The Impact of Pre-Stroke Depressive Symptoms, Fatalism, and Social Support on Disability after Stroke

Abstract

Background Psychological and social factors have been linked to stroke mortality; however, their impact on stroke disability is unclear. The purpose of this study was to evaluate the impact of pre-stroke fatalism, depressive symptoms, and social support on 90-day neurological, functional, and cognitive outcomes. Methods Ischemic strokes (2008–2011) were identified from the Brain Attack Surveillance in Corpus Christi Project. Validated scales were used to assess fatalism, depressive symptoms, and social support during baseline interviews. The National Institutes of Health Stroke Scale (NIHSS), Activities of Daily Living/ Instrumental Activities of Daily Living (ADL/IADL) scale, and Modified Mini-Mental State Exam (3MSE) were used to assess 90-day outcomes. The associations between the pre-stroke variables and 90-day outcomes were estimated from regression models adjusting for demographics, risk factors, tPA treatment, and comorbidities. Results Among 364 stroke survivors, higher pre-stroke fatalism was associated with worse functional (0.17 point higher ADL/IADL per IQR higher fatalism; CI 0.05, 0.30) and cognitive (2.81 point lower 3MSE per IQR higher fatalism; CI 0.95, 4.67) outcomes. Higher pre-stroke depressive symptoms were associated with worse functional (0.16 point higher ADL/IADL per IQR higher PHQ-9; CI 0.04, 0.28) and cognitive (2.28 point lower 3MSE per IQR higher PHQ-9; CI 0.46, 4.10) outcomes. Participants in the middle tertile of social support had better cognitive outcomes (3.75 points higher 3MSE; CI 0.93, 6.56) compared to the highest tertile. Conclusions The associations between pre-stroke fatalism, depressive symptoms, and social support and 90-day outcomes suggest that psychosocial factors play an important role in stroke recovery.

Effectiveness of neuromuscular electrical stimulation for wrist rehabilitation after acute ischemic stroke

“…Stroke is one of the most server conditions, which often results in high disability, mortality, and morbidity. [ 1 – 3 ] It is reported that it has affected 7 million adults in America with 3.0% of the population from 2007 to 2010, according to the American Stroke Association statistics. [ 4 , 5 ] Of those populations, many stroke survivors often suffer from limb paralysis, abnormal gait, aphasia, and other complications.…”

Proceedings of the First Curing Coma Campaign NIH Symposium: Challenging the Future of Research for Coma and Disorders of Consciousness

“…• Comorbidities: Medical comorbidities and their severity are critical determinants of patient outcome and should be taken into account in prognostic tools [124][125][126]. Premorbid cognition, mental health, and personality are under-ascertained yet may similarly contribute to patient-centered outcomes [127,128].…”

<p>Impact of psychiatric comorbidity on the severity, short-term functional outcome, and psychiatric complications after acute stroke</p>

“…Limited data exist on the relation between anxiety disorders and stroke incidence 33. However, there is a scarcity of studies investigating the relationship between prestroke psychiatric morbidity and the severity of stroke or outcome after stroke: two groups demonstrated associations between prestroke depression and stroke severity as well as functional outcome 11,12. Data on the impact of prestroke dementia on stroke severity and outcome are also consistent in that pre-existing dementia is associated with a higher burden of disability and higher rates of institutionalization after stroke 34–36.…”

“…Poststroke depression, for example, affects nearly a third of all stroke survivors within five years following stroke,9 and poststroke depression severity predicts the extent of impairment in activities of daily living after stroke 10. Pre-existing affective disorder, on the other hand, has been demonstrated to predict more severe strokes on admittance and to negatively impact functional and cognitive outcomes after stroke 11,12. Recent data from a large Swedish register study indicate that patients with prestroke psychosis showed a poorer outcome and poorer utilization of secondary pharmacological prevention after stroke 13.…”