The impact of depression on stroke recovery in the U.S

Globally, stroke is an important cause of physical, cognitive and emotional disability. The success of rehabilitation efforts for stroke patients is often measured in terms of physical functioning. However, because the adaptation process also involves psychological and social factors, and nursing goal is to holistically meet patient's health care needs, it is important to address emotional and social variables that impact the healing process. Therefore, the purpose of this prospective longitudinal study was to determine the impact of depression on functional ability in adults (n = 50) who have had a stroke in the U.S. The study was conducted at two large urban medical centers and one community hospital in the Midwest of the U.S. Depression screening and functional status evaluations were conducted within 10 days (Time 1) and three months (Time 2) post-stroke. In the total sample 46% (n = 23) described fewer depressive symptoms at Time 2; while 44% (n = 22) indicated more depressive symptoms, and 10% (n = 5) showed no difference between Time 1 and 2. In the total sample, 27 improved in functional status between Time 1 and Time 2, while 5 lost function at Time 2. The impact of stroke on depression in the U.S. as well as nursing implications globally are discussed.     

Prevalence of post-stroke depression in an Irish sample and its relationship with disability and outcome following inpatient rehabilitation

PURPOSE: (1). To examine the prevalence of depressive symptoms and operationally defined depressive disorder (major depression) in an Irish sample of subjects undergoing inpatient rehabilitation following their first stroke. (2). To investigate factors predictive of depression following stroke. (3). To examine the relationship between post-stroke depression and outcome following inpatient rehabilitation. METHODS: Fifty consecutive patients meeting inclusion criteria who were admitted for inpatient rehabilitation to a specialised unit following their first stroke were prospectively studied. Inclusion criteria: first stroke 3 - 12 months previously, lesion identified on CT or MRI, age 18 - 65 years, at least some sensory/motor impairment, no pre-existing disabling condition and Barthel Index score > 14 prior to stroke. Mood (Center for Epidemiologic Studies Depression scale, Hamilton Depression Rating Scale, DSM-IV diagnostic criteria for Major Depressive Disorder), Cognition (Mini-Mental State Examination) and Disability (Barthel Index, Rankin Disability Scale) were assessed one week after admission (baseline) and again after 2 months of rehabilitation. Outcome was measured as effectiveness of rehabilitation (Shah et al., 1990) and length of inpatient stay (LOS). RESULTS: 10/50 (20%) of the sample met criteria for major depressive disorder on admission. The best predictor of depression was gender, with females having a two-fold higher rate of both subjectively reported and objectively rated depressive symptoms. Depression was unrelated to baseline Barthel Disability, side of lesion or previous psychiatric history. The best predictor of effectiveness of rehabilitation was baseline Barthel Disability score. Depression did not predict either effectiveness or LOS. CONCLUSION: (1). Major depression is common in subjects undergoing rehabilitation following their first stroke. (2). Females appear to be especially at risk, possibly reflecting an increased general risk of depression. (3). Depression in our sample was not related to functional disability following stroke or early functional outcome following rehabilitation.     

Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients

OBJECTIVE: To examine how depressive symptoms, a history of depression, and cognitive functioning contribute to the prediction of rehabilitation efficiency in stroke patients. DESIGN: Consecutive admissions to an acute inpatient rehabilitation program were screened for cognitive functioning and level of depressive symptoms. History of depression was determined by family member interview. Functional status was evaluated at time of admission and discharge. Depressive symptoms, depression history, and cognitive functioning were examined as predictors of length of stay (LOS) and efficiency of utilization of rehabilitation services. SETTING: Acute inpatient rehabilitation hospital. PATIENTS: A total of 348 consecutive stroke admissions to an inpatient program were evaluated for depression and cognitive functioning, of whom 243 patients completed all aspects of the screening. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation progress, measured with the LOS efficiency measure (LOS-EFF) of the FIM instrument, and length of rehabilitation hospital stay. RESULTS: Patients with higher levels of depressive symptoms used rehabilitation services less efficiently than those with lower symptom levels but did not have longer LOSs. History of depression was associated with longer LOS and less efficient use of rehabilitation services. Cognitive impairment did not predict rehabilitation efficiency. CONCLUSIONS: The present study lends further support to the benefits of screening stroke patients at the time of rehabilitation admission for depression and history of depression. Identifying patients who have high levels of depressive symptoms and/or a previous depressive episode will allow more comprehensive assessment and rapid intervention.     

