Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
Stroke and Telehealth Research, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia.
Disabil Rehabil. 2023 Feb;45(3):504-511. doi: 10.1080/09638288.2022.2032413. Epub 2022 Feb 9.
To describe types of mental health treatment accessed by community-based stroke survivors and factors associated with access.
A sub-group of registrants from the Australian Stroke Clinical Registry completed a supplementary survey 2.5 years post-stroke. Self-reported information about depression/anxiety and treatment access were collected. Demographic and clinical data were obtained through linkages with registry and government data. Staged multivariable logistic regression was conducted to examine factors associated with treatment access.
Among 623 registrants surveyed (37% female, median age 69 years), 26% self-reported a medical diagnosis of depression/anxiety at 2.5 years post-stroke. Of these, only 30% reported having accessed mental health services, mostly through government-funded Medicare schemes. Younger age (odds ratio (OR) 0.95, 95% CI 0.93, 0.98), history of mental health treatment (OR 3.38, 95% CI 1.35, 8.48), feeling socially isolated (OR 2.32, 95% CI 1.16, 4.66), self-reported medical diagnosis of depression/anxiety (OR 4.85, 95% CI 2.32, 10.14), and government-subsidised team care plan arrangement (OR 4.05, 95% CI 1.96, 8.37) were associated with receiving treatment.
Many stroke survivors have untreated depression/anxiety. Primary care practitioners should be supported in undertaking effective detection and management. Older and newly diagnosed individuals should be educated about depression/anxiety and available supports.Implications for rehabilitationPrimary care providers play a pivotal role in the pathway to mental health care, and therefore should always screen for depression/anxiety and provide comprehensive assessment and referral to specialist services where necessary.Targeted psychoeducation should be provided to survivors of stroke who are older and newly diagnosed with depression/anxiety, to increase awareness about mood problems following stroke.Primary care providers should collaborate with other health professionals (e.g., through coordinating a team care arrangement plan), to address patients' multiple and complex rehabilitation needs.Rehabilitation professionals should remain informed about current evidence-based treatments for post-stroke depression/anxiety and pathways that enable their patients to access these services.
描述社区脑卒中幸存者所接受的心理健康治疗类型以及与治疗相关的因素。
澳大利亚脑卒中临床登记处的注册者亚组在脑卒中后 2.5 年完成了一项补充调查。通过登记处和政府数据的链接收集有关抑郁/焦虑和治疗的自我报告信息。人口统计学和临床数据通过与登记处和政府数据的链接获得。采用多变量逐步逻辑回归分析方法，以检验与治疗相关的因素。
在接受调查的 623 名注册者中（女性占 37%，中位年龄 69 岁），2.5 年后有 26%的人自我报告患有抑郁/焦虑的医学诊断。其中，只有 30%的人报告接受了心理健康服务，主要是通过政府资助的医疗保险计划。年龄较轻（优势比（OR）0.95，95%可信区间 0.93，0.98）、有心理健康治疗史（OR 3.38，95%可信区间 1.35，8.48）、感觉社会孤立（OR 2.32，95%可信区间 1.16，4.66）、自我报告的抑郁/焦虑医学诊断（OR 4.85，95%可信区间 2.32，10.14）和政府补贴的团队护理计划安排（OR 4.05，95%可信区间 1.96，8.37）与接受治疗相关。
许多脑卒中幸存者有未治疗的抑郁/焦虑。应支持初级保健医生进行有效的检测和管理。应向新诊断和年龄较大的个体进行抑郁/焦虑的教育，并提供有关可用支持的信息。
初级保健提供者在心理健康治疗途径中起着关键作用，因此应始终筛查抑郁/焦虑，并在必要时提供全面评估和转介至专科服务。应向年龄较大和新诊断为抑郁/焦虑的脑卒中幸存者提供有针对性的心理教育，以提高他们对卒中后情绪问题的认识。初级保健提供者应与其他卫生专业人员合作（例如，通过协调团队护理安排计划），以满足患者的多种和复杂的康复需求。康复专业人员应始终了解针对卒中后抑郁/焦虑的循证治疗方法，以及使患者能够获得这些服务的途径。
