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Geusgens CAV, van Tilburg DCH, Fleischeuer B, Bruijel J. The relation between insomnia and depression in the subacute phase after stroke. Neuropsychol Rehabil 2024:1-17. [PMID: 38941450 DOI: 10.1080/09602011.2024.2370072] [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: 07/13/2023] [Accepted: 06/11/2024] [Indexed: 06/30/2024]
Abstract
Prevalence rates for both depression and insomnia the first year after stroke are around 30%, significantly impacting the prospects of recovery, rehabilitation, and quality of life. Furthermore, the risk of insomnia and depression becoming chronic is high in the subacute phase post-stroke. This cross-sectional observational study investigated whether insomnia and depression are related in the subacute phase post-stroke, using validated instruments. Sixty-six outpatient stroke survivors participated. Depression was measured using the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) and insomnia severity with the Insomnia Severity Index (ISI). A multiple linear regression analysis was used to examine the association between the dependent variable post-stroke depression and the independent variables insomnia and pre-stroke depression treatment. Results showed that insomnia (β = 0.48, t = 4.40, p < 0.001) and pre-stroke depression treatment (β = 0.24, t = 2.28, p = 0.026) were both significant predictors of depression. Participants with more insomnia complaints and participants with pre-stroke depression treatment had more depression symptoms post-stroke. Therefore, it is important to be alert in the subacute phase post-stroke of both, insomnia and depression complaints.
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Affiliation(s)
- Chantal A V Geusgens
- Department of Clinical and Medical Psychology, Zuyderland Medical Center, Sittard & Heerlen, The Netherlands
| | - Debbie C H van Tilburg
- Department of Clinical and Medical Psychology, Zuyderland Medical Center, Sittard & Heerlen, The Netherlands
| | - Britt Fleischeuer
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jessica Bruijel
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
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2
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Blake JJ, Gracey F, Whitmore S, Broomfield NM. Comparing the Symptomatology of Post-stroke Depression with Depression in the General Population: A Systematic Review. Neuropsychol Rev 2023:10.1007/s11065-023-09611-5. [PMID: 37667057 DOI: 10.1007/s11065-023-09611-5] [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: 07/14/2022] [Accepted: 07/12/2023] [Indexed: 09/06/2023]
Abstract
Previous research into the phenomenological differences of post-stroke depression (PSD) has typically focused on comparisons of symptom profiles between stroke and non-stroke population controls. This systematic review aimed to synthesize these findings with results from other methodological approaches that contribute to an understanding of phenomenological differences. Articles were identified via a systematic search of seven databases and additional manual searching. A narrative synthesis approach was adopted because of the high methodological heterogeneity. Twelve articles comparing the symptomatology of depression between stroke and non-stroke controls were included. Three distinct methodological approaches, relevant to the aim, were identified: comparisons of profiles among groups with similar overall depression severity, comparisons of the strengths of correlations between a symptom and depression, and comparisons of latent symptom severity. The symptomatology of depression was generally similar between the groups, including somatic symptoms, despite the hypothesized interference of comorbid physical stroke effects. Despite high heterogeneity, there was a tentative indication that post-stroke depression manifests with comparatively less severe/prevalent anhedonia. Possible mechanisms for the observed similarities and differences are explored, including suggestions for future research.
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Affiliation(s)
- J J Blake
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - F Gracey
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - S Whitmore
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - N M Broomfield
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
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3
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Volz M, Mundiyanapurath S, Schauenburg H, Meuth SG, Wild B, Werheid K, Barber JP, Schäfer R, Beerbaum L, Dinger U. Integrative-interpersonal dynamic therapy for poststroke depression (INID): study protocol of a randomised controlled pilot trial. BMJ Open 2023; 13:e077656. [PMID: 37553187 PMCID: PMC10414082 DOI: 10.1136/bmjopen-2023-077656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Depression is the most frequent psychiatric disorder following stroke, affecting about one-third of stroke survivors. Patients experience poorer recovery, lower quality of life and higher mortality compared with stroke survivors without depression. Despite these well-known malign consequences, poststroke depression (PSD) is regarded underdiagnosed and undertreated. Evidence of beneficial effects of psychotherapy to treat PSD remains scarce and inconclusive and is limited by heterogeneity in design, content and timing of the intervention. This pilot study aims to assess the feasibility of a newly developed integrative-interpersonal dynamic PSD intervention in an outpatient setting and provide a first estimation of the potential effect size as basis for the sample size estimation for a subsequent definite trial. METHOD AND ANALYSIS Patients will be recruited from two German stroke units. After discharge from inpatient rehabilitation, depressed stroke survivors will be randomised to short-term psychotherapy (12 weeks, ≤16 sessions) or enhanced treatment as usual. The manualised psychotherapy integrates key features of the Unified Psychodynamic and Cognitive-Behavioural Unified Protocol for emotional disorders and was adapted for PSD. Primary endpoints are recruitment feasibility and treatment acceptability, defined as a recruitment rate of ≥20% for eligible patients consenting to randomisation and ≥70% completion-rate of patients participating in the treatment condition. A preliminary estimation of the treatment effect based on the mean difference in Patient Health Questionnaire-9 (PHQ-9) scores between intervention and control group six months poststroke is calculated. Secondary endpoints include changes in depression (PHQ-9/Hamilton Depression Scale) and anxiety (Generalised Anxiety Disorder 7) of all participants across all follow-ups during the first year poststroke. ETHICS AND DISSEMINATION The INID pilot study received full ethical approval (S-321/2019; 2022-2286_1). Trial results will be published in a peer-reviewed journal in the first half of 2025. One-year follow-ups are planned to be carried out until summer 2025. TRIAL REGISTRATION NUMBER DRKS00030378.
