White Jennifer H, Attia John, Sturm Jonathan, Carter Gregory, Magin Parker
Hunter Stroke Service, Hunter New England Local Health District , New South Wales , Australia .
Disabil Rehabil. 2014;36(23):1975-82. doi: 10.3109/09638288.2014.884172. Epub 2014 Feb 6.
Few longitudinal studies explore post-stroke patterns of psychological morbidity and factors contributing to their change over time. We aimed to explore predictors of post-stroke depression (PSD) and post-stroke anxiety over a 12-month period.
A prospective cohort study. Consecutively recruited stroke patients (n=134) participated in face-to-face interviews at baseline, 3, 6, 9, and 12 months. Primary outcome measures were depression and anxiety (measured via Hospital Anxiety and Depression Scale). Independent variables included disability (Modified Rankin Scale), Quality-of-life (Assessment Quality-of-life), social support (Multi-dimensional Scale Perceived Social Support) and community participation (Adelaide Activities Profile (AAP)). Secondary outcomes were predictors of resolution and development of PSD and anxiety.
Anxiety (47%) was more common than depression (22%) at baseline. Anxiety (but not depression) scores improved over time. Anxiety post-stroke was positively associated with baseline PSD (p<0.0001), baseline anxiety (p<0.0001) and less disability (p=0.042). PSD was associated with baseline anxiety (p<0.0001), baseline depression (p=0.0057), low social support (p=0.0161) and low community participation (p<0.0001). The only baseline factor predicting the resolution of PSD (if depressed at baseline) was increased social support (p=0.0421). Factors that predicted the onset of depression (if not depressed at baseline) were low community participation (p=0.0015) and higher disability (p=0.0057).
While more common than depression immediately post-stroke, anxiety attenuates while the burden of depression persists over 12 months. Clinical programs should assess anxiety and depression, provide treatment pathways for those identified, and address modifiable risk factors, especially social support and social engagement. Implications for Rehabilitation Psychological distress post stroke is persisting. Multi-disciplinary teams that establish goals with patients promoting social and community engagement could assist in managing psychological morbidity. A shift towards promoting longer-term monitoring and management of stroke survivors must be undertaken, and should consider the factors that support and hinder psychological morbidity.
很少有纵向研究探讨中风后心理疾病的模式及其随时间变化的影响因素。我们旨在探讨中风后12个月内中风后抑郁（PSD）和中风后焦虑的预测因素。
一项前瞻性队列研究。连续招募的中风患者（n = 134）在基线、3个月、6个月、9个月和12个月时参加面对面访谈。主要结局指标为抑郁和焦虑（通过医院焦虑抑郁量表测量）。自变量包括残疾（改良Rankin量表）、生活质量（生活质量评估）、社会支持（多维感知社会支持量表）和社区参与（阿德莱德活动量表（AAP））。次要结局是PSD和焦虑缓解及发生的预测因素。
基线时焦虑（47%）比抑郁（22%）更常见。焦虑（而非抑郁）得分随时间改善。中风后焦虑与基线PSD（p<0.0001）、基线焦虑（p<0.0001）和较少残疾（p = 0.042）呈正相关。PSD与基线焦虑（p<0.0001）、基线抑郁（p = 0.0057）、低社会支持（p = 0.0161）和低社区参与（p<0.0001）相关。预测PSD缓解（如果基线时抑郁）的唯一基线因素是社会支持增加（p = 0.0421）。预测抑郁发作（如果基线时未抑郁）的因素是低社区参与（p = 0.0015）和较高残疾（p = 0.0057）。
虽然中风后立即焦虑比抑郁更常见，但焦虑会减轻，而抑郁负担在12个月内持续存在。临床项目应评估焦虑和抑郁，为确诊者提供治疗途径，并解决可改变的风险因素，特别是社会支持和社会参与。康复的意义中风后的心理困扰持续存在。与患者共同制定促进社会和社区参与目标的多学科团队可协助管理心理疾病。必须转向促进对中风幸存者的长期监测和管理，并应考虑支持和阻碍心理疾病的因素。
