State of the science in inflammation and stroke recovery: A systematic review

Stroke is a major cause of mortality worldwide, and survivors often have major life-changing disabilities. Annually in the United States, an estimated 795,000 people experience a new or recurrent stroke. All types of stroke involve an inflammatory reaction that follows the initial phase of incidence. However, investigations into any links between inflammatory markers and recovery processes in the context of post-stroke rehabilitation are lacking. In this systematic review, we searched the literature in PubMed, SCOPUS, and CINAHL databases to gather information on inflammatory biomarkers related to stroke and their association with rehabilitation outcomes, according to PRISMA guidelines. Eleven articles (n = 1.773 stroke patients) were selected. Immune markers (interleukin 6 [IL-6], C-reactive protein, IL-1α, tumor necrosis factor α, soluble intercellular adhesion molecule 1) and functional status assessments (Modified Rankin Score, National Institutes of Health Stroke Scale, Functional Independence Measure, etc.) were the primary measures used in the reviewed studies. We found preliminary evidence for the evaluation of inflammatory biomarkers post-stroke, including the role of inflammation in functional recovery and the influence of rehabilitation on inflammation. This is the first systematic review of the topic. The review identifies several gaps in the literature that are critical for understanding the potential use of inflammatory markers to improve post-stroke outcomes.     

New factors that affect quality of life in patients with aphasia

BackgroundAphasia severity is known to affect quality of life (QoL) in stroke patients, as is mood disorders, functional limitations, limitations on activities of daily life, economic status and level of education. However, communication limitation or fatigue has not been explored in this specific population.ObjectiveWe aimed to investigate whether these factors were associated with QoL in patients with aphasia after stroke.MethodsPatients with aphasia were included from April 2014 to November 2017 after a first stroke and were followed for 2 years post-stroke. QoL was assessed at follow-up by the French Sickness Impact Profile 65 (SIP-65). We explored predictors such as mood disorders, communication impairment, fatigue, limitations on activities of daily life, and aphasia severity in addition to socio-demographic factors.ResultsWe included 32 individuals (22 men; mean age 60.7 [SD 16.6] years) with aphasia after a first stroke. Poor QoL as assessed by the SIP-65 was significantly associated (Pearson correlations) with increased severity of aphasia initially (P = 0.008) and at follow-up (P = 0.01); increased communication activity limitations at follow-up (P < 0.001); increased limitations on activities of daily life at baseline (P = 0.008) and follow-up (P < 0.001); increased fatigue at follow-up (P = 0.001); and increased depression symptoms at follow-up (P = 0.001). On multivariable analysis, QoL was associated with communication activity limitations, limitations on activities of daily life, fatigue and depression, explaining more than 75% of the variance (linear regression R² = 0.756, P < 0.001). The relative importance in predicting the variance was 32% for limitations on activities of daily life, 21% fatigue, 23% depression and 24% communication activity limitations.ConclusionAphasia severity, mood disorders and functional limitations may have a negative effect on QoL in patients with aphasia. Also, for the first time, we show that fatigue has an important impact on QoL in this population. Specific management of this symptom might be beneficial and should be explored in future studies.     

Handicap in stroke survivors

Background and purpose: As survival following stroke improves, individuals are more likely to live with the aftermath of stroke rather than immediately die from it. The purpose of this study was to examine the consequences of stroke on the life activities of survivors in the social realm (stroke handicap) using the framework of the World Health Organization's International Classification of Impairments, Disabilities and Handicaps. Methods: Multivariate analysis of variance was applied to cross-sectional data from a clinical study to investigate the correlates of handicap in a cohort of hemispheric stroke survivors at 3 months (n= 145) and at 1 year (n= 135) after stroke onset. Handicap was assessed with the Reintegration to Normal Living Index, impairment by the Adams' Hemispheric Stroke Scale and Zung Depression Scale, and disability by the Functional Independence Measure. Environmental variables in the model included marital status and receipt of rehabilitation therapy. Results: Physical disability and post-stroke depressive symptoms were associated with handicap at both follow-up periods (p<0.05). Cognitive disability and impairments from a previous stroke were also associated with handicap (p<0.01), but only at 1 year. The presence of a spouse was found to benefit male survivors at 1 year. Conclusions: Disability and depressive symptoms restrict the meaningful life activities of stroke survivors in the first year of recovery. Social supports may be influential in reducing their impact.     

