The Positive Effect of Integrated Care on Depressive Symptoms in Stroke SurvivorsJoubert J.a · Joubert L.b · Reid C.c · Barton D.d · Cumming T.e · Mitchell P.f · House M.f · Heng R.g · Meadows G.h · Walterfang M.d · Pantelis C.d · Ames D.e · Davis S.a
aDepartment of Neurology, Royal Melbourne Hospital, bSchool of Social Work, University of Melbourne, cDepartment of Epidemiology and Preventive Medicine, Monash University, dDepartment of Psychiatry, Royal Melbourne Hospital, eNational Ageing Research Institute, fDepartment of Radiology, Royal Melbourne Hospital, gDepartment of Radiology, Western General Hospital, and hSchool of Psychology, Psychiatry and Psychological Medicine, Monash University, Melbourne, Australia
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Article / Publication Details
Background: Depressive symptoms occur in approximately one-third of stroke patients. We sought to evaluate whether an integrated model of stroke care and secondary prevention reduced depressive symptomatology in stroke survivors. Methods: The integrated care (IC) model is a multifaceted program that provides ongoing collaboration between a specialist stroke service and primary care physicians, using telephone tracking, a bi-directional information feedback loop, management of vascular risk factors, and regular screening for depressive symptoms. Results: Patients exposed to the IC model exhibited significantly fewer depressive symptoms than controls at 12 months post stroke (as measured by the PHQ-9 screening tool; p = 0.006). At 12 months, 30/91 (33%) of the treatment group had depressive symptoms, compared to 52/95 (55%) of the control group (p = 0.003). With other variables adjusted for, the major associates of being depressed at 12 months were group allocation and physical disability. Conclusion: The integrated care approach provides a framework for detecting and monitoring depressive symptoms, and appears to be protective against post-stroke depression.
© 2008 S. Karger AG, Basel
- Hackett ML, Yapa C, Parag V, Anderson CS: Frequency of depression after stroke: a systematic review of observational studies. Stroke 2005;36:1330–1340.
- Herrmann N, Black SE, Lawrence J, Szekely C, Szalai JP: The Sunnybrook stroke study: A prospective study of depressive symptoms and functional outcome. Stroke 1998;29:618–624.
- King RB: Quality of life after stroke. Stroke 1996;27:1467–1472.
- Everson SA, Roberts RE, Goldberg DE, Kaplan GA: Depressive symptoms and increased risk of stroke mortality over a 29-year period. Arch Intern Med 1998;158:1133–1138.
- House A, Knapp P, Bamford J, Vail A: Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke 2001;32:696–701.
- Hackett ML, Anderson CS: Frequency, management, and predictors of abnormal mood after stroke: the Auckland Regional Community Stroke (ARCOS) study, 2002 to 2003. Stroke 2006;37:2123–2128.
- Johnson JL, Minarik PA, Nystrom KV, Bautista C, Gorman MJ: Poststroke depression incidence and risk factors: an integrative literature review. J Neurosci Nurs 2006;38:316–327.
- Hackett ML, Anderson CS: Predictors of depression after stroke: a systematic review of observational studies. Stroke 2005;36:2296–2301.
- Aben I, Denollet J, Lousberg R, Verhey F, Wojciechowski F, Honig A: Personality and vulnerability to depression in stroke patients. Stroke 2002;33:2391–2395.
- Berg A, Palomaki H, Lehtihalmes M, Lonnqvist J, Kaste M: Poststroke depression: an 18-month follow-up. Stroke 2003;34:138–143.
- Kotila M, Numminen H, Waltimo O, Kaste M: Depression after stroke: results of the FINNSTROKE study. Stroke 1998;29:368–372.
- Chemerinski E, Robinson RG, Kosier JT: Improved recovery in activities of daily living associated with remission of poststroke depression. Stroke 2001;32:113–117.
- Ramasubbu R, Robinson RG, Flint AJ, Kosier T, Price TR: Functional impairment associated with acute poststroke depression: the Stroke Data Bank study. J Neuropsychiatry Clin Neurosci 1998;10:26–33.
- Kauhanen M, Korpelainen JT, Hiltunen P, Brusin E, Mononen H, Maatta R, Nieminen P, Sotaniemi KA, Myllyla VV: Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke 1999;30:1875–1880.
