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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 1  |  Page : 17-22

Incidence and risk factors of poststroke depression among acute stroke survival patients attending neurology outpatient department of a selected hospital in Kolkata


1 Final year M.Sc. Nursing, College of Nursing, Medical College and Hospital, Kolkata, West Bengal, India
2 Senior Lecturer, College of Nursing, Medical College and Hospital, Kolkata, West Bengal, India

Date of Submission22-Dec-2020
Date of Decision22-Jan-2021
Date of Acceptance05-Mar-2021
Date of Web Publication17-Jun-2021

Correspondence Address:
Dr. Uma Rani Adhikari
Department of Nursing Education, College of Nursing, Medical College and Hospital, 88 College Street, Kolkata - 700 073, West Benga
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iopn.iopn_60_20

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  Abstract 


Background: Poststroke depression is consider as the most common emotional disorder of stroke survivors; it can affect one among three of stroke survivors at any time up to 5 years after stroke. Researcher chooses the topic to give focus on the emotional health of the stroke survivors after the stroke. This study was conducted to identify the incidence (short-term incidence) and risk factors of poststroke depression among acute stroke survival patients. Subjects and Methods: This descriptive survey design was conducted at neurology outpatient department of a selected hospital in Kolkata. Total 104 acute (within 3 months following stroke) stroke survival patients were selected by purposive sampling technique for this study purpose. Incidence of poststroke depression was identified by Montgomery–Asberg depression rating scale and for risk factors of poststroke depression; National Institutes of Health Stroke Scale, Barthel Index, and Mini-mental status examination were used. Tool was pretested before the final study. Results: The findings of the study showed that the incidence (short-term incidence) of poststroke depression was 52% (95% confidence interval: 42.2%–61.8%). The Chi-square value reveals that there is a significant association between poststroke depression and deterioration of disease condition from the onset of the disease, days of suffering from the disease, number of admission for the disease, severity of stroke, impairment of level of independence, and impairment of cognitive function. Conclusion: Identifying the risk factors of poststroke depression, the nurses can screen the stroke survival patients for early detection of depression following stroke.

Keywords: Acute stroke survival patients, incidence, poststroke depression, risk factors


How to cite this article:
Ghosh C, Adhikari UR. Incidence and risk factors of poststroke depression among acute stroke survival patients attending neurology outpatient department of a selected hospital in Kolkata. Indian J Psy Nsg 2021;18:17-22

How to cite this URL:
Ghosh C, Adhikari UR. Incidence and risk factors of poststroke depression among acute stroke survival patients attending neurology outpatient department of a selected hospital in Kolkata. Indian J Psy Nsg [serial online] 2021 [cited 2021 Sep 21];18:17-22. Available from: https://www.ijpn.in/text.asp?2021/18/1/17/318674




