Physical consequences of depression in the stroke patient

Schubert, Daniel; Taylor, Cynthia; Lee, Suk; Mentari, Askin; Tamaklo, Wilberforce

doi:10.1016/0163-8343(92)90028-9

Cited by 78 publications

(36 citation statements)

References 42 publications

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“…The relationship between post-stroke functional impairment and PSDS is poorly understood [36]. Some have argued that stroke patients may develop depressive symptoms as a psychological reaction to limited physical functioning [37], others speculated that depressive symptoms themselves produce functional impairment as a result of fatigue, hopelessness, and diminished motivation [38] and a third point of view is that physical disabilities can both be a cause or a consequence of depressive symptoms [39]. …”

Section: Discussionmentioning

confidence: 99%

Post-Stroke Depressive Symptoms Are Associated with Post-Stroke Characteristics

et al. 2009

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Background: Several studies have described the frequency and risk factors of post-stroke depressive symptoms (PSDS). However, most studies did not exclude patients with depressive symptoms shortly before stroke and paid little attention to prestroke risk factors of depression, including previous depressive episodes, white matter lesions, and brain atrophy. These are potential limitations to assess the true effect of stroke on the occurrence of depressive symptoms. Our aim was to investigate the prevalence and risk factors of PSDS with adjustments for the previously mentioned prestroke factors. Methods: 420 consecutive patients with an acute clinical symptomatic transient ischemic attack or cerebral infarction were eligible for enrolment in this study. The presence of PSDS was rated by the Hospital Anxiety and Depression Scale 6–8 weeks after stroke. The relation between (pre-) stroke factors and PSDS was assessed with multivariate regression analysis. Results: The prevalence of PSDS was 13% and did not differ between stroke subtype or first-ever/ever occurrence of stroke. Higher degree of post-stroke handicap was related to PSDS (OR = 5.39; 95% CI = 2.40–12.08) and more functional independence had a protective effect on PSDS (OR = 0.88; 95% CI = 0.77–1.00). Conclusions: This is the largest study that investigated the prevalence and risk factors of PSDS by carefully excluding patients with depressive symptoms shortly before stroke. PSDS were not related to lesion side or location, but to the degree of post-stroke handicap and functional independence. Early detection of PSDS and their risk factors might help to predict long-term outcome and could promote early interventions of (behavioral) rehabilitation treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Post-Stroke Depressive Symptoms Are Associated with Post-Stroke Characteristics

et al. 2009

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“…Astrom, Adolfsson, and Asplund (1993) found that rather than one condition causing the other, it was an interaction of the two that increased the effects of both. However, after finding an association between depression and decreased physical functioning following stroke, Schubert, Taylor et al (1992) suggested a causal relationship, whereby depression results in the deterioration of physical functioning. They reached this conclusion after completing a study involving 21 stroke patients aged 47-72 years.…”

Section: Physical Functioningmentioning

confidence: 99%

Poststroke depression: Prevalence, course, and associated factors

1996

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Despite the considerable amount of research that has been undertaken on poststroke depression, a review of the literature demonstrates that there are many inconclusive findings in the area. In particular, the causes and course of the disorder remain to be firmly established. While studies of prevalence differ with respect to the nature and timing of their assessment procedures, most conclude that poststroke depression has a negative impact on the rehabilitation of the stroke patient. Very little research is available on te relationship between poststroke depression and care-giver burden. However, recent studies have adopted more rigorous methodological procedures, allowing some insights into the complex mixture of factors which determine the occurrence of poststroke depression.

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“…depression has been found to be associ ated with decreased physical functional abil ity as summarized by Schubert et al [20]. This may delay patients from achieving the maxi mal benefit of rehabilitation therapies as de fined by improvement in physical functioning abilities.…”

Section: Discussionmentioning

confidence: 99%

“…At a simple, atheoretical level, depression requires that ward staff solve depression-asso ciated problems before discharge, resulting in increased LOS, where these problems are dif ferent or more severe than usual stroke-or amputation-associated rehabilitation prob lems. Examples would include disposition difficulty with depression-caused lowered self-care [20] and associated hesitancy of nursing home or relative to assume care when a patient has less self-care abilities.…”

Section: Discussionmentioning

confidence: 99%

Increase of Medical Hospital Length of Stay by Depression in Stroke and Amputation Patients: A Pilot Study

Schubert

Burns²,

Paras³

et al. 1992

Psychother Psychosom

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Past studies have found that medical patients with the diagnosis of depression (comorbidity) have longer hospital lengths of stay (LOS) than those without the diagnosis of depression. This suggested that scores on a depression scale would be positively correlated with LOS. On a rehabilitation ward, 14 stroke and 17 amputee patients were given the Geriatric Depression Scale (GDS) and lengths of stay were recorded. Correlations between GDS scores and LOS were + 0.575 for stroke and + 0.266 for amputee patients, both in the hypothesized direction. Explanations considered included: (1) depression and medical illness each produce morbidity which summate to require increased LOS; (2) depression delays medical recovery as well as the appearance of medical recovery, and (3) discharge planning is complicated by depression. When depression is associated with inpatient medical illness, DRGs may need to be reevaluated.

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Physical consequences of depression in the stroke patient

Cited by 78 publications

References 42 publications

Post-Stroke Depressive Symptoms Are Associated with Post-Stroke Characteristics

Post-Stroke Depressive Symptoms Are Associated with Post-Stroke Characteristics

Poststroke depression: Prevalence, course, and associated factors

Increase of Medical Hospital Length of Stay by Depression in Stroke and Amputation Patients: A Pilot Study

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