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Griffiths M, Kontou E, Ford C. Psychological support after stroke: unmet needs and workforce requirements of clinical neuropsychological provision for optimal rehabilitation outcomes. Br J Hosp Med (Lond) 2023; 84:1-8. [PMID: 38019203 DOI: 10.12968/hmed.2023.0289] [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] [Indexed: 11/30/2023]
Abstract
Stroke services must detect and manage psychological and neuropsychological problems that occur after stroke, such as cognitive and language impairments, post-stroke apathy, post-stroke emotionalism, depression, anxiety, post-traumatic stress disorder, personality changes and suicidality. Stroke neuropsychology plays a key role in the assessment, understanding and management of these consequences of stroke, as well as contributing to complex case management, staff supervision and training. Where these provisions are absent from the stroke rehabilitation pathway, this significantly limits potential rehabilitation outcomes. To manage the scale of psychological and neuropsychological needs post stroke, clinical guidance recommends the use of a matched care system, in which these needs are triaged and matched with corresponding levels of support. Recent workforce guidelines provide clear professional recommendations for psychological staffing skill mix and threshold requirements for clinical oversight and clinical governance assurances.
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Affiliation(s)
- Mark Griffiths
- Clinical Health Psychology Services, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Eirini Kontou
- School of Medicine, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Catherine Ford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
- All Hallows Neurological Rehabilitation Centre, CareTech, Norwich, UK
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Chun HYY, Ford A, Kutlubaev MA, Almeida OP, Mead GE. Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence. Stroke 2021; 53:1402-1410. [PMID: 34865508 DOI: 10.1161/strokeaha.121.035499] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression and anxiety each affect around 1 in 3 people during the first year after a stroke. Suicide causes the death of about 3 to 4/1000 stroke survivors during the first 5 years. This narrative review describes the best available evidence for the epidemiology of depression, anxiety, and suicide; their prevention; and the treatment of anxiety and depression. We conclude with directions for future research.
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Affiliation(s)
| | - Andrew Ford
- University of Western Australia, Australia (A.F., O.P.A.)
| | | | | | - Gillian E Mead
- University of Edinburgh, United Kingdom (H.-Y.Y.C., G.E.M.)
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Alias A, Bertrand L, Bisson-Gervais V, Henry M. Suicide in obstructive lung, cardiovascular and oncological disease. Prev Med 2021; 152:106543. [PMID: 34538370 DOI: 10.1016/j.ypmed.2021.106543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023]
Abstract
Healthcare institutions face increasing demands stemming from the burden of noncommunicable diseases. The personal, social, financial and societal impact of these diseases are well-documented. However, the mental health concerns and trajectories of patients afflicted by chronic medical diseases have been under-recognized and are under-resourced. Despite that chronic diseases are associated with substantially increased risk of suicide, the medical world has largely failed to properly address suicide in the medically ill. Considering their high prevalence and mortality rate, this review article will highlight the mental health burden and suicide risk in obstructive lung, cardiovascular (including stroke) and oncological disease, in light of relevant data and conceptual models of suicide. Finally, general evidence-based suicide intervention strategies and potential selective adaptation of these strategies to the chronic medically ill patient populations and medical settings will be reviewed.
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Affiliation(s)
- Ali Alias
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada
| | - Lia Bertrand
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St Joseph's Healthcare Hamilton, West 5(th) Campus, 100 West 5(th) Street, Hamilton, ON L8N 3K7, Canada.
| | - Vanessa Bisson-Gervais
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, 5100 de Maisonneuve Blvd. West, Suite 720, Montreal, QC H4A 3T2, Canada; Segal Cancer Centre, Jewish General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada; Lady-Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada
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Williams MW, Li CY, Hay CC. Validation of the 10-item Center for Epidemiologic Studies Depression Scale Post Stroke. J Stroke Cerebrovasc Dis 2020; 29:105334. [PMID: 32992164 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To establish reliability and validity of the abbreviated (10-item) Center for Epidemiologic Studies Depression Scale (CESD-10) among individuals post stroke. METHOD The psychometric properties of the CESD-10 were evaluated in 1219 adults with stroke admitted to an eligible inpatient rehabilitation facilities (n = 11) across 9 different states post stroke during 2005 to 2006. This study was a secondary data analysis of the existing publicly available clinical trial dataset, Stroke Recovery in Underserved Populations study. Reliability, validity, factory structure and item-level psychometrics of the CESD-10 were examined. In addition, the predictive accuracy of the CESD-10 was compared against the CESD-20 (criterion). RESULTS The CESD-10 was highly correlated with the CESD-20 (r = 0.97). The CESD-10 had good internal reliability (Cronbach's α = 0.86). The CESD-20 and CESD-10 had similar accuracy in classifying individuals as depressed (Kappa = 0.85). CONCLUSION The 10-item CESD is a valid measure of depression for individuals post stroke.
