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Schwertfeger JL, Miller SA, Jordan M, Jordan D, Schneider KL. A 3-day 'stroke camp' addressed chronic disease self-management elements and perceived stress of survivors of stroke and their caregivers reduced: Survey results from the 14 US camps. Top Stroke Rehabil 2024; 31:1-10. [PMID: 37004716 DOI: 10.1080/10749357.2023.2196468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Stroke is a leading cause of disability for persons with stroke (PWS). Difficulty coping with long-term stress for PWS and their caregivers (CG) contributes to their poor health. Variations of chronic-disease self-management programs (CDSMPs) have reduced long-term stress in PWS and CGs. CDSMPs include training for decision-making, problem-solving, resource utilization, peer support, developing a patient-provider relationship, and environmental support. OBJECTIVE This study examined whether a user-designed stroke camp addressed CDSMP domains, used consistent activities, and decreased stress in PWS and CG. METHODS This open cohort survey study followed STROBE guidelines and assessed stress at four timepoints: 1 week before camp, immediately before camp, immediately after camp, and 1 month after camp. Mixed-model analysis examined changes in stress from the two baseline time points to the two post-camp time points. The research team reviewed documents and survey responses to assess activities described in camp documents and CDSMP domains across camps. POPULATION PWS and CG who attended a camp in 2019. The PWS sample (n = 40) included50% males, aged 1-41-years post stroke, 60% with ischemic, one-third with aphasia, and 37.5% with moderate-severe impairment. CG sample (n = 24) was 60.8% female, aged 65.5 years, and had 7.4 years CG experience. RESULTS Stress decreased significantly in PWS (Cohen's d = -0.61) and CGs (Cohen's d = -0.87) from pre- to post-camp. Activities addressing all but one CDSMP domains were evident across camps. CONCLUSIONS Stroke camp is a novel model that addresses CDSMP domains, which may reduce stress in PWS and CG. Larger, controlled studies are warranted.
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Affiliation(s)
- Julie Lynn Schwertfeger
- Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Steven A Miller
- Psychology, Rosalind Franklin University of Medicine and Science College of Health Professions, North Chicago, IL, USA
| | | | - Dean Jordan
- Spring Grove Fire Protection District. BattalionChief, Spring Grove, IL, USA
| | - Kristin L Schneider
- Rosalind Franklin University of Medicine& Science, College of Health Professions, North Chicago, IL, USA
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Gillam W, Godbole N, Sangam S, DeTommaso A, Foreman M, Lucke-Wold B. Neurologic Injury-Related Predisposing Factors of Post-Traumatic Stress Disorder: A Critical Examination. Biomedicines 2023; 11:2732. [PMID: 37893106 PMCID: PMC10604790 DOI: 10.3390/biomedicines11102732] [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: 08/31/2023] [Revised: 09/30/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
The present review aimed to identify the means through which neurologic injury can predispose individuals to Post-Traumatic Stress Disorder (PTSD). In recent years, comprehensive studies have helped to clarify which structures in the central nervous system can lead to distinct PTSD symptoms-namely, dissociative reactions or flashbacks-when damaged. Our review narrowed its focus to three common neurologic injuries, traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and stroke. We found that in each of the three cases, individuals may be at an increased risk of developing PTSD symptoms. Beyond discussing the potential mechanisms by which neurotrauma may lead to PTSD, we summarized our current understanding of the pathophysiology of the disorder and discussed predicted associations between the limbic system and PTSD. In particular, the effect of noradrenergic neuromodulatory signaling on the hypothalamic pituitary adrenal (HPA) axis as it pertains to fear memory recall needs to be further explored to better understand its effects on limbic structures in PTSD patients. At present, altered limbic activity can be found in both neurotrauma and PTSD patients, suggesting a potential causative link. Particularly, changes in the function of the limbic system may be associated with characteristic symptoms of PTSD such as intrusive memories and acute psychological distress. Despite evidence demonstrating the correlation between neurotrauma and PTSD, a lack of PTSD prognosis exists in TBI, SAH, and stroke patients who could benefit from early treatment. It should be noted that PTSD symptoms often compound with pre-existing issues, further deteriorating health outcomes for these patients. It is ultimately our goal to clarify the relationship between neurotrauma and PTSD so that earlier diagnoses and appropriate treatment are observed in clinic.
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Affiliation(s)
- Wiley Gillam
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (W.G.)
| | - Nikhil Godbole
- School of Medicine, Tulane University, New Orleans, LA 70112, USA;
| | - Shourya Sangam
- College of Liberal Arts and Sciences, University of Florida, Gainesville, FL 32603, USA
| | - Alyssa DeTommaso
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL 32827, USA
| | - Marco Foreman
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (W.G.)
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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3
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Wagner F, Rogenz J, Opitz L, Maas J, Schmidt A, Brodoehl S, Ullsperger M, Klingner CM. Reward network dysfunction is associated with cognitive impairment after stroke. Neuroimage Clin 2023; 39:103446. [PMID: 37307650 PMCID: PMC10276182 DOI: 10.1016/j.nicl.2023.103446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023]
Abstract
Stroke survivors not only suffer from severe motor, speech and neurocognitive deficits, but in many cases also from a "lack of pleasure" and a reduced motivational level. Especially apathy and anhedonic symptoms can be linked to a dysfunction of the reward system. Rewards are considered as important co-factor for learning, so the question arises as to why and how this affects the rehabilitation of stroke patients. We investigated reward behaviour, learning ability and brain network connectivity in acute (3-7d) mild to moderate stroke patients (n = 28) and age-matched healthy controls (n = 26). Reward system activity was assessed using the Monetary Incentive Delay task (MID) during magnetoencephalography (MEG). Coherence analyses were used to demonstrate reward effects on brain functional network connectivity. The MID-task showed that stroke survivors had lower reward sensitivity and required greater monetary incentives to improve performance and showed deficits in learning improvement. MEG-analyses showed a reduced network connectivity in frontal and temporoparietal regions. All three effects (reduced reward sensitivity, reduced learning ability and altered cerebral connectivity) were found to be closely related and differed strongly from the healthy group. Our results reinforce the notion that acute stroke induces reward network dysfunction, leading to functional impairment of behavioural systems. These findings are representative of a general pattern in mild strokes and are independent of the specific lesion localisation. For stroke rehabilitation, these results represent an important point to identify the reduced learning capacity after stroke and to implement individualised recovery exercises accordingly.
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Affiliation(s)
- Franziska Wagner
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany.
| | - Jenny Rogenz
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Laura Opitz
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Johanna Maas
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Alexander Schmidt
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Stefan Brodoehl
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Markus Ullsperger
- Faculty of Natural Sciences, Institute of Psychology, 39106 Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Otto-von-Guericke University Magdeburg, Germany
| | - Carsten M Klingner
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
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4
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Quality of life and mood disorders of mild to moderate stroke survivors in the early post-hospital discharge phase: a cross-sectional survey study. BMC Psychol 2023; 11:32. [PMID: 36721206 PMCID: PMC9890754 DOI: 10.1186/s40359-023-01068-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Exploring sociodemographic and disease characteristics that contribute to patient-reported outcomes can inform targeting of strategies to support recovery and adaptation to stroke. This study aimed to examine among a sample of stroke survivors at three months post-hospital discharge: (1) self-reported physical and mental health quality of life scores; (2) self-reported depressive and anxiety symptoms; and (3) sociodemographic and clinical predictors of these outcomes. METHODS This cross-sectional survey study recruited stroke survivors from eight hospitals in one Australian state. Adult survivors recently discharged from hospital stroke wards (within 3 months) were mailed a study information package and invited to complete a pen-and paper survey. Survey items assessed: quality of life (SF12v2), depression (PHQ-9), anxiety (GAD-7) and sociodemographic and clinical characteristics. Predictors were examined using multiple linear regression analysis. RESULTS Of the 1161 eligible patients who were posted a recruitment pack, 401 (35%) returned a completed survey. Participants reported a mean SF-12v2 Physical Composite Score (PCS) quality of life score of 44.09 (SD = 9.57); and a mean SF-12v2 Mental Composite Score (MCS) quality of life score of 46.84 (SD = 10.0). Approximately one third of participants (34%; n = 132) were classified as depressed (PHQ-9 ≥ 10); and 27% (n = 104) were classified as anxious (GAD-7 ≥ 8). Lower PCS was associated with being female, not employed and having a comorbid diagnosis of diabetes and atrial fibrillation. Lower MCS was associated with a history of transient ischemic attack (TIA). Males and those with higher levels of education, had greater odds of having lower depression severity; those with a history of TIA or diabetes had lower odds of having lower depression severity. Males had greater odds of having lower anxiety severity; those with a history of TIA had lower odds of having lower anxiety severity. CONCLUSION Sub-groups of stroke survivors may be at-risk of poorer quality of life and psychological morbidity in the early post-discharge phase. These findings support the role of early identification and prioritisation of at-risk survivors at discharge, as they may require modifications to standard hospital discharge processes tailored to their level of risk.
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5
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Hung KC, Wu JY, Illias AM, Chiu CC, Chang YJ, Liao SW, Wang KF, Chen IW, Sun CK. Association of a low vitamin D status with risk of post-stroke depression: A meta-analysis and systematic review. Front Nutr 2023; 10:1142035. [PMID: 36875853 PMCID: PMC9983120 DOI: 10.3389/fnut.2023.1142035] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
Background Although post-stroke depression (PSD) affects one-third of patients following an acute stroke, pooled evidence addressing the correlation between a low vitamin D status and the risk of PSD remains inconclusive. Methods Comprehensive database search of Medline, EMBASE, Cochrane library, and Google Scholar was performed from inception to December 2022. The primary outcome was the association of PSD risk with a low vitamin D status, while the secondary outcomes included the relationship between PSD and other risk factors. Results Analysis of seven observational studies published between 2014 and 2022 with 1,580 patients showed pooled incidences of vitamin D deficiency (defined as 25[OH] D levels < 50 nmol/L) and PSD of 60.1 and 26.1%, respectively. Patients with PSD had a lower circulating vitamin D concentration compared to those without [mean difference (MD) =-13.94 nmol/L, 95% CI: -21.83 to -6.05, p = 0.0005, I 2 = 91%, six studies, 1,414 patients]. Meta-analysis also demonstrated a correlation between a low vitamin D level and an increased PSD risk [odd ratio (OR) = 3.25, 95% CI: 1.57-6.69, p = 0.001, I 2 = 78.7%, 1,108 patients], the heterogeneity of which was found to be associated with the incidence of vitamin D deficiency but not female proportion on meta-regression. Besides, female gender (OR = 1.78, 95% CI: 1.3-2.44, p = 0.003, I 2 = 31%, five studies, 1,220 patients), hyperlipidemia (OR = 1.55, 95% CI: 1.01-2.36, p = 0.04, I 2 = 0%, four studies, 976 patients), and high National Institutes of Health Stroke Scale (NIHSS) scores (MD = 1.45, 95% CI: 0.58-2.32, p = 0.001, I 2 = 82%, five studies, 1,220 patients) were potential risk factors for PSD. For the primary outcome, the certainty of evidence was very low. Regarding secondary outcomes, the certainty of evidence was low for BMI, female gender, hypertension, diabetes, and stroke history, and very low for age, level of education, hyperlipidemia, cardiovascular disease, and NIHSS scores. Conclusion The results suggested an association of a low circulating vitamin D level with an increased risk of PSD. Besides, female gender, hyperlipidemia, high NIHSS score were related to an increased risk or occurrence of PSD. The current study may imply the necessity of routine circulating vitamin D screening in this population. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022381580.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.,School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
| | - Amina M Illias
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, Kaohsiung City, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan.,Department of Medical Education and Research, E-Da Cancer Hospital, Kaohsiung City, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Shu-Wei Liao
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Kuei-Fen Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Cheuk-Kwan Sun
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan.,Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
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6
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Pan C, Li G, Sun W, Miao J, Qiu X, Lan Y, Wang Y, Wang H, Zhu Z, Zhu S. Neural Substrates of Poststroke Depression: Current Opinions and Methodology Trends. Front Neurosci 2022; 16:812410. [PMID: 35464322 PMCID: PMC9019549 DOI: 10.3389/fnins.2022.812410] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/04/2022] [Indexed: 12/21/2022] Open
Abstract
Poststroke depression (PSD), affecting about one-third of stroke survivors, exerts significant impact on patients’ functional outcome and mortality. Great efforts have been made since the 1970s to unravel the neuroanatomical substrate and the brain-behavior mechanism of PSD. Thanks to advances in neuroimaging and computational neuroscience in the past two decades, new techniques for uncovering the neural basis of symptoms or behavioral deficits caused by focal brain damage have been emerging. From the time of lesion analysis to the era of brain networks, our knowledge and understanding of the neural substrates for PSD are increasing. Pooled evidence from traditional lesion analysis, univariate or multivariate lesion-symptom mapping, regional structural and functional analyses, direct or indirect connectome analysis, and neuromodulation clinical trials for PSD, to some extent, echoes the frontal-limbic theory of depression. The neural substrates of PSD may be used for risk stratification and personalized therapeutic target identification in the future. In this review, we provide an update on the recent advances about the neural basis of PSD with the clinical implications and trends of methodology as the main features of interest.
