patients (237 with placebo, 241 with escitalopram). Depressive symptoms were evaluated with the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Changes in MADRS and individual item scores at 12 weeks were compared between the treatment groups and among the stroke lesion location groups. Stroke lesion locations were grouped according to the anatomical distribution of serotonin fibers that originate from the midbrain/pons and spread to the forebrain via subcortical structures: "Midbrain-Pons," "Frontal-Subcortical," and "Others." Least-squares means were calculated to demonstrate the independent effect of lesion location. RESULTS Total MADRS scores decreased more significantly in the escitalopram than in the placebo group, while a significant effect of escitalopram was observed in only 3 items: apparent sadness, reported sadness, pessimistic thoughts. In the lesion location analyses, escitalopram users in the Frontal-Subcortical group showed significant improvement in total MADRS scores (placebo [n = 130] vs. escitalopram [n = 148], least-square mean [95% CI]: -2.3 [-3.5 to -0.2] vs. -4.5 [-5.5 to -3.4], p = .005), while those in the Midbrain-Pons and Others groups did not. CONCLUSIONS The effect of escitalopram on PSD may be more prominent in patients with particular depressive symptoms and stroke lesion locations, suggesting the need for tailored treatment strategies.
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Affiliation(s)
- Eun-Jae Lee
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Dae-Il Chang
- Department of Neurology, KyungHee University, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Goyang, Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University, Gwangju, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Busan, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University, Seoul, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University, Daegu, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University, Pyungchon, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University, Goyang, Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk University, Seoul, Korea
| | - Seongheon Kim
- Department of Neurology, Kangwon National University, Chuncheon, Korea
| | - Do-Young Kwon
- Department of Neurology, Korea University, Ansan, Korea
| | - Jei Kim
- Department of Neurology, Chungnam University, Daejeon, Korea
| | - Woo-Keun Seo
- Department of Neurology, Sungkyunkwan University, Seoul, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University, Daegu, Korea
| | - Sang-Won Park
- Department of Neurology, Daegu Fatima Hospital, Daegu, Korea
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University, Guri, Korea
| | - Jin Young Kim
- Department of Psychiatry, Hyundai Hospital, Eumseong, Korea
| | - Smi Choi-Kwon
- College of Nursing, Seoul National University, Seoul, Korea
| | - Min-Sun Kim
- College of Medicine, Michigan State University, MI, USA
| | - Ji-Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
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Chalmers C, Leathem J, Bennett S, McNaughton H, Mahawish K. The efficacy of problem solving therapy to reduce post stroke emotional distress in younger (18-65) stroke survivors. Disabil Rehabil 2017; 41:753-762. [PMID: 29172817 DOI: 10.1080/09638288.2017.1408707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the efficacy of problem solving therapy for reducing the emotional distress experienced by younger stroke survivors. METHOD A non-randomized waitlist controlled design was used to compare outcome measures for the treatment group and a waitlist control group at baseline and post-waitlist/post-therapy. After the waitlist group received problem solving therapy an analysis was completed on the pooled outcome measures at baseline, post-treatment, and three-month follow-up. RESULTS Changes on outcome measures between baseline and post-treatment (n = 13) were not significantly different between the two groups, treatment (n = 13), and the waitlist control group (n = 16) (between-subject design). The pooled data (n = 28) indicated that receiving problem solving therapy significantly reduced participants levels of depression and anxiety and increased quality of life levels from baseline to follow up (within-subject design), however, methodological limitations, such as the lack of a control group reduce the validity of this finding. CONCLUSION The between-subject results suggest that there was no significant difference between those that received problem solving therapy and a waitlist control group between baseline and post-waitlist/post-therapy. The within-subject design suggests that problem solving therapy may be beneficial for younger stroke survivors when they are given some time to learn and implement the skills into their day to day life. However, additional research with a control group is required to investigate this further. This study provides limited evidence for the provision of support groups for younger stroke survivors post stroke, however, it remains unclear about what type of support this should be. Implications for Rehabilitation Problem solving therapy is no more effective for reducing post stroke distress than a wait-list control group. Problem solving therapy may be perceived as helpful and enjoyable by younger stroke survivors. Younger stroke survivors may use the skills learnt from problem solving therapy to solve problems in their day to day lives. Younger stroke survivors may benefit from age appropriate psychological support; however, future research is needed to determine what type of support this should be.