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Affiliation(s)
| | | | - Henning Schauenburg
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sven Guenther Meuth
- Department of Neurology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Katja Werheid
- Department of Psychology, Clinical Neuropsychology and Psychotherapy, University of Bielefeld, Bielefeld, Germany
| | - Jacques P Barber
- Adelphi University, Gordon F Derner School of Psychology, New York City, New York, USA
| | - Ralf Schäfer
- Department of Psychosomatic Medicine and Psychotherapy, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Luisa Beerbaum
- Department of Psychosomatic Medicine and Psychotherapy, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Ulrike Dinger
- Department of Psychosomatic Medicine and Psychotherapy, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
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4
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van Nimwegen D, Hjelle EG, Bragstad LK, Kirkevold M, Sveen U, Hafsteinsdóttir T, Schoonhoven L, Visser-Meily J, de Man-van Ginkel JM. Interventions for improving psychosocial well-being after stroke: A systematic review. Int J Nurs Stud 2023; 142:104492. [PMID: 37084476 DOI: 10.1016/j.ijnurstu.2023.104492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/15/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Up to one third of all stroke patients suffer from one or more psychosocial impairments. Recognition and treatment of these impairments are essential in improving psychosocial well-being after stroke. Although nurses are ideally positioned to address psychosocial well-being, they often feel insecure about providing the needed psychosocial care. Therefore, we expect that providing nurses with better knowledge to deliver this care could lead to an improvement in psychosocial well-being after stroke. Currently it is not known which interventions are effective and what aspects of these interventions are most effective to improve psychosocial well-being after stroke. OBJECTIVE To identify potentially effective interventions - and intervention components - which can be delivered by nurses to improve patients' psychosocial well-being after stroke. METHODS A systematic review and data synthesis of randomized controlled trials and quasi experimental studies was conducted. Papers were included according to the following criteria: 1) before-after design, 2) all types of stroke patients, 3) interventions that can be delivered by nurses, 4) the primary outcome(s) were psychosocial. PubMed, Embase, PsychInfo, CINAHL and Cochrane library were searched (August 2019-April 2022). Articles were selected based on title, abstract, full text and quality. Quality was assessed by using Joanna Briggs Institute checklists and a standardized data extraction form developed by Joanna Brigss Institute was used to extract the data. RESULTS In total 60 studies were included, of which 52 randomized controlled trials, three non-randomized controlled trials, four quasi-experimental studies, and one randomized cross-over study. Nineteen studies had a clear psychosocial content, twenty-nine a partly psychosocial content, and twelve no psychosocial content. Thirty-nine interventions that showed positive effects on psychosocial well-being after stroke were identified. Effective intervention topics were found to be mood, recovery, coping, emotions, consequences/problems after stroke, values and needs, risk factors and secondary prevention, self-management, and medication management. Active information and physical exercise were identified as effective methods of delivery. DISCUSSION The results suggest that interventions to improve psychosocial well-being should include the intervention topics and methods of delivery that were identified as effective. Since effectiveness of the intervention can depend on the interaction of intervention components, these interactions should be studied. Nurses and patients should be involved in the development of such interventions to ensure it can be used by nurses and will help improve patients' psychosocial well-being. FUNDING AND REGISTRATION This study was supported by the Taskforce for Applied Research SIA (RAAK.PUB04.010). This review was not registered.
