The influence of self-efficacy,pre-stroke depression and perceived social support on self-reported depressive symptoms during stroke rehabilitation

Post-stroke depression (PSD) is the most common mental disorder following stroke; however, little is known about its pathogenesis. We investigated the predictive value and mutual relationship of psychological factors such as self-efficacy and social support and known risk factors such as pre-stroke depression, activities of daily living (ADL), cognitive functioning, and age for the emergence of depressive symptoms in the acute phase after stroke. Ninety-six ischaemic stroke inpatients residing at a rehabilitation centre completed an interview about 6.5 weeks post-stroke. The interview included demographic data, psychiatric anamnesis, the Barthel Index, Mini-Mental State Examination, Social Support Questionnaire, Generalized Self-Efficacy Scale, Stroke Self-Efficacy Questionnaire, and the Geriatric Depression Scale. A multiple regression analysis was performed to ascertain the predictive value of the factors on depressive symptoms. High self-efficacy, no history of pre-stroke depression, and high levels of perceived social support were the strongest protective factors for depressive symptoms. The influence of cognitive functioning on depressive symptoms was fully mediated by general self-efficacy, and general self-efficacy was a stronger predictor than stroke-specific self-efficacy. Neither ADL nor age significantly predicted depressive symptoms. Our findings suggest that consideration of self-efficacy and perceived social support in the inpatient rehabilitation setting may help prevent PSD.     

Pre-morbid personality and depression following stroke

BACKGROUND: The role of individual differences, including pre-morbid personality, in the development of post-stroke depression, has received relatively little attention. We undertook a cross-sectional study to investigate the relationship between pre-morbid personality and other individual differences, and depression following acute stroke. METHOD: We studied 61 consecutive patients admitted to a dedicated stroke inpatient unit. DSM-IV depressive diagnoses were ascertained using the Composite International Diagnostic Interview and depressive symptoms were ascertained on the Hamilton Depression Rating Scale and the Center for Epidemiologic Studies Depression Scale. Informant-rated personality scores were obtained on the full 240-item Neuroticism, Extraversion and Openness Personality Inventory--Revised. Adaptive function was measured on the Modified Barthel Index and the Instrumental Activities of Daily Living scale. Cognitive function was assessed on the Mini-mental State Examination. RESULTS: An increased risk of post-stroke depression was conferred by both pre-morbid neuroticism [odds ratio (OR) 3.69; 95% confidence interval (95% CI) 1.25-10.92] and a past history of mental disorder (OR 10.26; 95% CI 3.02-34.86). There was no significant relationship demonstrated between lesion location and post-stroke depression. CONCLUSIONS: Informant-rated pre-morbid neuroticism and a past history of mental disorder were important predictors of depression following stroke. Stroke side was not significantly related to risk of depressive symptoms following stroke.     

Hostility changes following antidepressant treatment: Relationship to stress and negative thinking

It is unclear whether changes in hostility following treatment are primarily related to improvement in depressive symptoms or are also closely associated with reductions in negative thinking or perceived stress. We evaluated 94 outpatients with major depression before and after eight weeks of fluoxetine treatment by administering the Symptom Questionnaire (SQ) Hostility Scale, the Hamilton Rating Scale for Depression (HAM-D), the Cognitions Questionnaire (CQ) and the Perceived Stress Scale (PSS). We observed significant elevations in scores on these questionnaires in depressed patients as compared to normal controls. Following treatment with fluoxetine, there was a statistically significant reduction in scores on all four questionnaires. We observed that changes in SQ Hostility were significantly positively related to changes in both depression severity and perceived stress, with these relationships remaining significant after adjusting for gender and baseline SQ Hostility. The relationship between SQ Hostility changes and reductions in negative thinking became significant only after adjusting for gender and baseline SQ hostility. Our results suggest that the marked decrease in hostility following antidepressant treatment is related to a reduction in depressive symptoms, stress levels and negative thinking.     

