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Zeng Y, Chen J, Liu J, Zhang Y, Wang H, Jiang Y, Ding W, Li Y, Li J. Factor structure and reliability of the symptom measurement of post-stroke depression in the rehabilitation stage. BMC Psychiatry 2024; 24:448. [PMID: 38877421 PMCID: PMC11179195 DOI: 10.1186/s12888-024-05906-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/10/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The incidence of Post Stroke Depression (PSD) in the Rehabilitation Stage is high, which can bring serious physical and psychological disorders to patients. However, there is still a lack of targeted tools for screening PSD in the rehabilitation stage. Therefore, the aim of this study was to evaluate the factor structure and reliability of a measurement instrument to screen for PSD in the rehabilitation stage. METHODS A cross-sectional study was conducted on 780 hospitalized stroke patients who were within the rehabilitation stage from May to August 2020. Exploratory factor analysis (EFA) as well as first- and second-order confirmatory factor analysis (CFA) were performed to evaluate the factor structure of the newly developed Symptom Measurement of Post-Stroke Depression in the Rehabilitation Stage (SMPSD-RS). The reliability and validity of the SMPSD-RS were also verified using several statistical methods. RESULTS EFA extracted a 24-item, five-factor (cognition, sleep, behavior, emotion, and obsession) model that can clinically explain the symptoms of PSD during the rehabilitation stage. A first-order CFA confirmed the EFA model with good model fit indices, and the second-order CFA further confirmed the five-factor structure model and showed acceptable model fit indices. Acceptable reliability and validity were also achieved by the corresponding indicators. CONCLUSION The SMPSD-RS was proven to have a stable factor structure and was confirmed to be reliable and valid for assessing PSD symptoms in stroke patients during the rehabilitation stage.
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Affiliation(s)
- Yawei Zeng
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junya Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jing Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yi Zhang
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hongxia Wang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yanhong Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weiwei Ding
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yun Li
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Masuccio FG, Grange E, Di Giovanni R, Rolla M, Solaro CM. Post-Stroke Depression in Older Adults: An Overview. Drugs Aging 2024; 41:303-318. [PMID: 38396311 DOI: 10.1007/s40266-024-01104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Detailed data on post-stroke depression (PSD) in older adults are limited in spite of the high vulnerability of this population to stroke. In fact, PSD prevalence in older adults ranges from 16.0 to 43.9%; however, timing and instruments of evaluation often differ significantly across all available studies. The etiology, genetic and inflammatory factors, as well as structural brain alterations, are claimed as part of a multifaceted mechanism of action in PSD onset. Thus, the aim of this narrative review was to further elaborate on the prevalence, etiology, diagnosis, consequences and treatment of PSD in older adults. The consequences of PSD in older adults may be devastating, including a poor functional outcome after rehabilitation and lower medication adherence. In addition, lower quality of life and reduced social participation, higher risk of new stroke, rehospitalization, and mortality have been reported. In this scenario, treating PSD represents a crucial step to prevent these complications. Both pharmacological and non-pharmacological therapies are currently available. The pharmacological treatment utilizes antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TAs) and new multimodal antidepressants (NMAs). Non-pharmacological therapies include psychological interventions and non-invasive brain stimulation techniques, while excluding drug administration. In the general population experiencing PSD, SSRIs (sertraline in particular) are the most prescribed, whereas the combination of antidepressants and psychotherapy is underused. Furthermore, about one-third of patients do not receive treatment for PSD. In regard to older adults with PSD, the possibility of more adverse effects or contraindications to antidepressant prescription due to comorbidities may limit the therapeutic window. Although drugs such as citalopram, escitalopram, sertraline, venlafaxine, and vortioxetine are usually well tolerated by older patients with PSD, the few randomized controlled trials (RCTs) specifically considering older adults with PSD have been conducted with fluoxetine, fluvoxamine, reboxetine, citalopram and nortriptyline, often with very small patient samples. Furthermore, data regarding the results of non-pharmacological therapies are scarce. High-quality RCTs recruiting large samples of older adults are needed in order to better manage PSD in this population. In addition, adequate screening and diagnosis instruments, with reliable timing of evaluation, should be applied.