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Affiliation(s)
- Dagmar van Nimwegen
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Ellen Gabrielsen Hjelle
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Line Kildal Bragstad
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Marit Kirkevold
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Unni Sveen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Thóra Hafsteinsdóttir
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, the Netherlands; Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lisette Schoonhoven
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johanna Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Janneke M de Man-van Ginkel
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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Ladwig S, Werheid K, Südmeyer M, Volz M. Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies. Front Psychiatry 2023; 14:1093918. [PMID: 36860505 PMCID: PMC9969555 DOI: 10.3389/fpsyt.2023.1093918] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Cerebral insults lead in many cases not only to cognitive impairment but also to disturbed emotionality. After stroke, one in three survivors develops a depression which impacts quality of life and rehabilitation. Meta-analyses have identified five main predictors of post-stroke depression (PSD): history of mental disorder, stroke severity, physical disability, cognitive impairment, and social support. However, these five established variables have never been conjointly investigated in a sample of stroke survivors. Therefore, their independent predictive values remain unclear. Moreover, predictors are most often used as time-invariant factors (status scores), neglecting the intraindividual dynamics after stroke. METHODS Our study analyses the data of two prospective longitudinal studies, investigating stroke survivors from two rehabilitation hospitals (N 1 = 273) and one acute care hospital (N 2 = 226). Baseline assessments included the five established predictors and depressive symptoms. After 6 months, depressive symptoms were reassessed in both studies (n 1 = 176, n 2 = 183), and physical disability and social support were reassessed in study 2. The predictivity of the five predictors and the additional predictivity of intraindividual dynamics for PSD were examined in multiple linear regression analyses. RESULTS History of mental disorder was a risk factor for depressive symptoms after stroke at all measurement times (B = 3.32 to 3.97; p < 0.01). Physical disability was a risk factor at all measurement times (B = -0.09 to -0.03; p < 0.05) except 6 months after rehabilitation. Social support was a protective factor (B = -2.69 to -1.91; p < 0.01) outside the acute phase (R 2 = 0.15-0.39). Intraindividual changes in physical disability and perceived social support were independent predictors of PSD 6 months after the acute phase (B = -0.08/-0.14; p < 0.01), in addition to status scores on established variables (ΔR 2 = 0.08, p < 0.001). DISCUSSION History of mental disorder, physical disability, and social support are independent predictors of depressive symptoms in the first year post-stroke, also when considered conjointly. Future studies should control for these variables when investigating new predictors of PSD. In addition, intraindividual changes in known predictors after stroke play a relevant role in the pathogenesis of PSD and should be considered in clinical practice and future research.
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Affiliation(s)
- Simon Ladwig
- Clinical Neuropsychology and Psychotherapy, Department of Psychology, Faculty of Psychology and Sport Science, Universität Bielefeld, Bielefeld, Germany
| | - Katja Werheid
- Clinical Neuropsychology and Psychotherapy, Department of Psychology, Faculty of Psychology and Sport Science, Universität Bielefeld, Bielefeld, Germany
| | - Martin Südmeyer
- Department of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany.,Department of Neurology, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Matthias Volz
- Clinical Psychology I, Department of Psychology, Faculty of Human Sciences, Universität Kassel, Kassel, Germany
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Jaroonpipatkul C, Onwanna J, Tunvirachaisakul C, Jittapiromsak N, Rakvongthai Y, Chutinet A, Supasitthumrong T, Maes M. Depressive symptoms due to stroke are strongly predicted by the volume and location of the cerebral infarction, white matter hyperintensities, hypertension, and age: A precision nomothetic psychiatry analysis. J Affect Disord 2022; 309:141-150. [PMID: 35430315 DOI: 10.1016/j.jad.2022.04.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/24/2022] [Accepted: 04/09/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To delineate the effects of white matter hyperintensities (WMHs) as measured by Fluid-attenuated inversion recovery (FLAIR) and infarction volume as measured by Diffusion-weighted imaging (DWI) on post-stroke depression symptoms. METHODS Baseline National Institutes of Health Stroke Score (NIHSS) and Modified Rankin Scale (mRS) scores, and FLAIR and DWI MRIs to assess WMHs and acute infarct volumes, respectively, were assessed in 47 patients (≥55 years) with acute ischemic stroke and 17 normal controls. The Montgomery-Åsberg Depression Rating Scale (MDRS) was assessed three months after the stroke. RESULTS The MADRS score was significantly increased in stroke patients as compared with normal controls. The MADRS scale is not unidimensional and cannot be used as an accurate indicator of depression severity in stroke patients. Three months after stroke, key depressive (sadness and inability to feel) and concentration-tension symptoms, and lassitude are significantly predicted by the infarct volume. Right side infarction strongly predicts key depressive symptoms and left side infarction strongly predicts concentration-tension and lassitude scores. Total WMHs significantly predict key depressive and concentration-tension symptoms, and lassitude, with these effects being mediated by right and left DWI stroke volumes and associated disabilities. CONCLUSIONS Interactions between age, hypertension, a chronic atherosclerotic process, and acute stroke account for the onset of key depressive symptoms three months after the acute infarct. Chronic and acute neuro-immune and neuro-oxidative stress pathways associated with the formation of WMHs and acute stroke may explain the incidence of post-stroke key depressive and concentration-tension symptoms, and lassitude.