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Affiliation(s)
| | - Chih-Ying Li
- University of Texas Medical Branch, Department of Occupational Therapy, Galveston, TX, USA
| | - Catherine C Hay
- Texas Woman's University, Houston, TX & TIRR Memorial Hermann, Houston, TX, USA
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Chen X, Zhang H, Xiao G, Lv C. Prevalence of suicidal ideation among stroke survivors: A systematic review and meta-analysis. Top Stroke Rehabil 2020; 28:545-555. [PMID: 33186090 DOI: 10.1080/10749357.2020.1846933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: The prevalence of suicidal ideation (SI) among stroke survivors has been the subject of several studies, but systematic review data regarding the prevalence of SI among stroke patients are still scarce.Objectives: To estimate the pooled prevalence of SI among stroke survivors.Methods: A comprehensive search strategy was established across the following electronic databases; Web of Science, PubMed, the Cochrane Library, Chinese Wanfang database and Chinese National Knowledge Infrastructure (CNKI). The 95% confidence interval (CI) given in each identified study was used to assess the outcomes. Cochran's Q test and I2 statistic were used to evaluate heterogeneity. The quality of the final evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We calculated the pooled prevalence of SI among stroke survivors before subgroup analysis and meta-regression was used to find the partial source of heterogeneity.Results: Twenty-one studies with a total of 17,189 participants were included in this study and the pooled prevalence of SI among stroke survivors was 12.25% (95%CI: 9.91-15.07%). Substantial heterogeneity was detected in the estimation of prevalence. The evidence was graded as very low for the overall outcome and the single item subgroup, while it was graded as low for the stable scale subgroup.Conclusions: This meta-analysis suggests a high prevalence of SI among stroke survivors. Routine screening of SI after stroke is needed to plan interventions aimed at reducing suicide risk.
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Affiliation(s)
- Xingxing Chen
- International Nursing College, Hainan Medical University, Haikou, Hainan, China
| | - Hua Zhang
- International Nursing College, Hainan Medical University, Haikou, Hainan, China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Department of Emergency, Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China
| | - Gui Xiao
- International Nursing College, Hainan Medical University, Haikou, Hainan, China
| | - Chuanzhu Lv
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Department of Emergency, Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China.,Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.,Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China
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Bartoli F, Pompili M, Lillia N, Crocamo C, Salemi G, Clerici M, Carrà G. Rates and correlates of suicidal ideation among stroke survivors: a meta-analysis. J Neurol Neurosurg Psychiatry 2017; 88:498-504. [PMID: 28331011 DOI: 10.1136/jnnp-2017-315660] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/07/2017] [Accepted: 03/01/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND A better understanding of the epidemiological impact of suicidal ideation after stroke is required to identify subjects needing personalised interventions. OBJECTIVE The aim of this meta-analysis was to estimate rates and correlates of suicidal ideation among stroke survivors. METHODS We searched via Ovid, Medline, Embase and PsycInfo from database inception until August 2016. Predefined outcomes were (1) rates of suicidal ideation based on random-effects pooled proportion and (2) relevant sociodemographic and clinical correlates, using random-effects odds ratio (OR) or standardised mean difference (SMD) for categorical and continuous variables, respectively. RESULTS Fifteen studies and 13 independent samples, accounting for 10 400 subjects, were included in meta-analyses. The pooled proportion of suicidal ideation among stroke survivors was 11.8% (7.4% to 16.2%), with high heterogeneity across studies (I2=97.3%). Current (OR=11.50; p<0.001) and past (OR=6.96; p<0.001) depression, recurrent stroke (OR=1.77; p<0.001), disability (SMD=0.58; p=0.01) and cognitive impairment (SMD=-0.22; p=0.03) were all associated with suicidal ideation. Moreover, suicidal ideation was less likely in stroke survivors who were married (OR=0.63; p<0.001), employed (OR=0.57; p=0.02) and had higher education levels (OR=0.55; p=0.002). CONCLUSION Despite some limitations, this meta-analysis shows that about one out of eight stroke survivors has suicidal ideation. Thus, there is enough evidence to support the use of routine screening and early interventions to prevent and treat suicidal ideation after stroke, especially among subjects carrying specific correlates.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Nicoletta Lillia