Prevalence of post-stroke depression in an Irish sample and its relationship with disability and outcome following inpatient rehabilitation

Purpose:?(1) To examine the prevalence of depressive symptoms and operationally defined depressive disorder (major depression) in an Irish sample of subjects undergoing inpatient rehabilitation following their first stroke. (2) To investigate factors predictive of depression following stroke. (3) To examine the relationship between post-stroke depression and outcome following inpatient rehabilitation.

Methods:?Fifty consecutive patients meeting inclusion criteria who were admitted for inpatient rehabilitation to a specialised unit following their first stroke were prospectively studied. Inclusion criteria: first stroke 3?–?12 months previously, lesion identified on CT or MRI, age 18?–?65 years, at least some sensory/motor impairment, no pre-existing disabling condition and Barthel Index score >?14 prior to stroke. Mood (Center for Epidemiologic Studies Depression scale, Hamilton Depression Rating Scale, DSM-IV diagnostic criteria for Major Depressive Disorder), Cognition (Mini-Mental State Examination) and Disability (Barthel Index, Rankin Disability Scale) were assessed one week after admission (baseline) and again after 2 months of rehabilitation. Outcome was measured as effectiveness of rehabilitation (Shah et al., 1990) and length of inpatient stay (LOS).

Results:?10/50 (20%) of the sample met criteria for major depressive disorder on admission. The best predictor of depression was gender, with females having a two-fold higher rate of both subjectively reported and objectively rated depressive symptoms. Depression was unrelated to baseline Barthel Disability, side of lesion or previous psychiatric history. The best predictor of effectiveness of rehabilitation was baseline Barthel Disability score. Depression did not predict either effectiveness or LOS.

Conclusion:?(1) Major depression is common in subjects undergoing rehabilitation following their first stroke. (2) Females appear to be especially at risk, possibly reflecting an increased general risk of depression. (3) Depression in our sample was not related to functional disability following stroke or early functional outcome following rehabilitation.     

Depressive Symptomatology and Functional Status Among Stroke Survivors: A Network Analysis

ObjectiveTo (1) characterize poststroke depressive symptom network and identify the symptoms most central to depression and (2) examine the symptoms that bridge depression and functional status.DesignSecondary data analysis of the Stroke Recovery in Underserved Population database. Networks were estimated using regularized partial correlation models. Topology, network stability and accuracy, node centrality and predictability, and bridge statistics were investigated.SettingEleven inpatient rehabilitation facilities across 9 states of the United States.ParticipantsPatients with stroke (N=1215) who received inpatient rehabilitation.InterventionsNot applicable.Main Outcome MeasuresThe Center for Epidemiologic Studies Depression Scale and FIM were administered at discharge from inpatient rehabilitation.ResultsDepressive symptoms were positively intercorrelated within the network, with stronger connections between symptoms within the same domain. “Sadness” (expected influence=1.94), “blues” (expected influence=1.14), and “depressed” (expected influence=0.97) were the most central depressive symptoms, whereas “talked less than normal” (bridge expected influence=?1.66) emerged as the bridge symptom between depression and functional status. Appetite (R²=0.23) and sleep disturbance (R²=0.28) were among the least predictable symptoms, whose variance was less likely explained by other symptoms in the network.ConclusionsFindings illustrate the potential of network analysis for discerning the complexity of poststroke depressive symptomology and its interplay with functional status, uncovering priority treatment targets and promoting more precise clinical practice. This study contributes to the need for expansion in the understanding of poststroke psychopathology and challenges clinicians to use targeted intervention strategies to address depression in stroke rehabilitation.     

The impact of discharge to a care home on longer term stroke outcomes

OBJECTIVE: To examine the impact of discharge to a care home on the longer term recovery after stroke. DESIGN: An uncontrolled naturalistic study of stroke survivors, matched for stroke severity, discharged from a stroke rehabilitation unit to either a care home (n = 65) or to their own home (n = 65). Stroke-related variables were assessed in both groups shortly before discharge and again at six months after discharge. SETTING: A stroke rehabilitation unit, care homes in the community and subjects' own homes. OUTCOME MEASURES: Functional activities of daily living (ADL), cognitive function, depression, health service utilization, health-related quality of life. RESULTS: Despite low levels of rehabilitation in both groups, at six months subjects discharged home had a better functional improvement in ADL (Barthel score 14.9 compared with 10.8) and health-related quality of life (HRQoL) (five-item EuroQol score 0.60 compared with 0.35). CONCLUSIONS: Poorer outcome in subjects discharged to care homes may be remediable and could respond to better rehabilitative efforts and increased social support and encouragement for this group of stroke survivors.     