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Affiliation(s)
| | - Jaruwan Onwanna
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | | | | | - Yothin Rakvongthai
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Aurauma Chutinet
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Stroke Center, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Research Center, Deakin University, Geelong, Australia
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7
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Wang Q, Qi Y, Li Y, Yan Z, Wang X, Ma Q, Tang C, Liu X, Wei M, Zhang H. Psychiatric traits and intracerebral hemorrhage: A Mendelian randomization study. Front Psychiatry 2022; 13:1049432. [PMID: 36684013 PMCID: PMC9850495 DOI: 10.3389/fpsyt.2022.1049432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Psychiatric traits have been associated with intracerebral hemorrhage (ICH) in observational studies, although their causal relationships remain uncertain. We used Mendelian randomization analyses to infer causality between psychiatric traits and ICH. METHODS We collected data from genome-wide association studies of ICH (n = 361,194) and eight psychiatric traits among Europeans, including mood swings (n = 451,619), major depressive disorder (n = 480,359), attention-deficit/hyperactivity disorder (n = 53,293), anxiety (n = 459,560), insomnia (n = 462,341), schizophrenia (n = 77,096), neuroticism (n = 374,323), and bipolar disorder (n = 51,710). We performed a series of bidirectional two-sample Mendelian randomization and related sensitivity analyses. A Bonferroni corrected threshold of p < 0.00625 (0.05/8) was considered to be significant, and p < 0.05 was considered suggestive of evidence for a potential association. RESULTS Mendelian randomization analyses revealed suggestive positive causality of mood swings on ICH (odds ratio = 1.006, 95% confidence interval = 1.001-1.012, p = 0.046), and the result was consistent after sensitivity analysis. However, major depressive disorder (p = 0.415), attention-deficit/hyperactivity disorder (p = 0.456), anxiety (p = 0.664), insomnia (p = 0.699), schizophrenia (p = 0.799), neuroticism (p = 0.140), and bipolar disorder (p = 0.443) are not significantly associated with the incidence of ICH. In the reverse Mendelian randomization analyses, no causal effects of ICH on mood swings (p = 0.565), major depressive disorder (p = 0.630), attention-deficit/hyperactivity disorder (p = 0.346), anxiety (p = 0.266), insomnia (p = 0.102), schizophrenia (p = 0.463), neuroticism (p = 0.261), or bipolar disorder (p = 0.985) were found. CONCLUSION Our study revealed that mood swings are suggestively causal of ICH and increase the risk of ICH. These results suggest the clinical significance of controlling mood swings for ICH prevention.
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Affiliation(s)
- Qingduo Wang
- Department of Neurosurgery, The Yangzhou School of Clinical Medicine of Dalian Medical University, Dalian, China
| | - Yajie Qi
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Zhengcun Yan
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiaodong Wang
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Qiang Ma
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Can Tang
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiaoguang Liu
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Min Wei
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hengzhu Zhang
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
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8
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Gu S, He Z, Xu Q, Dong J, Xiao T, Liang F, Ma X, Wang F, Huang JH. The Relationship Between 5-Hydroxytryptamine and Its Metabolite Changes With Post-stroke Depression. Front Psychiatry 2022; 13:871754. [PMID: 35558423 PMCID: PMC9086784 DOI: 10.3389/fpsyt.2022.871754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 12/14/2022] Open
Abstract
Post-stroke depression (PSD) is the most common and serious sequelae of stroke. Approximately 33% of stroke survivors were affected by PSD. However, many issues (e.g., incidence, diagnostic marker, and risk factor) related to PSD remained unclear. The "monoamine hypothesis" is a significant hypothesis for depression, which suggests that three monoamines play a key role in depression. Therefore, most current antidepressants are developed to modulate the monoamines on PSD treatment, and these antidepressants have good effects on patients with PSD. However, the potential mechanisms of three monoamines in PSD are still unclear. Previously, we proposed "three primary emotions," which suggested a new model of basic emotions based on the three monoamines. It may provide a new way for PSD treatment. In addition, recent studies have found that monoamine-related emotional intervention also showed potential effects in the treatment and prevention of PSD. This study discusses these issues and attempts to provide a prospect for future research on PSD.
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Affiliation(s)
- Simeng Gu
- Department of Psychology, Jiangsu University Medical School, Zhenjiang, China.,Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Zhengming He
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Qiuyue Xu
- Department of Nurse, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jie Dong
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Tingwei Xiao
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Fei Liang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Xianjun Ma
- Section of Brain Diseases, Department of Neurology, Lianyungang Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Lianyungang, China
| | - Fushun Wang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, United States.,Department of Surgery, Texas A&M University College of Medicine, Temple, TX, United States
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Dong L, Williams LS, Brown DL, Case E, Morgenstern LB, Lisabeth LD. Prevalence and Course of Depression During the First Year After Mild to Moderate Stroke. J Am Heart Assoc 2021; 10:e020494. [PMID: 34184539 PMCID: PMC8403325 DOI: 10.1161/jaha.120.020494] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/19/2021] [Indexed: 01/18/2023]
Abstract
Background This study examined the prevalence and longitudinal course of depression during the first year after mild to moderate stroke. Methods and Results We identified patients with mild to moderate ischemic stroke or intracerebral hemorrhage (National Institutes of Health Stroke Scale score <16) and at least 1 depression assessment at 3, 6, or 12 months after stroke (n=648, 542, and 533, respectively) from the Brain Attack Surveillance in Corpus Christi project (2014-2016). Latent transition analysis was used to examine temporal profiles of depressive symptoms assessed by the 8-item Patient Health Questionnaire between 3 and 12 months after stroke. Mean age was 65.6 years, 49.4% were women, and 56.7% were Mexican Americans. The prevalence of depression after stroke was 35.3% at 3 months, decreased to 24.9% at 6 months, and remained stable at 25.7% at 12 months. Approximately half of the participants classified as having depression at 3 or 6 months showed clinical improvement at the next assessment. Subgroups with distinct patterns of depressive symptoms were identified, including mild/no symptoms, predominant sleep disturbance and fatigue symptoms, affective symptoms, and severe/all symptoms. A majority of participants with mild/no symptoms retained this symptom pattern over time. The probability of transitioning to mild/no symptoms was higher before 6 months compared with the later period, and severe symptoms were more likely to persist after 6 months compared with the earlier period. Conclusions The observed dynamics of depressive symptoms suggest that depression after stroke tends to persist after 6 months among patients with mild to moderate stroke and should be continually monitored and appropriately managed.