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7
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Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Factors impacting the access and use of formal health and social services by caregivers of stroke survivors: an interpretive description study. BMC Health Serv Res 2022; 22:433. [PMID: 35365130 PMCID: PMC8975449 DOI: 10.1186/s12913-022-07804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence has shown that family and friend caregivers of stroke survivors are significantly and negatively impacted by caregiving. The negative effects of caregiving may persist over time suggesting that caregivers might benefit from ongoing engagement with supportive services. However, little is known about caregivers' use of formally funded health and social services, or the factors influencing their access to and use of these services. The aim of this study is to increase understanding of the factors that influence stroke caregivers' access and use of formal health and social services, from the perspective of stroke caregivers and healthcare providers. METHODS A qualitative study was conducted with stroke caregivers and health providers in Ontario, Canada using interpretive description. In-depth interviews were conducted with caregivers of survivors who experienced a stroke between six months to five years previous and healthcare providers who support caregivers and stroke survivors. All participants provided written informed consent. Interview data were analyzed using constant comparison to identify codes and develop key thematic constructs. RESULTS A total of 40 interviews were conducted with 22 stroke caregivers at an average 30-months post-stroke and 18 health providers. Factors that influenced stroke caregivers' access and use of services included: finances and transportation; challenges caregivers faced in caring for their health; trust that they could leave their family member and trust in health providers; limited information pertaining to services and a lack of suitable services; and the response of their social networks to their caregiving situation. CONCLUSION Stroke caregivers experience significant challenges in accessing and using formal health and social services. These challenges could be addressed by increasing availability of subsidized community-based supports such as respite and counselling tailored to meet the ongoing needs of caregivers. Systemic change is needed by the health system that readily includes and supports caregivers throughout the stroke recovery continuum, particularly in the community setting.
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Affiliation(s)
- Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada.,McMaster University, 1280 Main St. W, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada.,McMaster University, 1280 Main St. W, Hamilton, ON, Canada
| | - Patricia H Strachan
- School of Nursing, McMaster University, Hamilton, ON, Canada.,McMaster University, 1280 Main St. W, Hamilton, ON, Canada
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Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Formal Health and Social Services That Directly and Indirectly Benefit Stroke Caregivers: A Scoping Review of Access and Use. Can J Nurs Res 2022; 54:211-233. [PMID: 35130749 PMCID: PMC9109593 DOI: 10.1177/08445621211019261] [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] [Indexed: 11/21/2022] Open
Abstract
Stroke can be a life altering event that necessitates considerable amounts of
formal and informal care. The impacts of stroke often persist over time
requiring ongoing support for stroke survivors. Family members provide the
majority of care and experience many life changes as a result of their
caregiving role including social, financial, employment and health impacts.
Formal supports such as counselling, respite, and health promotion initiatives
that directly benefit caregivers or benefit them indirectly through supporting
the stroke survivor, are well-placed to help caregivers manage their caregiving
role. However, to date little is known about formal service use by stroke
caregivers and the factors that influence their service use. This scoping review
provides a critique and synthesis of what is known about stroke caregivers’
access and use of formal services intended to support them. Findings suggest
that while services are available, caregivers’ ability to use them are impacted
by both facilitators and barriers. Facilitators included: sex, age, and having a
higher household income (depending on services used). Barriers included: high
cost, poor service quality and deficient knowledge/communication regarding
service availability. This review highlights a significant gap in our knowledge
of caregivers’ experience in accessing and using formal services.
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Affiliation(s)
- Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada
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Chris F, Nicholas B, Jane M, Alan S, Sarah N, Shirley T, Kimberley G, Sally M, Jofre-Bonet M, Katerina H. A pilot economic evaluation of a feasibility trial for SUpporting wellbeing through PEeR-Befriending (SUPERB) for post-stroke aphasia. Clin Rehabil 2022; 36:683-692. [PMID: 35108114 PMCID: PMC8941719 DOI: 10.1177/02692155211063554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To explore the feasibility of a full economic evaluation of usual care plus
peer-befriending versus usual care control, and potential cost-effectiveness
of peer-befriending for people with aphasia. To report initial costs, ease
of instruments’ completion and overall data completeness. Design Pilot economic evaluation within a feasibility randomised controlled
trial Setting Community, England Participants People with post-stroke aphasia and low levels of psychological distress Intervention All participants received usual care; intervention participants received six
peer-befriending visits between randomisation and four months Main measures Costs were collected on the stroke-adapted Client Service Receipt Inventory
(CSRI) for health, social care and personal out-of-pocket expenditure
arising from care for participants and carers at 4- and 10-months
post-randomisation. Health gains and costs were reported using the General
Health Questionnaire-12 and the EQ-5D-5L. Mean (CI) differences for costs
and health gains were reported and uncertainty represented using
non-parametric bootstrapping and cost-effectiveness acceptability
curves. Results 56 participants were randomised. Mean age was 70.1 (SD 13.4). Most
(n = 37, 66%) had mild and many
(n = 14; 25%) severe aphasia. There was ≥94% completion of
CSRI questions. Peer-befriending was higher in intervention arm
(p < 0.01) but there were no significant differences
in total costs between trial arms. Peer-befriending visits costed on average
£57.24 (including training and supervision costs). The probability of
peer-befriending being cost-effective ranged 39% to 66%. Conclusions Economic data can be collected from participants with post-stroke aphasia,
indicating a full economic evaluation within a definitive trial is feasible.
A larger study is needed to demonstrate further cost-effectiveness of
peer-befriending.
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Affiliation(s)
- Flood Chris
- School of Health and Social Care, 4914London South Bank University, London, UK
| | - Behn Nicholas
- Centre for Language and Communication Sciences Research, School of Health Sciences, City, University of London, London, UK
| | - Marshall Jane
- Centre for Language and Communication Sciences Research, School of Health Sciences, City, University of London, London, UK
| | - Simpson Alan
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London, UK
| | - Northcott Sarah
- Centre for Language and Communication Sciences Research, School of Health Sciences, City, University of London, London, UK
| | - Thomas Shirley
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | | | - McVicker Sally
- Centre for Language and Communication Sciences Research, School of Health Sciences, City, University of London, London, UK
| | | | - Hilari Katerina
- Centre for Language and Communication Sciences Research, School of Health Sciences, City, University of London, London, UK
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10
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Wang X, Simons K, Gammonley D, Roberts AR, Bern-Klug M. Social Service Directors' Roles and Self-Efficacy in Suicide Risk Management in US Nursing Homes. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:791-810. [PMID: 34420479 DOI: 10.1080/01634372.2021.1936331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
Nursing home (NH) residents have many risk factors for suicide in later life and transitions into and out of NHs are periods of increased suicide risk. The purpose of this study was to describe NH social service directors (SSDs) roles in managing suicide risk and to identify factors that influence self-efficacy in this area. This study used data from the 2019 National Nursing Home Social Services Directors survey (n = 924). One-fifth (19.7%) of SSDs reported a lack of self-efficacy in suicide risk management, as indicated by either needing significant preparation time or being unable to train others on intervening with residents at risk for suicide. Ordinal logistic regression identified SSDs who were master's prepared, reported insufficient social service staffing as a minor barrier (versus a major barrier) to psychosocial care, and those most involved in safety planning for suicide risk were more likely to report self-efficacy for training others. Implications include the need for targeted training of NH social service staff on suicide prevention, such as safety planning as an evidence-based practice. Likewise, sufficient staffing of qualified NH social service providers is critically important given the acute and chronic mental health needs of NH residents.
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Affiliation(s)
- Xiaochuan Wang
- School of Social Work, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
| | - Kelsey Simons
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Denise Gammonley
- School of Social Work, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
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11
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Moss B, Northcott S, Behn N, Monnelly K, Marshall J, Thomas S, Simpson A, Goldsmith K, McVicker S, Flood C, Hilari K. 'Emotion is of the essence. … Number one priority': A nested qualitative study exploring psychosocial adjustment to stroke and aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:594-608. [PMID: 33826205 DOI: 10.1111/1460-6984.12616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Stroke and aphasia can have a profound impact on people's lives, and depression is a common, frequently persistent consequence. Social networks also suffer, with poor social support associated with worse recovery. It is essential to support psychosocial well-being post-stroke, and examine which factors facilitate successful adjustment to living with aphasia. AIMS In the context of a feasibility randomized controlled trial of peer-befriending (SUPERB), this qualitative study explores adjustment for people with aphasia in the post-acute phase of recovery, a phase often neglected in previous research. METHODS & PROCEDURES Semi-structured interviews were conducted with 20 people with aphasia and 10 significant others, who were purposively sampled from the wider group of 56 people with aphasia and 48 significant others. Interviews took place in participants' homes; they were analysed using framework analysis. OUTCOMES & RESULTS Participants with aphasia were 10 women and 10 men; their median (interquartile range-IQR) age was 70 (57.5-77.0) years. Twelve participants had mild aphasia, eight moderate-severe aphasia. Significant others were six women and four men with a median (IQR) age of 70.5 (43-79) years. They identified a range of factors that influenced adjustment to aphasia post-stroke. Some were personal resources, including mood and emotions; identity/sense of self; attitude and outlook; faith and spirituality; and moving forward. Significant others also talked about the impact of becoming carers. Other factors were external sources of support, including familial and other relationships; doctors, nurses and hospital communication; life on the ward; therapies and therapists; psychological support, stroke groups; and community and socializing. CONCLUSIONS & IMPLICATIONS To promote adjustment in the acute phase, hospital staff should prioritize the humanizing aspects of care provision. In the post-acute phase, clinicians play an integral role in supporting adjustment and can help by focusing on relationship-centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy. What this paper adds What is already known on the subject Anxiety and depression are common consequences of stroke, with depression rates high at 33% at 1 year post-onset. There is evidence that the psychological needs of people with aphasia are even greater than those of the general stroke population. Social support and social networks are also negatively impacted. Few studies have examined adjustment when people are still in hospital or in the early stages of post-stroke life in the community (< 6 months). Further, many stroke studies exclude people with aphasia. What this paper adds to existing knowledge Adjustment to living with stroke and aphasia begins in the early stages of recovery. While this partly depends on personal resources, many factors depend on external sources of help and support. These include doctors, nurses and hospital communication, their experience of life on the ward, and their therapists' person-centred care. What are the potential or actual clinical implications of this work? Clinicians play an integral role in facilitating people with aphasia to utilize their personal resources and support systems to adjust to life after stroke. They can help by focusing on relationship-centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy.
