Academic journal article Health and Social Work

Poststroke Depression: Social Workers' Role in Addressing an Underrecognized Psychological Problem for Couples Who Have Experienced Stroke

Academic journal article Health and Social Work

Poststroke Depression: Social Workers' Role in Addressing an Underrecognized Psychological Problem for Couples Who Have Experienced Stroke

Article excerpt

Each year, approximately 800,000 people in the United States experience stroke (American Heart Association [AHA], 2010). This works out to about one stroke every 40 seconds, less time than it takes most people to grab a quick snack, check their telephone messages, or say goodbye to their family in the morning. Fortunately, the large majority of people survive these encounters with stroke, and as treatments for acute stroke advance, the number of people riving with the aftereffects of stroke is increasing (AHA, 2010). However, for these relatively fortunate survivors and their families, rife is rarely the same,-with about one-third of survivors experiencing permanent disability following stroke (AHA, 2010). Given these statistics, it is not surprising that stroke is cited as the leading cause of adult disability in both the United States and the world (World Health Organization, 2003). Compounding these problems, many survivors also experience an array of residual social consequences, such as unemployment and relationship problems (Neau et al., 1998; TeaseR, McRae, & Finestone, 2000), and psychological sequela, including emotionality, mania, psychosis, anxiety, and depression (Paranthaman & Baldwin, 2006). Of these, depression has been identified as the most common psychological problem experienced by stroke survivors, ultimately affecting approximately 33 percent of that population (Hackett, Yapa, Parag, & Anderson, 2005).

In addition to the immediate pain and distress caused by what has been termed "post-stroke depression" (PSD), the condition has been associated with a host of adverse physical and psychosocial outcomes, including poor engagement in rehabilitation activities, longer hospital inpatient periods, impaired social and family functioning, and inability to return to work (Carod-Artal, Trizotto, Coral, & Moreira, 2009; Santus, Ranzenigo, Caregnato, & Inzoli, 1990; Turner-Stokes & Hassan, 2002). In starker terms, PSD has been linked with a significantly increased risk of mortality, including mortality from suicide (Stenager, Madsen, Stenager, & Boldsen, 1998). For instance, Morris, Robinson, Andrzejewski, Samuels, and Price (1993) found that survivors diagnosed with PSD were 3.4 times more likely to have died during a 10-year follow-up period.

Unfortunately, PSD is likely not strictly an experience of survivors (Han & Haley, 1999). The interdependence of couples' emotional well-being has been established in both healthy and chronic-illness populations (Kouros & Cummings, 2010; Pruchno, Wilson-Genderson, & Cartwright, 2009), and there is also evidence that depression may be a shared experience among stroke survivors and spouses (Palmer & Glass, 2003; Visser-Meiley et al., 2006). Falconer, Naughton, Strasser, and Sinacore (1994) reported that up to 46 percent of stroke survivors indicated that "unpaid helpers" were their primary caregivers at the time of hospital discharge. For such informal caregivers, many if not most of whom are spouses, depression following stroke is also a significant problem, affecting between 36 percent and 53 percent of the population (Grant, Bartolucci, Elliot, & Giger, 2000; Wade, Leigh-Smith, & Hewer, 1986).

With these facts in mind, the following article has two primary goals. The first is to call social work and other rehabilitation practitioners' attention to a major, but often underrecognized, problem associated with stroke: PSD among survivors and their spouses. Depression following a health event like stroke is not "natural" or unavoidable. Familiarizing ourselves with the factors that contribute to, or are associated with, PSD is critical as we work to prevent or identify and treat PSD in the individuals with whom we work. Included in this discussion is a review of common measures for assessment of PSD and resources for accessing these measures for use in social work practice.

The second goal of this article is to underscore the need for social workers to view survivors in the context of their committed relationships, especially with respect to mental health conditions like PSD. …

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