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Affiliation(s)
- Liming Dong
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMI
| | - Linda S. Williams
- Health Services Research and Development Center for Health Information and CommunicationRoudebush VA Medical CenterIndianapolisIN
- Department of NeurologyIndiana University School of MedicineIndianapolisIN
- Regenstrief Institute, Inc.IndianapolisIN
| | - Devin L. Brown
- Stroke ProgramUniversity of Michigan Medical SchoolAnn ArborMI
| | - Erin Case
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMI
| | - Lewis B. Morgenstern
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMI
- Stroke ProgramUniversity of Michigan Medical SchoolAnn ArborMI
| | - Lynda D. Lisabeth
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMI
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Cai H, Wang XP, Yang GY. Sleep Disorders in Stroke: An Update on Management. Aging Dis 2021; 12:570-585. [PMID: 33815883 PMCID: PMC7990374 DOI: 10.14336/ad.2020.0707] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Stroke is a leading cause of disability and mortality all over the world. Due to an aging population, the incidence of stroke is rising significantly, which has led to devastating consequences for patients. In addition to traditional risk factors such as age, hypertension, hyperlipidemia, diabetes and atrial fibrillation, sleep disorders, as independent modifiable risk factors for stroke, have been highlighted increasingly. In this review, we provide an overview of common types of current sleep disturbances in cerebrovascular diseases, including insomnia, hypersomnia, breathing-related sleep disorders, and parasomnias. Moreover, evidence-based clinical therapeutic strategies and pitfalls of specific sleep disorders after stroke are discussed. We also review the neurobiological mechanisms of these treatments as well as their effects on stroke. Since depression after stroke is so prevalent and closely related to sleep disorders, treatments of post-stroke depression are also briefly mentioned in this review article.
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Affiliation(s)
- Hongxia Cai
- Department of Neurology, Tong-Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiao-Ping Wang
- Department of Neurology, Tong-Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Guo-Yuan Yang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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López-Espuela F, Roncero-Martín R, Canal-Macías MDLL, Moran JM, Vera V, Gomez-Luque A, Lendinez-Mesa A, Pedrera-Zamorano JD, Casado-Naranjo I, Lavado-García J. Depressed Mood after Stroke: Predictive Factors at Six Months Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249542. [PMID: 33419273 PMCID: PMC7766010 DOI: 10.3390/ijerph17249542] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
We aimed to know the prevalence of post-stroke depression (PSD) in our context, identify the variables that could predict post-stroke depression, by using the Hamilton Depression Rating Scale, occurring within six months after stroke, and identify patients at high risk for PSD. Methods: descriptive, cross-sectional and observational study. We included 173 patients with stroke (transient ischemic attack (TIA) included) and collected sociodemographic and clinical variables. We used the Hamilton Depression Scale (HDS) for depression assessment and Barthel Index and modified Rankin Scale (mRS) for functional assessment. The neurological severity was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Results: 35.5% were women, aged 71.16 (±12.3). Depression was present in 42.2% patients (n = 73) at six months after stroke. The following variables were significantly associated with PSD: diagnosis of previous depression (p = 0.005), the modified Rankin Scale at discharge (p = 0.032) and length of hospital stay (p = 0.012). Conclusion: PSD is highly prevalent after stroke and is associated with the severity, left location of the stroke, and the degree of disability at discharge. Its impact justifies the evaluation and early treatment that still continues to be a challenge today.
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Affiliation(s)
- Fidel López-Espuela
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Raúl Roncero-Martín
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Maria de la Luz Canal-Macías
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
- Correspondence: ; Tel.: +34-927257450
| | - Jose M. Moran
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Vicente Vera
- Department of Stomatology II, School of Dentistry, Complutense University, 28040 Madrid, Spain;
| | - Adela Gomez-Luque
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Alejandro Lendinez-Mesa
- Nursing Department, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain;
| | - Juan Diego Pedrera-Zamorano
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | | | - Jesus Lavado-García
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
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12
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Laures-Gore JS, Dotson VM, Belagaje S. Depression in Poststroke Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1798-1810. [PMID: 33181048 DOI: 10.1044/2020_ajslp-20-00040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The aim of this tutorial is to provide speech-language pathologists with foundational knowledge of poststroke depression comorbidly occurring with aphasia. Given the negative effect of depression on functional outcomes and mortality, it is crucial that speech-language pathologists possess this knowledge in order to better advocate for and treat their patients. Method and Results Three areas of complementary expertise (speech-language pathology, psychology, and neurology) collaborated on this tutorial to address the following areas: (a) provide terminology associated with depression and related mood disorders, (b) describe the potential underlying pathophysiology of depression in the general population, (c) provide an overview of our existing understanding of comorbid poststroke depression and aphasia, and (d) summarize current assessment methods and interventions for poststroke depression in adults with aphasia. Conclusion Given the compounding impact aphasia and depression have on rehabilitation outcomes, it is imperative that speech-language pathologists understand terminology, assessment, and treatment practices for depression.
