Mitchell Pamela H, Teri Linda, Veith Richard, Buzaitis Ann, Tirschwell David, Becker Kyra, Fruin Michael, Kohen Ruth, Cain Kevin C
Department of Biobehavioral Nursing and Health Systems, School of Nursing and School of Medicine, University of Washington, Seattle, Washington 98195-7266, USA.
J Stroke Cerebrovasc Dis. 2008 May-Jun;17(3):109-15. doi: 10.1016/j.jstrokecerebrovasdis.2007.12.002.
Depression is a sufficiently common sequela of a completed stroke to warrant intervention to improve mood, social, and functional outcome. Pharmacologic trials suggest short-term mood improvement from antidepressant treatment but no studies to date have determined whether these short-term gains can be enhanced and extended by a brief psychosocial/behavioral intervention delivered by advanced practice nurses. In addition, drug trials have not reported on functional outcomes such as limitations in ability, limitations in participation, and overall quality of survival. This randomized controlled trial was designed to evaluate the short- and long-term efficacy of a new brief psychosocial/behavioral intervention adjunctive to antidepressant treatment in reducing poststroke depression and improving functional outcomes.
A total of 101 survivors of ischemic stroke with poststroke depression were randomly assigned to receive a brief psychosocial/behavioral intervention plus antidepressant or usual care, including antidepressants.
The primary outcome was reduction in depressive symptom severity (Hamilton Depression Rating Scale) at 12 months after stroke. Secondary outcomes were reductions in limitations in activity (Barthel Index), reduction in limitation in participation, and overall stroke impact (Stroke Impact Scale) at 6, 12, and 24 months poststroke. Factors influencing best response to psychosocial intervention were also explored.
This article provides detail on the design and treatment methods of this randomized trial in progress. Findings from this study provide important information regarding the long-term efficacy of such a behavioral intervention in reducing poststroke depression and subsequent impaired aspects of psychosocial and physical recovery.
抑郁症是卒中完全发作后十分常见的后遗症，有必要进行干预以改善情绪、社交及功能预后。药物试验表明抗抑郁治疗可使情绪在短期内得到改善，但迄今为止尚无研究确定由高级执业护士实施的简短心理社会/行为干预能否增强并延长这些短期疗效。此外，药物试验尚未报告功能预后情况，如能力受限、参与受限及总体生存质量。本随机对照试验旨在评估一种新型简短心理社会/行为干预辅助抗抑郁治疗在减轻卒中后抑郁及改善功能预后方面的短期和长期疗效。
总共101名患有卒中后抑郁的缺血性卒中幸存者被随机分配接受简短心理社会/行为干预加抗抑郁药治疗或常规护理，常规护理包括使用抗抑郁药。
主要结局为卒中后12个月时抑郁症状严重程度降低（汉密尔顿抑郁量表）。次要结局为卒中后6、12和24个月时活动受限（巴氏指数）降低、参与受限降低及总体卒中影响（卒中影响量表）。还探讨了影响心理社会干预最佳反应的因素。
本文详细介绍了这项正在进行的随机试验的设计和治疗方法。本研究结果提供了重要信息，即这种行为干预在减轻卒中后抑郁以及随后心理社会和身体恢复受损方面的长期疗效。