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giuseppe Salemi
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Division of Psychiatry, University College London, London, UK
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Lewin-Richter A, Volz M, Jöbges M, Werheid K. Predictivity of Early Depressive Symptoms for Post-Stroke Depression. J Nutr Health Aging 2015; 19:754-8. [PMID: 26193859 DOI: 10.1007/s12603-015-0540-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Depression is a frequent complication after stroke. However, little is known about the predictive value of early self-reported depressive symptoms (DS) for later development of post-stroke depression (PSD) 6 months after discharge. DESIGN Using a prospective longitudinal design, we investigated the prevalence of DS and examined their predictive value for depressive disorders 6 months after stroke while statistically controlling major established PSD risk factors. SETTING AND PARTICIPANTS During inpatient rehabilitation, 96 stroke patients were screened for DS. After 6 months, 71 patients were attainable for a follow-up. MEASUREMENTS DS was assessed using the 15-item Geriatric Depression Scale (GDS-15). At follow-up a telephone interview that included the Structured Clinical Interview for Psychiatric Disorders (SCID), which is based on DSM-IV criteria, and the GDS-15 was conducted. Patients with major depression (MD) at the follow-up were considered to have PSD. RESULTS Regression analyses were conducted to examine the influence of early DS on PSD after 6 months while controlling for age, premorbid depression, and functional and cognitive impairments. The percentage of patients who scored above the GDS-15 cut-off for clinically relevant DS increased significantly, from 37% to 44%, after 6 months. According to the SCID, 27% of stroke patients fulfilled the criteria for MD, and another 16% fulfilled those for minor depression. Logistic regression showed that DS at baseline significantly predicted PSD at follow-up (odds ratio: 1.43; 95% CI: 1.15-1.8). CONCLUSION Self-reported DS during inpatient rehabilitation are predictive for PSD 6 months after discharge. Assessment of early DS contributes to identifying stroke patients at risk for PSD, thereby facilitating prevention and treatment.
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Affiliation(s)
- A Lewin-Richter
- Katja Werheid, Department of Psychology, Humboldt Universität zu Berlin, 10099 Berlin,
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Tanislav C, Kropp P, Grittner U, Holzhausen M, Fazekas F, Jungehülsing GJ, Tatlisumak T, von Sarnowski B, Putaala J, Huber R, Thijs V, Schmidt R, Kaps M, Enzinger C, Dichgans M, Norrving B, Rolfs A. Clinically relevant depressive symptoms in young stroke patients - results of the sifap1 study. Neuroepidemiology 2015; 44:30-8. [PMID: 25659436 DOI: 10.1159/000371389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although post-stroke depression is widely recognized, less is known about depressive symptoms in the acute stage of stroke and especially in young stroke patients. We thus investigated depressive symptoms and their determinants in such a cohort. METHODS The Stroke in Young Fabry Patients study (sifap1) prospectively recruited a large multinational European cohort (n = 5,023) of patients with a cerebrovascular event aged 18-55. For assessing clinically relevant depressive symptoms (CRDS, defined by a BDI-score ≥18) the self-reporting Beck Depression Inventory (BDI) was obtained on inclusion in the study. Associations with baseline parameters, stroke severity (National Institutes of Health Stroke Scale, NIHSS), and brain MRI findings were analyzed. RESULTS From the 2007 patients with BDI documentation, 202 (10.1%) had CRDS. CRDS were observed more frequently in women (12.6 vs. 8.2% in men, p < 0.001). Patients with CRDS more often had arterial hypertension, diabetes mellitus, and hyperlipidemia than patients without CRDS (hypertension: 58.0 vs. 47.1%, p = 0.017; diabetes mellitus: 17.9 vs. 8.9%, p < 0.001; hyperlipidemia: 40.5 vs. 32.3%, p = 0.012). In the subgroup of patients with ischemic stroke or TIA (n = 1,832) no significant associations between CRDS and cerebral MRI findings such as the presence of acute infarcts (68.1 vs. 65.8%, p = 0.666), old infarctions (63.4 vs. 62.1%, p = 0.725) or white matter hyper-intensities (51.6 vs. 53.7%, p = 0.520) were found. CONCLUSION Depressive symptoms were present in 10.1% of young stroke patients in the acute phase, and were related to risk factors but not to imaging findings.