Motor and functional recovery in patients with post-stroke depression

Purpose: Depression is very common following stroke. Correlation between post-stroke depression (PSD) and functional outcome has been shown, but differential impact both on functional and motor recovery has not been deeply investigated. This study evaluates the influence of PSD on motor and functional outcome.

Method: One hundred and seventeen acute stroke patients were selected in an intensive rehabilitation department, and divided into two groups according to the presence of PSD (PSD + and PSD -). Screening measures were DSM-IV criteria, the Geriatric Depression Scale and the Cornell Scale. Outcomes were evaluated on the basis of the Barthel Index (BI) and the Fugl - Meyer Assessment Scale (FMA). Measurements were performed at admission to the department (T1), discharge (T2) and follow up (T3) in a whole period of 3 months from stroke.

Results: Both groups showed a significant improvement in all outcome measures. Improvement differences were not significant on FMA scores in either group at each assessment; the PSD group had a significant higher improvement on BI score at follow-up. According to the logistic model, from T1 to T2 and from T1 to T3, only motor recovery shows a significant relation with functional recovery; from T2 to T3 PSD is the only significant factor related to functional recovery.

Conclusions: PSD is not an influencing factor for motor recovery. Results show a negative impact of PSD on the functional recovery process after discharge and not during hospitalisation. Discharge appears to be a critical step for management of PSD.     

Characterization of elderly patients in rehabilitation: stroke versus hip fracture

PURPOSE: To compare the characteristics of elderly patients hospitalized for rehabilitation following stroke with those following hip fracture (HF). METHODS: A prospective study in a geriatrics department of a general university hospital in southern Israel. Five hundred and sixteen hospitalized elderly patients were included in the study, 221 following stroke and 295 following HF. The characteristics were compared by univariate and logistic regression analyses. RESULTS: The mean age (+/-SD) of the stroke patients was 71.7+/-7.8 years compared to 77.4+/-7.9 for HF (p < 0.000001). Fifty-three per cent of the stroke patients were women compared to 76% of the HF patients (p < 0.000001). Stroke patients had significantly lower levels of folic acid (p = 0.00002). HF patients had more hearing and visual impairments (p = 0.008 and p = 0.017, respectively), but these were related to age differences between the groups. The Folstein Minimental test result was significantly higher in the HF group (p = 0.002). There were no differences in the symptoms of depression score as measured by geriatric depression screening scale. The Functional Independent Measure scale showed a higher pre-event functional capacity among the stroke patients (p < 0.000001), but there was no difference in this scale on admission to rehabilitation or upon discharge. CONCLUSIONS: There is a difference in the nature of the stroke and HF events. When either event involves an elderly patient with a broad range of limitations and diseases, a new medical condition develops. In this condition the symptoms of depression and the functional state at admission and upon discharge are not significantly different between these groups of patients.     

Family member knowledge and expectations for functional recovery after stroke

OBJECTIVE: To assess the stroke knowledge and expectations for recovery among the family members of stroke patients in an acute rehabilitation hospital. DESIGN: Survey study of 50 family members of stroke patients undergoing inpatient rehabilitation at a single urban rehabilitation hospital. RESULTS: Sixty percent of participants were able to identify whether their family member had sustained a cerebral hemorrhage or infarct; 48% were able to identify at least one treatment provided to their family member for his or her stroke. The average length of stay predicted by participants closely matched the average patient length of stay. Participants tended to overestimate the functional abilities of their family member with a stroke, both on initial assessment and discharge. This overestimation was more substantial for discharge functional ability than for initial assessment. Participants were able to predict discharge location with substantial accuracy (82% agreement, kappa = 0.41). CONCLUSIONS: The knowledge of stroke etiology and functional outcome of family members of individuals undergoing rehabilitation after stroke shows significant limitations. Participants' ability to predict functional outcome on discharge was worse than their knowledge of current functional status. Participant predictions of length of stay and discharge disposition were areas of relative strength. Further efforts are needed to enhance the knowledge level of family members of patients undergoing rehabilitation after stroke.     

