The Distress Management System for Stroke (DMSS): An approach for screening and initial intervention for post-stroke psychological distress

Abstract

Aim: To develop a practical system to enable nurses to screen for psychological distress following stroke.Background: Mood disorders and psychological distress are prevalent following stroke, but often go undetected and therefore untreated. National guidelines recommend screening for distress, but the evidence suggests that there are significant barriers to the implementation of post-stroke mood and psychological distress screening programmes. One barrier relates to limitations of questionnaire methods for identifying distress. Specifically, existing mood questionnaires are often too lengthy; miss important emotional changes that result from stroke; and do not necessarily point nurses towards the most helpful intervention approaches. Methods:We sought to develop a brief, clinically valid screening system that could be used by nurses to identify the levels of psychological distress experienced by stroke survivors. As well as determining levels of distress, the system was intended to aid the identification of first-line interventions that nurses could offer to alleviate distress.Results: A screening system was identified from the oncology literature (the Distress Management System [DMS]) that appeared to meet the broad requirements for screening for stroke-related distress. To tailor the DMS for stroke settings, we obtained feedback on the components of the DMS from stroke survivors and stroke nurses, and also consulted the research literature. This led us to: (1) retain the distress screening component of the DMS, the 'Distress Thermometer'; (2) modify the DMS's 'Concerns Checklist' to reflect the main problems encountered after stroke; and (3) add a 'Resource Pack' to the screening system to enable nurses to offer first-line interventions targeted at individuals' distress. The result, the Distress Management System for Stroke (DMSS), is presented in full in this paper. Conclusion:The DMSS is a potentially useful tool for nurses working in stroke settings. It is brief, straightforward to administer, captures the main emotional concerns of stroke survivors, and the findings from the DMSS can be used to structure interventions for psychological distress. Future work is required, however, to establish the DMSS's reliability, validity and clinical effectiveness.

Depression after stroke: The role of the GP

“…Informal communication aids, such as hand gestures, changing tone of voice, facial expressions, or images and formal aids may be of some benefit in expressing concepts and building rapport. Use of a 'Distress Thermometer', a self-rating visual analogue scale from 0 (no distress) to 10 (extreme distress), can help patients to express how they have felt over the past week (Gillespie and Cadden, 2013). Such methods are however limited in their sensitivity when screening for depression and can be open to misinterpretation.…”

STARR - Decision SupporT and self-mAnagement system for stRoke survivoRs Vision based Rehabilitation System

“…Adapted from [22]. stroke anger proneness (PSAP), and post-stroke fatigue [14][15][16]. Their emotional wellbeing is important throughout, especially when interacting with rehabilitation systems at home such as our vision based platform proposed in STARR.…”