Returning to work after a stroke: a retrospective study at the Physical and Rehabilitation Medicine Center La Tour de Gassies

ObjectiveTo study work re-entry by patients having suffered a stroke at least 3 years previously.Patients and methodsThis was a retrospective survey in which a questionnaire was administered to all patients admitted after a first stroke to the “La Tour de Gassies” Centre for Physical and Rehabilitation Medicine (CPRM) in France between January 2005 and June 2007 and who were in work at the time of the incident.ResultsFifty-six of the 72 included patients (78%) completed and returned the survey questionnaire. The mean age at the time of the stroke was 48.3 ± 10.1. Eighteen (32.1%) of the 56 patients returned to work after their stroke (mean post-stroke time interval: 19.2 ± 13.4 months). Negative prognostic factors for a return to work were living alone, the presence of severe functional impairment and the presence of speech disorders. Positive prognostic factors included specific, professional support and early involvement of the occupational physician. Patients who resumed driving were more likely to return to work and there was a positive correlation between the time to work re-entry and the time to resumption of driving.ConclusionClose cooperation between occupational health services and CPRM appears to be necessary to speed the return to work by stroke patients.     

Post-discharge outcomes after resuscitation from out-of-hospital cardiac arrest: A ROC PRIMED substudy

ImportanceAssessment of morbidity is an important component of evaluating interventions for patients with out-of-hospital cardiac arrest (OHCA).ObjectiveWe evaluated among survivors of OHCA cognition, functional status, health-related quality of life and depression as functions of patient and emergency medical services (EMS) factors.DesignProspective cohort sub-study of a randomized trial.SettingThe parent trial studied two comparisons in persons with non-traumatic OHCA treated by EMS personnel participating in the Resuscitation Outcomes Consortium.ParticipantsConsenting survivors to discharge.Main outcome measuresTelephone assessments up to 6 months after discharge included neurologic function (modified Rankin score, MRS), cognitive impairment (Adult Lifestyle and Function Mini Mental Status Examination, ALFI-MMSE), health-related quality of life (Health Utilities Index Mark 3, HUI3) and depression (Telephone Geriatric Depression Scale, T-GDS).ResultsOf 15,794 patients enrolled in the parent trial, 729 (56% of survivors) consented. About 644 respondents (88% of consented) completed ≥ 1 assessment. Likelihood of assessment was associated with baseline characteristics and study site. Most respondents had MRS ≤ 3 (82.7%), no cognitive impairment (82.7% ALFI-MMSE ≥ 17), no severe impairment in health (71.6%, HUI3 ≥ 0.7) and no depression (90.1% T-GDS ≤ 10). Outcomes did not differ by trial intervention or time from hospital discharge.Conclusions and relevanceThe majority of patients in this large cohort who survived cardiac arrest and were interviewed had no, mild or moderate health impairment. Concern about poor quality of life is not a valid reason to abandon efforts to improve an EMS system's response to cardiac arrest.     

Estudio del impacto del medio rural o urbano sobre la discapacidad residual tras un ictus

ObjectivesTo assess the residual disability in a sample of patients after suffering a first episode of a stroke and to compare the disability of those patients who live in rural areas with those living in urban areas.MethodologyAn observational, longitudinal study of a cohort of 89 patients from a Neurology Unit, affected by cerebrovascular accident. The following factors were assessed: sociodemographic and environmental factors, co-morbidity, functional status, disability, depression and anxiety, and quality of life. The different clinical and demographic variables were compared after admission to the unit, at hospital discharge, and 3 months afterwards. Regression analyses were also carried out in order to study the association between the clinical and sociodemographic factors, and post-stroke disability.ResultsCompared to their previous clinical state, after suffering a stroke patients showed a higher rate of co-morbidity (P < .0001), disability (P < .0001), depression (P = .002), and a poorer quality of life (P = .013).The difference between patients coming from rural and urban areas was not statistically significant in terms of disability, quality of life, anxiety, depression, or co-morbidity.ConclusionsThe level of disability, depression and co-morbidity that patients showed after suffering a stroke was similar to the results obtained in other studies. As a novel feature, there were no differences between patients living in rural areas after suffering a stroke and those living in urban areas, as regards disability, depression, or co-morbidity.     