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Affiliation(s)
| | - Janet Leathem
- a School of Psychology , Massey University , Wellington , New Zealand
| | - Simon Bennett
- a School of Psychology , Massey University , Wellington , New Zealand
| | - Harry McNaughton
- b Stroke/Rehabilitation Research , Medical Research Institute of New Zealand , Wellington , New Zealand
| | - Karim Mahawish
- c Older Persons Rehabilitation Services , Rotorua Hospital , Rotorua , New Zealand
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Vansimaeys C, Zuber M, Pitrat B, Join-Lambert C, Tamazyan R, Farhat W, Bungener C. Combining Standard Conventional Measures and Ecological Momentary Assessment of Depression, Anxiety and Coping Using Smartphone Application in Minor Stroke Population: A Longitudinal Study Protocol. Front Psychol 2017; 8:1172. [PMID: 28747895 PMCID: PMC5506189 DOI: 10.3389/fpsyg.2017.01172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022] Open
Abstract
Context: Stroke has several consequences on survivors’ daily life even for those who experience short-lasting neurological symptoms with no functional disability. Depression and anxiety are common psychological disorders occurring after a stroke. They affect long-term outcomes and quality of life but they are difficult to diagnose because of the neurobiological consequences of brain lesions. Current research priority is given to the improvement of the detection and prevention of those post-stroke psychological disorders. Although previous studies have brought promising perspectives, their designs based on retrospective tools involve some limits regarding their ecological validity. Ecological Momentary Assessment (EMA) is an alternative to conventional instruments that could be a key in research for understanding processes that underlined post-stroke depression and anxiety onset. We aim to evaluate the feasibility and validity of anxiety, depression and coping EMA for minor stroke patients. Methods: Patients hospitalized in an Intensive Neuro-vascular Care Unit between April 2016 and January 2017 for a minor stroke is involved in a study based on an EMA methodology. We use a smartphone application in order to assess anxiety and depression symptoms and coping strategies four times a day during 1 week at three different times after stroke (hospital discharge, 2 and 4 months). Participants’ self-reports and clinician-rates of anxiety, depression and coping are collected simultaneously using conventional and standard instruments. Feasibility of the EMA method will be assessed considering the participation and compliance rate. Validity will be the assessed by comparing EMA and conventional self-report and clinician-rated measures. Discussion: We expect this study to contribute to the development of EMA using smartphone in minor stroke population. EMA method offers promising research perspective in the assessment and understanding of post-stroke psychological disorders. The development of EMA in stroke population could lead to clinical implications such as remotely psychological follow-ups during early supported discharge. Trial registration: European Clinical Trials Database Number 2014-A01937-40
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Affiliation(s)
- Camille Vansimaeys
- Laboratory of Psychopathology and Health Processes, Psychology Institute, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Mathieu Zuber
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Benjamin Pitrat
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de ParisParis, France
| | - Claire Join-Lambert
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Ruben Tamazyan
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Wassim Farhat
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Catherine Bungener
- Laboratory of Psychopathology and Health Processes, Psychology Institute, Université Paris Descartes-Sorbonne Paris CitéParis, France
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Hadidi NN, Lindquist R, Buckwalter K, Savik K. Feasibility of a Pilot Study of Problem-Solving Therapy for Stroke Survivors. Rehabil Nurs 2015; 40:327-37. [DOI: 10.1002/rnj.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 11/11/2022]
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Neuropathological substrates and structural changes in late-life depression: the impact of vascular burden. Acta Neuropathol 2012; 124:453-64. [PMID: 22836715 DOI: 10.1007/s00401-012-1021-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 01/01/2023]
Abstract
A first episode of depression after 65 years of age has long been associated with both severe macrovascular and small microvascular pathology. Among the three more frequent forms of depression in old age, post-stroke depression has been associated with an abrupt damage of cortical circuits involved in monoamine production and mood regulation. Late-onset depression (LOD) in the absence of stroke has been related to lacunes and white matter lesions that invade both the neocortex and subcortical nuclei. Recurrent late-life depression is thought to induce neuronal loss in the hippocampal formation and white matter lesions that affect limbic pathways. Despite an impressive number of magnetic resonance imaging (MRI) studies in this field, the presence of a causal relationship between structural changes in the human brain and LOD is still controversial. The present article provides a critical overview of the contribution of neuropathology in post-stroke, late-onset, and late-life recurrent depression. Recent autopsy findings challenge the role of stroke location in the occurrence of post-stroke depression by pointing to the deleterious effect of subcortical lacunes. Despite the lines of evidences supporting the association between MRI-assessed white matter changes and mood dysregulation, lacunes, periventricular and deep white matter demyelination are all unrelated to the occurrence of LOD. In the same line, neuropathological data show that early-onset depression is not associated with an acceleration of aging-related neurodegenerative changes in the human brain. However, they also provide data in favor of the neurotoxic theory of depression by showing that neuronal loss occurs in the hippocampus of chronically depressed patients. These three paradigms are discussed in the light of the complex relationships between psychosocial determinants and biological vulnerability in affective disorders.