Depressive symptoms following ischemic stroke

Depressed mood and other depressive symptoms frequently seen after cerebral stroke contribute to an unfavorable prognosis in this patient population. Identification of the subgroup of patients at increased risk for depressive symptoms is a prerequisite of early treatment. In the study aimed at evaluation of post-stroke depressive symptoms prevalence and risk factors participants were 766 consecutive patients with ischemic cerebral infarction, admitted in the years 1997-2000 to the Stroke Unit, Neurology Department in Cracow. Data concerning depressive symptoms, demographic characteristics and clinical variables were obtained from medical records. Depressive symptoms during the hospitalization were found in 19% of cases. Younger age, neurological deficits and previous history of psychiatric disorders were independent factors increasing the risk of post-stroke depressive symptoms. The study allowed to identify the subpopulation of stroke patients at risk for affective disorders following a cerebrovascular accident.     

Depressive symptoms in patients admitted to a semi-intensive stroke unit

Aim of this study was to evaluate depressive symptoms in a semi-intensive Stroke Unit (SI-SU) by a scale specifically devised to assess depression in patients with stroke and to identify the symptoms better contributing to the early detection of post stroke depression (PSD). Fifty-four patients admitted to a SI-SU because of suffering from single, first-ever hemispheric stroke were enrolled. Depressive symptoms were assessed by the Post Stroke Depression Rating Scale (PSDRS). All patients were also evaluated by the National Institute of Health Stroke Scale (NIHSS), the modified Rankin scale, the Mini-Mental State Examination (MMSE) and the Frontal Assessment Battery (FAB). The PSDRS detected depressive symptoms in twenty-two patients (40%). The PSDRS scores were not influenced by severity of stroke, functional outcome, site of lesion and type of stroke. Three psychopathological factors were identified inside the PSDRS: "reactivity", "melancholic" and "apathetic", with significant inverse correlations with cognitive measures found only with the "apathetic" factor Less than one-half items of the PSDRS were able to identify overt depressive symptoms. Depressive symptoms are a frequent and early complication in patients referred to a SI-SU with the PSDRS being a suitable tool to detect depressive symptoms in acute phases of stroke.     

Depression, perceived family criticism, and functional status among older, primary-care patients.

OBJECTIVE: Relatively little research has examined the role of family factors in later-life depression, particularly in the broad range of depressive conditions seen in primary care. Authors tested the hypotheses that 1) perceived family criticism is independently associated with depression, 2) that family criticism and depression are independently associated with functional disability, and 3) that perceived family criticism moderates the association between depression and functional disability. METHODS: This cross-sectional study recruited 379 adults age > or =65 years from primary-care practices. Study measures included the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression, the Family Emotional Involvement and Criticism Scale, and several measures of functional disability. Multiple regression determined independent associations, and a multiplicative interaction term tested the moderator model of the third hypothesis. RESULTS: Perceived family criticism was independently associated with depression diagnosis and depressive symptoms. Depression diagnosis, depressive symptoms, and perceived family criticism were each independently associated with functional status. Perceived family criticism did not moderate the association between depressive symptoms and functional status in the overall study group, although it did moderate the association between depression diagnosis and instrumental activities of daily living when only early-onset depressed patients were included. CONCLUSIONS: Authors confirmed the first and second hypotheses; however data did not support the third hypothesis. These results provide support for clinicians to attend to quality of primary family relationships and perceived criticism in depressed older adults and for researchers to consider aspects of family functioning as covariates or potential targets for intervention studies.     

Psychological factors and subjective cognitive complaints after stroke: Beyond depression and anxiety

ABSTRACT

Subjective Cognitive Complaints (SCC) are common after stroke and adversely affect quality of life. In the present study, we determined the associations of depression, anxiety, perceived stress and fatigue with post-stroke SCC, and whether these associations were independent of objective cognitive functioning, stroke characteristics and individual differences in personality traits and coping styles. Using a cross-sectional design, SCC and psychological measures were obtained in 208 patients (mean 3.3?±?0.5 months after stroke; 65.9% men; mean age 64.9?±?12.4 years). SCC were assessed using the Checklist for Cognitive and Emotional consequences following stroke (CLCE) inventory. Validated questionnaires were used to measure depression and anxiety (Hospital Anxiety and Depression Scale), perceived stress (Perceived Stress Scale), fatigue (Fatigue Assessment Scale), personality traits (Eysenck Personality Questionnaire Revised Short Scale) and coping style (Utrecht Coping List). Multivariate hierarchical linear regression analyses were used to adjust for covariates. Depression (β?=?0.35), anxiety (β?=?0.38), perceived stress (β?=?0.39), and fatigue (β?=?0.39) were associated with CLCE scores, independent of demographic, cognitive performance and stroke-related covariates. After including personality traits and coping styles in the model, independent associations with CLCE scores were found for fatigue (β?=?0.26, p?=?.003) and neuroticism (β?=?0.21, p?=?.05). Interventions aimed at improving psychological resilience and increasing energy levels might be a worthwhile addition to stroke rehabilitation programmes by reducing SCC and improving quality of life.     