The rapid resolution of depression and anxiety symptoms after lower limb amputation

OBJECTIVE: To ascertain the course of depressive and anxiety symptoms shortly after amputation and again after a period of inpatient rehabilitation. DESIGN AND SETTINGS: A cohort study in inpatients admitted to a rehabilitation ward after lower limb amputation. SUBJECTS: One hundred and five successive admissions over a one-year period. INTERVENTIONS: Nil. MAIN MEASURES: Hospital Anxiety and Depression Scale (HADS) on admission and discharge with correlation to demographic and patient features. RESULTS: At admission, 28 (26.7%) and 26 (24.8%) patients had symptoms of depression and anxiety respectively. This dropped to 4 (3.8%) and 5 (4.8%) by time of discharge, a mean of 54.3 days later. These reductions were statistically significant, as was the association between patients having symptoms of both depression and anxiety (P < 0.001). Patient stay was longer in those with symptoms (depression, P < 0.03; anxiety P < 0.001). There was no association with level of amputation, success of limb-fitting, age or gender. Depressive symptoms were associated with presence of other medical conditions (P < 0.01) and anxiety scores with living in isolation (P < 0.05). CONCLUSION: Depression and anxiety are commonly reported after lower limb amputation and previously thought to remain high for up to 10 years. We have found that levels of both depression and anxiety resolve rapidly. It is possible that a period of rehabilitation teaching new skills and improving patient independence and mobility may modify the previous bleak outlook of amputees. This positive finding may be useful in the rehabilitation of even the most distressed of amputees.     

Unilateral spatial neglect: relation to rehabilitation outcomes in patients with right hemisphere stroke

OBJECTIVE: To examine the relation between left unilateral spatial neglect (USN) and rehabilitation outcomes in patients with right hemisphere stroke. DESIGN: A retrospective analysis of a database of right hemisphere stroke patients. SETTING: Acute inpatient rehabilitation hospital. PARTICIPANTS: Patients (N=175) with a diagnosis of right hemisphere stroke who had undergone a neuropsychologic screening including assessment of USN and depressive symptoms at time of admission to an inpatient rehabilitation program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional status was evaluated with the FIM instrument at admission and discharge. The relationship between USN, depressive symptoms, cognitive functioning, length of stay (LOS), and rate of progress in rehabilitation was examined via univariate (correlational) and multivariate (Cox regression) analyses. RESULTS: Patients with USN had longer LOS and progressed more slowly compared with those without USN. When matched against patients with equally poor functional status at admission, USN patients still had longer admissions and progressed more slowly. CONCLUSIONS: USN is a unique predictor of rehabilitation outcomes in patients with right hemisphere stroke. Identification of those specific functional skill areas most affected by USN may make possible the development of targeted interventions aimed at these key areas.     

Association of antidepressant medication therapy with inpatient rehabilitation outcomes for stroke, traumatic brain injury, or traumatic spinal cord injury

Weeks DL, Greer CL, Bray BS, Schwartz CR, White JR Jr. Association of antidepressant medication therapy with inpatient rehabilitation outcomes for stroke, traumatic brain injury, or traumatic spinal cord injury.

Objective

To study whether outcomes in patients who have undergone inpatient rehabilitation for stroke, traumatic brain injury (TBI), or traumatic spinal cord injury (TSCI) differ based on antidepressant medication (ADM) use.

Design

Retrospective cohort study of 867 electronic medical records of patients receiving inpatient rehabilitation for stroke, TBI, or TSCI. Four cohorts were formed within each rehabilitation condition: patients with no history of ADM use and no indication of history of depression; patients with no history of ADM use but with a secondary diagnostic code for a depressive illness; patients with a history of ADM use prior to and during inpatient rehabilitation; and patients who began ADM therapy in inpatient rehabilitation.

Setting

Freestanding inpatient rehabilitation facility (IRF).

Participants

Patients diagnosed with stroke (n=625), TBI (n=175), and TSCI (n=67).

Interventions

Not applicable.

Main Outcome Measures

FIM, rehabilitation length of stay (LOS), deviation between actual LOS and expected LOS, and functional gain per day.

Results

In each impairment condition, patients initiating ADM therapy in inpatient rehabilitation had longer LOS than patients in the same impairment condition on ADM at IRF admission, and had significantly longer LOS than patients with no history of ADM use and no diagnosis of depression (P<.05). LOS for patients initiating ADM therapy as inpatients even exceeded LOS for patients without ADM history, but who had a diagnosis for a depressive disorder. Deviation in LOS was significantly larger in the stroke and TBI groups initiating ADM in IRF than their counterparts with no history of ADM use, illustrating that the group initiating ADM therapy in rehabilitation significantly exceeded expected LOS. Increased LOS did not translate into functional gains, and in fact, functional gain per day was lower in the group initiating ADM therapy in IRF.

