The economic impact of mental healthcare consumption before and after stroke in a cohort of stroke patients in the Netherlands: a record linkage study

A higher burden of post-stroke depression and anxiety and their predictors among stroke survivors in the Amhara Regional State, Ethiopia, in 2024: a prospective multicenter study

Background

A substantial proportion of stroke survivors suffer from post-stroke depression and anxiety. These mental disorders are linked to several modifiable risk factors and lead to severe functional impairment or premature death. There is a lack of evaluation, prevention, and treatment of these prevalent mental illnesses. This study aimed to investigate the overall burden of post-stroke depression and anxiety and their predictors in the Amhara Regional State, Ethiopia, in 2024.

Methods

From 01 February to 01 April 2024, a multicenter cross-sectional study was conducted on 404 stroke survivors from five comprehensive specialized hospitals in the Amhara Regional State, Ethiopia. Five trained physiotherapists conducted interviews, reviewed medical records, and took physical measurements using a pretested, semi-structured questionnaire to obtain high-quality data for analysis. Descriptive statistics were taken into consideration to provide a broad overview of the data and distribution of conditions. Additionally, binary logistic regression was used to find predictors with a p-value of less than 0.2 that could be subjected to multivariate logistic regression analysis, which was used to find the significant associated factors. A p-value of less than 0.05 with a 95% confidence interval (CI) was deemed significant.

Results

The prevalence of post-stroke depression and anxiety among stroke survivors in the Amhara Regional State was 64.1% (95% CI: 59.3-68.6%) and 45.5% (95% CI: 40.7-50.4), respectively. Variables including male sex [adjusted odds ratio (AOR)=1.97, 95% CI: 1.06-3.67], stroke complication presence (AOR=2.83, 95% CI: 1.64-4.88), and comorbidity presence (AOR=6.23, 95% CI: 3.91-9.19) were significantly associated with post-stroke depression. Retirement (AOR=1.64, 95% CI: 1.91-4.72), less time for hospitalization (AOR=2.05, 95% CI: 1.09-3.84), and comorbidity presence (AOR=2.09, 95% CI: 1.32-3.29) were the significantly associated factors of post-stroke anxiety.

Conclusions

Relatively higher burdens of post-stroke depression and anxiety were observed among stroke survivors in the Amhara Regional State, Ethiopia. Variables such as sex, stroke complication, and comorbidity, and retirement, time for hospitalization, and comorbidity were predictors significantly associated with post-stroke depression and anxiety, respectively. Early mental health screening and diagnosis of old age, complicated case patients, and retired stroke survivors are required for early-stage interventions.

Prevalence and network structure of depression and its association with quality of life among older stroke survivors: findings from a national survey in China

Background

Post-stroke depression (PSD) is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life (QoL). To date, few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.

Aims

This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.

Methods

This study was based on the 2017-2018 collection of data from a large national survey in China. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CESD), while QoL was measured with the World Health Organization Quality of Life-brief version. Network analysis was employed to explore the structure of PSD, using expected influence (EI) to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.

Results

A total of 1123 stroke survivors were included, with an overall prevalence of depression of 34.3% (n=385; 95% confidence interval 31.5% to 37.2%). A higher risk of PSD was significantly associated with limited activities of daily living (odds ratio (OR)=1.340; p=0.048), presence of heart diseases (OR=1.589; p=0.002) and more severe anxiety symptoms (OR=1.472; p<0.001). In the network model of depression, the most central symptoms were CESD3 ('feeling blue/depressed', EI: 1.180), CESD6 ('feeling nervous/fearful', EI: 0.864) and CESD8 ('loneliness', EI: 0.843). In addition, CESD5 ('hopelessness', EI: -0.195), CESD10 ('sleep disturbances', EI: -0.169) and CESD4 ('everything was an effort', EI: -0.150) had strong negative associations with QoL.

Conclusion

This study found that PSD was common among older Chinese stroke survivors. Given its negative impact on QoL, appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.

Development of a Care Bundle for Stroke Survivors with Psychological Symptoms: Evidence Summary and Delphi Study

Background

Psychological symptoms such as depression and anxiety are quite common among stroke survivors and have great negative impacts on patients.

Objective

To develop a care bundle through reviewing and integrating care strategies for psychological symptoms after stroke and then improve the bundle by Delphi study.

Methods

A structured search of the literature was performed to identify studies evaluating interventions for stroke patients with psychological symptoms such as depression and anxiety. Two trained researchers screened papers through the titles, abstracts, and full-texts independently. All studies complying with the eligibility criteria were appraised using quality assessment tools. Related interventions with evaluated evidence levels formed the preliminary bundle. Afterward, the Delphi study was carried out to improve the bundle, and the experts were contacted by e-mail. Ten clinical experts specialized in stroke and psychological rehabilitation were recruited. The reliability of experts was represented by the effective response rate and authority coefficient (Cr). The consensus was deemed to be reached when the mean score for item importance is all equal or above 3.50 and the coefficient of variation (CV) is all equal or below 0.20. The Kendall coefficient W test was adopted to evaluate the consensus on agreement among the experts as well. Data analysis was performed using SPSS V.22.0.

