Padberg Inken, Hotter Benjamin, Liebenau Andrea, Knispel Petra, Lehnerer Sophie, Heel Sabine, Wellwood Ian, Meisel Andreas
Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Neurocure Clinical Research Center, Department of Neurology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Risk Manag Healthc Policy. 2020 Apr 1;13:285-293. doi: 10.2147/RMHP.S228265. eCollection 2020.
Details on adequate care and prevalence of depression in long-term stroke aftercare are limited. We aimed to determine long-term depression rates after stroke and to test for an association between depression and inadequate screening, socio-economic complications and lack of sub-optimal care.
In this cross-sectional study, 57 patients were re-invited into the clinic 2-3 years after stroke. Patients were interviewed about recalled screening concerning depression and unmet needs. Depression, the patient's social situation, and confounders were assessed by standardized scores.
In our study, 20% (n = 11) of patients were classified as depressed by the HDRS-17 score result. However, only 36% of all patients recalled to have been previously screened for depression and only 43% of those patients also recalled out-patient screening. Patients classified as depressed reported significantly lower recalled screening rates (9% vs 43%; p = 0.036) and higher rates of self-reported unmet need with emotional problems (72% vs 18%; p < 0.001). Depression in our study was further associated with a worse socio-economic situation, fewer social contacts, unmet needs with regard to emotional problems and higher rates of recommendations to apply for additional social support.
Our data suggest that systematic out-patient screening for depression is lacking in stroke aftercare. Furthermore, the high rate of unmet emotional needs, the poor socio-economic situation and the higher rates of recommendations for social counselling and application for benefits suggest an undersupply of care in the out-patient setting that is more prominent in patients with depression and warrants further studies to investigate the underlying causes.
长期中风后护理中充分护理及抑郁症患病率的详细信息有限。我们旨在确定中风后的长期抑郁症发生率，并测试抑郁症与筛查不足、社会经济并发症及缺乏次优护理之间的关联。
在这项横断面研究中，57名患者在中风后2至3年被重新邀请到诊所。就有关抑郁症的回忆性筛查及未满足的需求对患者进行访谈。通过标准化评分评估抑郁症、患者的社会状况及混杂因素。
在我们的研究中，根据HDRS-17评分结果20%（n = 11）的患者被归类为抑郁。然而，所有患者中只有36%回忆起之前曾接受过抑郁症筛查，且这些患者中只有43%回忆起有门诊筛查。被归类为抑郁的患者报告的回忆性筛查率显著较低（9%对43%；p = 0.036），且自我报告的情感问题未满足需求率较高（72%对18%；p < 0.001）。我们研究中的抑郁症还与更差的社会经济状况、更少的社会交往、情感问题方面的未满足需求以及申请额外社会支持的较高推荐率相关。
我们的数据表明，中风后护理中缺乏对抑郁症的系统性门诊筛查。此外，情感需求未满足率高、社会经济状况差以及社会咨询和福利申请的较高推荐率表明门诊护理供应不足，在抑郁症患者中更为突出，需要进一步研究以调查潜在原因。