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Affiliation(s)
- Fabio Giuseppe Masuccio
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone SNC, 13040, Moncrivello, VC, Italy
| | - Erica Grange
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone SNC, 13040, Moncrivello, VC, Italy
| | - Rachele Di Giovanni
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone SNC, 13040, Moncrivello, VC, Italy
| | - Martina Rolla
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone SNC, 13040, Moncrivello, VC, Italy
| | - Claudio Marcello Solaro
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone SNC, 13040, Moncrivello, VC, Italy.
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Chen J, Liu J, Zeng Y, Li R, Wang Y, Ding W, Guo J, Lin H, Li J. Development and initial validation of a clinical measure to assess symptoms of post-stroke depression in stroke patients at the rehabilitation stage. Front Psychol 2022; 13:928257. [PMID: 35967723 PMCID: PMC9369669 DOI: 10.3389/fpsyg.2022.928257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background The high incidence of post-stroke depression (PSD) during rehabilitation exerts a negative effect on the treatment and functional recovery of patients with stroke and increases the risk of mortality. It is necessary to screen PSD in the rehabilitation stage and thus provide effective intervention strategies. However, existing measurements used to assess PSD in the rehabilitation stage in patients with stroke lack specificity. This study aimed to develop a clinical measure to assess symptoms of PSD in the rehabilitation stage. Methods The research team created the initial items through a literature review and semi-structured interviews of patients with stroke. Then, the symptom-related items were estimated by three panels: healthcare professionals (N = 41), Delphi experts (N = 15), and patients with stroke in the rehabilitation stage (N = 30). Results The literature review and semi-structured interview produced 51 symptom-related items including six domains, and the items were reduced to 47 by the healthcare professionals. The symptom-related items were further reduced to 33 items by a two-round Delphi consultation. The initiative coefficients of the two Delphi rounds were 71.4 and 100%, the expert authority coefficients were both 0.85, Kendall’s W were 0.152 and 0.408 (p < 0.01), and the coefficient of variation (CV) were 0.05–0.32 and 0.00–0.18, respectively. The item-level content validity index (I-CVI) was 0.53–1.00, the scale-level CVI/universal agreement (S-CVI/UA) was 0.26, and the S-CVI/average (S -CVI/Ave) was 0.85 for the first found Delphi consultation; the I-CVI was 0.67–1.00, the S-CVI/UA was 0.61, and the S-CVI/Ave was 0.97 for the second round Delphi consultation. All content validity indicators have been significantly improved compared with the first round. Using mean ≥ 4 and full score ≥ 0.5, combined with CV ≤ 0.16 as the item criteria, a clinical measure of PSD with 33 items and 6 dimensions (cognition, sleep, behavior, emotion, body, and guilt) was finally formed after two rounds. The patients with stroke made no further revisions after evaluation. Conclusion The research team developed a specific tool with good content validity to assess the symptoms of PSD in the rehabilitation stage.
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Affiliation(s)
- Junya Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Jing Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yawei Zeng
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Ruonan Li
- Division of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yucui Wang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiwei Ding
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Junyi Guo
- Department of Rehabilitation, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Junyi Guo,
| | - Haiyun Lin
- Department of Rehabilitation, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Haiyun Lin,
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, China
- Jufang Li,
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Ding W, Chen J, Liu J, Lin B, Li S, Li F, Guo J, Li Y, Li J. Development and validation of the Health Education Adherence Scale for Stroke Patients: a cross-sectional study. BMC Neurol 2022; 22:69. [PMID: 35227225 PMCID: PMC8883719 DOI: 10.1186/s12883-022-02597-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Due to the lack of health education adherence assessment tools for stroke patients, the assessment of health education adherence in this population is insufficient, which hinders the prevention and rehabilitation of stroke. This study aims to develop and validate a Health Education Adherence Scale for Stroke Patients (HEAS-SP). Methods A cross-sectional design with a purposive sampling method was used for this study. Six hundred and fifty-four eligible participants completed the demographic questionnaire and the HEAS-SP. The data collection lasted for 7 months, from March 1stto September 30th in 2019. Item analysis and exploratory and confirmatory factor analysis were employed to develop and validate the HEAS-SP. Results The item analysis, exploratory and confirmatory factor analysis resulted in a 20-item HEAS-SP with 4 domains: medication adherence, diet adherence, rehabilitation exercise adherence, and healthy lifestyle adherence. The four-domain model demonstrated acceptable model fit indexes and the 20-item HEAS-SP demonstrated acceptable reliability and validity. Conclusion The 20-item HEAS-SP was shown to have acceptable reliability and validity for assessing health education adherence with respect to diet, medication, rehabilitation exercise and healthy lifestyle in stroke patients, making it a potential basis for developing targeted interventions for stroke patients.