Long-term neurological outcome after cardiac arrest and therapeutic hypothermia

Aim of the studyTo analyse the neurological status of survivors after cardiac arrest (CA) treated with hypothermia.MethodsWe prospectively included all patients with CA treated with hypothermia at intensive care units (ICU) in two university hospitals and one regional hospital. All adult survivors at 6 months after CA, n = 48, were invited for neurological follow-up and 43 accepted. History, clinical status, ability testing and questionnaires were administered to screen for difficulties, including Assessment of Motor and Process Skills, Neurobehavioral Cognitive Status Examination, Frontal Lobe Assessment Battery, EQ-VAS quality of life scale, Skåne Sleep Index, Hospital Anxiety and Depression Rating Scale, Self-reported Montgomery and Åstrand Depression Rating Scale, Global Deterioration Scale, Rivermead Behavioural Memory Test, and the Cerebral Performance Categories (CPC).ResultsNo patient was found to be in a chronic vegetative state and all patients were living at home, one with extensive help. Thirty-six patients were in CPC1 at follow-up, and some degree of neurological sequelae was found in 40 patients, but was mild in all but 3. Three patients had no subjective complaints, nor could any deficits be detected. Initial defects improved over-time. Short-term memory loss, executive frontal lobe dysfunction along with mild depression and sleep rhythm disturbances were the most common findings.ConclusionsMild cognitive impairment is common following hypothermia-treated cardiac arrest but has little effect on activities of daily living or quality of life.     

Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind,randomised, controlled trial

BackgroundUpper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF).ObjectiveThis was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains.MethodsWe randomized 45 patients with acute stroke into 2 groups (conventional therapy, n = 22, and RAT, n = 23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction.ResultsIn total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P = 0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P = 0.02) and patient social participation (Stroke Impact Scale +18%; P = 0.01). Participants’ abilities to perform manual activities and activities of daily living improved similarly in both groups.ConclusionFor the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.     

Los factores que influyen en el proceso de adaptación 6 meses después de un ictus:un análisis de trayectoria

ObjectiveThe purpose of this study was to identify the determinant factors that influence the adaptation process and quality of life after a stroke.MethodsThis study is an observational study using a cross-sectional design. Respondents were patients who were 6 months post-discharge after non-hemorrhagic stroke and their family caregivers. Information about respondents was taken from medical record data at two regional general hospitals in West Kalimantan Province, Indonesia. A total of 80 patients were selected using a consecutive sampling method. Theoretical models of patient and caregiver factors that influence adaptation responses and post-stroke quality of life were tested using path analysis.ResultsCaregiver coping, self-efficacy, and illness acceptance had a direct effect on the post-stroke psychosocial adaptation response by 58.1%, with self-efficacy contributing the most (β = 0.668, p < 0.0001). Self-efficacy, illness acceptance, and healthy behavior had a direct effect on the physiological adaptation response by 24.3%, where self-efficacy also contributed the most (β = 0.272, p < 0.014). Psychosocial adaptation and physiological adaptation had a direct effect on the quality of life by 54.6%, where psychosocial adaptation showed the largest contribution (β = 0.63, p < 0.0001).ConclusionSelf-efficacy contributes the most to both psychosocial and physiological adaptations 6 months after stroke. Psychosocial adaptation and self-efficacy have been proven to be the determinant factors that contribute the most to the quality of life of patients 6 months after stroke.     