  Introduction Top


According to the WHO,[1] stroke is the rapid development of clinical signs and symptoms and focal neurological disturbance lasting more than 24 hrs or leading to death with no apparent cause other than vascular origin. Stroke is the third most common cause of death after heart disease and cancer in developed countries.[2] According to the report of 2019 by American Heart Association regarding the Heart disease and Stroke statistics[3] that estimate 7.0 million Americans ≥20 years of age had a stroke, the overall prevalence of stroke was estimated 2.5%. Nationwide the hospitalizations for acute ischemic stroke significantly increased for both the males and females and for certain ethnic groups among younger adults aged 18–54 years. Although global age adjusted mortality rates for ischemic and hemorrhagic stroke decreased between 1990 and 2015, annually stroke rate, as well as related death and disability-adjusted life-years lost, increased. In the low-income and middle-income countries, the majority of global stroke burden is present. Emotional health of stroke survivors is very much important like their physical health. Globally, approximately 15 million people annually who have stroke are at risk of developing poststroke depression (PSD).[4] PSD is considered as the most common emotional disorder of stroke survivors. It can affect one among three of stroke survivors at any time up to 5 years after stroke.[4] PSD is one of the important complications of stroke, that is rarely diagnosed and its treatment is unevenly administered. The fourth cause of disability is depressive disorder, but in future, it is expected that it will come second after cardiovascular disease.[5] Incidence of PSD ranged from 5% to 63%.[6],[7] The prevalence of PSD varies widely, ranging from 25% to 79%.[8] A recent study indicated that the prevalence of PSD is 62.5% in the initial assessment at the 2nd week of poststroke; at the end of 1 month during the 2nd assessment, the prevalence rate is 59.57%; and after 3 months during the 3rd assessment, the prevalence rate of PSD is 48.14%.[9] It has been reported that cultural variations have effect on the incidence and prevalence of depression among general population, and this appears to be true for PSD, with reported prevalence rate ranging from 6% to 79%, the reported prevalence rates of PSD in ethnic Chinese populations were 16.4% and 17.2% in Hong Kong, 34.9% and 62.2% in Taiwan, 43.4% in China, and 55% in Singapore. There is a variation in the peak incidence of PSD; it has been reported that particularly within 3 months after stroke, there is an increased frequency of PSD,[10] on the other hand, 3rd to 6th months after stroke has also been reported as peak incidence for PSD following stroke.[11] In recent decades, evidence has indicated that there are some well-known risk factors such as medical history, a history of mental disorder, and stroke characteristics for PSD, and PSD is highly prevalent among men and women; however, it appears that PSD is more common in women than men.[12] The most frequently reported risk factors for depressed mood are female gender, stroke severity, lack of social support, history of depression, and functional impairment or level of handicap and level of independence.[13],[14] In developed countries, several studies have been performed to explore the psychological problems and quality of life among stroke survivors. Although in various developing countries along with India have no published data available regarding the psychological problems and quality of lives among stroke survivors, despite stroke is one of the most common causes of disability and handicap in those communities. We are witnessing in the clinical field that people give less importance to the mental health than physical health. Although PSD is one of the important complications after stroke, it is ignored by the stroke patient along with their family members, and they provide more importance to their physical health rather than their mental health. Hence, the study on incidence, risk factors of PSD of stroke patients after stroke are chosen.


  Subjects and Methods Top


It was a descriptive study involving the Neurology outpatient department of a selected hospital, Kolkata. Data were collected from October 25, 2019, to November 30, 2019. After taking informed consent, a total of 104 patients were included in the study, those fulfilled the inclusion criteria. Before undertaking the study, the proposal was duly approved by the Institutional Ethics Committee. Pretesting of the tool was done before final data collection. A preliminary study was conducted to check the feasibility and practicability of the study. Each participant was taken to the separate room for maintaining confidentiality; structure interview schedule was used to find the sociodemographic information; Montgomery–Asberg depression rating scale used to find the incidence of depression; National Institutes of Health stroke scale used to find the severity of stroke, Modified Barthel Index used to assess the level of dependence, and MMSE to find cognitive status was administered to each participant. Inclusion criteria were patients within 3 months after stroke, who can speak and understand Bengali and who are willing to participate in this study with written consent. Exclusion criteria had history of depression, psychosis, or severe substance abuse, and on psychiatric medication, patient aged <30 and >70 and who have aphasia. Descriptive and inferential statistics are used for data analysis. Frequency and percentage distribution are computed for describing the demographic characteristics and the incidence of PSD. Chi-square test is calculated to find the association between potential risk factors and PSD. SPSS Statistics version 17 (2008, SPSC Inc., Chicago, Illinois, USA) software is used for statistical analysis.