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Affiliation(s)
- Weiwei Ding
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junya Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jing Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Beibei Lin
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shihen Li
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fengzhen Li
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junyi Guo
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Yun Li
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Yue Y, Liu R, Chen J, Cao Y, Wu Y, Zhang S, Li H, Zhu J, Wu A, Yuan Y. The Reliability and Validity of Post Stroke Depression Scale in Different Type of Post Stroke Depression Patients. J Stroke Cerebrovasc Dis 2021; 31:106222. [PMID: 34839235 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE A self-rating post stroke depression scale (PSDS) showed a good reliability and validity to assess severity of depressive symptoms among stroke patients. This study aimed to retest the psychometric properties of PSDS in different types of post-stroke depression (PSD). MATERIALS AND METHODS A total of 170 stroke patients were recruited in the study. 82 and 25 patients were respectively diagnosed as PSD symptoms disorder (PSDSD) and PSD disorder (PSDD) patients according to their respective diagnostic criteria. The PSDS and the 9-item Patient Health Questionnaire (PHQ-9) were used to assess the severity of depression. Cronbach α, Spearman rank coefficient and independent sample t-test were conducted to examine reliability, internal consistency and discriminate validity. Then the receiver operating characteristic curve and Youden index were used to performance evaluation and cut-off value respectively in different subtypes of PSD patients. RESULTS The Cronbach α of PSDS was 0.857, indicting a good reliability. The Spearman correlation coefficient between PSDS and PHQ-9 was 0.942 (P<0.001). The discriminate validity displayed significant difference between PSDSD as well as PSDD and no depression patients (all P<0.001). 5/24 and 10/24 were the cut-off value for PSDSD and PSDD patients. CONCLUSIONS PSDS is a useful screen tool with an acceptable psychometric properties for estimation of different subtypes of PSD patients.
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Affiliation(s)
- Yingying Yue
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, No.87 Dingjiaqiao Road, Nanjing, Jiangsu 210009, China; Institute of Psychosomatics, Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
| | - Rui Liu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jiu Chen
- Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China; Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yin Cao
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Yanfeng Wu
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, China
| | - Shining Zhang
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Huajie Li
- Department of Neurology, Changzhou First People's Hospital, Changzhou, Jiangsu 213000, China
| | - Jijun Zhu
- Department of Neurology, Yancheng Third People's Hospital, Yancheng, Jiangsu 224000, China
| | - Aiqin Wu
- Department of Psychosomatics, The Affiliated First Hospital of Suzhou University, Suzhou, Jiangsu 215006, China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, No.87 Dingjiaqiao Road, Nanjing, Jiangsu 210009, China; Institute of Psychosomatics, Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
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Properties of the Early Symptom Measurement of Post-Stroke Depression: Concurrent Criterion Validity and Cutoff Scores. J Nurs Res 2021; 28:e107. [PMID: 32516198 DOI: 10.1097/jnr.0000000000000380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Early-stage post-stroke depression (PSD) increases the risk of stroke-related disability and mortality in the first year of recovery. Presently available screening measures were developed to assess major depression, and none used a PSD screening criterion that was systematically developed and tested in populations of patients with acute stroke. PURPOSE The purpose of this study was to evaluate the concurrent criterion validity and cutoff scoring of the Early Symptom Measurement of Post-Stroke Depression (ESM-PSD) instrument in hospitalized patients with acute stroke. METHODS Purposive recruitment of newly admitted patients yielded a qualified sample of 139 nonaphasic participants who were 7-30 days post mild-to-moderate stroke confirmed by computed tomography and magnetic resonance images. Participants responded to the ESM-PSD and Hamilton Rating Scale for Depression-24 (HAMD-24). RESULTS The mean number of post-stroke days was 11.99 (SD = 7.68). Cronbach's alpha estimates of internal consistency were ESM-PSD = .90 and HAMD-24 = .76. ESM-PSD measurement sensitivity and specificity were superior. The following three ESM-PSD cutoff scores, determined by the receiver operating characteristic curve, were used to assess clinically relevant early-symptom levels: no PSD < 14.5, low PSD = 14.5-25.5, moderate PSD = 25.5-45.5, high PSD ≥ 45.5. CONCLUSION/IMPLICATIONS FOR PRACTICE ESM-PSD cutoff scores show the expected correspondence with mild-moderate-severe HAMD-24 symptoms, which was evidenced by the high area under the receiver operating characteristic curve. Planned follow-up research will assess the efficacy of using ESM-PSD scores to detect increased risk of major depression onset in patients with acute stroke.