Evidence for accelerated vascular aging in bipolar disorder

ObjectivesLittle is known about the effect of lifetime history of depression on ischemic stroke outcomes. This study compared a measure of current symptoms of depression at the time of the stroke and a measure of lifetime history of depression for their ability to predict quality of life and functioning at 3 and 12 months after stroke.MethodsA cohort of 460 ischemic stroke patients from the 2005 Greater Cincinnati/North Kentucky Stroke Study was assessed within 2 weeks of the stroke, including the 10-item Center for Epidemiological Studies Depression Scale (CESD) for current symptoms of depression. Lifetime history of depression was also assessed by a 2-question measure at 3 and 12 months after stroke. Two outcome measures, Stroke Specific Quality of Life (SSQOL) and the modified Rankin Scale (mRS) to assess functional status, were also collected at 3 and 12 months.ResultsOf the 322 survivors included in the analysis, 52.2% reported depression on at least one measure. Both current symptoms and lifetime history of depression predicted poor functional outcomes and poor quality of life at 3 and 12 months, after adjustment for age, race, sex, prior stroke, baseline functional status, and stroke severity. The combination of depression measures was a better predictor of poor outcomes than either measure alone.ConclusionDepression by either measure was a frequent, substantial, and independent predictor of poor outcomes at 3 and 12 months after stroke. Stroke outcomes studies should further examine the predictive value of assessing both depressive symptoms at the time of the stroke and lifetime history of depression.     

The relationship between the perception of social support and post-stroke depression in hospitalized patients

In our study we examined the relationship between the perceived adequacy of social support and post-stroke depression in 76 hospitalized Australian patients. Social support or the perception of its lack, particularly from a spouse care-giver, was associated significantly with both the presence and severity of depressive disorder. Furthermore, depressed patients who perceived their support to be inadequate had a longer duration of depressive illness than depressed patients who perceived their support in a more favorable light. We conclude that following stroke, perception of social support from key relationships may mediate the emotional response to this life crisis. The implications of these findings are discussed.     

Depressive symptoms in acute stroke: A cross-sectional study of their association with sociodemographics and clinical factors

The aim of the study was to estimate the prevalence of post-stroke depression (PSD) in the acute phase following first-ever stroke, and to identify its sociodemographic and clinical correlates. Data were collected in a cross-sectional correlational study from face-to-face interviews using structured questionnaires and patients' medical records. The sample consisted of 109 patients with first-ever stroke. Depressive symptoms after stroke were measured with Beck Depression Inventory II. Mild, moderate or severe depressive symptoms were reported by 27% of the participants. PSD was uniquely associated with post-stroke fatigue, sleep latency and sleep disturbance. Patients with PSD also reported slightly more bodily pain. Stroke type, stroke location, and the sociodemographic characteristics we examined were unrelated to PSD. Further research is needed to assess the role sleep changes, fatigue and bodily pain might have in relation to depression in the acute phase after stroke.     

Mild depression in young adults with cerebral infarction at long-term follow-up: A population-based study

We sought to evaluate the prevalence of and risk factors for post-stroke depression (PSD) at long-term follow-up in young adults aged 15-49 years with first-ever cerebral infarction in a population-based study. Scores on Montgomery-Asberg Depression Rating Scale (MADRS) were obtained at follow-up (mean time 6.0 years after the stroke) and analysed in subgroups. MADRS scores were obtained in 196 of 209 surviving patients. PSD (MADRS>or=7) was detected in 56 patients (28.6%). None had severe PSD. Alcoholism (P=0.006), depressive symptoms any time before the index stroke (P=0.016), and severe neurological deficits on admission for the index stroke (P=0.043) were independently associated with PSD. PSD seems milder in young ischaemic stroke patients compared with older patients. Alcoholism, depression any time before the index stroke, and severity of neurological deficits on admission for the stroke increased the risk of developing PSD in the long run.     