Fulfilling the psychological and information need of the family members of critically ill patients using interactive mobile technology: A randomised controlled trial

BackgroundIntensive care nurses may have an important role in empowering families by providing psychological support and fulfilling the family's pivotal need for information.AimTo determine whether ‘education of families by tab’ about the patient’s condition was more associated with improved anxiety, stress, and depression levels than the ‘education of families by routine’.Research designA randomized control trial of 74 main family caregivers (intervention: 39; control: 35).SettingAn adult intensive care unit.Main outcome measuresDepression Anxiety Stress Scale, and Communication and Physical Comfort Scale.ResultsAlthough information need satisfaction was not significantly different between intervention and control groups, the former reported significantly better depression score on Depression Anxiety Stress Scale comparing to the control group (p < 0.01; η² = 0.09) with a medium effect size. Reduction of anxiety in the intervention group were clinically significant.ConclusionThe results suggest that use of ‘education of family by tab’ is promising for intensive care nurses to provide psychological support for family members. More studies are needed to investigate this aspect of family care for better psychological support and information need satisfaction that contributes to the evidence-based practice of intensive care nursing.     

Acute phase factors associated with the course of depression during the first 18 months after first-ever stroke

Purpose: The aim of this study was to describe the course of post-stroke depression (PSD) during the first 18 months after first-ever stroke and to examine differences in the course of depressive symptoms in relation to patient demographic and clinical characteristics in the acute phase. Methods: As part of a longitudinal cohort study, data were collected from medical records and in face-to-face interviews using standardized questionnaires within 15 days after stroke and 6, 12 and 18 months later. The sample consisted of 94 patients with first-ever stroke. PSD was measured with the Beck Depression Inventory II. Repeated measures analysis of variance was used to evaluate the course of depressive symptoms over time and in relation to demographic and clinical variables. Results: Depression levels were stable during the 18 months after first-ever stroke. However, depression scores were significantly higher among patients who had lower physical functioning in the acute phase, were living alone or were not employed at the time of stroke. Conclusions: Several demographic and acute phase factors were associated with a more severe PSD course following stroke. Psychosocial support that begins in the acute phase and continues throughout the rehabilitation process may be helpful in improving both physical and psychological outcomes following stroke.

• Implications for Rehabilitation

• Depression levels are stable during the first 18 months after first-ever stroke.

• The course of post-stroke depression is related to the level of physical functioning in the acute phase, whether the stroke survivors live alone and their employment status at the time of stroke.

• Psychological support that begins in the acute phase and continues throughout the rehabilitation process may be helpful in improving both physical and psychological outcomes following stroke.

     

Exploring the experience of psychological morbidity and service access in community dwelling stroke survivors: a follow-up study

Abstract

Purpose: Post-stroke depression occurs in one-third of stroke survivors with a similar risk of development across short, intermediate and long-term recovery stages. Knowledge of factors influencing psychological morbidity beyond the first year post-stroke can inform long-term interventions and improve community service access for stroke survivors. This paper aimed to identify the physical and psycho-social functioning status of stroke survivors beyond 12 months post-stroke. Qualitative processes explored the longer term experiences of psychological morbidity and service access needs. Method: A cross-sectional follow-up of participants from a prospective cohort study. In that study, patients and were followed for 12 months post-stroke. In this study, participants from that cohort study were interviewed up to five years post-stroke. Data generation and analysis were concurrent and were analysed thematically, employing a process of constant comparison. Results: Our sample included 14 participants, aged 58–89 years at an average of three years post-stroke (range 18 months to five years). Our qualitative key themes emerged as follows: physical impacts on post-stroke psychological morbidity, the experience of psychological distress, factors attenuating distress and service delivery implications. Conclusions: The experience of psychological morbidity persists beyond 12 months post-stroke, having a profound impact on community access, and social participation. Clinical implications are a need for long-term psychological monitoring post-stroke and for ongoing rehabilitation that addresses disability, community participation and social support.

• Implications for Rehabilitation

• Psychological distress post-stroke is complex and persists over time, thus requiring longer term monitoring beyond the first 12 months of stroke onset.

• Longer term access to allied health can play a significant role in providing interventions that address distress and maintain community participation.

• If patients meet threshold scores at any time, then GPs should consider initiating appropriate treatment, including pharmacotherapy, referral to psychotherapy and referral to community stroke rehabilitation.