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Chen J, Li Y, Liu J, Zhang Y, Zeng Y, Chen M, Ding W, Lu Z, Xu H, Li J. Symptom clusters of early-stage poststroke depression: A mixed-methods study. Nurs Open 2021; 8:2488-2497. [PMID: 33471441 PMCID: PMC8363377 DOI: 10.1002/nop2.772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/20/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022] Open
Abstract
Aim To identify the symptom clusters of early‐stage poststroke depression (PSD) and provide an in‐depth understanding of the symptoms. Design A mixed‐methods study with a convenient sampling method was used. Methods A cross‐sectional questionnaire survey in 231 stroke patients and semi‐structured interviews in 14 stroke patients were conducted in the neurological department of a comprehensive hospital in Southeast China. Data from the questionnaire survey were analysed through descriptive and exploratory factor analyses; data from the semi‐structured interview were transcribed verbatim and analysed through inductive content analysis. This study adheres to the GRAMMS checklist. Results Exploratory factor analysis revealed six symptom clusters of early‐stage PSD that accounted for an ideal variance in PSD: nervous, wakefulness, emotional, dull, guilt and low mood. Further, inductive content analysis revealed five themes that were like the above symptom clusters, except for the dull symptom cluster.
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Affiliation(s)
- Junya Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yun Li
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jing Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yi Zhang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yawei Zeng
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Mengjiao Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Weiwei Ding
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Zhongqiu Lu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongbo Xu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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A Cross-sectional Study of Attention Bias for Facial Expression Stimulation in Patients with Stroke at the Convalescence Stage. Int J Behav Med 2020; 28:511-522. [PMID: 33263171 DOI: 10.1007/s12529-020-09940-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Post-stroke depression increases the likelihood of adverse physical symptoms. Attentional bias (AB) for negative stimuli is important in depression onset, maintenance, and remission. Stroke is more likely in older adults, who can have reduced cognitive function. Individuals with mild cognitive impairment (MCI) can have delayed reaction times (RTs). We hypothesized that RT to select neutral facial expression is affected by depressive symptoms and cognitive function in patients with stroke. METHODS This study analyzed 61 patients with stroke. Beck Depression Inventory-Second Edition (BDI-II) and Profile of Mood States (short version) scores were determined. Task stimuli comprised eight pairs of facial expressions containing affective (angry) and neutral faces. AB was measured as the RT to select the neutral face in two simultaneously presented images using attention bias modification (ABM) software. Patients were grouped according to depressive symptoms using BDI-II scores. Between-subject factors of depressive symptoms and cognitive function were determined by ANCOVA. RESULTS No significant interaction was found between depressive symptoms and cognitive function on RT. There was a main effect of cognitive function, but not depressive symptoms. In patients with hemiparesis and depressive symptoms, RT was significantly shorter in patients without MCI compared with patients with MCI. CONCLUSIONS People with stroke and elevated depression symptoms with hemiparesis but without MCI quickly selected neutral facial expressions from neutral and aversive expressions, and thus do not need ABM to escape aversive stimuli. ABM in response to aversive stimuli may be useful in evaluating negative emotions in individuals with post-stroke depression without MCI.
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Wen Yean C, Wan Ahmad WK, Mustafa WA, Murugappan M, Rajamanickam Y, Adom AH, Omar MI, Zheng BS, Junoh AK, Razlan ZM, Bakar SA. An Emotion Assessment of Stroke Patients by Using Bispectrum Features of EEG Signals. Brain Sci 2020; 10:E672. [PMID: 32992930 PMCID: PMC7601112 DOI: 10.3390/brainsci10100672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 01/06/2023] Open
Abstract
Emotion assessment in stroke patients gives meaningful information to physiotherapists to identify the appropriate method for treatment. This study was aimed to classify the emotions of stroke patients by applying bispectrum features in electroencephalogram (EEG) signals. EEG signals from three groups of subjects, namely stroke patients with left brain damage (LBD), right brain damage (RBD), and normal control (NC), were analyzed for six different emotional states. The estimated bispectrum mapped in the contour plots show the different appearance of nonlinearity in the EEG signals for different emotional states. Bispectrum features were extracted from the alpha (8-13) Hz, beta (13-30) Hz and gamma (30-49) Hz bands, respectively. The k-nearest neighbor (KNN) and probabilistic neural network (PNN) classifiers were used to classify the six emotions in LBD, RBD and NC. The bispectrum features showed statistical significance for all three groups. The beta frequency band was the best performing EEG frequency-sub band for emotion classification. The combination of alpha to gamma bands provides the highest classification accuracy in both KNN and PNN classifiers. Sadness emotion records the highest classification, which was 65.37% in LBD, 71.48% in RBD and 75.56% in NC groups.