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A clinical pathway including psychotherapy approaches for managing emotional difficulties after acquired brain injury. CNS Spectr 2009; 14:632-8. [PMID: 20173688 DOI: 10.1017/s1092852900023877] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Emotional difficulties, such as anxiety and depression, are common after acquired brain injury in adults and can influence long-term outcome. Diagnosis in a brain injury context can be difficult. Ideally, rehabilitation approaches should consider the specific treatment of anxiety and depression as well and may include pharmacotherapy, individual psychotherapy, and family interventions. Psychotherapy, especially in regards to longer-term adjustment to brain injury, may have an important adjunctive role in treatment approaches, but adaptations of techniques may be needed. A clinical pathway is described which can help to raise clinicians awareness, as well as increase detection rates and consideration of the specific role of individual psychotherapy in this clinical population. However, an important caveat is that clinical pathways should not serve as a substitute, but rather a facilitator, for the process of reasoning about individual patients in everyday clinical practice.
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9
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Kapfhammer HP. Depressive und Angststörungen bei somatischen Krankheiten. PSYCHIATRIE UND PSYCHOTHERAPIE 2008. [PMCID: PMC7122024 DOI: 10.1007/978-3-540-33129-2_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Depressiv-ängstliche Störungen sind bei den unterschiedlichen somatischen Erkrankungen häufig. Sie sind nicht nur als Reaktion auf die Situation der Erkrankung zu verstehen, sondern in ein komplexes Bedingungsgefüge eingebettet. Sie sind besonders häufig bei Erkrankungen, die das Zentralnervensystem oder endokrine Regulationssysteme direkt betreffen. Es besteht ein enger Zusammenhang zur Chronizität, Schwere und Prognose der Erkrankung. Eigenständige Effekte von diversen pharmakologischen Substanzgruppen sind wahrscheinlich.
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Sas K, Csete K, Vezekényi Z, Sztriha L, Vécseil L, Papp JG. Effects of citalopram and fluoxetine on the corticocerebral blood flow in conscious rabbits. ACTA ACUST UNITED AC 2007; 94:167-77. [PMID: 17853768 DOI: 10.1556/aphysiol.94.2007.3.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Depression, which is associated with an increased incidence of vascular events, frequently occurs following stroke. Selective serotonin reuptake inhibitory drugs (SSRIs) as antidepressants, are well tolerated, and also seem to be effective in post-stroke depression. The aim of this study was to investigate the effects of the SSRIs citalopram and fluoxetine, on the corticocerebral blood flow (cCBF) in rabbits with unilateral carotid occlusion induced cerebral ischemia. The cCBF was measured by the hydrogen clearance technique. After determination of the mean baseline cCBF, the effects of individual doses (0.1, 0.3 and I mg/kg) of citalopram or fluoxetine on the cCBF were investigated. Following the induction of an impaired cCBF, the changes in cCBF after drug treatments in this condition were likewise measured. The mean arterial blood pressure (MABP) and the heart rate (HR) from the electrocardiogram (ECG) were also determined. Neither citalopram nor fluoxetine influenced the cCBF in the control group. Fluoxetine improved the cCBF only very slightly in the ischemic animals. In contrast, all the doses of citalopram exerted pronounced and dose-dependent cCBF-increasing effects in the animals with unilateral carotid occlusion (maximal mean ACBF: 10, 16 and 27 ml/min/100 g tissue). The HR was decreased in both groups. Only citalopram treatment led to a slight MABP-decreasing effect. Besides enhancement of the serotonergic transmission in the brain, the cCBF-increasing effect of citalopram under ischemic conditions may be of benefit in post-stroke and vascular depression.
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Affiliation(s)
- K Sas
- Department of Neurology, University of Szeged, P O Box 427, H-6701 Szeged, Semmelweis u 6, H-6725 Szeged, Hungary.
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Wilz G, Barskova T. Predictors of psychological and somatic components of poststroke depression: a longitudinal study. Top Stroke Rehabil 2007; 14:25-40. [PMID: 17573310 DOI: 10.1310/tsr1403-25] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Depression after stroke is common and increases morbidity and mortality in the first years after stroke onset. Nevertheless, little is known about the role of psychosocial factors on the etiology of depression in early as well as in the late poststroke stages. The aim of our study was to investigate the influence of stroke survivors' mental impairment as well as the quality of their social relationships on the development of poststroke depression (PSD). METHOD The study used a longitudinal design. Eighty-one German stroke patients were investigated twice, directly after discharge (on the average of 3 months after stroke onset) and 1 year later. Hierarchical regression analyses and cross-lagged partial correlation analyses tested direct and indirect mediating effects of potential predictors on poststroke depressive symptoms. RESULTS Time 1 patients' perceived cognitive and emotional functioning predicted psychological depressive symptoms at Time 2. Quality of patients' social relationships mediated the effect of the stroke-related emotional deficits on depression. CONCLUSION In contrast to the previous research, the study provided more evidence for causal influence of different risk factors on PSD. Results support the biopsychosocial model of PSD. Early and late PSD seem to be based on partially different etiological mechanisms.
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Affiliation(s)
- Gabriele Wilz
- Department of Clinical and Health Psychology, Technical University of Berlin, Berlin, Germany
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