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Affiliation(s)
- Becky Moss
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Sarah Northcott
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nicholas Behn
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Katie Monnelly
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Jane Marshall
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Shirley Thomas
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care and Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kimberley Goldsmith
- Biostatistics Department, Division of Psychology and Systems Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sally McVicker
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
- Aphasia Re-Connect, London, UK
| | - Chris Flood
- School of Health and Social Care, London South Bank University, London, UK
| | - Katerina Hilari
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
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12
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Hilari K, Behn N, James K, Northcott S, Marshall J, Thomas S, Simpson A, Moss B, Flood C, McVicker S, Goldsmith K. Supporting wellbeing through peer-befriending (SUPERB) for people with aphasia: A feasibility randomised controlled trial. Clin Rehabil 2021; 35:1151-1163. [PMID: 33624514 PMCID: PMC8273536 DOI: 10.1177/0269215521995671] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To determine the feasibility and acceptability of peer-befriending, for people with aphasia. Design: Single-blind, parallel-group feasibility randomised controlled trial comparing usual care to usual care + peer-befriending. Participants and setting: People with aphasia post-stroke and low levels of distress, recruited from 5 NHS Hospitals and linked community services; their significant others; and 10 befrienders recruited from community. Intervention: Six 1-hour peer-befriending visits over three months. Main measures: Feasibility parameters included proportion eligible of those screened; proportion consented; missing data; consent and attrition rates. Acceptability was explored through qualitative interviews. Outcomes for participants and significant others were measured at baseline, 4- and 10-months; for peer-befrienders before training and after one/two cycles of befriending. Results: Of 738 patients identified, 75 were eligible of 89 fully screened (84%), 62 consented (83% of eligible) and 56 randomised. Attrition was 16%. Adherence was high (93% attended ⩾2 sessions, 81% all six). The difference at 10 months on the GHQ-12 was 1.23 points on average lower/better in the intervention arm (95% CI 0.17, −2.63). There was an 88% decrease in the odds of GHQ-12 caseness (95% CI 0.01, 1.01). Fourty-eight significant others and 10 peer-befrienders took part. Procedures and outcome measures were acceptable. Serious adverse events were few (n = 10, none for significant others and peer-befrienders) and unrelated. Conclusions: SUPERB peer-befriending for people with aphasia post-stroke experiencing low levels of distress was feasible. There was preliminary evidence of benefit in terms of depression. Peer-befriending is a suitable intervention to explore further in a definitive trial. Clinical trial registration-URL:http://www.clinicaltrials.gov Unique identifier: NCT02947776 Subject terms: Translational research, mental health, rehabilitation, quality and outcomes, stroke
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Affiliation(s)
- Katerina Hilari
- Centre for Language and Communication Science Research, City, University of London, London, UK
| | - Nicholas Behn
- Centre for Language and Communication Science Research, City, University of London, London, UK
| | - Kirsty James
- King's Clinical Trials Unit, King's College London, London, UK
| | - Sarah Northcott
- Centre for Language and Communication Science Research, City, University of London, London, UK
| | - Jane Marshall
- Centre for Language and Communication Science Research, City, University of London, London, UK
| | | | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Becky Moss
- Centre for Language and Communication Science Research, City, University of London, London, UK
| | - Chris Flood
- School of Health and Social Care, London South Bank University, London, UK
| | - Sally McVicker
- Centre for Language and Communication Science Research, City, University of London, London, UK
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13
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Etherton MR, Shah S, Haolin X, Xian Y, Maisch L, Hannah D, Lindholm B, Lytle B, Thomas L, Smith EE, Fonarow GC, Schwamm LH, Bhatt DL, Hernandez AF, O'Brien EC. Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors. Stroke Vasc Neurol 2021; 6:384-394. [PMID: 33526632 PMCID: PMC8485250 DOI: 10.1136/svn-2020-000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/10/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Depression is common after stroke and is often treated with antidepressant medications (AD). ADs have also been hypothesised to improve stroke recovery, although recent randomised trials were neutral. We investigated the patterns of in-hospital AD initiation after ischaemic stroke and association with clinical and readmission outcomes. Methods All Medicare fee-for-service beneficiaries aged 65 or older hospitalised for ischaemic stroke in participating Get With The Guidelines-Stroke hospitals between April and December 2014 were eligible for this analysis. Outcome measures included days alive and not in a healthcare institution (home time), all-cause mortality and readmission within 1-year postdischarge. Propensity score (PS)-adjusted logistic regression models were used to evaluate the associations between AD use and each outcome measure. We also compared outcomes in patients prescribed selective serotonin reuptake inhibitors (SSRIs) AD versus those prescribed non-SSRI ADs. Results Of 21 805 AD naïve patients included in this analysis, 1835 (8.4%) were started on an AD at discharge. Patients started on an AD had higher rates of depression and prior ischaemic stroke, presented with higher admission National Institutes of Health Stroke Scale score and were less likely to be discharged home. Similarly, patients started on an SSRI had lower rates of discharge to home. Adjusting for stroke severity, patients started on an AD had worse all-cause mortality, all-cause readmission, major adverse cardiac events, readmission for depression and decreased home-time. However, AD use was also associated with an increased risk for the sepsis, a falsification endpoint, suggesting the presence of residual confounding. Conclusions Patients with ischaemic stroke initiated on AD therapy are at increased risk of poor clinical outcomes and readmission even after PS adjustment, suggesting that poststroke depression requiring medication is a poor prognostic sign. Further research is needed to explore the reasons why depression is associated with worse outcome, and whether AD treatment modifies this risk or not.
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Affiliation(s)
- Mark R Etherton
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shreyansh Shah
- Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Xu Haolin
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Ying Xian
- Neurology, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | | | | | | | - Barbara Lytle
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Laine Thomas
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Eric E Smith
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gregg C Fonarow
- Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Lee H Schwamm
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Deepak L Bhatt
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Emily C O'Brien
- Population Health, Duke Clinical Research Institute, Durham, North Carolina, USA
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14
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Sarkar A, Sarmah D, Datta A, Kaur H, Jagtap P, Raut S, Shah B, Singh U, Baidya F, Bohra M, Kalia K, Borah A, Wang X, Dave KR, Yavagal DR, Bhattacharya P. Post-stroke depression: Chaos to exposition. Brain Res Bull 2020; 168:74-88. [PMID: 33359639 DOI: 10.1016/j.brainresbull.2020.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022]
Abstract
Cerebral ischemia contributes to significant disabilities worldwide, impairing cognitive function and motor coordination in affected individuals. Stroke has severe neuropsychological outcomes, the major one being a stroke. Stroke survivors begin to show symptoms of depression within a few months of the incidence that overtime progresses to become a long-term ailment. As the pathophysiology for the progression of the disease is multifactorial and complex, it limits the understanding of the disease mechanism completely. Meta-analyses and randomized clinical trials have shown that intervening early with tricyclic antidepressants and selective serotonin receptor inhibitors can be effective. However, these pharmacotherapies possess several limitations that have given rise to newer approaches such as brain stimulation, psychotherapy and rehabilitation therapy, which in today's time are gaining attention for their beneficial results in post-stroke depression (PSD). The present review highlights numerous factors like lesion location, inflammatory mediators and genetic abnormalities that play a crucial role in the development of depression in stroke patients. Further, we have also discussed various mechanisms involved in post-stroke depression (PSD) and strategies for early detection and diagnosis using biomarkers that may revolutionize treatment for the affected population. Towards the end, along with the preclinical scenario, we have also discussed the various treatment approaches like pharmacotherapy, traditional medicines, psychotherapy, electrical stimulation and microRNAs being utilized for effectively managing PSD.
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Affiliation(s)
- Ankan Sarkar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Deepaneeta Sarmah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Aishika Datta
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Harpreet Kaur
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Priya Jagtap
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Swapnil Raut
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Birva Shah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Upasna Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Falguni Baidya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Mariya Bohra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Kiran Kalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Anupom Borah
- Cellular and Molecular Neurobiology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, Assam, India
| | - Xin Wang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Kunjan R Dave
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pallab Bhattacharya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India.