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Affiliation(s)
- Choong Wen Yean
- Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis (UniMAP), Arau 02600, Perlis, Malaysia; (C.W.Y.); (M.I.O.); (B.S.Z.)
| | - Wan Khairunizam Wan Ahmad
- Faculty of Electrical Engineering Technology, Universiti Malaysia Perlis (UniMAP), Arau 02600, Perlis, Malaysia; (W.A.M.); (A.H.A.)
| | - Wan Azani Mustafa
- Faculty of Electrical Engineering Technology, Universiti Malaysia Perlis (UniMAP), Arau 02600, Perlis, Malaysia; (W.A.M.); (A.H.A.)
| | - Murugappan Murugappan
- Department of Electronics and Communication Engineering, Kuwait College of Science and Technology, Doha Area, 7th Ring Road, Kuwait City 13133, Kuwait;
| | - Yuvaraj Rajamanickam
- School of Electrical and Electronic Engineering, Nanyang Technological University (NTU), 50 Nanyang Avenue, Singapore 639798, Singapore;
| | - Abdul Hamid Adom
- Faculty of Electrical Engineering Technology, Universiti Malaysia Perlis (UniMAP), Arau 02600, Perlis, Malaysia; (W.A.M.); (A.H.A.)
| | - Mohammad Iqbal Omar
- Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis (UniMAP), Arau 02600, Perlis, Malaysia; (C.W.Y.); (M.I.O.); (B.S.Z.)
| | - Bong Siao Zheng
- Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis (UniMAP), Arau 02600, Perlis, Malaysia; (C.W.Y.); (M.I.O.); (B.S.Z.)
| | - Ahmad Kadri Junoh
- Institute of Engineering Mathematics, Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia;
| | - Zuradzman Mohamad Razlan
- Faculty of Mechanical Engineering Technology, Universiti Malaysia Perlis (UniMAP), Arau 02600, Perlis, Malaysia; (Z.M.R.); (S.A.B.)
| | - Shahriman Abu Bakar
- Faculty of Mechanical Engineering Technology, Universiti Malaysia Perlis (UniMAP), Arau 02600, Perlis, Malaysia; (Z.M.R.); (S.A.B.)
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Astuti P, Kusnanto K, Dwi Novitasari F. Depression and functional disability in stroke patients. J Public Health Res 2020; 9:1835. [PMID: 32728574 PMCID: PMC7376455 DOI: 10.4081/jphr.2020.1835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Stroke patients often suffer from depression, a mental disorder that worsens their condition and slows down the recovery process. Depression is the leading cause of functional disability due to inability to cope with daily stressors and to function independently in their activities. The purpose of this study is to analyze the relationship between depression and functional disability levels in post-stroke patients. Design and Methods: This is an analytic observational research with a cross-sectional approach. The population in exam consisted of all 4-12 week post-stroke patient in the hospital (about 139 patients). The study focused on 104 respondents, who were selected using simple random sampling techniques. Results: The results show that 62.5% stroke patients suffered mild depressive episodes after the stroke while 58.7% experienced mild disabilities. Analysis results using the Pearson Product Moment Test obtained P=0,000. This shows there is a relationship between the level of depression and the degree of functional disability in post-stroke patients. Conclusions: It can be concluded that there is a significant relationship between the levels of post-stroke depression and the functional disability. Families are expected to provide a safe, supportive, and comfortable environment to lessen the level of depression.