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Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke 2014; 9:1017-25. [PMID: 25117911 DOI: 10.1111/ijs.12357] [Citation(s) in RCA: 651] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/12/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Approximately 15 million people who suffer a stroke globally each year are at risk of developing depression. AIM To update our systematic review and meta-analysis of the frequency of depression after stroke published in 2005, including studies published before July 2004. METHODS We included all published observational studies (to 31 May 2013) with prospective consecutive recruitment and quantification of the proportion of people with depression after stroke. We included studies of adult (>18 years) patients with a clinical diagnosis of stroke, where an assessment of depression or depressive symptom burden was performed at a pre-specified time-point for all study participants. RESULTS Data were available from 61 studies including 25,488 people. The proportional frequency of depression varied considerably across studies; however, the pooled frequency estimate of 31% (95% confidence interval 28% to 35%) was not significantly different from the 33% (difference of 2%, 95% confidence interval <1% to 3%) reported in the 2005 review. The proportion with depression between one and five-years (25%; 95% confidence interval 16 to 33%) and at five years after stroke (23%; 95% confidence interval 14 to 31%) was significantly lower. CONCLUSION Despite systematic review evidence describing validated depression screening tools and effective treatment and prevention strategies for depression after stroke, there has not been a significant reduction in the proportion of people experiencing depression after stroke. There is a pressing need for increased clinical uptake of evidenced-based strategies to screen for, prevent, and treat depression after stroke.
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Affiliation(s)
- Maree L Hackett
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia; Reader in Epidemiology, The University of Central Lancashire, Preston, Lancashire, UK
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Affiliation(s)
- Harold P. Adams
- From the Departments of Neurology (H.P.A.) and Psychiatry (R.G.R.), Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Robert G. Robinson
- From the Departments of Neurology (H.P.A.) and Psychiatry (R.G.R.), Carver College of Medicine, University of Iowa, Iowa City, IA
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Salter KL, Foley NC, Zhu L, Jutai JW, Teasell RW. Prevention of poststroke depression: does prophylactic pharmacotherapy work? J Stroke Cerebrovasc Dis 2012; 22:1243-51. [PMID: 22554569 DOI: 10.1016/j.jstrokecerebrovasdis.2012.03.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 03/20/2012] [Accepted: 03/25/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Given the negative influence of poststroke depression (PSD) on functional recovery, cognition, social participation, quality of life, and risk for mortality, the early initiation of antidepressant therapy to prevent its development has been investigated; however, individual studies have offered conflicting evidence. The present systematic review and meta-analysis examined available evidence from published randomized controlled trials (RCTs) evaluating the effectiveness of pharmacotherapy for the prevention of PSD to provide updated pooled analyses. METHODS Literature searches of 6 databases were performed for the years 1990 to 2011. RCTs meeting study inclusion criteria were evaluated for methodologic quality. Data extracted included the antidepressant therapy used, treatment timing and duration, method(s) of assessment, and study results pertaining to the onset of PSD. Pooled analyses were conducted. RESULTS Eight RCTs were identified for inclusion. Pooled analyses demonstrated reduced odds for the development of PSD associated with pharmacologic treatment (odds ratio [OR] 0.34; 95% confidence interval [CI] 0.22-0.53; P<.001), a treatment duration of 1 year (OR 0.31; 95% CI 0.18-0.56; P<.001), and the use of a selective serotonin reuptake inhibitor (OR 0.37; 95% CI 0.22-0.61; P<.001). CONCLUSIONS The early initiation of antidepressant therapy, in nondepressed stroke patients, may reduce the odds for development of PSD. Optimum timing and duration for treatment and the identification of the most appropriate recipients for a program of indicated prevention require additional examination.
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Affiliation(s)
- Katherine L Salter
- Aging, Rehabilitation & Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital, London, Ontario, Canada.