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15
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Thomas SA, Drummond AE, Lincoln NB, Palmer RL, das Nair R, Latimer NR, Hackney GL, Mandefield L, Walters SJ, Hatton RD, Cooper CL, Chater TF, England TJ, Callaghan P, Coates E, Sutherland KE, Eshtan SJ, Topcu G. Behavioural activation therapy for post-stroke depression: the BEADS feasibility RCT. Health Technol Assess 2020; 23:1-176. [PMID: 31524133 DOI: 10.3310/hta23470] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is currently insufficient evidence for the clinical effectiveness and cost-effectiveness of psychological therapies for post-stroke depression. OBJECTIVE To evaluate the feasibility of undertaking a definitive trial to evaluate the clinical effectiveness and cost-effectiveness of behavioural activation (BA) compared with usual stroke care for treating post-stroke depression. DESIGN Parallel-group, feasibility, multicentre, randomised controlled trial with nested qualitative research and a health economic evaluation. SETTING Acute and community stroke services in three sites in England. PARTICIPANTS Community-dwelling adults 3 months to 5 years post stroke who are depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) or the Visual Analogue Mood Scales 'Sad' item. Exclusions: patients who are blind and/or deaf, have dementia, are unable to communicate in English, do not have mental capacity to consent, are receiving treatment for depression at the time of stroke onset or are currently receiving psychological intervention. RANDOMISATION AND BLINDING Participants were randomised (1 : 1 ratio) to BA or usual stroke care. Randomisation was conducted using a computer-generated list with random permuted blocks of varying sizes, stratified by site. Participants and therapists were aware of the allocation, but outcome assessors were blind. INTERVENTIONS The intervention arm received up to 15 sessions of BA over 4 months. BA aims to improve mood by increasing people's level of enjoyable or valued activities. The control arm received usual care only. MAIN OUTCOME MEASURES Primary feasibility outcomes concerned feasibility of recruitment to the main trial, acceptability of research procedures and measures, appropriateness of baseline and outcome measures, retention of participants and potential value of conducting the definitive trial. Secondary feasibility outcomes concerned the delivery of the intervention. The primary clinical outcome 6 months post randomisation was the PHQ-9. Secondary clinical outcomes were Stroke Aphasic Depression Questionnaire - Hospital version, Nottingham Leisure Questionnaire, Nottingham Extended Activities of Daily Living, Carer Strain Index, EuroQol-5 Dimensions, five-level version and health-care resource use questionnaire. RESULTS Forty-eight participants were recruited in 27 centre-months of recruitment, at a recruitment rate of 1.8 participants per centre per month. The 25 participants randomised to receive BA attended a mean of 8.5 therapy sessions [standard deviation (SD) 4.4 therapy sessions]; 23 participants were allocated to usual care. Outcome assessments were completed by 39 (81%) participants (BA, n = 18; usual care, n = 21). Mean PHQ-9 scores at 6-month follow-up were 10.1 points (SD 6.9 points) and 14.4 points (SD 5.1 points) in the BA and control groups, respectively, a difference of -3.8 (95% confidence interval -6.9 to -0.6) after adjusting for baseline PHQ-9 score and centre, representing a reduction in depression in the BA arm. Therapy was delivered as intended. BA was acceptable to participants, carers and therapists. Value-of-information analysis indicates that the benefits of conducting a definitive trial would be likely to outweigh the costs. It is estimated that a sample size of between 580 and 623 participants would be needed for a definitive trial. LIMITATIONS Target recruitment was not achieved, although we identified methods to improve recruitment. CONCLUSIONS The Behavioural Activation Therapy for Depression after Stroke trial was feasible with regard to the majority of outcomes. The outstanding issue is whether or not a sufficient number of participants could be recruited within a reasonable time frame for a definitive trial. Future work is required to identify whether or not there are sufficient sites that are able to deliver the services required for a definitive trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN12715175. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 47. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | | | - Rebecca L Palmer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Roshan das Nair
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Nicholas R Latimer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Gemma L Hackney
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Laura Mandefield
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Stephen J Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rachael D Hatton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy L Cooper
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Timothy F Chater
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | | | - Elizabeth Coates
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Katie E Sutherland
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Sarah Jacob Eshtan
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Gogem Topcu
- School of Medicine, University of Nottingham, Nottingham, UK
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16
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Bangalore S, Shah R, Gao X, Pappadopulos E, Deshpande CG, Shelbaya A, Prieto R, Stephens J, Chambers R, Schepman P, McIntyre RS. Economic burden associated with inadequate antidepressant medication management among patients with depression and known cardiovascular diseases: insights from a United States-based retrospective claims database analysis. J Med Econ 2020; 23:262-270. [PMID: 31665949 DOI: 10.1080/13696998.2019.1686311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Aims: The current study examined the association between insufficient major depressive disorder (MDD) care and healthcare resource use (HCRU) and costs among patients with prior myocardial infarction (MI) or stroke.Methods: This was a retrospective study conducted using the MarketScan Claims Database (2010-2015). The date of the first MI/stroke diagnosis was defined as the cardiovascular disease (CVD) index date and the first date of a subsequent MDD diagnosis was the index MDD date. Adequacy of MDD care was assessed during the 90 days following the index MDD date (profiling period) using 2 measures: dosage adequacy (average fluoxetine equivalent dose of ≥20 mg/day for nonelderly and ≥10 mg/day for elderly patients) and duration adequacy (measured as the proportion of days covered of 80% or higher for all MDD drugs). Study outcomes included all-cause and CVD-related HCRU and costs which were determined from the end of the profiling period until the end of study follow-up. Propensity-score adjusted generalized linear models (GLMs) were used to compare patients receiving adequate versus inadequate MDD care in terms of study outcomes.Results: Of 1,568 CVD patients who were treated for MDD, 937 (59.8%) were categorized as receiving inadequate MDD care. Results from the GLMs suggested that patients receiving inadequate MDD care had 14% more all-cause hospitalizations, 4% more all-cause outpatient visits, 17% more CVD-related outpatient visits, 13% more CVD-related emergency room (ER) visits, higher per patient per year CVD-related hospitalization costs ($21,485 vs. $17,756), higher all-cause outpatient costs ($2,820 vs. $2,055), and higher CVD-related outpatient costs ($520 vs. $434) compared to patients receiving adequate MDD care.Limitations: Clinical information such as depression severity and frailty, which are potential predictors of adverse CVD outcomes, could not be ascertained using administrative claims data.Conclusions: Among post-MI and post-stroke patients, inadequate MDD care was associated with a significantly higher economic burden.
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Affiliation(s)
- Sripal Bangalore
- Cardiovascular Outcomes Group, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | | | - Xin Gao
- Pharmerit International, LP, Bethesda, MD, USA
| | | | | | - Ahmed Shelbaya
- Pfizer Inc., New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | | | | | - Roger S McIntyre
- Mood Disorders PsychoPharmacology Unit University Health Network, University of Toronto, Toronto, Canada
- Brain and Cognition Discovery Foundation, Toronto, Canada
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17
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Shek AC, Biondi A, Ballard D, Wykes T, Simblett SK. Technology-based interventions for mental health support after stroke: A systematic review of their acceptability and feasibility. Neuropsychol Rehabil 2019; 31:432-452. [PMID: 31833819 DOI: 10.1080/09602011.2019.1701501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mental health disturbances are common after stroke and linked to a slower recovery. Current face-to-face treatment options are costly and often inaccessible. Technology advances have made it possible to overcome some of these barriers to deliver technology-based mental health interventions remotely, but we do not know how acceptable and feasible they are. This systematic review aims to provide an examination of the acceptability and feasibility of technology-based mental health interventions provided to stroke patients and evaluate any barriers to their adoption. A total of 13 studies were included investigating interventions targeting non-specific mental health, depression or anxiety. The delivery technologies were: video conferencing, computer programmes, telephones, DVDs, CDs, robot-assisted devices, and personal digital assistants. Rates of refusal to participate were low (7.9-25%). Where satisfaction was reported, this was generally high. Many studies achieved high levels of adherence (up to 89.6%). This was lower for some technologies (e.g., robotic assistive devices). Where dropout occurred, this was for reasons including a decline in health as well as technical difficulties. Overall, the literature displays early evidence of using technology to deliver mental health interventions to patients with stroke. This review has identified factors that the design of future studies should take into consideration.
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Affiliation(s)
- Anthony Chun Shek
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrea Biondi
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dominic Ballard
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health, The South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Sara Katherine Simblett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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18
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Schwertfeger JL, Thuente L, Hung P, Larson SL. Post-discharge interventions to enhance coping skills for survivors of stroke and their caregivers: a scoping review protocol. JBI Evid Synth 2019; 18:332-340. [DOI: 10.11124/jbisrir-d-18-00024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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19
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Obembe AO, Simpson LA, Sakakibara BM, Eng JJ. Healthcare utilization after stroke in Canada- a population based study. BMC Health Serv Res 2019; 19:192. [PMID: 30917828 PMCID: PMC6438024 DOI: 10.1186/s12913-019-4020-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/18/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND More people are surviving stroke but are living with functional limitations that pose increasing demands on their families and the healthcare system. The aim of this study was to determine the extent to which stroke survivors use healthcare services on a population level compared to people without a stroke. METHODS This was a cross-sectional population-based survey that collected information related to health status, healthcare utilization and health determinants using the 2014 Canadian Community Health Survey. Healthcare utilization was assessed by a computer-assisted personal interview asking about visits to healthcare professionals in the last 12 months. Negative binomial regression was used to estimate the incidence rate ratios (IRR) and 95% confidence intervals (CI) for the number of health professional visits between stroke survivors and people without a stroke. The regression models were adjusted for demographics, as well as for mobility, mood/anxiety disorder and cardiometabolic comorbid conditions. RESULTS The study sample included 35,759 respondents (948 stroke, 34,811 non-stroke) and equate to 12,396,641 (286,783 stroke; 12,109,858 non-stroke) when sampling weights were applied. Stroke survivors visited their family doctor the most, and stroke was significantly associated with more visits to most healthcare professionals [e.g., family doctor IRR 1.6 (CI 1.4-1.8); nurse IRR 3.0 (CI 1.8-4.8); physiotherapist IRR 1.8 (CI 1.1-1.9); psychologist IRR 4.0 (CI 1.1-5.7)] except the dental practitioner, which was less [IRR 0.7 (CI 0.6-0.9)]. Mood/anxiety condition, but not cardiometabolic comorbid condition increased the probability of visiting a family doctor or social worker/ counsellor among people with stroke. CONCLUSION Stroke survivors visited healthcare professionals more often than people without stroke, and were approximately twice as likely to visit with those who manage problems that may arise after a stroke (e.g., family doctor, nurse, psychologist, physiotherapist). The effects of a stroke include mobility impairment and mood/ anxiety disorders. Therefore, adequate access to stroke-related healthcare services should be provided for stroke survivors, as this may improve functional outcome and reduce future healthcare costs.
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Affiliation(s)
- Adebimpe O. Obembe
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Lisa A. Simpson
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, Canada
| | - Brodie M. Sakakibara
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Janice J. Eng
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
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20
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Hilari K, Behn N, Marshall J, Simpson A, Thomas S, Northcott S, Flood C, McVicker S, Jofre-Bonet M, Moss B, James K, Goldsmith K. Adjustment with aphasia after stroke: study protocol for a pilot feasibility randomised controlled trial for SUpporting wellbeing through PEeR Befriending (SUPERB). Pilot Feasibility Stud 2019; 5:14. [PMID: 30693094 PMCID: PMC6341752 DOI: 10.1186/s40814-019-0397-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/09/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite the high prevalence of mood problems after stroke, evidence on effective interventions particularly for those with aphasia is limited. There is a pressing need to systematically evaluate interventions aiming to improve wellbeing for people with stroke and aphasia. This study aims to evaluate the feasibility of a peer-befriending intervention. METHODS/DESIGN SUPERB is a single blind, parallel group feasibility trial of peer befriending for people with aphasia post-stroke and low levels of psychological distress. The trial includes a nested qualitative study and pilot economic evaluation and it compares usual care (n = 30) with usual care + peer befriending (n = 30). Feasibility outcomes include proportion screened who meet criteria, proportion who consent, rate of consent, number of missing/incomplete data on outcome measures, attrition rate at follow-up, potential value of conducting main trial using value of information analysis (economic evaluation), description of usual care, and treatment fidelity of peer befriending. Assessments and outcome measures (mood, wellbeing, communication, and social participation) for participants and significant others will be administered at baseline, with outcome measures re-administered at 4 and 10 months post-randomisation. Peer befrienders will complete outcome measures before training and after they have completed two cycles of befriending. The qualitative study will use semi-structured interviews of purposively sampled participants (n = 20) and significant others (n = 10) from both arms of the trial, and all peer befrienders to explore the acceptability of procedures and experiences of care. The pilot economic evaluation will utilise the European Quality of life measure (EQ-5D-5 L) and a stroke-adapted version of the Client Service Receipt Inventory (CSRI). DISCUSSION This study will provide information on feasibility outcomes and an initial indication of whether peer befriending is a suitable intervention to explore further in a definitive phase III randomised controlled trial. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02947776, registered 28th October 2016.
