Testing a Model of Depression and Functional Status in Stroke Survivors

Article excerpt

Abstract: Depression negatively affects functional status and recovery potential for patients with many chronic diseases and for elderly patients. The purpose of this research was to determine what could be said with confidence regarding the relationships between post-stroke depression, functional status, and the mediating strategies of physical rehabilitation and pharmacologic treatment. To accomplish this purpose, a model of depression and functional status in stroke survivors was proposed and tested using meta-analytic techniques. Using a derived conceptual model derived f, it was proposed that depression and functional status were related and could be mediated when they operated through the health care system. An extensive review of the stroke research completed after 1989 resulted in the identification of 31 subject-studies that examined depression and functional status in the post-stroke survivors. Twenty-six of the studies were non-experimental and 5 were randomized clinical trials. Meta-analytic methods were used to synthesize the results of the subject-studies. A small to moderate population Effect Size (ES) r of .25 (P = . 000, k = 21, N = 2310) with a Binomial Effect Size Display (BESD) of .37 - .63 was found for a homogenous grouping of non-experimental studies examining the relationship between depression and functional status in the post-stroke population. A moderate to large ESr of .43 (P = .000, k = 5, N = 182), with a BESD of .29 - .71, was fauna for a homogeneous grouping of experimental studies examining the relationship between depression and functional status in the post-stroke population when mediated by physical rehabilitation and pharmacologie treatment for depression. Analysis of the derived model, Depression and Functional Status in Stroke Survivors, supports the existence of a statistically and clinically significant relationship between depression and functional status, and pharmacologic treatment and physical rehabilitation mediate that relationship. The reciprocal interaction between depression and functional status can best be approached through appropriate and timely treatment of both post-stroke manifestations, depression and functional deficit.

Key words: Model of Depression, Functional Status in Stroke Survivors

Stroke, the third leading cause of death, is the most common disabling disease. Approximately 731,000 persons suffer a stroke yearly in the United States (Gorelick, Sacco, Smith, Alberts, Mustone-Alexander, Rader et al., 1999). Over 4 million American stroke survivors are alive today. Approximately 2/3 of the individuals who suffer a stroke survive and require some level of rehabilitation (National Institute of Neurological Disorders [NINDS], 2002).

Depression, a common complication of stroke, leads to increased mortality and morbidity, impedes the process of rehabilitation, is associated with poor outcomes, and increased hospital stays ((Turner-Stokes & Hassan, 2002a, 2002b). Depression is a common disabling condition observed by primary care providers (Ostir, Markides, Peek & Goodwill, 2001). In a community based study, D Epiro (1999) found that 10% of the population had symptoms meeting the criteria for major depression and an additional 20% of the population had symptoms of depression that did not meet the criteria for major depressions. Depressed patients from this population with gastrointestinal disease, diabetes, heart disease, stroke, and cancer responded slower and less favorably to medical intervention, had lower survival rates, and a decreased quality of life.

BACKGROUND AND SIGNIFICANCE

Post-stroke depression is associated with cognitive, functional and social deficits which limits rehabilitation outcomes (Tulane-Stokes, 2002a, 200b). Researchers have examined the prevalence of post-stroke depression alone and in combination with functional status, the relevance of location of the stroke lesion to the occurrence and severity of depression and effect on functional status, and the influence of various medications and treatments in mediating depression and functional status. …