     

老年病人脑卒中后抑郁与社会支持的相关分析及心理护理

目的研究老年病人脑卒中后抑郁与社会支持相关性,做好心理护理。方法对60例老年脑卒中病人进行抑郁与社会支持的心理量表调查,分析相关性。结果老年病人脑卒中后抑郁与社会支持呈负相关(r=-0.28,P<0.05)。60例老年脑卒中病人抑郁占36.66%。结论老年脑卒中后抑郁与社会支持呈负相关。在早期进行心理护理的同时不可忽视社会支持系统的作用,以帮助患者适应疾病过程,减少脑卒中后抑郁发生率,提高生存质量。     

Active versus receptive group music therapy for major depressive disorder—A pilot study

ObjectivesTo compare the effects of 1) active group music therapy and 2) receptive group music therapy to group counseling in treatment of major depressive disorder (MDD).Design & settingOn top of standard care, 14 MDD outpatients were randomly assigned to receive 1) active group music therapy (n = 5), 2) receptive group music therapy (n = 5), or 3) group counseling (n = 4). There were 12 one-hour weekly group sessions in each arm.Main outcome measuresParticipants were assessed at baseline, 1 month (after 4 sessions), 3 months (end of interventions), and 6 months. Primary outcomes were depressive scores measured by Montgomery-Åsberg Depression Rating Scale (MADRS) Thai version. Secondary outcomes were self-rated depression score and quality of life.ResultsAt 1 month, 3 months, and 6 months, both therapy groups showed statistically non-significant reduction in MADRS Thai scores when compared with the control group (group counseling). The reduction was slightly greater in the active group than the receptive group. Although there were trend toward better outcomes on self-report depression and quality of life, the differences were not statistically significant.ConclusionGroup music therapy, either active or receptive, is an interesting adjunctive treatment option for outpatients with MDD. The receptive group may reach peak therapeutic effect faster, but the active group may have higher peak effect. Group music therapy deserves further comprehensive studies.     

Assessment of quality of life in stroke patients with hemiplegia

Stroke is a major public health issue. Even though most hemiplegic stroke patients may obtain a good functional outcome, many remain dissatisfied with their lives. Indeed, quality of life and subjective well-being should be taken into account in any assessment of stroke survival.ObjectiveTo assess long-term quality of life in stroke patients (compared with healthy controls) and the corresponding determinants and predictive factors.MethodThe patient population consisted of 80 of the 217 first-stroke survivors treated between January and June 2005 in the Clinical Neurosciences Department at Bordeaux University Hospital. After a mean follow-up period of 2 years, 24 patients were interviewed in their homes and data from the 56 others were obtained in a telephone interview. Demographic information, clinical status on admission and functional status (as assessed by Barthel Index) and depression (on the ADRS) at the time of the study visit were recorded. Quality of life was assessed by using the Sickness Impact Profile (SIP-65) and Bränholm and Fugl-Meyer's Satisfaction with Life Scale (LiSat 11). The patients’ data were compared with those from 149 healthy controls.ResultsLife satisfaction and quality of life were significantly impaired in stroke patients, compared with controls. All life domains were impaired. The worst scores were observed for independence and health-related items in the LiSat 11 and the physical and communication items in the SIP-65. Quality of life was strongly correlated with functional independence, the persistence of hemiplegia and depressive mood, which is in agreement with literature findings. Neither gender nor the initial Rankin score had a significant impact on these parameters.Discussion–ConclusionQuality of life at 2 years is significantly impaired in stroke survivors and seems more difficult to predict than functional independence. However, in addition to these objective results, our interviews suggest that receiving adequate social support might be as important to patients as recovering independence.     