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Affiliation(s)
- Katerina Hilari
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Nicholas Behn
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Jane Marshall
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Alan Simpson
- Centre for Mental Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Shirley Thomas
- Division of Rehabilitation and Ageing, School of Medicine, Floor B, The Medical School, Queen’s Medical Centre, University of Nottingham, Nottingham, NG7 2UH UK
| | - Sarah Northcott
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Chris Flood
- Centre for Mental Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Sally McVicker
- Aphasia Re-Connect at City, Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Mireia Jofre-Bonet
- Department of Economics, School of Arts and Social Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Becky Moss
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Kirsty James
- Biostatistics & Health Informatics Department, Division of Psychology and Systems Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, UK
| | - Kimberley Goldsmith
- Biostatistics & Health Informatics Department, Division of Psychology and Systems Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, UK
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21
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Stein LA, Goldmann E, Zamzam A, Luciano JM, Messé SR, Cucchiara BL, Kasner SE, Mullen MT. Association Between Anxiety, Depression, and Post-traumatic Stress Disorder and Outcomes After Ischemic Stroke. Front Neurol 2018; 9:890. [PMID: 30450075 PMCID: PMC6224432 DOI: 10.3389/fneur.2018.00890] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Stroke patients are known to be at risk of developing anxiety, depression, and post-traumatic stress disorder (PTSD). Objective: To determine the overlap between anxiety, depression, and PTSD in patients after stroke and to determine the association between these disorders and quality of life, functional status, healthcare utilization, and return to work. Methods: A cross-sectional telephone survey was conducted to assess for depression, anxiety, PTSD, and health-related outcomes 6-12 months after first ischemic stroke in patients without prior psychiatric disease at a single stroke center. Results: Of 352 eligible subjects, 55 (16%) completed surveys. Seven subjects (13%) met criteria for probable anxiety, 6 (11%) for PTSD, and 11 for depression (20%). Of the 13 subjects (24%) who met criteria for any of these disorders, 6 (46%) met criteria for more than one, and 5 (39%) met criteria for all three. There were no significant differences in baseline characteristics, including stroke severity or neurologic symptoms, between those with or without any of these disorders. Those who had any of these disorders were less likely to be independent in their activities of daily living (ADLs) (54 vs. 95%, p < 0.001) and reported significantly worse quality of life (score of 0-100, median score of 50 vs. 80, p < 0.001) compared to those with none of these disorders. Conclusions: Anxiety, depression, and PTSD are common after stroke, have a high degree of co-occurrence, and are associated with worse outcomes, including quality of life and functional status.
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Affiliation(s)
- Laura A. Stein
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Emily Goldmann
- College of Global Public Health, New York University, New York, NY, United States
| | - Ahmad Zamzam
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Jean M. Luciano
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Steven R. Messé
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Brett L. Cucchiara
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Scott E. Kasner
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Michael T. Mullen
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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22
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MacKenzie HM, Rice D, Teasell R, Macaluso S. Screening Adherence for Depression Post Stroke: Evaluation of Outpatients, a London Experience (SAD PEOPLE). Top Stroke Rehabil 2018; 26:6-17. [PMID: 30346909 DOI: 10.1080/10749357.2018.1536096] [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: 10/28/2022]
Abstract
BACKGROUND Post stroke depression (PSD) is common, and the transition home following discharge may be especially challenging for stroke survivors. OBJECTIVES This study aimed to determine how well specific Canadian Best Practice Recommendations for PSD screening were adopted within a stroke rehabilitation outpatient clinic before and after the utilization of a standardized clinical form. METHODS Practices were evaluated through retrospective chart review before and after the implementation of the standardized form which cued physicians to administer the Patient Health Questionnaire 9 (PHQ-9) at the first outpatient visit. Participants included those aged ≥18 years with a primary diagnosis of stroke. RESULTS One hundred thirty-five subjects' charts were reviewed. Form implementation was associated with increased rates of PSD screening (93.8% versus 0%) and charting regarding mood (55.4% versus 15.7%). CONCLUSION This study highlights the frequency of depressive symptoms in an outpatient cohort and demonstrates how screening rates can be improved by using a standardized form. Routine PHQ-9 completion at the first outpatient visit was associated with more physician-patient discussion and documentation regarding mood.
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23
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El-Majzoub S, Mucsi I, Li M, Moussaoui G, Lipman ML, Looper KJ, Novak M, Rej S. Psychosocial Distress and Health Service Utilization in Patients Undergoing Hemodialysis: A Prospective Study. PSYCHOSOMATICS 2018; 60:385-392. [PMID: 30396686 DOI: 10.1016/j.psym.2018.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND End-stage renal disease is associated with significant morbidity, high-symptom burden, and health care use. Studies have not yet assessed psychosocial distress and health care utilization in this population. OBJECTIVE This study examines psychosocial distress and its association with hospitalization and emergency room (ER) visits in patients on maintenance hemodialysis (HD). METHODS The Distress Assessment and Response Tool (DART) was administered to 80 adults on HD in a single treatment center. The DART assessed for anxiety, depression, and social distress. Health care utilization data were extracted prospectively from electronic medical charts. The time between psychosocial distress and hospitalization or ER visits during 12-month follow-up was examined using Cox proportional hazard models. RESULTS Overall 46% of the sample reported psychosocial distress, with 33% screening above the threshold for depression, 14% for anxiety, and 36% for significant social distress. In multivariable regression adjusting for age, sex, and comorbidity, the presence of psychosocial distress was associated with shorter time to hospitalization (hazard ratio: 2.4 [1.1, 5.0], p = 0.03) during 12-month follow-up. Psychosocial distress was not significantly associated with ER visits in either univariable (hazard ratio: 1.3 [0.7, 2.3], p = 0.5) or multivariable (hazard ratio: 1.4 [0.8, 2.6], p = 0.3) analyses. CONCLUSION Psychosocial distress is frequent in patients undergoing maintenance HD and is associated with shorter time to hospitalization. Future longitudinal studies should examine if health service use can be reduced through routine distress screening and psychosocial distress intervention.
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Affiliation(s)
- Salam El-Majzoub
- Geri-PARTy Research Group, Jewish General Hospital, Department of Psychiatry, McGill University, Montreal, Canada.
| | - Istvan Mucsi
- Multiorgan Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - Madeline Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ghizlane Moussaoui
- Geri-PARTy Research Group, Jewish General Hospital, Department of Psychiatry, McGill University, Montreal, Canada
| | - Mark L Lipman
- Division of Nephrology, Jewish General Hospital, Montreal, Canada
| | - Karl J Looper
- Geri-PARTy Research Group, Jewish General Hospital, Department of Psychiatry, McGill University, Montreal, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Jewish General Hospital, Department of Psychiatry, McGill University, Montreal, Canada
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24
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Vasiliadis HM, Gontijo Guerra S, Chudzinski V, Préville M. Healthcare costs in chronically ill community-living older adults are dependent on mental disorders. J Public Health (Oxf) 2018; 38:e563-e570. [PMID: 28158471 DOI: 10.1093/pubmed/fdv180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
| | - Samantha Gontijo Guerra
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada J1K 2R1
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25
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Harrell C, Zainaldin C, McFarlane D, Hyer M, Stein D, Sayeed I, Neigh G. High-fructose diet during adolescent development increases neuroinflammation and depressive-like behavior without exacerbating outcomes after stroke. Brain Behav Immun 2018; 73:340-351. [PMID: 29787857 PMCID: PMC9280910 DOI: 10.1016/j.bbi.2018.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/01/2018] [Accepted: 05/18/2018] [Indexed: 12/20/2022] Open
Abstract
Diseases, disorders, and insults of aging are frequently studied in otherwise healthy animal models despite rampant co-morbidities and exposures among the human population. Stressor exposures can increase neuroinflammation and augment the inflammatory response following a challenge. The impact of dietary exposure on baseline neural function and behavior has gained attention; in particular, a diet high in fructose can increase activation of the hypothalamic-pituitary-adrenal axis and alter behavior. The current study considers the implications of a diet high in fructose for neuroinflammation and outcomes following the cerebrovascular challenge of stroke. Ischemic injury may come as a "second hit" to pre-existing metabolic pathology, exacerbating inflammatory and behavioral sequelae. This study assesses the neuroinflammatory consequences of a peri-adolescent high-fructose diet model and assesses the impact of diet-induced metabolic dysfunction on behavioral and neuropathological outcomes after middle cerebral artery occlusion. We demonstrate that consumption of a high-fructose diet initiated during adolescent development increases brain complement expression, elevates plasma TNFα and serum corticosterone, and promotes depressive-like behavior. Despite these adverse effects of diet exposure, peri-adolescent fructose consumption did not exacerbate neurological behaviors or lesion volume after middle cerebral artery occlusion.
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Affiliation(s)
- C.S. Harrell
- Department of Physiology, Emory University School of Medicine, United States
| | - C. Zainaldin
- Department of Physiology, Emory University School of Medicine, United States
| | - D. McFarlane
- Department of Physiology, Emory University School of Medicine, United States
| | - M.M. Hyer
- Department of Anatomy & Neurobiology, Virginia Commonwealth University, United States
| | - D. Stein
- Department of Emergency Medicine, Emory University School of Medicine, United States
| | - I. Sayeed
- Department of Emergency Medicine, Emory University School of Medicine, United States
| | - G.N. Neigh
- Department of Physiology, Emory University School of Medicine, United States,Department of Anatomy & Neurobiology, Virginia Commonwealth University, United States,Corresponding author at: Department of Anatomy & Neurobiology, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA 23298, United States. (G.N. Neigh)
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26
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Aronow H, Fila S, Martinez B, Sosna T. Depression and Coleman Care Transitions Intervention. SOCIAL WORK IN HEALTH CARE 2018; 57:750-761. [PMID: 30015601 DOI: 10.1080/00981389.2018.1496514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Coleman Care Transitions Intervention (CTI) is a "Patient Activation Model." Depression can be a barrier to activation and may challenge CTI. This study addressed whether CTI coaches modified the intervention for older adults who screened positive for depression. Over 4,500 clients in a Centers for Medicare and Medicaid Services demonstration completed screening for depression with the PHQ-9; one in five screened positive (score = 9+). Our findings suggest that coaches modified CTI and played a more directive role for clients who screened positive for depression, resulting in similar 30-day readmission rates among patients who screened positive for depression risk and those who did not. That finding stands in contrast to the widely reported higher readmission rates among people screening positive for depression.
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Affiliation(s)
- Harriet Aronow
- a Department of Nursing Research , Cedars-Sinai Medical Center , Los Angeles , USA
| | - Susan Fila
- b Santa Monica College , Department of Health and Wellbeing Services , Los Angeles , CA , USA
| | - Bibiana Martinez
- a Department of Nursing Research , Cedars-Sinai Medical Center , Los Angeles , USA
| | - Todd Sosna
- c Jewish Family Service of Los Angeles , Los Angeles , USA
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27
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Sun C, Yang F, Wang C, Wang Z, Zhang Y, Ming D, Du J. Mutual Information-Based Brain Network Analysis in Post-stroke Patients With Different Levels of Depression. Front Hum Neurosci 2018; 12:285. [PMID: 30065639 PMCID: PMC6056615 DOI: 10.3389/fnhum.2018.00285] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/25/2018] [Indexed: 11/15/2022] Open
Abstract
Post-stroke depression (PSD) is the most common stroke-related emotional disorder, and it severely affects the recovery process. However, more than half cases are not correctly diagnosed. This study was designed to develop a new method to assess PSD using EEG signal to analyze the specificity of PSD patients' brain network. We have 107 subjects attended in this study (72 stabilized stroke survivors and 35 non-depressed healthy subjects). A Hamilton Depression Rating Scale (HDRS) score was determined for all subjects before EEG data collection. According to HDRS score, the 72 patients were divided into 3 groups: post-stroke non-depression (PSND), post-stroke mild depression (PSMD) and post-stroke depression (PSD). Mutual information (MI)-based graph theory was used to analyze brain network connectivity. Statistical analysis of brain network characteristics was made with a threshold of 10-30% of the strongest MIs. The results showed significant weakened interhemispheric connections and lower clustering coefficient in post-stroke depressed patients compared to those in healthy controls. Stroke patients showed a decreasing trend in the connection between the parietal-occipital and the frontal area as the severity of the depression increased. PSD subjects showed abnormal brain network connectivity and network features based on EEG, suggesting that MI-based brain network may have the potential to assess the severity of depression post stroke.