- Nys GMS, van Zandvoort MJE, van der Worp HB, de Haan EHF, de Kort PLM, Jansen BPW, Kappelle LJ: Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke. J Neurol Sci 2006;247:149–156.
- Robinson RG, Szetela B: Mood changes following left hemispheric brain injury. Ann Neurol 1981;9:447–453.
- Starkstein SE, Robinson RG, Price TR: Comparison of cortical and subcortical lesions in the production of poststroke mood disorders. Brain 1987;110:1045–1059.
- Carson AJ, MacHale S, Allen K, Lawrie SM, Dennis M, House A, Sharpe M: Depression after stroke and lesion location: a systematic review. Lancet 2000;356:122–126.
- Singh A, Herrmann N, Black SE: The importance of lesion location in poststroke depression: a critical review. Can J Psychiatry 1998;43:921–927.
- Vataja R, Pohjasvaara T, Leppavuori A, Mntyl R, Aronen HJ, Salonen O, Kaste M, Erkinjuntti T: Magnetic resonance imaging correlates of depression after ischemic stroke. Arch Gen Psychiatry 2001;58:925–931.
- Vataja R, Leppavuori A, Pohjasvaara T, Mantyla R, Aronen HJ, Salonen O, Kaste M, Erkinjuntti T: Poststroke depression and lesion location revisited. J Neuropsychiatry Clin Neurosci 2004;16:156–162.
- Aben I, Lodder J, Honig A, Lousberg R, Boreas A, Verhey F: Focal or generalized vascular brain damage and vulnerability to depression after stroke: a 1-year prospective follow-up study. Int Psychogeriatr 2006;18:19–35.
- Robinson RG, Schultz SK, Castillo C, Kopel T, Kosier JT, Newman RM, Curdue K, Petracca G, Starkstein SE: Nortriptyline versus fluoxetine in the treatment of depression and in short-term recovery after stroke: a placebo-controlled, double-blind study. Am J Psychiatry 2000;157:351–359.
- Andersen G, Vestergaard K, Lauritzen L: Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram. Stroke 1994;25:1099–1104.
- Williams LS, Kroenke K, Bakas T, Plue LD, Brizendine E, Tu W, Hendrie H: Care management of poststroke depression: a randomized, controlled trial. Stroke 2007;38:998–1003.
- Palomaki H, Kaste M, Berg A, Lonnqvist R, Lonnqvist J, Lehtihalmes M, Hares J: Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry 1999;66:490–494.
- Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
- Bonita R, Beaglehole R: Modification of Rankin Scale: recovery of motor function after stroke. Stroke 1988;19:1497–1500.
Mahoney F, Barthel D: Functional evaluation: the Barthel Index. Md Med J 1965;14:61–65.
Hawthorne G, Richardson J, Osborne R: The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. QoL Res 1999;8:209–224.
- Harwood RH, Rogers A, Dickinson E, Ebrahim S: Measuring handicap: The London Handicap Scale, a new outcome measure for chronic disease. Qual Health Care 1994;3:11–16.
- Robinson BC: Validation of a Caregiver Strain Index. J Gerontol 1983;38:344–348.
- Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T: Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke. Stroke 2006;37:577–617.
- Spitzer RL, Kroenke K, Williams JBW: Validity and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA 1999;282:1737–1744.
- Helenius J, Soinne L, Salonen O, Kaste M, Turgut T: Leukoaraiosis, ischemic stroke, and normal white matter on diffusion-weighted MRI. Stroke 2002;33:45–50.
- Damasio H: A computed tomographic guide to the identification of cerebral vascular territories. Arch Neurol 1983;40:138–142.
- Paul SL, Dewey HM, Sturm JW, Macdonell RA, Thrift AG: Prevalence of depression and use of antidepressant medication at 5-years poststroke in the North East Melbourne Stroke Incidence Study. Stroke 2006;37:2854–2855.
- Williams LS, Brizendine EJ, Plue L, Bakas T, Tu W, Hendrie H, Kroenke K: Performance of the PHQ-9 as a screening tool for depression after stroke. Stroke 2005;36:635–638.
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