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Affiliation(s)
- Puji Astuti
- Doctoral Program of Public Health, Faculty of Public Health.,Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Indonesia
| | - Kusnanto Kusnanto
- Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Indonesia
| | - Ferra Dwi Novitasari
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya
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Guo L, Zauszniewski JA, Liu Y, Yv S, Zhu Y. Is resourcefulness as a mediator between perceived stress and depression among old Chinese stroke patients? J Affect Disord 2019; 253:44-50. [PMID: 31029012 DOI: 10.1016/j.jad.2019.04.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/07/2019] [Accepted: 04/21/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to explore whether resourcefulness can serve as a mediator between perceived stress and depression among old Chinese stroke patients. METHODS A cross-sectional study was conducted in six hospitals during July 2016 to July 2017, from five cities of Henan Province, China. A demographic questionnaire, the Perceived Stress Scale (PSS), the Resourcefulness Scale (RS) and the Center for Epidemiologic Studies Depression Scale (CES-D) were distributed among 3000 old stroke patients, and 2907 of them completed this survey. Correlation analysis, multiple linear regression and structural equation model (SEM) were used for statistical analysis of the study. RESULTS The total scores of the resourcefulness were negatively correlated with perceived stress (r= -0.795, P<0.01) and depression (r= -0.772, P<0.01); It indicated positive correlation of the total scores of perceived stress and depression (r = 0.820, P<0.01). Multiple regression analyses showed that resourcefulness mediated the relationship between perceived stress and depression, which reduced the effect of perceived stress on depression by 16.3% (from 0.464 to 0.301) on the subscale "sense of being out of control" and by 20.3% (from 0.411 to 0.208) on the subscale "feeling of tension" when resourcefulness was included in the model. Structural equation model validated these findings, and further confirmed that resourcefulness had a partial mediation effect (39.4% of total effect) between perceived stress and depression. LIMITATIONS This cross-sectional study does not allow for examination of the relationship between pre-stroke resourcefulness and post-stroke depression, or the potential intervening role of perceived stress. CONCLUSION Resourcefulness was found to be a mediator between perceived stress and depression, suggesting the potential benefit of an intervention to teach resourcefulness skills to decrease depression in highly stressed older Chinese stroke patients.
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Affiliation(s)
- Lina Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Jaclene A Zauszniewski
- Frances Payne Bolton School of Nursing, Case Western Reserve University. Euclid Avenue Cleveland, Ohio, USA
| | - Yanjin Liu
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan, People's Republic of China.
| | - Suyuan Yv
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yiru Zhu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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Abstract
Chinese family caregivers of dementia patients suffer considerable grief in their caregiving activity; little research has been conducted on dementia caregivers' grief in China. This study aims to (a) confirm the factor structure of the Mandarin version of the Marwit-Meuser Caregiver Grief Inventory-Short Form (MM-CGI-SF), (b) evaluate the levels of family caregivers' grief, and (c) explore the best predictors of family caregivers' grief. A cross-sectional study was conducted to collect data from 91 caregivers of dementia patients. The Mandarin version of the MM-CGI-SF had a three-factor structure. Family caregivers' grief was at an average level. Family caregivers' monthly household income and caring time per day predicted their own grief. The Mandarin version of the MM-CGI-SF possessed the same factor structure as the original English version, and the Chinese family caregivers experienced an average grief which was predicted by the monthly household income and caring time per day of the caregivers.
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Affiliation(s)
| | - Yun Li
- The First Affiliated Hospital of Wenzhou Medical University, China
| | - Ping Li
- Wenzhou Medical University, China
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13
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Li J, Li Y, Li P, Ye M. Early Symptom Measurement of Post-Stroke Depression: Development and validation of a new short version. J Adv Nurs 2018; 75:482-493. [PMID: 30375007 DOI: 10.1111/jan.13885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/21/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to develop and test the psychometric properties of the Early Symptom Measurement of Post-Stroke Depression-Short Form (ESMPSD-SF). BACKGROUND The ESMPSD is a specific measurement tool designed to detect early depressive symptoms in acute stroke patients, but it is too long for use in busy clinical settings. DESIGN A psychometric study was conducted. METHODS Five hundred and twenty-one post-stroke patients completed two questionnaires, the demographic and the ESMPSD questionnaire, over a period of 10 months, from July 2016-April 2017. The item reduction process was used to reduce the number of items in the ESMPSD questionnaire and consisted of item analysis, exploratory, and confirmatory factor analysis. RESULTS The item reduction process resulted in a 12-item short version questionnaire with evidence of acceptable construct validity and internal reliability. Four factors explaining high total variance were extracted: "low," "guilt," "emotional," and "wakefulness". Estimates of all confirmatory model fit indices met the standard criteria. All standardized factor loading estimates of the 12 items met the standard criteria and the variances explained by the items were acceptable. Moreover, internal reliability estimates of the 12-item questionnaire were acceptable, and the corrected item-total correlation and item-subscale correlation also demonstrated evidence of acceptable reliability of the short form questionnaire. CONCLUSIONS The ESMPSD-SF demonstrates evidence of acceptable reliability and validity to screen early depressive symptoms in acute stroke patients in busy clinical settings.