Psychological Burden in Stroke Survivors and Caregivers Dyads at the Rehabilitation Center of Kinshasa (Democratic Republic of Congo): A Cross-Sectional Study

IntroductionStroke is a major cause of burden which can lead to anxiety and depressive disorders in stroke patients and their caregivers. This study aimed to assess the burden of depression and anxiety and covariates as well as its association with functional disability level among stroke survivors and caregivers dyads.MethodsThis cross-sectional study assessed for anxiety and depressive symptoms, and perceived burden among survivors of stroke and their caregivers in the rehabilitation center of Kinshasa; using the Hospital Anxiety and Depression Scale to identify participants with anxiety and depression; the Zarit Burden Inventory to assess the burden of depression and anxiety; and the modified Rankin scale used to assess functional outcome or level of disability.ResultsEight in ten caregivers of stroke survivors perceived the burden, which took more expression of depression than anxiety, whereas three in ten stroke survivors had a burden expressed by symptoms consistent with depressive and anxiety disorders. Being married increases the risk of perceiving the burden among stroke survivors. We found a positive association between high level of burden and depression and anxiety among caretakers of stroke survivors. Moreover, our findings did not reveal a statistical association between the burden and level of dependence evaluated based on the severity of disability.ConclusionsThe psychological burden is higher among caregivers than stroke survivors. Specialized programs targeted the psychological distress, its association with anxiety and depressive symptoms; and the functional disability level of stroke survivors should be integrated into the rehabilitation center of patients with disabled illnesses. Our findings warrant further studies to test the impact of reducing psychological burden on functional disability.     

Psychological distress and salivary secretory immunity

Stress-induced impairments of mucosal immunity may increase susceptibility to infectious diseases. The present study investigated the association of perceived stress, depressive symptoms, and loneliness with salivary levels of secretory immunoglobulin A (S-IgA), the subclasses S-IgA1, S-IgA2, and their transporter molecule Secretory Component (SC). S-IgA/SC, IgA1/SC and IgA2/SC ratios were calculated to assess the differential effects of stress on immunoglobulin transport versus availability.This study involved 113 university students, in part selected on high scores on the UCLA Loneliness Scale and/or the Beck Depression Inventory. Stress levels were assessed using the Perceived Stress Scale. Unstimulated saliva was collected and analysed for total S-IgA and its subclasses, as well as SC and total salivary protein. Multiple linear regression analyses, adjusted for gender, age, health behaviours, and concentration effects (total protein) revealed that higher perceived stress was associated with lower levels of IgA1 but not IgA2. Perceived stress, loneliness and depressive symptoms were all associated with lower IgA1/SC ratios. Surprisingly, higher SC levels were associated with loneliness and depressive symptoms, indicative of enhanced transport activity, which explained a lower IgA1/SC ratio (loneliness and depression) and IgA2/SC ratio (depression).This is the first study to investigate the effects of protracted psychological stress across S-IgA subclasses and its transporter SC. Psychological stress was negatively associated with secretory immunity, specifically IgA1. The lower immunoglobulin/transporter ratio that was associated with higher loneliness and depression suggested a relative immunoglobulin depletion, whereby availability was not keeping up with enhanced transport demand.     

卒中单元护理模式对卒中后抑郁患者疗效的影响

目的 探讨卒中单元护理模式对卒中后抑郁患者的影响。方法 将52例卒中后抑郁患者,随机分为治疗组和对照组,对所有患者均进行常规护理和常规治疗,治疗组在此基础上加用卒中单元护理模式,对两组患者的神经功能和精神状态进行对照研究。结果 按照卒中单元护理模式进行护理干预的患者汉密尔顿抑郁量表（Hamilton Rating Scale forDepression,HRSD）评分、Barthel指数（Barthel index,BI）和神经功能改良Rankin量表（The ModifiedRankin Scales,mRS）评分较常规护理组得到明显改善（P <0.01）。结论 对卒中后抑郁的患者,早期实施卒中单元模式护理,是减轻患者的抑郁情绪、提高康复效果的有效护理方法。     

