Depression and stroke
Three studies investigate the association between stroke and depression following the Stroke Association findings this year.
More than 100,000 people will have a stroke in the UK each year and two thirds will be discharged from hospital with a disability (Stroke Association 2017). In the UK the incidence of stroke fell by nearly 20% from 1990-2010 (Lackland et al 2014) and this is largely explained by improved interventions aimed at reducing cardiovascular risk factors such as arterial hypertension, diabetes, smoking and cholesterol/dyslipidaemia including increased physical exercise.
Advances in pharmacological management including antidepressant therapy, and technology such as rapid endovascular thrombectomy for acute ischaemic stroke, along with growing expertise, has seen stroke management revolutionised resulting in improved survival rates particularly in specialist centres (Klourfeld et al 2016).
However, it is estimated that 30-60% of patients will experience depressive symptoms following a stroke, which is associated with poorer health outcomes, rehabilitation restrictions, extended hospital admissions and an increase in morbidity and mortality (Hackett and Pickles 2014).
This article looks at three studies investigating the association between stroke and depression.
- Stroke Association (2017) State of the nation. Key statistics.
- Lackland DT, Roccella EJ, Deutsch M et al (2014) Factors influencing the decline in stroke mortality: Statement from the American Heart Association/American Stroke Association. Stroke. 45, 1, 315-353.
- Klourfeld E, Zerna C, Al-Ajlan FS et al (2016) The future of endovascular treatment: Insights from the ESCAPE investigators. International Journal of Stroke. 11, 2, 156-163.
- Hackett ML, Pickles K (2014) Part 1: Frequency of depression after stroke; an updated systematic review and meta-analysis of observational studies. International Journal Stroke. 9, 8, 1017-1025
A depression screening protocol for patients with acute stroke: A quality improvement project
This US-based nurse practitioner study investigated the implementation and evaluation of a depression screening protocol specific to patients post-acute stroke through an evidence-based clinical scholarship project design.
The post stroke depression (PSD) protocol was developed based on validated Patient Health Questionnaire-9 (PHQ-9) scores (to assess any depressive symptomatology) and was further informed by a retrospective review of individual patient records and an educational staff booklet. Statistical data analyses investigated relationships between variables.
Findings indicated the potential of this protocol to identify previously unrecognised post stroke depression. Recommendations included integration with electronic medical record systems, multidisciplinary team mental health reviews, nurse-led nonpharmacological intervention initiatives and focused questioning at outpatient follow-up.
McIntosh C (2017) American Association of Neuroscience Nurses. 49, 1, 39-48
Post stroke depression: risk factors and potential effects on functional recovery
A Turkish study investigated risk factors that may influence onset of post stroke depression and impact on functional improvement after rehabilitation among 93 patients admitted to a specialist stroke rehabilitation clinic up to six months following a stroke.
Five measurement tools collated data about spasticity, function, ambulation, and emotional stability. All patients had hemiplegia and participated in a one month rehabilitation programme including a home-based programme on discharge. All participants were seen at a one month follow up appointment where 49 (53%) were diagnosed with depression.
Qualitative and quantitative analyses were undertaken to detect any variable associations and measure functional change. The authors found depression had a negative impact on functional improvement, providing further evidence of the complexity of issues associated with depression particularly in younger suffers.
Karaahmet OZ, Gurcay E, Avluk OC et al (2017) International Journal of Rehabilitation Research. 40, 1, 71-75.
Reduction in retained activity participation is associated with depressive symptoms 3 months after mild stroke: An observational cohort study
The relationship between depression and activity participation was explored as part of a large Australian, cross sectional, multi-centre post stroke recovery project. Eligibility included admission with ischaemic stroke with no significant history of disability to one of five leading acute adult stroke units in Melbourne.
The validated depressive symptom measure (MADRS-SIGMA) and the adapted Activity Card Sort (ACS) scale guided initial interviews and data collection. Multivariable and ad hoc regression analyses were undertaken to explore whether a relationship between depression and retained activity participation (adjusted for age, stroke severity and prior participation activity) could be identified and quantified in the early months of stroke recovery.
Findings extend previous knowledge indicating that depressive symptoms negatively impact overall activity participation. Further research is needed to understand and unpick influences on activity participation from the perspective of stroke survivors.
Tamara TSE, Douglas J, Lentin P et al (2017) Journal of Rehabilitation Medicine. 49, 2, 120-127
Compiled by Kathy Davis, nurse researcher The Children’s Trust, Surrey and independent specialist nurse consultant, colorectal and pelvic floor disorders, London.