Conclusions

Explanations for unexpectedly long LOS in patients initiating ADM in inpatient rehabilitation focus on the potential for ADM to inhibit therapy-driven remodeling of the nervous system when initiated close in time to nervous system injury, or the possibility that untreated sequelae (eg, depressive symptoms or fatigue) were limiting progress in therapy, which triggered ADM treatment.     

31例脑卒中偏瘫患者康复疗效观察

目的观察现代康复综合治疗对脑卒中偏瘫患者功能恢复的影响。方法 6 1例脑卒中偏瘫患者根据是否接受康复治疗分为两组 :治疗组 31例 ,接受 1— 2个月的康复治疗 ,并辅以理疗 ;对照组 30例 ,未接受康复治疗。根据患者入院和出院时Fugl Meyer偏瘫功能评分进行比较。结果两组出院时功能评分比入院时均有增加 ,康复治疗组功能评分明显高于对照组 ,两组比较有非常显著性差异 (P <0 .0 1)。结论现代康复综合治疗对脑卒中偏瘫的功能恢复有明显的促进作用     

Caregiver availability for severe stroke results in improved functional ability at discharge from inpatient rehabilitation

Purpose: To evaluate the predictive capacity of caregiver availability on functional ability at time of discharge from inpatient rehabilitation in individuals with severe first-time stroke.

Methods: A retrospective chart review was conducted of severe stroke inpatients admitted to a stroke rehabilitation unit between April 2005 and December 2009. Follow-up telephone interviews were conducted with patients to determine caregiver availability at time of discharge. Hierarchical linear regression analysis was performed to assess the predictive capacity of caregiver availability on functional ability at discharge from an inpatient rehabilitation unit after controlling for covariates.

Results: Data from 180 individuals were included in the analysis. Individuals with a caregiver had significantly higher levels of functional ability at discharge compared to those without (85.8?±?23.6 versus 72.9?±?20.3; p?F (5,174)?=?26.21, p?Conclusions: The presence of a caregiver at time of discharge from inpatient rehabilitation is predictive of significantly higher functional ability at discharge in individuals with severe stroke.

• Implications for rehabilitation

• The availability of a caregiver at time of discharge from inpatient rehabilitation is predictive of improved functional ability at discharge in individuals with severe stroke.

• The presence of an available caregiver positively influences the functional recovery of individuals with severe stroke and may be an important element to successful rehabilitation.

     

Characterization of elderly patients in rehabilitation: stroke versus hip fracture

Purpose: To compare the characteristics of elderly patients hospitalized for rehabilitation following stroke with those following hip fracture (HF). Methods: A prospective study in a geriatrics department of a general university hospital in southern Israel. Five hundred and sixteen hospitalized elderly patients were included in the study, 221 following stroke and 295 following HF. The characteristics were compared by univariate and logistic regression analyses. Results: The mean age (+/-SD) of the stroke patients was 71.7+/-7.8 years compared to 77.4+/-7.9 for HF (p < 0.000001). Fifty-three per cent of the stroke patients were women compared to 76% of the HF patients (p < 0.000001). Stroke patients had significantly lower levels of folic acid (p = 0.00002). HF patients had more hearing and visual impairments (p = 0.008 and p = 0.017, respectively), but these were related to age differences between the groups. The Folstein Minimental test result was significantly higher in the HF group (p = 0.002). There were no differences in the symptoms of depression score as measured by geriatric depression screening scale. The Functional Independent Measure scale showed a higher preevent functional capacity among the stroke patients (p < 0.000001), but there was no difference in this scale on admission to rehabilitation or upon discharge. Conclusions: There is a difference in the nature of the stroke and HF events. When either event involves an elderly patient with a broad range of limitations and diseases, a new medical condition develops. In this condition the symptoms of depression and the functional state at admission and upon discharge are not significantly different between these groups of patients.     

A psychotropic drug treatment of psychiatric symptoms after stroke

Psychiatric syndromes are common in the patients with cerebrovascular disease. Poststroke depression (PSD) is a most frequent complication of after cerebrovascular disease. Depression affects 20-50% of patients within a year after stroke. PSD has a negative impact on functional recovery. Poststroke anxiety disorder, apathy and pathological laughing and crying are also frequent and under-detected symptoms. In this chapter, we described an outline mainly on treatment of PSD among these symptoms, in paticular, about antidepressant medications. There is an association between depression and atherosclerosis. Several trials have shown evidence that antidepressants may prevent depressive symptoms after stroke. The concept of "vascular depression" will suggest that the establishment of a new treatment strategy is demanded in future.     