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Affiliation(s)
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, Atlanta
- Gerontology Institute, Georgia State University, Atlanta
| | - Samir Belagaje
- Departments of Neurology and Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
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13
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Uchida H, Hiragaki Y, Nishi Y, Nakahara S, Koumoto J, Onmyoji Y, Fujimoto N, Kawakami K, Ishii M, Hirao K. An iPad application-based intervention for improving post-stroke depression symptoms in a convalescent rehabilitation ward: A pilot randomized controlled clinical trial protocol. Internet Interv 2020; 21:100340. [PMID: 32944505 PMCID: PMC7481559 DOI: 10.1016/j.invent.2020.100340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is a neuropsychiatric sequela that causes serious adverse effects on the prognosis of stroke patients. Our developed iPad application is a very innovative approach designed to improve participants' depressive symptoms by presenting positive words stimuli in a video. Although this application has fewer side effects than existing pharmacological and non-pharmacological interventions and is likely less burdensome for patients and caregivers, its efficacy for PSD has not been investigated. Here we present a pilot randomized controlled trial (RCT) protocol to investigate the therapeutic potential of this application intervention for PSD patients. METHODS This study is designed as a 5-week, single-center, open-label, parallel-group, pilot RCT. Thirty-two patients with PSD will be randomly assigned to a combination of the iPad application and usual rehabilitation or usual rehabilitation alone (1:1 allocation ratio). The iPad application intervention lasts 3 min a day, and the usual rehabilitation lasts 3 h a day. The primary outcome is the change from baseline in The Center for Epidemiologic Studies Depression Scale score at the end of the 5-week intervention. DISCUSSION This pilot RCT is the first study to investigate the potential of iPad application interventions to reduce depressive symptoms in PSD patients. This pilot RCT determines whether this is a viable and effective intervention and informs the design for a full-scale trial. If our hypothesis is correct, this trial can provide evidence to augment the standard practice of iPad application interventions to improve depressive symptoms in patients with PSD.
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Key Words
- API, Application Programming Interface
- CBT, Cognitive Behavioral Therapy
- CRW, Convalescent Rehabilitation Ward
- Depression
- Mobile applications
- OT, Occupational Therapists
- PSD, Post-stroke Depression
- PT, Physical Therapists
- RCT, Randomized Controlled Trial
- Rehabilitation
- SPSRS, Subliminal Priming with Supraliminal Reward Stimulation
- ST, Speech Therapists
- Stroke
- rTMS, Repetitive Transcranial Magnetic Stimulation
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Affiliation(s)
- Hiroyuki Uchida
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Yoshiya Hiragaki
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Yuta Nishi
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Shiori Nakahara
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Junki Koumoto
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Yusuke Onmyoji
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Norimasa Fujimoto
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kazuho Kawakami
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Masato Ishii
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kazuki Hirao
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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14
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Reliability and Validity of the Patient Health Questionnaire-9 as a Screening Tool for Poststroke Depression. J Neurosci Nurs 2019; 51:147-152. [PMID: 31058767 DOI: 10.1097/jnn.0000000000000442] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Screening for poststroke depression (PSD) using a valid and reliable tool is recommended for all stroke survivors. This literature review identifies the specificity, sensitivity, and appropriateness of the 9-item Patient Health Questionnaire (PHQ-9) to screen stroke patients for PSD. METHODS Relevant databases were searched using the following selection criteria: (1) peer-reviewed primary research, (2) published from 2012 to 2018 (to evaluate the most recent research using this tool), and (3) examined the specificity and sensitivity of the PHQ-9 for screening stroke survivors for PSD. RESULTS Six studies, with an overall level of evidence grade of "B," representing an overall total sample size of 930 participants (851 given a diagnosis of stroke and 49 given a diagnosis of transient ischemic attacks) met criteria for inclusion in the review. Only 2 studies reported data on all of the components necessary to determine the robustness of this tool to screen for depression in stroke survivors. CONCLUSION Evidence regarding the sensitivity and specificity of the PHQ-9 to screen stroke patients for PSD is inconclusive. Additional research is needed to address the appropriateness of the PHQ-9 as a depression screening tool in this population. Clinicians should validate the results of PHQ-9 screening of ischemic stroke patients for PSD with the Structured Clinical Interview for DSM-5, the standard for diagnosing depression, before initiating treatment of PSD.
