Evolution of Depression Symptoms following Stroke: A Prospective Study Using Computerized Ambulatory Monitoring

Abstract

Background: Despite the high prevalence and impact of post-stroke depression (PSD), questions persist concerning the nature and stability of PSD over time. The current study uses state-of-the-art computerized ambulatory monitoring techniques to assess daily life depression symptoms following stroke and examines the evolution of depression levels over a three-month period. Methods: 48 patients admitted to a university hospital neurology unit for ischemic or hemorrhagic stroke participated in ambulatory monitoring of DSM-IV depression symptoms for a one-week period after hospital discharge. Clinician-administered measures of depression were also obtained at discharge and again three months later. Results: The percentage of the sample with elevated depression scores was the same at discharge and three months later, but consistency in depression profiles was low. Ambulatory monitoring revealed that elevated depression levels at hospital discharge were most strongly associated with anhedonia (t ratio = 4.840, p < 0.001) and fatigue (t ratio = 4.00, p < 0.001), whereas individuals with elevated scores at three months were predicted by daily life negative thoughts (t ratio = 4.051, p < 0.001), anxious mood (t ratio = 3.489, p < 0.01), sad mood (t ratio = 2.621, p < 0.05) and emotional reactivity (t ratio = 2.466, p < 0.05). Conclusions: The prevalence of depression may appear stable during the immediate weeks and months following stroke, but it is likely to be composed of very different symptom profiles. The immediate physical and psychological impact of stroke may induce somatic symptoms that explain elevated depression levels and which may not indicate a risk factor for later depression.

The Role of Short Term Psychological and Somatic Anxiety in the Prediction of Long Term Anxiety of Early Hospital Discharged Patients with Complete Functional Recovery after a Mild Stroke

“…Thus, the present results go along with our hypothesis and suggest that psychological anxiety at three months is the only predictor of general anxiety at six months when considering a 2-factor structure of the HADS-A. Those results are in line with previous research about Post-Stroke Depression (Sibon et al, 2012) and are primarily documented here related to PSA. The main findings of the study propose that anxiety does not simply go Note.…”

“…Previous studies on post-stroke depression using daily Ecological Momentary Assessment of depressive symptoms (Jean, Swendsen, Sibon, Feher, & Husky, 2013;Sibon et al, 2012) have led to promising results for the comprehension of depression's characteristics and process in stroke survivors. Such designs have to be considered in future studies of anxiety in the acute phase of stroke.…”

Exploring the feasibility and usability of the experience sampling method to examine the daily lives of patients with acquired brain injury

“…Similarly, in ESM studies in stroke survivors, Jean et al (2013), Johnson et al (2009), Mazure et al (2014, and Sibon et al (2012) offered support for the feasibility of ESM, evidencing compliance rates of up to 84% of measurement moments being answered. Further, they recommended the application of ESM for investigating functional impairments in the natural context and for investigating constructs that cannot easily be assessed by standardised clinical questionnaires, such as identifying precursors of symptom expression (Johnson et al, 2009).…”

“…With respect to ABI, a small number of studies has used ESM (Jean, Swendsen, Sibon, Fehér, & Husky, 2013;Johnson et al, 2009;Juengst et al, 2015;Lewandowski, Rieger, Smyth, Perry, & Gathje, 2009;Mazure, Weinberger, Pittman, Sibon, & Swendsen, 2014;Sibon, Lassalle-Lagadec, Renou, & Swendsen, 2012); and support the capacity of this method to assess cognitive, physical and affective complaints after brain injury. For instance, Juengst et al (2015) investigated mood and anxiety symptoms in individuals with traumatic brain injury (TBI) and found initial support for the validity, usability and feasibility of assessing these symptoms using a smartphone "mhealth" application (Juengst et al 2015).…”

“…Further, they recommended the application of ESM for investigating functional impairments in the natural context and for investigating constructs that cannot easily be assessed by standardised clinical questionnaires, such as identifying precursors of symptom expression (Johnson et al, 2009). Specifically, patients' ESM reports of fatigue, negative affect and anxiety were found to be predictive of the risk of depression three months post-stroke (Sibon et al, 2012), and performing sports and working in the acute post-stroke phase was associated with higher depression scores (Jean et al, 2013). Finally, Mazure et al (2014) evidenced greater reactivity to stressful life events in female relative to male stroke survivors.…”