The sensitivity of somatic symptoms in post-stroke depression: a discriminant analytic approach

BACKGROUND: Somatic and neurocognitive symptoms of depression may overlap with the physical symptoms of stroke, and thus make the diagnosis of post-stroke depression difficult. AIM: To assess the sensitivity of individual depressive symptoms and their contribution to the diagnosis of post-stroke depression. PATIENTS AND METHODS: Two hundred and six patients with first-ever stroke, participating in a longitudinal study, were administered the Structured Clinical Interview for DSM-IV and the Hamilton Depression Rating Scale (HAM-D). In a discriminant analysis the relative contribution of the individual HAM-D items to the diagnosis of major depressive disorder was evaluated. RESULTS: The cumulative incidence of post-stroke major depressive disorder was 32%. The discriminant model based on HAM-D item scores was highly significant (p<0.001) and classified 88.3% of patients correctly as depressed or nondepressed. As expected, 'depressed mood' discriminated best between depressed and non-depressed stroke patients. 'Reduced interests' had a relatively low sensitivity and may in part reflect 'apathy', which often is considered a separate construct. With the exception of 'suicidal thoughts', most psychological symptoms, such as 'hypochondriasis', 'lack of insight' and 'feelings of guilt', were not very sensitive. Some somatic symptoms, such as 'reduced appetite', 'psychomotor retardation', and 'fatigue' had high discriminative properties. CONCLUSION: Psychological, neurocognitive and somatic symptoms of depression differ among themselves in terms of diagnostic sensitivity, and should be considered individually. Some somatic symptoms are highly sensitive for depression and should not be neglected by following an 'exclusive' or 'attributional' approach to the diagnosis of PSD.     

卒中后抑郁的相关因素分析

目的探讨卒中后抑郁(PSD)的相关因素。方法采用汉密尔顿抑郁量表(HAMD)在卒中后14 d及90 d对300例脑卒中患者进行评分,并据此分为PSD组及非PSD组,对两组间的卒中部位、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表评分(mRS)及简易精神状态检查表(MMSE)评分进行比较。结果 140例(46.7%)患者发生PSD;卒中灶多发或位于左侧半球、额颞叶及基底节的患者PSD发生率明显高于卒中灶单发、位于右侧半球、顶枕叶及皮质的患者(均P<0.05);PSD组发病14 d时NIHSS评分、发病14 d及90 d时mRS评分明显高于非PSD组(P<0.05～0.01)。结论 PSD发生与多灶性卒中及卒中灶位于左侧半球、额颞叶、基底节区有关;且与卒中后神经功能缺损程度及残疾程度有关。     

Depressive syndromes in neurological disorders

Depressive syndromes represent a common and often characteristic feature in a number of neurological disorders. One prominent example is the development of post-stroke depression, which can be observed in more than one-third of stroke survivors in the aftermath of an ischemic stroke. Thus, post-stroke depression represents one of the most prevalent, disabling, and potentially devastating psychiatric post-stroke complications. On the other hand, depressive syndromes may also be considered as a risk factor for certain neurological disorders, as recently revealed by a meta-analysis of prospective cohort studies, which demonstrated an increased risk for ischemic events in depressed patients. Moreover, depressive syndromes represent common comorbidities in a number of other neurological disorders such as Parkinson’s disease, multiple sclerosis, or epilepsy, in which depression has a strong impact on both quality of life and outcome of the primary neurological disorder.

     

Subthreshold depression and cognitive impairment but not demented in stroke patients during their rehabilitation