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15
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Trusova NA, Levin OS. Clinical significance and possibilities of therapy of post-stroke depression. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:60-67. [DOI: 10.17116/jnevro201911909260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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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: 40] [Impact Index Per Article: 6.7] [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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17
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Kwon CY, Lee B, Chung SY, Kim JW, Shin A, Choi YY, Yun Y, Leem J. Herbal medicine Sihogayonggolmoryeo-tang or Chai-Hu-Jia-Long-Gu-Mu-Li-Tang for the treatment of post-stroke depression: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e12384. [PMID: 30235703 PMCID: PMC6160176 DOI: 10.1097/md.0000000000012384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of herbal medicine Sihogayonggolmoryeo-tang (SGYMT) or Chai-Hu-Jia-Long-Gu-Mu-Li-Tang for the treatment of post-stroke depression. METHODS AND ANALYSIS The following electronic databases will be searched up to July 2018 without language or publication status restrictions: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing, and Allied Health Literature (CINAHL), and PsycARTICLES. We will also search Korean and Chinese databases. Any clinical randomized controlled trials related to SGYMT treatment for post-stroke depression will be included. Changes in the degree of depression and adverse events will be assessed as primary outcomes. The total effective rate and changes in neurological function, activities of daily living, and quality of life will be evaluated as secondary outcomes. Study selection, data extraction, assessment of study quality, and evaluation of the quality of evidence for the main findings will be performed independently by 2 researchers. The data synthesis and analysis will be performed using RevMan version 5.3. The results will be expressed as a risk ratio for dichotomous data and as the mean difference or standardized mean difference for continuous data. Data will be synthesized by either a fixed-effects or random-effects model according to a heterogeneity test or the number of studies included in the meta-analysis. The methodological quality of the included studies will be evaluated using the Cochrane Collaboration's risk of bias tool. The quality of evidence for each main outcome will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. ETHICS AND DISSEMINATION Ethical approval is not required because individual patient data are not included. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentations. PROSPERO REGISTRATION NUMBER CRD42018102939.
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Affiliation(s)
- Chan-Young Kwon
- Chung-Yeon Medical Institute, Gwangju
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Boram Lee
- Department of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong
| | - Sun-Yong Chung
- Department of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong
| | - Jong Woo Kim
- Department of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong
| | | | - Ye-yong Choi
- Chung-Yeon Medical Institute, Gwangju
- Research and Development Institute, CY Pharma Co
| | - Younghee Yun
- Chung-Yeon Medical Institute, Gwangju
- Research and Development Institute, CY Pharma Co
| | - Jungtae Leem
- Chung-Yeon Medical Institute, Gwangju
- Dongshin Korean Medicine Hospital, Seoul, Republic of Korea
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18
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Van Dijk MJ, Hafsteinsdóttir TB, Schuurmans MJ, Man‐van Ginkel JM. Feasibility of a nurse‐led intervention for the early management of depression after stroke in hospital. J Adv Nurs 2018; 74:2882-2893. [DOI: 10.1111/jan.13806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Mariska J. Van Dijk
- School of Nursing Faculty of Health Care University of Applied Sciences Utrecht Utrecht The Netherlands
| | - Thóra B. Hafsteinsdóttir
- Julius Center for Health Science and Primary Care Department of Nursing Science University Medical Center Utrecht University Utrecht Utrecht The Netherlands
- Nursing Science Program in Clinical Health Science University Medical Center Utrecht University Utrecht Utrecht The Netherlands
- Faculty of Health Care University of Applied Sciences Utrecht Utrecht The Netherlands
| | - Marieke J. Schuurmans
- Julius Center for Health Science and Primary Care Department of Nursing Science University Medical Center Utrecht University Utrecht Utrecht The Netherlands
- Faculty of Health Care University of Applied Sciences Utrecht Utrecht The Netherlands
| | - Janneke M. Man‐van Ginkel
- Julius Center for Health Science and Primary Care Department of Nursing Science University Medical Center Utrecht University Utrecht Utrecht The Netherlands
- Nursing Science Program in Clinical Health Science University Medical Center Utrecht University Utrecht Utrecht The Netherlands
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19
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Volz M, Voelkle MC, Werheid K. General self-efficacy as a driving factor of post-stroke depression: A longitudinal study. Neuropsychol Rehabil 2018; 29:1426-1438. [PMID: 29299953 DOI: 10.1080/09602011.2017.1418392] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Post-stroke depression (PSD) is the most common psychiatric condition after stroke, affecting one third of survivors. Despite identification of meaningful predictors, knowledge about the interplay between these factors remains fragmentary. General self-efficacy (GSE) is closely linked to PSD, yet direction and magnitude of this relationship remains unclear. The authors assessed the relationship between GSE and depression during the first two years post-stroke while controlling for stable inter-individual differences using continuous time (CT) structural equation modelling (SEM). Patients of two German rehabilitation centres (N = 294, mean age = 63.78 years, SD = 10.83) were assessed six weeks after ischemic stroke and at four follow-ups covering two years. GSE Scale and Geriatric Depression Scale (GDS) were used to assess GSE and depression. CT-analysis revealed significantly higher within-person cross-effects of GSE on GDS (a21 = -.29) than vice versa (a12 = -.17). Maximal cross-lagged effects emerged six months post-stroke. Our results show that decreasing GSE led to increasing depressiveness, and only to a smaller extent vice versa. This suggests that fostering GSE by strengthening perceived control after stroke can counter PSD emersion and exacerbation. Six months post-stroke, when patients face social re-integration, programmes focusing on GSE could potentially help to prevent later PSD.
