Date Presented 03/28/20
We present evidence from a one-year longitudinal study of the prospective associations between depression and functional status in 1,219 stroke survivors after hospital discharge. Cross-lagged analyses found reciprocal relationships between depression and functional status over time. Our results not only aid in the identification of targets for intervention, but they also offer insight into how and when to intervene for stroke survivors transitioning to community settings.
Primary Author and Speaker: Alex Wong
Contributing Authors: Jiayu Wang, Mandy Fong, Carolyn Baum, Kenneth Ottenbacher, Eric Lenze
PURPOSE: Previous studies exploring the relationship between depression and functional impairment in stroke have been cross-sectional (Sinyor et al., 1986), rendering causality and temporality impossible to determine. However, understanding the dynamic nature of the depression–function relationship is critical, as it will help clinicians determine how and when to intervene to enhance function and psychological well-being for stroke survivors. A cross-lagged panel model overcomes this issue. This study was aimed to use this model to unravel the direction of effects between depressed mood and functional status among stroke survivors throughout the first year post-stroke.
DESIGN: A longitudinal study using information from the Stroke Recovery in Underserved Population (SRUP) database (Ostir, Ottenbacher, & Kuo, 2016). Depressed mood and functional status were assessed at hospital discharge and at 3-month and 12-month follow-up using the Center for Epidemiologic Studies Depression Scale and Functional Independence Measure, respectively.
METHOD: This study included 1219 adults aged 55 years old or older who had a stroke and were admitted to one of eleven inpatient rehabilitation facilities. The mean age of participants was 68.3 (SD = 13.8) years, 75% were non-Hispanic white, and 51% were women. The average length of stay was 20.5 (SD = 11.3) days, and the most prevalent type of stroke was ischemic (73%). A structural equation modeling cross-lagged panel analysis, adjusting for clinical covariates, was used to infer causal associations in data from this longitudinal research design, for which the criterion variables were depressed mood and functional status, considered simultaneously.
RESULTS: Our overall model demonstrated good fit based on fit indices (CFI = 0.987, TLI = 0.924, RMSEA = 0.051). Depressed mood and functional status were bi-directionally related to each other over time. Reduced depressed mood predicted subsequent increased functional status, whereas reduced functional status predicted subsequent increased depressed mood (all p < 0.001).
CONCLUSION: Depression and functional status are dynamic processes and can change over time, triggering a cycle of reciprocal causality.
IMPACT: Our results have implications for stroke rehabilitation, especially through psychosocial behavioral interventions. Results suggest that implementation of structured activity interventions targeting the improvement of daily functioning, as well as treatment strategies targeting depression, such as cognitive behavior therapy, delivered through home-based or ambulatory care services could mitigate the development of chronic depression and further functional decline (Mitchell et al., 2008).
References
Mitchell, P. H., Teri, L., Veith, R., Buzaitis, A., Tirschwell, D., Becker, K., . . . Cain, K. C. (2008). Living well with stroke: design and methods for a randomized controlled trial of a psychosocial behavioral intervention for poststroke depression. J Stroke Cerebrovasc Dis, 17(3), 109-115. doi:10.1016/j.jstrokecerebrovasdis.2007.12.002
Ostir, G., Ottenbacher, K., & Kuo, Y. F. (2016). Stroke Recovery in Underserved Populations 2005-2006 [United States].
Sinyor, D., Amato, P., Kaloupek, D. G., Becker, R., Goldenberg, M., & Coopersmith, H. (1986). Post-stroke depression: relationships to functional impairment, coping strategies, and rehabilitation outcome. Stroke, 17(6), 1102-1107. doi:10.1161/01.STR.17.6.1102
