卒中后抑郁与功能障碍——一项 3 年前瞻性研究。
Post-stroke depression and functional impairments - A 3-year prospective study.
机构信息
Clinical Psychology and Psychotherapy, Department of Psychology, University of Osnabrück, Osnabrück, Germany.
Clinical Psychology and Psychotherapy, Department of Psychology, University of Osnabrück, Osnabrück, Germany; Clinical Psychology and Psychotherapy, Department of Psychology, Helmut-Schmidt-University/University of the German Federal Armed Forces Hamburg, Hamburg, Germany.
出版信息
Compr Psychiatry. 2020 May;99:152171. doi: 10.1016/j.comppsych.2020.152171. Epub 2020 Mar 9.
BACKGROUND
Post-Stroke Depression (PSD) is a severe condition, affecting about 30% of stroke survivors within a five-year period after stroke. Post-stroke functional impairments (FI) and social support are associated with PSD. It is inconclusive, whether one of the factors, post-stroke FI and PSD, shows a stronger predictive value on the respective other over time. The aims of the present study were to 1) investigate the relationship between PSD, FI, and social support of stroke patients in a 3-year prospective design, and 2) address methodological shortcomings of previous studies.
METHODS
We investigated 174 stroke survivors and assessed PSD with a structured clinical interview and a dimensional symptom rating scale. We conducted regression analyses and applied the approach of multiple imputations (MI) for missing data due to dropout during follow-up.
RESULTS
PSD prevalence was 32.2% in the acute phase after stroke. Individuals with a PSD in this phase revealed a fivefold higher risk for PSD 3 years later. FI in the acute phase did not additionally contribute to the prediction of PSD at follow-up. Compared to individuals without PSD in the acute phase, individuals with PSD had an increased risk for FI at follow-up. Limitations regarding sample characteristics, design, and dropout are discussed.
CONCLUSIONS
Results indicate that PSD rather than FI represents a crucial risk factor for negative long-term consequences regarding physical and psychological health after stroke. Post-stroke treatment might be optimized by a routine assessment of PSD and FI after stroke and considering the results for personalized treatment options.
背景
中风后抑郁（PSD）是一种严重的疾病，约有 30%的中风幸存者在中风后五年内会出现这种情况。中风后的功能障碍（FI）和社会支持与 PSD 有关。目前还不确定，在时间上，是其中一个因素，即中风后的 FI 和 PSD，对另一个因素有更强的预测价值。本研究的目的是 1）在 3 年的前瞻性设计中调查中风患者 PSD、FI 和社会支持之间的关系，2）解决以前研究中的方法学缺陷。
方法
我们调查了 174 名中风幸存者，并使用结构化临床访谈和维度症状评定量表评估 PSD。我们进行了回归分析，并应用了缺失数据的多重插补（MI）方法，因为在随访期间存在脱落。
结果
中风后急性期 PSD 的患病率为 32.2%。在这个阶段患有 PSD 的个体在 3 年后患有 PSD 的风险高出五倍。急性期的 FI 并没有额外增加对 PSD 随访的预测。与急性期没有 PSD 的个体相比，患有 PSD 的个体在随访时 FI 的风险增加。讨论了关于样本特征、设计和脱落的局限性。
结论
结果表明，PSD 而不是 FI，代表了中风后身体和心理健康方面负面长期后果的关键风险因素。中风后治疗可以通过常规评估 PSD 和 FI 并考虑个性化治疗方案的结果来优化。
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