Article

Few longitudinal studies explore post-stroke patterns of psychological
morbidity and factors contributing to their change over time. We aimed to explore
predictors of post-stroke depression (PSD) and post-stroke anxiety over a
12-month period. METHODS: A prospective cohort study. Consecutively recruited
stroke patients (n=134) participated in face-to-face interviews at baseline, 3,
6, 9, and 12 months. Primary outcome measures were depression and anxiety
(measured via Hospital Anxiety and Depression Scale). Independent variables
included disability (Modified Rankin Scale), Quality-of-life (Assessment
Quality-of-life), social support (Multi-dimensional Scale Perceived Social
Support) and community participation (Adelaide Activities Profile (AAP)).
Secondary outcomes were predictors of resolution and development of PSD and
anxiety. RESULTS: Anxiety (47%) was more common than depression (22%) at
baseline. Anxiety (but not depression) scores improved over time. Anxiety
post-stroke was positively associated with baseline PSD (p<0.0001), baseline
anxiety (p<0.0001) and less disability (p=0.042). PSD was associated with
baseline anxiety (p<0.0001), baseline depression (p=0.0057), low social support
(p=0.0161) and low community participation (p<0.0001). The only baseline factor
predicting the resolution of PSD (if depressed at baseline) was increased social
support (p=0.0421). Factors that predicted the onset of depression (if not
depressed at baseline) were low community participation (p=0.0015) and higher
disability (p=0.0057). CONCLUSION: While more common than depression immediately
post-stroke, anxiety attenuates while the burden of depression persists over 12
months. Clinical programs should assess anxiety and depression, provide treatment
pathways for those identified, and address modifiable risk factors, especially
social support and social engagement. Implications for Rehabilitation
Psychological distress post stroke is persisting. Multi-disciplinary teams that
establish goals with patients promoting social and community engagement could
assist in managing psychological morbidity. A shift towards promoting longer-term
monitoring and management of stroke survivors must be undertaken, and should
consider the factors that support and hinder psychological morbidity.

Langue : ANGLAIS