Background –  Subthreshold depression (sD) and cognitive impairment but not demented (CIND) in stroke patients are associated with poorer rehabilitative outcomes. Their diagnosis can easily be operationalized using validated scales.
Aim –  The aim of the study was to ascertain the prevalence of depressive symptoms and cognitive impairment in stroke patients during three crucial stages of the rehabilitative process, viz. upon admission, upon planned discharges from rehabilitation hospitals and at 6 months post-stroke, using validated scales like the Geriatric Depression Scale and Abbreviated Mental Test (recommended by the British Geriatric Society). Their baseline risk factors were also ascertained.
Results –  On admission, the prevalence of depressive symptoms and cognitive impairment was 60% and 54% respectively. The prevalence upon planned discharges and 6 months post-stroke, respectively, of depressive symptoms was 38% and 34% and that of impaired cognition was 33% and 40%. Baseline independent correlates at 6 months post-stroke depressive symptoms were: recurrent stroke (OR 3.34); on admission cognitive impairment (OR 4.78) and ADL dependence (OR 5.28). And that of cognitive impairment were: increasing age (OR 8.07); post-stroke dysphagia (OR 4.58); on admission cognitive impairment (OR 23.95) and on admission depressive symptoms (OR 3.50).
Conclusions –  Continuous screening and appropriate intervention, especially at baseline, would significantly decrease the burden posed by stroke patients with such psychological impairments in the community.     

Predictors of depressive symptoms in patients with stroke – a three-month follow-up

Background and purposeDepression is one of the most common post-stroke complications, which could impair rehabilitation outcome and quality of life, and could also increase mortality after stroke. The aim of the present study was to assess the association between demographic, socioeconomic and clinical (stroke risk factors, type of stroke, location of vascular lesion, cognitive functions) factors on the presence and severity of post-stroke depressive symptoms in patients after first ever stroke as well as on their social functioning.Material and methodsA prospective, cohort study with a three-month observation period was performed in seven centres. Severity of depressive symptoms was assessed with the help of a short, 15-item version of the Geriatric Depression Scale (GDS), 3 months after stroke onset.ResultsOn the basis of GDS (GDS ≤ 5 points or > 5 points) patients were allocated to a group without (n = 160) or with symptoms suggestive of depression (n = 82). The study groups did not differ with respect to age, sex or place of residence. Univariate logistic regression analysis showed that independent predictors for the presence of symptoms suggestive of depression at 3 months after stroke were: low level of education, low income, greater severity of stroke, worse functional status, self-reported problems with daily-living activities and need of help in daily living activities. More than 60% of patients with depressive symptoms limited their social contacts. Patients with depressive symptoms were unsatisfied with their relations with life partners and friends.ConclusionsOur study showed a complex aetiology of post-stroke depressive symptoms with an important role of socioeconomic factors. Depressive symptoms after stroke worsen existing health, social and economic problems, and cause social isolation of patients.     

卒中后抑郁的发生率及其相关因素的前瞻性研究

目的 前瞻性随访研究住院患者卒中后抑郁（post-stroke depression,PSD）发病率及其相关危险因素。方法 采用17项汉密尔顿抑郁量表（Hamilton Depression Scale, HAMD）对101例卒中住院患者在2周、3个月和6个月时分别进行抑郁情绪评定,调查住院患者中卒中后抑郁的发病率,同时测评患者一般资料、改良Rankin量表（modified Rankin Scales,mRS）、美国国立卫生研究院卒中量表（the NationalInstitutes of Health Stroke Scale,NIHSS）以及简明智力测验（mini-mental state examination,MMSE）,分析影响卒中后抑郁的相关临床因素。结果 （1）PSD 2周时首次发生率显著高于3个月和6个月（45.5% vs 6.4%,P <0.01;45.5% vs7.3%,P <0.01）,PSD总体发生率在2周、3个月和6个月时无统计学差异（P >0.05）,PSD患者3个月内抑郁缓解率显著高于3～6个月期间（23.9% vs 3.1%,P =0.029）,PSD患者死亡率显著高于非PSD患者（P <0.05）;（2）2周时左侧半球卒中患者PSD发生率显著高于右侧和双侧卒中患者（P =0.047）,2周、3个月和6个月时PSD患者MMSE评分显著低于非PSD患者（P均<0.01）,而mRS和NIHSS评分显著高于非PSD患者（均P <0.01）;（3）2周时PSD的发生与NIHSS（P <0.01）、mRS（P <0.01）、左侧半球卒中相关;而3个月和6个月时PSD的发生与NIHSS和mRS相关（P均<0.05）;2周、3个月和6个月时PSD的发生与MMSE无关（P >0.05）。（4）未发现PSD与性别、年龄、卒中性质、病灶数目、高血压、糖尿病、文化程度相关（P >0.05）。结论 PSD可能多发于卒中后2周内,NIHSS、mRS评分及2周大脑半球病变与PSD发生显著相关。