Results

Through a systematic evidence summary and two-round Delphi study, the items that were given high scores and got consensus by experts were chosen for the bundle. The iDAME bundle consisted of five interventions eventually: maintaining Interaction, tailored Diet, Acupressure, mindfulness Meditation, and physical Exercise.

Conclusion

The development of an evidence-based and consensus-based iDAME bundle which integrated western and traditional Chinese medicine intervention was described. Evidence summary made the bundle become scientific, while the Delphi study made it more maneuverable. Based on these results, the bundle would be potentially implemented in stroke patients for their psychological symptoms.

A study of optimal concentration range and time window of sevoflurane preconditioning for brain protection in MCAO rats

Background

Sevoflurane preconditioning improves brain function in MCAO rats, and there are several methods for determining appropriate concentration and time windows for preconditioning. This study investigated the brain protective effects with a single sevoflurane preconditioning at different concentrations and different time windows on MCAO rats.

Methods

Adult Sprague-dawley rats were randomly assigned to 14 groups. The rats in the sevoflurane preconditioning group inhaled 0.5 MAC, 1.0 MAC, and 1.3 MAC sevoflurane, respectively for 3 h, and then MCAO models were established at 6 h, 12 h, 24 h, and 48 h. MCAO and sham groups underwent no preconditioning with sevoflurane. The neurological severity score, cerebral infarct volume and brain water content of the rats were measured 24 h after reperfusion.

Results

After inhalation of 1.3 MAC sevoflurane for 3 h of preconditioning, the MCAO model was established after 24 h. This preconditioning improved the neurological severity score, reduce cerebral infarct volume and brain water content in MCAO rats. After inhalation of 1.0 MAC sevoflurane for 3 h of preconditioning, MCAO model established after 24 h reduced the cerebral infarct volume and brain water content of MCAO rats, but the neurological severity score showed no significant improvement, and no significant brain protective effects were observed at other concentrations and time windows.

Conclusions

These results suggested that after inhalation of 1.3 MAC sevoflurane for 3 h of preconditioning, MCAO model established after 24 h demonstrated significant brain protective effects in MCAO rats.

Building Wellbeing in People With Chronic Conditions: A Qualitative Evaluation of an 8-Week Positive Psychotherapy Intervention for People Living With an Acquired Brain Injury

Research indicates that Acquired Brain Injury (ABI) is associated with significant and chronic impairment across multiple areas of functioning including physical, cognitive, emotional and behavioral domains. Whilst impairments associated with ABI can be ameliorated, cure is seldom possible. The emergence of positive psychology reflects a paradigm shift in health and wellbeing research, highlighting the role of character strengths, positive emotions, meaning, and resilience. Positive psychology interventions have been demonstrated to improve wellbeing in a variety of populations, although research investigating the impact of positive psychotherapy for people living with ABI are sparse. Here we characterize the experience of an 8-week positive psychotherapy intervention for 13 people living with ABI including four mentors and nine participants using thematic analysis of transcripts collected during mini-groups and one-to-one interviews. Six main themes were identified including empowerment, social opportunity, coping, cultivation of positive emotion, consolidation of skills and barriers. Results indicated that wellbeing can be promoted and improved in individuals with ABI. Recent theoretical developments in wellbeing science highlight scope to improve the intervention by connecting individuals to their communities and spending time in nature.

Effects of physical therapy on mental function in patients with stroke

OBJECTIVE

In this study, we aimed to determine the effects of physical therapy intervention on mental function in patients with stroke.

METHODS

In this retrospective experimental study, we included 134 patients previously diagnosed with anxiety and depression who presented to our outdoor physical therapy clinic with hemiplegia owing to stroke during 2016 to 2018. The main interventions were neurodevelopmental techniques, strength training, stationary cycling, and shoulder wheel exercise. The treatment duration was 6 months, 5 days a week. Key outcome measurement tools included the Patient Health Questionnaire-9 (PHQ-9), Disability Rating Scale (DRS), and Functional Independent Measure (FIM). Baseline and post-interventional measurements were compared using a paired-sample t-test.

RESULTS

Baseline scores on the PHQ-9, DRS, and FIM were 24.77±1.24, 19.67±1.25, and 20.77±1.74, respectively; post-intervention scores on these three scales were 9.08±0.49, 7.78±1.49, and 82.52±10.03 respectively. In the comparison, significant differences were observed between baseline and post-interventional scores.

CONCLUSION

We found that physiotherapy interventions improved motor function in patients with stroke as well as their mental function. Patients with stroke with impaired mental function can improve by participating in a physiotherapy treatment program.