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Affiliation(s)
- Changcheng Sun
- Rehabilitation Medical Department, Tianjin Union Medical Centre, Tianjin, China
| | - Fei Yang
- Department of Health and Exercise Science, Tianjin University of Sport, Tianjin, China
| | - Chunfang Wang
- Rehabilitation Medical Department, Tianjin Union Medical Centre, Tianjin, China
| | - Zhonghan Wang
- Rehabilitation Medical Department, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ying Zhang
- Rehabilitation Medical Department, Tianjin Union Medical Centre, Tianjin, China
| | - Dong Ming
- Department of Biomedical Engineering, College of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Jingang Du
- Rehabilitation Medical Department, Tianjin Union Medical Centre, Tianjin, China
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28
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Majumdar S, Morris R. Brief group-based acceptance and commitment therapy for stroke survivors. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 58:70-90. [DOI: 10.1111/bjc.12198] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah Majumdar
- South Wales Doctoral Programme in Clinical Psychology; Cardiff University; UK
| | - Reg Morris
- South Wales Doctoral Programme in Clinical Psychology; Cardiff University; UK
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29
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Vasiliadis HM, Milan R, Gontijo Guerra S, Fleury MJ. Patient and health system factors associated with hospital readmission in older adults without cognitive impairment. Gen Hosp Psychiatry 2018; 53:44-51. [PMID: 29804009 DOI: 10.1016/j.genhosppsych.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the factors associated with hospital readmission. METHODS Data used in this study came from a population-based survey of older adults without cognitive impairment. Cox regression was used to assess the factors associated with readmission within a 2-year follow-up period. According to Andersen's model of healthcare seeking behavior, study variables considered included predisposing, enabling and need factors at the individual and health system levels. RESULTS Of the 433 participants with an index hospitalization, 97% were discharged with a physical and 3% with a psychiatric disorder. During follow-up, 29% (128/433) were readmitted with a median time to readmission reaching 83 days. The risk of readmission was associated with the following: age, marital status, attraction index of the region of residence for psychiatric services, the presence of an anxio-depressive and other mental disorder, as well as a disorder of the musculoskeletal system. The presence of a physical and psychiatric comorbidity was also associated with readmission. CONCLUSIONS Post-discharge follow-up of vulnerable populations with a history of mental disorders and improved availability of psychiatric services in the community are associated with a reduced risk of readmission.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (QC), Canada and Charles-Le Moyne Hospital Research Center, Greenfield Park, (QC), Canada.
| | - Raymond Milan
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, (QC), Canada.
| | | | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, (QC), Canada and Douglas Mental Health University Institute Research Centre, Montreal, (QC), Canada.
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30
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Doupnik SK, Lawlor J, Zima BT, Coker TR, Bardach NS, Rehm KP, Gay JC, Hall M, Berry JG. Mental Health Conditions and Unplanned Hospital Readmissions in Children. J Hosp Med 2018; 13:445-452. [PMID: 29964274 DOI: 10.12788/jhm.2910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Mental health conditions (MHCs) are prevalent among hospitalized children and could influence the success of hospital discharge. We assessed the relationship between MHCs and 30-day readmissions. METHODS This retrospective, cross-sectional study of the 2013 Nationwide Readmissions Database included 512,997 hospitalizations of patients ages 3 to 21 years for the 10 medical and 10 procedure conditions with the highest number of 30-day readmissions. MHCs were identified by using the International Classification of Diseases, 9th Revision-Clinical Modification codes. We derived logistic regression models to measure the associations between MHC and 30-day, all-cause, unplanned readmissions, adjusting for demographic, clinical, and hospital characteristics. RESULTS An MHC was present in 17.5% of medical and 13.1% of procedure index hospitalizations. Readmission rates were 17.0% and 6.2% for medical and procedure hospitalizations, respectively. In the multivariable analysis, compared with hospitalizations with no MHC, hospitalizations with MHCs had higher odds of readmission for medical admissions (adjusted odds ratio [AOR], 1.23; 95% confidence interval [CI], 1.19-1.26] and procedure admissions (AOR, 1.24; 95% CI, 1.15-1.33). Three types of MHCs were associated with higher odds of readmission for both medical and procedure hospitalizations: depression (medical AOR, 1.57; 95% CI, 1.49-1.66; procedure AOR, 1.39; 95% CI, 1.17-1.65), substance abuse (medical AOR, 1.24; 95% CI, 1.18-1.30; procedure AOR, 1.26; 95% CI, 1.11-1.43), and multiple MHCs (medical AOR, 1.43; 95% CI, 1.37-1.50; procedure AOR, 1.26; 95% CI, 1.11-1.44). CONCLUSIONS MHCs are associated with a higher likelihood of hospital readmission in children admitted for medical conditions and procedures. Understanding the influence of MHCs on readmissions could guide strategic planning to reduce unplanned readmissions for children with cooccurring physical and mental health conditions.
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Affiliation(s)
- Stephanie K Doupnik
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Lawlor
- Children's Hospital Association, Washington, DC and Lenexa, Kansas, USA
| | - Bonnie T Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California, USA
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Naomi S Bardach
- Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Kris P Rehm
- Monroe Carell Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - James C Gay
- Monroe Carell Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Matt Hall
- Children's Hospital Association, Washington, DC and Lenexa, Kansas, USA
| | - Jay G Berry
- Department of Medicine, Division of General Pediatrics, Complex Care Service, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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31
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Lopes A, Fonseca I, Sousa A, Branco M, Rodrigues C, Coelho T, Sequeiros J, Freitas P. Psychopathological Dimensions in Portuguese Subjects with Transthyretin Familial Amyloid Polyneuropathy. Biomed Hub 2017; 2:1-14. [PMID: 31988916 PMCID: PMC6945894 DOI: 10.1159/000485118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/09/2017] [Indexed: 11/21/2022] Open
Abstract
Background Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a fatal, chronic, progressive disease. It is a rare hereditary amyloidosis, which manifests as a sensorimotor neuropathy and autonomic dysfunction. It begins during adulthood. Aims and Methods Our aim is to evaluate psychopathological dimensions in a population attending a consultation center for TTR-FAP. Two hundred and nine subjects (symptomatic and asymptomatic carriers), 84 men and 127, women participated in the study. Most subjects were married (67.1%) and most of them were still working; 33% were retired from work or on a sick leave. A sociodemographic questionnaire and The Brief Symptom Inventory (BSI) were applied. Statistical analysis was performed (descriptive analysis, Mann-Whitney, Wilcoxon, and Spearman tests). Results The Global Symptom Index (GSI) was significantly higher in patients (p = 0.001). Considering GSI, 32.7% of total subjects were above the median for general population. When subgroups were evaluated, 25.6% of symptomatic carriers, 26.3% of subjects without established diagnosis, and 39.1% of patients were above median. GSI was significantly higher in patients (p = 0.001). Some BSI dimensions were also significantly higher in the patient group (somatization, depression, anxiety, and psychoticism) when compared with carriers. Women scored higher than men. Sick women scored higher for all dimensions except somatization. Asymptomatic carriers scored statistically higher for phobic anxiety (p = 0.01), interpersonal sensitivity, anxiety, and depression. In patients, most dimensions and GSI (rho = 0.33, p = 0.002) had positive correlations with years of disease. Conclusions TTR-FAP patients and carriers are a very vulnerable group for psychological distress and psychopathological problems. Women and patients are at higher risk.
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Affiliation(s)
- Alice Lopes
- Unidade Corino de Andrade, Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar do Porto, Porto, Portugal.,ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Isabel Fonseca
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal.,EPIUnit and Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal
| | - Alexandra Sousa
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Margarida Branco
- Unidade Corino de Andrade, Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar do Porto, Porto, Portugal
| | - Carla Rodrigues
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Coelho
- Unidade Corino de Andrade, Serviço de Neurofisiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Sequeiros
- ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal.,IBMC - Institute for Molecular and Cell Biology and i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal
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Sarfo FS, Jenkins C, Singh A, Owolabi M, Ojagbemi A, Adusei N, Saulson R, Ovbiagele B. Post-stroke depression in Ghana: Characteristics and correlates. J Neurol Sci 2017; 379:261-265. [PMID: 28716256 DOI: 10.1016/j.jns.2017.06.032] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/16/2017] [Accepted: 06/19/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poststroke depression (PSD) is prevalent and is an important determinant of functional recovery, quality of life and mortality after stroke. Scanty data on the nature of PSD among stroke survivors in sub-Saharan Africa prompted this study. OBJECTIVE To assess the prevalence and predictors of depression in a convenience sample of Ghanaian stroke survivors. METHODS We evaluated consecutive stroke survivors encountered at a comprehensive neurology clinic in a tertiary medical center in Ghana. The Center for Epidemiologic Studies Depression Scale (CES-D) and Geriatric Depression Scale (GDS) were both used to screen for depressive symptoms and subjects were considered as depressed if they scored ≥16 on the CES-D scale and >5 on the GDS. Demographic and clinical data on stroke type and severity as well as health-related quality of life indicators were collected. Predictors of stroke-related depression were assessed using a logistic regression model. RESULTS Of 200 stroke survivors, mean±SD age was 62.0±14.4years, and 105 (52.5%) patients were men. Among the cohort 78.5% were classified as being depressed by CES-D, 42.5% by GDS, and 36.5% on both CES-D and GDS. In multivariable analyses, for each unit increase on the Modified Rankin scale (i.e. worsening disability), there were higher odds of depression (adjusted OR 1.85; 1.28-2.69, p=0.001), and being divorced (vs. being married) was linked to depression (adjusted 2.82; 1.18-6.71, p=0.02). Stroke survivors with depression demonstrated profound diminutions in the physical, psycho-social, cognitive and eco-social domains of quality of life compared with those without depression (p<0.05). CONCLUSION Almost 4 out of 10 stroke survivors in this Ghanaian cohort displayed clinically significant depression. Prospective interventional studies are urgently needed to provide solid evidence-based and culturally tailored interventions to address post-stroke depression particularly in LMICs.
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Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | - Arti Singh
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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van Eeden M, van Mastrigt GAPG, Evers SMAA, van Raak EPM, Driessen GAM, van Heugten CM. The economic impact of mental healthcare consumption before and after stroke in a cohort of stroke patients in the Netherlands: a record linkage study. BMC Health Serv Res 2016; 16:688. [PMID: 27964721 PMCID: PMC5155378 DOI: 10.1186/s12913-016-1915-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/09/2016] [Indexed: 11/20/2022] Open
Abstract
Background Post-stroke healthcare consumption is strongly associated with a mental health diagnosis. This study aimed to identify stroke patients who utilised mental healthcare facilities, explored their mental healthcare consumption pre-stroke and post-stroke, and examined possible predictors of costs incurred by mental healthcare consumption post-stroke. Methods Three databases were integrated, namely the Maastricht University Medical Centre (MUMC) Medical Administration, the Stroke Registry from the Department of Neurology at MUMC, and the Psychiatric Case Registry South-Limburg. Patients from the MUMC who suffered their first-ever stroke between January 1 2000 and December 31 2004 were included and their records were analysed for mental healthcare consumption from 5 years preceding to 5 years following their stroke (1995–2009). Regression analysis was conducted to identify possible predictors of mental healthcare consumption costs. Results A total of 1385 patients were included and 357 (25.8%) received services from a mental healthcare facility during the 10-year reference period around their stroke. The costs of mental healthcare usage increased over time and peaked 1 year post-stroke (€7057; 22% of total mental healthcare costs). The number of hospitalisation days and mental healthcare consumption pre-stroke were significant predictors of mental healthcare costs. Explained variances of these models (costs during the 5 years post-stroke: R2 = 15.5%, costs across a 10 year reference period: R2 = 4.6%,) were low. Conclusion Stroke patients have a significant level of mental healthcare comorbidity leading to relatively high mental healthcare costs. There is a relationship between stroke and mental healthcare consumption costs, but results concerning the underlying factors responsible for these costs are inconclusive.