Expanding the role of the stroke nurse: a pragmatic clinical trial

AIMS: This paper reports a study evaluating whether expanding a specialist nursing role to provide outreach education and support to stroke patients and carers after discharge from hospital is effective in promoting recovery. BACKGROUND: Building therapeutic relationships with patients and carers is a key component of the nursing role in stroke rehabilitation, although this is limited by the constraints of service organization. METHODS: A pragmatic randomized controlled trial was undertaken. Patients with a diagnosis of stroke were randomized to receive continued support from a stroke nurse (n = 87) or usual care and follow-up (n = 89) after discharge from hospital. Patients were recruited from two hospitals in the north-west of England from November 1999 to April 2001. Patient dependence (Barthel Index), general health (Nottingham Health Profile), activities of living (Frenchay Activity of Living Index), depression (Beck Depression Inventory) and carer strain (Carer Strain Index) were assessed at 3 and 12 months after stroke. RESULTS: The continued intervention of a stroke nurse after discharge was associated with improved patient perceptions of general health at 12 months (median difference 42.6, P = 0.012), and in particular reduced negative emotional reaction (P = 0.037) and perceived social isolation (P = 0.002). In addition, the intervention reduced carer strain at 3 months (P = 0.045), and reduced deterioration in physical dependence from 3 to 12 months (P = 0.049). CONCLUSION: The provision of continued intervention from a stroke nurse after discharge from hospital, focusing on education and support, has tangible benefits for patients and carers.     

Depression, healing, and recovery from coronary artery bypass surgery.

BACKGROUND: Effects of postoperative depression on recovery from coronary artery bypass grafting have not been widely studied. OBJECTIVES: To evaluate emotional and physical recovery after bypass surgery and investigate associations between depressive symptoms and infections and impaired wound healing in patients with high and low levels of depressive symptoms. METHODS: A nonrandomized, comparative, longitudinal design was used to study 72 bypass surgery patients without serious noncardiac comorbidities who were available for follow-up after discharge. Patients completed questionnaires to assess depressive symptoms, emotional recovery, and physical recovery within 48 hours after extubation, at discharge from the hospital, and 6 weeks later and performed 6-minute walk tests at the last 2 times. Infections and impaired wound healing (as indicated by positive cultures, antibiotic treatment, or extra treatments, such as debridements or incisions and drainage) were identified by chart audit. RESULTS: At discharge, patients with higher depressive symptom scores (indicating more symptoms) reported poorer emotional recovery (P<.001) and poorer physical recovery (P=.007) and achieved shorter walking distances (P<.001) than did patients with lower scores (indicating fewer symptoms). Six weeks after discharge, emotional and physical recovery remained lower in patients with more depressive symptoms (P<.001). Infections and impaired wound healing were more common among patients with higher depressive symptom scores (46%) than among patients with lower scores (19%, P=.03). CONCLUSIONS: After bypass surgery, depressive symptoms are associated with infections, impaired wound healing, and poor emotional and physical recovery.     

Stroke: the increasing complexity of carer needs.

In Australia, more than 346,000 individuals who experience a stroke return to living in their homes with varying degrees of disability. They rely on emotional and physical support from informal carers, typically family members. Informal carers have an indispensable role in patient care poststroke, and the ability of carers to manage this role effectively is crucial for stroke survivors to be able to return home. The aim of this study was to examine the impact of the caring role on carers of stroke survivors, particularly the services provided and the levels of depression and well-being experienced. The study used a longitudinal design incorporating survey methods. Stroke survivors were assessed for functional ability, quality of life, and depression using three assessment tools: the Stroke Impact Scale, World Health Organization Quality of Life-BREF scale, and Zung Self-Rating Depression Scale. A total of 26 people were surveyed: 13 stroke survivors and their 13 carers. Carer knowledge of stroke support services was also explored. Information was collected by using survey methods and structured interviews at 3 weeks and at 3 months postdischarge. The main finding was that depression scores for carers and stroke survivors were below Australian norms at both assessment time points. The major concern identified by carers was poor follow-up procedures for initiating rehabilitation in the home. This study highlighted that a lack of appropriate discharge planning, in conjunction with early discharge of stroke survivors, can have an impact on the rehabilitation process and place increased and unrealistic demands on carers.