School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
Neuropsychol Rev. 2022 Mar;32(1):51-69. doi: 10.1007/s11065-021-09501-8. Epub 2021 Mar 23.
Apathy and depression are common sequelae of acquired brain injury (ABI). Apathy is a syndrome characterized by diminished motivation and purposeful behaviours. Depression is a mood disorder featuring sadness, worthlessness, anhedonia and suicidal ideation. Both are associated negatively with activities of daily living (ADL), the skills required to fulfil basic and complex physical needs. However, the current literature's results are inconsistent and based on relatively small sample sizes. Furthermore, the unique and combined effects of apathy and depression as predictors of ADL have not yet been estimated. This is important, as both may have implications for planning rehabilitation after an ABI. Consequently, we aimed to estimate the association between apathy, depression and ADL in the stroke and traumatic brain injured population via meta-analysis and meta-analytic path-analysis. Based on the meta-analyses (N = 1,166 to N = 1,389), we estimated the following statistically significant bivariate effects: depression and apathy (r = .53, 95% CI: .42/.63), depression and ADL (r = -.27, 95% CI: -.43/-.11), apathy and ADL (r = -.41, 95% CI: -.51/-.31). A meta-analytic mediation model found that depression had a significant indirect effect onto ADL (β = -.17, 95% CI: -.26/-.09), while apathy had a significant direct effect (β = -.34, 95% CI: -.48/-.19) onto ADL (model R = .16). We interpreted the results to suggest that apathy and depression may impact adversely on engagement with ADL in people with ABI, although the potential influence of depression on ADL may occur primarily through its influence on apathy. Thus, greater focus on apathy by practitioners may be merited in cases with ABI.
淡漠和抑郁是获得性脑损伤（ABI）的常见后遗症。淡漠是一种以动机和有目的行为减少为特征的综合征。抑郁是一种以悲伤、无价值感、快感缺失和自杀意念为特征的情绪障碍。两者都与日常生活活动（ADL）呈负相关，ADL 是满足基本和复杂身体需求所需的技能。然而，目前文献的结果不一致，并且基于相对较小的样本量。此外，淡漠和抑郁作为 ADL 预测因素的独特和综合影响尚未得到估计。这很重要，因为两者都可能对 ABI 后的康复计划产生影响。因此，我们旨在通过荟萃分析和荟萃分析路径分析来估计淡漠、抑郁和 ADL 之间在中风和创伤性脑损伤人群中的关联。基于荟萃分析（N = 1,166 至 N = 1,389），我们估计了以下具有统计学意义的双变量影响：抑郁和淡漠（r =.53，95%CI：.42/.63），抑郁和 ADL（r = -.27，95%CI： -.43/-.11），淡漠和 ADL（r = -.41，95%CI： -.51/-.31）。一项荟萃分析中介模型发现，抑郁对 ADL 有显著的间接影响（β = -.17，95%CI： -.26/-.09），而淡漠对 ADL 有显著的直接影响（β = -.34，95%CI： -.48/-.19）（模型 R =.16）。我们解释结果表明，淡漠和抑郁可能会对 ABI 患者的 ADL 参与产生不利影响，尽管抑郁对 ADL 的潜在影响可能主要通过其对淡漠的影响而发生。因此，在 ABI 患者中，从业者可能更值得关注淡漠。