Ambulatory activity in stroke survivors associated with functional outcome and quality of life: An observational cohort study

BackgroundPhysical activity is beneficial in stroke prevention and recovery. Understanding activity dynamics and its effect on outcome after stroke is important to improve recommendations and develop interventions.ObjectivesWe examined serial changes in daily ambulatory activity (AA) averaged over 1 week in people with subacute to chronic stroke and its association with functional outcome (modified Rankin scale [mRS]) and quality of life (EQ-5D-3L).MethodsThis observational study examined AA in stroke survivors with no to moderate disability (US National Institute of Stroke Scale [NIHSS] score) who were mostly community dwelling and had cryptogenic stroke based on data from the Continuous Cardiac Monitoring to Assess Atrial Fibrillation After Cryptogenic Stroke study. The participants underwent long-term AA monitoring by accelerometric activity data obtained from an insertable cardiac monitor without receiving any specific encouragement regarding physical activity. We analysed AA changes and assessed the association between baseline AA and mRS/EQ-5D-3L scores. A small group of participants had follow-up data for 2 years, which allowed for analysing long-term serial changes.ResultsWe included 186 participants (mean [SD] age 61.3 [11.2] years, 67% male, mean 39 [28] days after stroke). AA increased during the subacute phase in individuals with mild (NIHSS score 1–4, P < 0.001) and moderate (NIHSS score 5–10, P = 0.013) disability but not in the non-impaired group. Baseline AA was inversely associated with NIHSS score (P < 0.001) and was associated with mRS score (P = 0.001) and weakly correlated with EQ-5D-3L score at 6 months (P = 0.032, r = 0.22). For the 45 participants with follow-up data (mean age 64.5 [9.7] years, 80% male, mean 34 [21] days after stroke), AA remained stable.ConclusionAA increased in stroke survivors with impairments but remained stable in those whose symptoms had resolved. AA during the early subacute period was associated with mRS and EQ-5D-3L scores at 6 months. Insertable cardiac monitoring offers a feasible method for monitoring activity over prolonged periods in people after stroke. Its increased use may offer an opportunity to overcome the limited reliability and validity of many existing measures.Trial registrationClinicalTrials.gov (NCT00924638).     

Health-related quality of life and its predictors among outpatients with coronary heart disease in Singapore

Aims and BackgroundCoronary heart disease (CHD) is a major cause of death and disability and negatively impacts on patients' health-related quality of life (HRQoL). This study aimed to explore HRQoL and identify its predictors among outpatients with CHD in Singapore.MethodsA correlational study was conducted with a convenience sample of 106 outpatients with CHD recruited from a public hospital. HRQoL outcomes were measured using the Short Form-12 Health Survey (SF-12), Medical Outcomes Study Social Support Survey (MOS-SSS) and Hospital Anxiety and Depression Scale (HADS).ResultsPatients reported a generally high level of HRQoL as assessed by SF-12. Those aged over 65 years reported significantly higher mental health and those who were married had higher levels of education or income reported significantly higher physical health. There were significant negative correlations between physical and mental health and anxiety and depression (p < .05). Perceived social support was negatively correlated with anxiety and depression and positively correlated with mental health. Education level and depression significantly predicted physical health, while age, anxiety and depression predicted mental health.ConclusionAnxiety, depression, age and education are significant predictors of HRQoL in this patient population and should be assessed routinely and, where appropriate, addressed through individually-tailored interventions.     

脑卒中患者家庭照顾者抑郁及社会支持的纵向研究

目的 调查脑卒中患者家庭照顾者抑郁和社会支持状况,分析动态变化及相互关联,为循证护理提供依据.方法 采用抑郁量表(CES-D)和社会支持量表(MSPSS)对164例脑卒中患者的家庭照顾者于患者出院前,出院后3用、12用及24用进行调查分析.结果 照顾者在这4个时闻点的抑郁发生率分别为48.2%、44.5%、39.6%及42.1%.照顾者在患者出院后12用、24周的抑郁水平显著低于患者住院期间(P<0.05);社会支持得分分别为4.93分、5.18分、5.22分及5.29分,照顾者在出院后感知的社会支持显著高于出院前(P<0.01);CES-D得分在10分及以上的照顾者感知的社会支持显著低于得分在10分以下者(P<0.05).结论 脑卒中患者家庭照顾者感知的社会支持不充足,但抑郁较常见,他们感知的社会支持水平越低,越趋向于出现抑郁症状.