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Affiliation(s)
- M van Eeden
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - G A P G van Mastrigt
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - E P M van Raak
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G A M Driessen
- MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - C M van Heugten
- MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
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Towfighi A, Ovbiagele B, El Husseini N, Hackett ML, Jorge RE, Kissela BM, Mitchell PH, Skolarus LE, Whooley MA, Williams LS. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 48:e30-e43. [PMID: 27932603 DOI: 10.1161/str.0000000000000113] [Citation(s) in RCA: 368] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. Individuals with PSD are at a higher risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice.
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Systematic Review of Hospital Readmissions in Stroke Patients. Stroke Res Treat 2016; 2016:9325368. [PMID: 27668120 PMCID: PMC5030407 DOI: 10.1155/2016/9325368] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/08/2016] [Indexed: 12/21/2022] Open
Abstract
Background. Previous evidence on factors and causes of readmissions associated with high-impact users of stroke is scanty. The aim of the study was to investigate common causes and pattern of short- and long-term readmissions stroke patients by conducting a systematic review of studies using hospital administrative data. Common risk factors associated with the change of readmission rate were also examined. Methods. The literature search was conducted from 15 February to 15 March 2016 using various databases, such as Medline, Embase, and Web of Science. Results. There were a total of 24 studies (n = 2,126,617) included in the review. Only 4 studies assessed causes of readmissions in stroke patients with the follow-up duration from 30 days to 5 years. Common causes of readmissions in majority of the studies were recurrent stroke, infections, and cardiac conditions. Common patient-related risk factors associated with increased readmission rate were age and history of coronary heart disease, heart failure, renal disease, respiratory disease, peripheral arterial disease, and diabetes. Among stroke-related factors, length of stay of index stroke admission was associated with increased readmission rate, followed by bowel incontinence, feeding tube, and urinary catheter. Conclusion. Although risk factors and common causes of readmission were identified, none of the previous studies investigated causes and their sequence of readmissions among high-impact stroke users.
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Thomas SA, Coates E, das Nair R, Lincoln NB, Cooper C, Palmer R, Walters SJ, Latimer NR, England TJ, Mandefield L, Chater T, Callaghan P, Drummond AER. Behavioural Activation Therapy for Depression after Stroke (BEADS): a study protocol for a feasibility randomised controlled pilot trial of a psychological intervention for post-stroke depression. Pilot Feasibility Stud 2016; 2:45. [PMID: 27965862 PMCID: PMC5153669 DOI: 10.1186/s40814-016-0072-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/25/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND There is currently insufficient evidence for the clinical and cost-effectiveness of psychological therapies for treating post-stroke depression. METHODS/DESIGN BEADS is a parallel group feasibility multicentre randomised controlled trial with nested qualitative research and economic evaluation. The aim is to evaluate the feasibility of undertaking a full trial comparing behavioural activation (BA) to usual stroke care for 4 months for patients with post-stroke depression. We aim to recruit 72 patients with post-stroke depression over 12 months at three centres, with patients identified from the National Health Service (NHS) community and acute services and from the voluntary sector. They will be randomly allocated to receive behavioural activation in addition to usual care or usual care alone. Outcomes will be measured at 6 months after randomisation for both participants and their carers, to determine their effectiveness. The primary clinical outcome measure for the full trial will be the Patient Health Questionnaire-9 (PHQ-9). Rates of consent, recruitment and follow-up by centre and randomised group will be reported. The acceptability of the intervention to patients, their carers and therapists will also be assessed using qualitative interviews. The economic evaluation will be undertaken from the National Health Service and personal social service perspective, with a supplementary analysis from the societal perspective. A value of information analysis will be completed to identify the areas in which future research will be most valuable. DISCUSSION The feasibility outcomes from this trial will provide the data needed to inform the design of a definitive multicentre randomised controlled trial evaluating the clinical and cost-effectiveness of behavioural activation for treating post-stroke depression. TRIAL REGISTRATION Current controlled trials ISRCTN12715175.
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Affiliation(s)
- Shirley A Thomas
- Division of Rehabilitation and Ageing, School of Medicine, B Floor Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH UK
| | - Elizabeth Coates
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Roshan das Nair
- Division of Rehabilitation and Ageing, School of Medicine, B Floor Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH UK
| | - Nadina B Lincoln
- Division of Rehabilitation and Ageing, School of Medicine, B Floor Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH UK
| | - Cindy Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Rebecca Palmer
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Stephen J Walters
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Nicholas R Latimer
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Timothy J England
- Vascular Medicine, Division of Medical Sciences and GEM, School of Medicine, Royal Derby Hospital, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT UK
| | - Laura Mandefield
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Timothy Chater
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Patrick Callaghan
- School of Health Sciences, A Floor, South Block, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA UK
| | - Avril E R Drummond
- School of Health Sciences, A Floor, South Block, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA UK
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Vahid-Ansari F, Lagace DC, Albert PR. Persistent post-stroke depression in mice following unilateral medial prefrontal cortical stroke. Transl Psychiatry 2016; 6:e863. [PMID: 27483381 PMCID: PMC5022078 DOI: 10.1038/tp.2016.124] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/20/2016] [Accepted: 05/05/2016] [Indexed: 01/10/2023] Open
Abstract
Post-stroke depression (PSD) is a common outcome following stroke that is associated with poor recovery. To develop a preclinical model of PSD, we targeted a key node of the depression-anxiety circuitry by inducing a unilateral ischemic lesion to the medial prefrontal cortex (mPFC) stroke. Microinjection of male C57/BL6 mice with endothelin-1 (ET-1, 1600 pmol) induced a small (1 mm(3)) stroke consistently localized within the left mPFC. Compared with sham control mice, the stroke mice displayed a robust behavioral phenotype in four validated tests of anxiety including the elevated plus maze, light-dark, open-field and novelty-suppressed feeding tests. In addition, the stroke mice displayed depression-like behaviors in both the forced swim and tail suspension test. In contrast, there was no effect on locomotor activity or sensorimotor function in the horizontal ladder, or cylinder and home cage activity tests, indicating a silent stroke due to the absence of motor abnormalities. When re-tested at 6 weeks post stroke, the stroke mice retained both anxiety and depression phenotypes. Surprisingly, at 6 weeks post stroke the lesion site was infiltrated by neurons, suggesting that the ET-1-induced neuronal loss in the mPFC was reversible over time, but was insufficient to promote behavioral recovery. In summary, unilateral ischemic lesion of the mPFC results in a pronounced and persistent anxiety and depression phenotype with no evident sensorimotor deficits. This precise lesion of the depression circuitry provides a reproducible model to study adaptive cellular changes and preclinical efficacy of novel interventions to alleviate PSD symptoms.
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Affiliation(s)
- F Vahid-Ansari
- Ottawa Hospital Research Institute (Neuroscience), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - D C Lagace
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada,Department of Cellular and Molecular Medicine, University of Ottawa Brain and Mind Research Institute, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H-8M5, Canada E-mail:
| | - P R Albert
- Ottawa Hospital Research Institute (Neuroscience), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada,Ottawa Hospital Research Institute (Neuroscience), University of Ottawa Brain and Mind Research Institute, 451 Smyth Road, Ottawa, ON K1H-8M5, Canada. E-mail:
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Ayalon L. The Potential Role of Dependency in the Weaning Process: The Case of a 57-Year-Old Woman Connected to a Mechanical Ventilator. Clin Case Stud 2016. [DOI: 10.1177/1534650107296819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Weaning from the mechanical ventilator is considered a difficult task, with the majority of patients remaining permanently connected to the machine. This case report demonstrates the role of dependency and denial as important factors in the weaning process from the mechanical ventilator. Supportive psychotherapy and relaxation training were provided to Rebecca (pseudonym), a 57-year-old woman connected to the mechanical ventilator. After numerous failures to wean, it was decided that Rebecca would leave the rehabilitation hospital to an assisted-living facility, connected to the mechanical ventilator. However, following a repeated discussion of Rebecca's prognosis and discharge plans, Rebecca weaned off the mechanical ventilation and made “a miraculous recovery” within days. This case study demonstrates the significant role that psychological factors play in the patient's ability to wean off the mechanical ventilator. Integrating psychology and medicine can result in better health care outcomes.
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Is health-related quality of life between 90 and 180 days following stroke associated with long-term unmet needs? Qual Life Res 2016; 25:2053-62. [PMID: 26847339 DOI: 10.1007/s11136-016-1234-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Understanding the relationship between health-related quality of life (HRQoL) and long-term unmet needs is important for guiding services to optimise life following stroke. We investigated whether HRQoL between 90 and 180 days following stroke was associated with long-term unmet needs. METHODS Data from Australian Stroke Clinical Registry (AuSCR) registrants who participated in the Australian Stroke Survivor Needs Survey were used. Outcome data, including the EQ-5D, are routinely collected in AuSCR between 90 and 180 days post-stroke. Unmet needs were assessed at a median of 2 years and categorised into: health; everyday living; work/leisure; and support domains. Multivariable regression was used to determine associations between the EQ-5D dimensions and the likelihood of experiencing unmet needs and the visual analogue scale (VAS) (rating 0-100) and number of reported unmet needs. RESULTS In total, 173 AuSCR registrants completed the Needs Survey (median age 69 years, 67 % male; 77 % ischaemic stroke). VAS scores were negatively associated with the number of reported long-term unmet needs [irr 0.98, (95 % CI 0.97, 0 99) p < 0.001]. Having EQ-5D activity limitations was associated with unmet living needs (aOR 4.5, 95 % CI 1.1, 18.8). Requiring living supports at 90-180 days was associated with unmet health needs (aOR 4.9, 95 % CI 1.5, 16.1). Those with pain at 90-180 days were less likely to report unmet health (aOR 0.09, 95 % CI 0.02, 0.4) and support needs (aOR 0.2, 95 % CI 0.06, 0.6). CONCLUSION Routinely collected HRQoL data can identify survivors at risk of experiencing long-term unmet needs. This information is important for targeting service delivery to optimise outcomes following stroke.
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Vallury KDB, Jones M, Gray R. Do family-oriented interventions reduce poststroke depression? A systematic review and recommendations for practice. Top Stroke Rehabil 2015; 22:453-9. [PMID: 25816867 DOI: 10.1179/1074935715z.00000000061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Up to half of all stroke survivors become depressed. Poststroke depression (PSD) negatively impacts on quality of life and rehabilitation outcomes and increases risk of mortality. Depression is also common in carers, leading to poorer outcomes in survivors. Few stroke patients receive adequate care to support prevention and management of PSD. We aimed to systematically review the evidence regarding the effectiveness of family-oriented interventions to prevent and manage depression after stroke and identify components of effective interventions. METHODS A systematic review was conducted, adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eight databases were searched, and relevant journals and reference lists were hand searched. Abstracts were screened for relevance and two authors independently assessed selected full texts against inclusion criteria. Studies were included if they (1) engaged stroke patients and their informal/family caregivers; (2) measured changes in depression due to an intervention; and (3) were available in English. RESULTS Twenty-five of 2741 identified citations met the inclusion criteria. Five studies demonstrated significant reductions in depression. Commonalities across effective studies included the delivery of interventions that were structured and multicomponent, actively engaged patients and families, coordinated care, and were initiated soon after a stroke. CONCLUSION Family-oriented stroke rehabilitation may reduce depression in stroke survivors and their family caregivers. More research is required to clarify the effectiveness, feasibility, and acceptability of working with families and patients living with or who may be at risk of PSD.