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Sibon I, Lassalle-Lagadec S, Renou P, Swendsen J. Evolution of depression symptoms following stroke: a prospective study using computerized ambulatory monitoring. Cerebrovasc Dis 2012; 33:280-5. [PMID: 22285959 DOI: 10.1159/000334663] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 10/20/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the high prevalence and impact of post-stroke depression (PSD), questions persist concerning the nature and stability of PSD over time. The current study uses state-of-the-art computerized ambulatory monitoring techniques to assess daily life depression symptoms following stroke and examines the evolution of depression levels over a three-month period. METHODS 48 patients admitted to a university hospital neurology unit for ischemic or hemorrhagic stroke participated in ambulatory monitoring of DSM-IV depression symptoms for a one-week period after hospital discharge. Clinician-administered measures of depression were also obtained at discharge and again three months later. RESULTS The percentage of the sample with elevated depression scores was the same at discharge and three months later, but consistency in depression profiles was low. Ambulatory monitoring revealed that elevated depression levels at hospital discharge were most strongly associated with anhedonia (t ratio = 4.840, p < 0.001) and fatigue (t ratio = 4.00, p < 0.001), whereas individuals with elevated scores at three months were predicted by daily life negative thoughts (t ratio = 4.051, p < 0.001), anxious mood (t ratio = 3.489, p < 0.01), sad mood (t ratio = 2.621, p < 0.05) and emotional reactivity (t ratio = 2.466, p < 0.05). CONCLUSIONS The prevalence of depression may appear stable during the immediate weeks and months following stroke, but it is likely to be composed of very different symptom profiles. The immediate physical and psychological impact of stroke may induce somatic symptoms that explain elevated depression levels and which may not indicate a risk factor for later depression.
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Affiliation(s)
- Igor Sibon
- University of Bordeaux, National Center for Scientific Research (INCIA, CNRS 5287), Bordeaux, France
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Kouwenhoven SE, Kirkevold M, Engedal K, Biong S, Kim HS. The lived experience of stroke survivors with early depressive symptoms: A longitudinal perspective. Int J Qual Stud Health Well-being 2011; 6:QHW-6-8491. [PMID: 22162976 PMCID: PMC3234797 DOI: 10.3402/qhw.v6i4.8491] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2011] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of the study was to describe the lived experience as it develops over time in stroke survivors suffering from early depressive symptoms. METHOD This paper presents a phenomenological hermeneutical interview-study of nine participants at 6, 12, and 18 months after stroke. FINDINGS The participants related the depressive symptoms to the consequences of the stroke, and the experience of loss was crucial. Depressive symptoms was not meaningful on its own, but formed the backdrop of the experience of stroke. Our findings revealed three patterns of experience: (1) finding a restored self; (2) trapped in a different life; and (3) fighting to regain self. TWO GROUPS OF STROKE SURVIVORS ARE PARTICULARLY VULNERABLE AND SHOULD RECEIVE SPECIAL ATTENTION: (a) old adults living alone; and (b) adults experiencing serious threats to their commitments such as to work, family, and children. CONCLUSION Depressive symptoms have a severe impact on life after stroke. Life circumstances, degree of residual impairment from a stroke, and social context were found to influence people to move along different paths. Older adults living alone and adults experiencing serious threat to their commitments should receive special attention, in terms of further research and in terms of follow-up in clinical practice. More studies investigating the experience of post-stroke depression (PSD) over time and the association between depressive symptoms and loss/grieving are needed. There is also a need for continued empirical research on the identification of effective interventions aimed at prevention or improved coping with PSD.
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Pascoe MC, Crewther SG, Carey LM, Crewther DP. Inflammation and depression: why poststroke depression may be the norm and not the exception. Int J Stroke 2011; 6:128-35. [PMID: 21371275 DOI: 10.1111/j.1747-4949.2010.00565.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ischaemic stroke often precedes the appearance of clinical depression. Poststroke depression in turn influences the prognostic outcome. In the interest of advancing our understanding of the biological mechanisms underlying the development of poststroke depression, this systematic review explores the immunological processes driving the development of inflammation-related cell death in mood-related brain regions. Particular attention has been paid to cytokine-driven intrinsic apoptosis factors, including intracellular calcium, glutamate excitotoxicity and free radicals that appear in the brain following ischaemic damage and whose presence significantly increases the likelihood of clinically defined depression.
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Affiliation(s)
- Michaela C Pascoe
- Brain Sciences Institute, Swinburne University, Melbourne, Vic, Australia
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Aben L, Ponds RW, Heijenbrok-Kal MH, Visser MM, Busschbach JJ, Ribbers GM. Memory Complaints in Chronic Stroke Patients Are Predicted by Memory Self-Efficacy rather than Memory Capacity. Cerebrovasc Dis 2011; 31:566-72. [DOI: 10.1159/000324627] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 01/21/2011] [Indexed: 11/19/2022] Open
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