  Results Top


In total, 104 patients were studied among them majority (84.62%) of the stroke survival patients are under the age group of 51–70 years and 60.58% of the stroke survival patients are female. [Table 1]a depicts that 88.46% of the stroke survival patients are married, majority (75%) are from rural area and 53.85% of the stroke survival patients have >4 family members. About 48.08% of them are educated up to secondary level and 39.42% of their monthly family income is Rs. 6000–10000. [Table 1]b shows that majority (88.48%) of them have no family history of stroke, 43.27% have the history of smoking, and 13.46% have the history of alcoholism. Majority (91.35%) of them are suffering from ischemic stroke and 68.26% of stroke survival patients have one comorbidity.
Table 1:

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[Figure 1] shows that 52% (95% confidence interval [CI]: 42.2%–61.8%) of acute stroke survival patients are suffering from depression where 30.76% of patients are suffering from mild depression, 15.38% are suffering from moderate, 5.76% are suffering from severe depression, and 48% of acute stroke survival patients are not suffering from depression [Figure 2]. There is no significant association found between poststroke PSD and age, sex, family history of stroke, and history of smoking and alcoholism [Table 2]a.
Table 2:

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Figure 1: Pie diagram showing percentage distribution of incidence of poststroke depression among acute stroke survival patients

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Figure 2: Cylindrical bar diagram showing percentage distribution of severity of the depression among acute stroke survival patients

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[Table 2]b reflects that there is no significant association found between PSD and type of stroke and number of comorbidity present. However, significant association found between PSD and deterioration of disease after onset, days of suffering, number of hospital admission for the disease, severity of stroke, impairment of level of independence, and impairment of cognitive function.


  Discussion Top


In the present study, it is found that the incidence (short-term incidence–3 months) of PSD among acute stroke survival patient is 52% (95% CI 42.2%–61.8%). Ilut et al.[15] found that the incidence of PSD was 19.33%. Tsai et al.[10] indicated that the incidence rate of PSD at the 1st, 3rd, 6th, and 9th months was 4%, 8%, 9%, and 10%, respectively, and the overall incidence of 1 year was 11%. This discrepancies are occurred which may be due to the time of assessment of the patients after stroke, the tool used to assess the depression, methodological heterogeneity, the characteristics of the sample, the inclusion and exclusion criteria, the setting, sample size, and the duration of the study. This study included the Montgomery–Asberg depression rating scale to identify the PSD among acute stroke survival patients, and this study only included the stroke survival patients within 3 months after stroke and aged between >30 and ≤70. However, this study indicates the incidence that is short term (3 months) of PSD rather than the 1-year incidence, and thus, it is difficult to compare this study with the other studies. In the present study, it is found that there is no significant relationship between the nonmodifiable risk factors (age and sex) with PSD. These findings are consistent with the study conducted by Ayerbe et al.[16] and Jiao et al.[17] The present study also identifies that there is no significant association between type of stroke and PSD. Johnson et al.[18] also failed to make any conclusion in their literature review regarding the association of type of stroke with PSD. The present study finds a significant association between severity of stroke and PSD. This association is supported by the study conducted by Tsai et al.[10] The present study makes a conclusion that there is a significant association between PSD and impairment of activity of daily living; this finding of the present study is consistent with the study conducted by De Ryck et al.[13] and Tsai et al.[10] where they found significant relationship between impairment of activity of daily living with PSD. Mohammed et al.[19] conducted a study where they identified that there was a significant association between PSD and impairment of cognitive function, the present study also reveals that there is a significant association between impairment of cognitive function and PSD. The present study fails to establish any relationship between PSD with a history of smoking and alcoholism which is supported by the study conducted by De Ryck et al.[13] Stroke patients often have comorbid illnesses; cardiovascular disease is the most common comorbid illness among stroke patients.[20] The risk of developing depression among stroke survivors with heart disease is higher as heart disease has been linked with an increased incidence of depression among stroke survival patients.[21] There are very few amount of researches exist at the present time regarding the association between stroke, heart disease, and depression. According to the study findings of Hayee et al.[22] and Nannetti et al.,[23] there was no association between comorbid heart disease and PSD; this support my present study findings which also fails to identify relationship between PSD and presence of comorbidity.


  Conclusion Top


The present study reveals that the incidence (short-term incidence) of PSD is quite high (52%). Severity of stroke, level of dependence, cognitive impairment, deterioration of disease condition after onset, and number of hospital admission for the disease are significantly associated with PSD. Hence, identifying the risk factors of PSD will help the nurses to screen the stroke survival patients for early detection of depression following stroke.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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