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Affiliation(s)
- Kari D B Vallury
- University Department of Rural Health (UDRH), University of South Australia , Whyalla, Australia
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Morris R. Meeting the psychological needs of community-living stroke patients and carers: a study of third sector provision. Disabil Rehabil 2015; 38:52-61. [PMID: 25731861 DOI: 10.3109/09638288.2015.1014932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To elucidate how community stroke staff in a major third sector organisation experienced their role and understood and responded to clients' psychological needs. METHOD In stage 1, three focus groups of 28 staff in total were recorded, transcribed and analysed using inductive thematic analysis. Themes were authenticated by new staff groups. In stage 2, these themes informed the construction of a questionnaire delivered through the organisation's intranet by "Survey Monkey". RESULTS Five themes emerged from the focus groups: background and context; perceptions of clients' psychological issues; approaches to meeting psychological needs; the experience of working with psychological needs and sources of support; aspirations for future development. Four themes were used in constructing the questionnaire. Responses from 144 staff with diverse qualifications and experience were received; over half encountered 16 (of 35) psychological issues at least once per week. Stroke survivors' needs predominated over carers' needs. Skills used to address psychological problems were identified, also training and support needs and future aspirations. Support needs included information, training and access to specialist consultants. CONCLUSIONS Psychological issues were central in the work of third sector community stroke staff; psychological skills were routinely used. Attention to means of supporting and developing these skills is required. IMPLICATIONS FOR REHABILITATION Service leaders and commissioners should be aware that third sector community stroke staff frequently deal with a diverse range of psychological issues and perceive psychological care as central. Service leaders should consider providing training in assessment and management of mood and cognition, risk assessment and management and basic counselling. Staff should be provided with access to specialist consultation and better information about psychological aspects of referrals. There is uncertainty about key methods for supporting the delivery of psychological care (supervision, mentoring and peer support) which requires consideration.
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Affiliation(s)
- Reg Morris
- a Clinical Psychology, School of Psychology, Cardiff University, and Cardiff and Vale University Health Board , Cardiff , UK
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Vickrey BG, Williams LS. Posttraumatic stress disorder after cerebrovascular events: broadening the landscape of psychological assessment in stroke and transient ischemic attack. Stroke 2014; 45:3182-3. [PMID: 25278558 DOI: 10.1161/strokeaha.114.006865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Barbara G Vickrey
- From the Department of Neurology, University of California, Los Angeles (B.G.V.); Department of Neurology, Greater Los Angeles Veteran's Administration HealthCare System, Los Angeles, CA (B.G.V.); Department of Neurology, Indiana University School of Medicine, Indianapolis (L.S.W.); Department of Neurology, Richard L. Roudebush Veteran's Administration Medical Center, Indianapolis, IN (L.S.W.); and Regenstrief Institute, Inc, Indianapolis, IN (L.S.W.)
| | - Linda S Williams
- From the Department of Neurology, University of California, Los Angeles (B.G.V.); Department of Neurology, Greater Los Angeles Veteran's Administration HealthCare System, Los Angeles, CA (B.G.V.); Department of Neurology, Indiana University School of Medicine, Indianapolis (L.S.W.); Department of Neurology, Richard L. Roudebush Veteran's Administration Medical Center, Indianapolis, IN (L.S.W.); and Regenstrief Institute, Inc, Indianapolis, IN (L.S.W.)
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Kronenberg G, Gertz K, Heinz A, Endres M. Of mice and men: modelling post-stroke depression experimentally. Br J Pharmacol 2014; 171:4673-89. [PMID: 24838087 DOI: 10.1111/bph.12775] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 04/21/2014] [Accepted: 05/04/2014] [Indexed: 12/14/2022] Open
Abstract
At least one-third of stroke survivors suffer from depression. The development of comorbid depression after stroke is clinically highly significant because post-stroke depression is associated with increased mortality, slows recovery and leads to worse functional outcomes. Here, we review the evidence that post-stroke depression can be effectively modelled in experimental rodents via a variety of approaches. This opens an exciting new window onto the neurobiology of depression and permits probing potential underlying mechanisms such as disturbed cellular plasticity, neuroendocrine dysregulation, neuroinflammation, and neurodegeneration in a novel context. From the point of view of translational stroke research, extending the scope of experimental investigations beyond the study of short-term end points and, in particular, acute lesion size, may help improve the relevance of preclinical results to human disease. Furthermore, accumulating evidence from both clinical and experimental studies offers the tantalizing prospect of 5-hydroxytryptaminergic antidepressants as the first pharmacological therapy for stroke that would be available during the subacute and chronic phases of recovery. Interdisciplinary neuropsychiatric research will be called on to dissect the mechanisms underpinning the beneficial effects of antidepressants on stroke recovery.
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Affiliation(s)
- G Kronenberg
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Berlin, Germany; Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
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Humphreys I, Thomas S, Phillips C, Lincoln N. Cost analysis of the Communication and Low Mood (CALM) randomised trial of behavioural therapy for stroke patients with aphasia. Clin Rehabil 2014; 29:30-41. [PMID: 24942481 DOI: 10.1177/0269215514537656] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the cost effectiveness of a behavioural therapy intervention shown to be clinically effective in comparison with usual care for stroke patients with aphasia. DESIGN Randomised controlled trial with comparison of costs and calculation of incremental cost effectiveness ratio. SETTING Community. PARTICIPANTS Participants identified as having low mood on either the Visual Analog Mood Scale sad item (≥50) or Stroke Aphasic Depression Questionnaire Hospital version 21 (SADQH21) (≥6) were recruited. INTERVENTIONS Participants were randomly allocated to behavioural therapy or usual care using internet-based randomisation generated in advance of the study by a clinical trials unit. MAIN MEASURES Outcomes were assessed at six months after randomisation, blind to group allocation. The costs were assessed from a service use questionnaire. Effectiveness was defined as the change in SADQH21 scores and a cost-effectiveness analysis was performed comparing the behavioural group with the usual care control group. The cost analysis was undertaken from the perspective of the UK NHS and Social Services. RESULTS The greatest difference was in home help costs where there was a saving of £56.20 in the intervention group compared to an increase of £61.40 in the control group. At six months the SADQH21 score for the intervention group was 17.3 compared to the control group value of 20.4. This resulted in a mean increase of 0.7 in the control group, compared to a mean significant different decrease of 6 in the intervention group (P = 0.003). The Incremental Cost-Effectiveness Ratio indicated that the cost per point reduction on the SADQH21 was £263. CONCLUSION Overall the behavioural therapy was found to improve mood and resulted in some encouraging savings in resource utilisation over the six months follow-up.
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Affiliation(s)
- Ioan Humphreys
- Swansea Centre for Health Economics, Swansea University, UK
| | - Shirley Thomas
- Division of Rehabilitation and Ageing, University of Nottingham, UK
| | - Ceri Phillips
- Swansea Centre for Health Economics, Swansea University, UK
| | - Nadina Lincoln
- Division of Rehabilitation and Ageing, University of Nottingham, UK
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White JH, Attia J, Sturm J, Carter G, Magin P. Predictors of depression and anxiety in community dwelling stroke survivors: a cohort study. Disabil Rehabil 2014; 36:1975-82. [DOI: 10.3109/09638288.2014.884172] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Community reintegration in stroke survivors: Relationship with motor function and depression. Hong Kong Physiother J 2013. [DOI: 10.1016/j.hkpj.2013.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Zhang WN, Pan YH, Wang XY, Zhao Y. A prospective study of the incidence and correlated factors of post-stroke depression in China. PLoS One 2013; 8:e78981. [PMID: 24260141 PMCID: PMC3832506 DOI: 10.1371/journal.pone.0078981] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 09/25/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is commonly observed among stroke survivors. However, statistical analysis of such data is scarce in developing countries. The purpose of this study is to examine the incidence of PSD and its relationship with stroke characteristics in China. METHODS This was a prospective hospital-based study. Stroke patients were assessed within two weeks after acute ischemic stroke onset and then reevaluated at three months. Hamilton Depression Scale (HAMD) was used for screening depression (PSD). Subjects with HAMD score of ≥7 were further assessed with the World Health Organization Composite International Diagnostic Interview. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS). Stroke outcome was measured by the modified Rankin Scale (mRS). RESULTS One hundred and two stroke patients were recruited, only ninety-one patients completed del period (men = 53, 63.74%), with mean age 60.0±10.4 years (range, 34-82 years). The incidence of PSD was 27.47% two weeks after stroke. The occurrence of PSD was unrelated with age, stroke type, stroke lesion and the history of disease. In univariate analysis gender, PSD was correlated with female gender. In multivariate logistic regression analysis, poor stroke outcome (mRS≥3) (OR 12.113, CI 1.169 to 125.59, P<0.05) was the important predictors of PSD. CONCLUSIONS The study indicated that gender, functional dependence and stroke outcome are determinants of PSD occurrence during the first 2 weeks after stroke in China.
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Affiliation(s)
- Wei-Na Zhang
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
| | - Yong-Hui Pan
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
- * E-mail:
| | - Xiao-Yu Wang
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
| | - Yue Zhao
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
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Ellis C, Grubaugh AL, Egede LE. Factors Associated with SF-12 Physical and Mental Health Quality of Life Scores in Adults with Stroke. J Stroke Cerebrovasc Dis 2013; 22:309-17. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.09.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 09/06/2011] [Accepted: 09/09/2011] [Indexed: 11/28/2022] Open
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Rodwin BA, Spruill TM, Ladapo JA. Economics of psychosocial factors in patients with cardiovascular disease. Prog Cardiovasc Dis 2013; 55:563-73. [PMID: 23621966 DOI: 10.1016/j.pcad.2013.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Growing evidence supports a causal relationship between cardiovascular disease and psychosocial factors such as mental health and behavioral disorders, acute and chronic stress, and low socioeconomic status. While this has enriched our understanding of the interaction between cardiovascular risk factors, much less is known about its economic implications. In this review, we evaluate the economic impact of psychosocial factors in persons at risk for or diagnosed with cardiovascular disease. Most studies have focused on depression and almost uniformly conclude that patients with cardiovascular disease and comorbid depression use a greater number of ambulatory and hospital services and incur higher overall costs. Additionally, comorbid depression may also reduce employment productivity in patients with cardiovascular disease, further magnifying its economic impact. Recent randomized trials have demonstrated that innovative care delivery models that target depression may reduce costs or at least be cost neutral while improving quality of life. The growing population burden and overlap of cardiovascular disease, comorbid mental illness, and other psychosocial factors suggest that future research identifying cost-effective or cost-saving treatment models may have significant health and economic implications.
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Affiliation(s)
- Benjamin A Rodwin
- Department of Medicine, New York University School of Medicine, New York 10016, USA
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