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Affiliation(s)
- Matthias Volz
- Department of Psychology, Humboldt Universität zu Berlin , Berlin , Germany
| | - Manuel C Voelkle
- Department of Psychology, Humboldt Universität zu Berlin , Berlin , Germany.,Max Planck Institute for Human Development, Center for Lifespan Psychology , Berlin , Germany
| | - Katja Werheid
- Department of Psychology, Humboldt Universität zu Berlin , Berlin , Germany.,Department of Neurology, Ernst von Bergmann Klinikum , Potsdam , Germany
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20
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Bjartmarz I, Jónsdóttir H, Hafsteinsdóttir TB. Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study. BMC Nurs 2017; 16:72. [PMID: 29213212 PMCID: PMC5709925 DOI: 10.1186/s12912-017-0262-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/10/2017] [Indexed: 11/14/2022] Open
Abstract
Background Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses’ and auxiliary nurses’ view of the implementation. Methods A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation. Results Improved nursing documentation was found for 23 items (N = 37), which was significant for nine items focusing mobility (p = 0.002, p = 0.024, p = 0.012), pain (p = 0.012), patient teaching (p = 0.001, p = 0.000) and discharge planning (p = 0.000, p = 0.002, p = 0.004). Improved guideline use was found for 20 QIT-items (N = 30), with significant improvement on six items focusing on mobility (p = 0.023), depression (p = 0.033, p = 0.025, p = 0.046, p = 0.046), discharge planning (p = 0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p = 0.019) and Context (p = 0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care. Conclusion Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention. Electronic supplementary material The online version of this article (10.1186/s12912-017-0262-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingibjörg Bjartmarz
- Clinical Nurse Specialist, Department of Rehabilitation, Landspítali University Hospital, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, University of Iceland, Reykjavík, Iceland.,Nursing Care for Chronically Ill Adults, Landspítali University Hospital, Reykjavík, Iceland
| | - Thóra B Hafsteinsdóttir
- Faculty of Nursing, University of Iceland, Reykjavík, Iceland.,Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Abstract
: Nearly one-third of stroke survivors experience depression. Poststroke depression is associated with longer hospital stays, poor physical and cognitive recovery, poor quality of life, high caregiver distress, increased risk of recurrent stroke, and higher rates of morbidity and mortality. Poststroke depression, however, often goes unrecognized and untreated because the physical and cognitive repercussions of stroke make it difficult to identify. Nurses are well positioned to recognize poststroke depression, educate patient caregivers, and aid patients who have poststroke depression in their efforts to achieve physical, cognitive, and emotional recovery. This article explains how poststroke depression often manifests, describes associated risk factors, and discusses the screening tools and therapeutic interventions nurses can use to identify and help manage depression in patients following stroke.
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van Dijk MJ, de Man-van Ginkel JM, Hafsteinsdóttir TB, Schuurmans MJ. Psychometric evaluation of the Signs of Depression Scale with a revised scoring mechanism in stroke patients with communicative impairment. Clin Rehabil 2017; 31:1653-1663. [PMID: 28511591 PMCID: PMC5697565 DOI: 10.1177/0269215517708328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate (1) the diagnostic value of the Signs of Depression Scale (SODS) in a Likert scale format and (2) whether the Likert scale improves the diagnostic value compared with the original dichotomous scale. DESIGN Cross-sectional multicentre study. SETTING One general and one university hospital in the Netherlands. SUBJECTS A total of 116 consecutive hospitalized stroke patients, of whom 53 were patients with communicative impairment. MAIN MEASURES Depression was diagnosed with the Composite International Diagnostic Interview (CIDI) administered to the patients' relatives. The Barthel Index (BI) was used as an external validator. RESULTS The correlation between the CIDI and the SODS-Likert or the SODS was small ( rb = 0.18), and the correlation between the Barthel Index and the SODS-Likert ( rs = -0.30) or the SODS ( rs = -0.33) was moderate. For both instruments, the discriminatory power for diagnosing depression when compared with the CIDI was best at a cut-off score of ⩾2. The internal consistency of the SODS-Likert was acceptable (α = 0.69) and slightly higher than that of the SODS (α = 0.57). The inter-rater reliability of the SODS-Likert and the SODS was acceptable (intraclass correlation coefficient (ICC) 0.66 and ICC 0.80, respectively). The clinical utility was rated good. CONCLUSION The diagnostic value of the SODS did not improve using a Likert scale format. However, the diagnostic value of the original dichotomous SODS is reasonable for the initial mood assessment of stroke patients with communicative impairment.
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Affiliation(s)
- Mariska J van Dijk
- 1 Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Janneke M de Man-van Ginkel
- 2 Julius Center for Health Sciences and Primary Care, Department of Nursing Science, University Medical Center Utrecht, Utrecht, The Netherlands.,3 Nursing Science, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thóra B Hafsteinsdóttir
- 1 Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands.,2 Julius Center for Health Sciences and Primary Care, Department of Nursing Science, University Medical Center Utrecht, Utrecht, The Netherlands.,3 Nursing Science, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J Schuurmans
- 1 Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands.,2 Julius Center for Health Sciences and Primary Care, Department of Nursing Science, University Medical Center Utrecht, Utrecht, The Netherlands.,3 Nursing Science, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
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