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Affiliation(s)
- Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yun Li
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ping Li
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Maiyun Ye
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Noveletto F, Soares AV, Mello BA, Sevegnani CN, Eichinger FLF, Hounsell MDS, Bertemes-Filho P. Biomedical Serious Game System for Balance Rehabilitation of Hemiparetic Stroke Patients. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2179-2188. [PMID: 30334802 DOI: 10.1109/tnsre.2018.2876670] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hemiparetic stroke patients can have several muscular and postural disorders which compromise their balance. Serious games (SG) emerged as a new approach to enhance conventional treatment by making it a motivating method to meet individual needs. This paper evaluated the therapeutic effects of a biomedical SG system developed for balance evaluation and training of hemiparetic stroke patients. The system consists of a balance board with inertial sensors and a computer system that runs the game. A novel scoring system for balance evaluation, which extracts metric information regarding patients' performance while gaming, was proposed. A quasi-experimental study was performed with six hemiparetic patients in an exercise program using the SG twice per week for 10 weeks. Twelve healthy subjects were recruited for determining the baseline score for balance by using the proposed system. Significant effect sizes (ES) were observed for dynamic balance (ES = 0.9), functional mobility (ES = 0.4), and center of pressure displacement of the balance board (ES = 1.9).Significant correlations between game scores and clinical scales suggest that the use of the scoring system for balance evaluation is feasible. The results of this paper support the clinical potential of a biomedical SG for balance rehabilitation of hemiparetic stroke patients.
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Guo LN, Liu YJ, McCallum J, Söderhamn U, Ding XF, Yv SY, Zhu YR, Guo YR. Perceived stress and depression amongst older stroke patients: Sense of coherence as a mediator? Arch Gerontol Geriatr 2018; 79:164-170. [PMID: 30265911 DOI: 10.1016/j.archger.2018.08.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to explore the relationship between perceived stress, sense of coherence, and depression among older stroke patients. METHODS A demographic questionnaire, the Perceived Stress Scale (PSS), the Sense of Coherence Scale (SOC) and the Center for Epidemiologic Studies Depression Scale (CES-D) were distributed to 3000 older stroke patients from Neurology wards in six large general hospitals, and 2907 individuals completed the survey. Data analysis consisted of correlation, multiple linear regression, and structural equation modeling. RESULTS The total score of the SOC and perceived stress showed a negative correlation (r = -0.80, P < 0.01), the total SOC of coherence and depression also resulted in a negative correlation (r = -0.77, P < 0.01), and the total score of the perceived stress and depression resulted in a positive correlation (r = 0.82, P < 0.01). The results of multiple regression analyses indicated that SOC mediated the association between perceived stress and depression, and the influence of perceived stress on depression was decreased by 16.0%with in the sense of being out of control dimension and was decreased by 12.3% within the feeling of tension dimension when sense of coherence was added to the model. The structural equation model confirmed that the sense of coherence had a partial mediation effect between perceived stress and depression. CONCLUSION SOC is the mediating variable between perceived stress and depression, and can reduce the influence of perceived stress on depression.
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Affiliation(s)
- Li-Na Guo
- Department of Neurology, the first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yan-Jin Liu
- Department of Nursing, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
| | - Jacqueline McCallum
- Department of Nursing & Community Health, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Ulrika Söderhamn
- Faculty of Health and Sport Sciences, Department of Health and Nursing Sciences, University of Agder, Grimstad, Aust-Agder, Norway.
| | - Xian-Fei Ding
- Department of Integrated ICU, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - Su-Yuan Yv
- Department of Neurology, the first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yi-Ru Zhu
- Department of Neurology, the first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yv-Ru Guo
- Department of Osteology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
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