Long-Term Changes in Poststroke Depressive Symptoms: Effects of Functional Disability and Social Support.

IF 2.4 4区 医学 Q2 CLINICAL NEUROLOGY Journal of Neuropsychiatry and Clinical Neurosciences Pub Date : 2023-01-01 DOI:10.1176/appi.neuropsych.20220134
Jae-Chan Ryu, Jong S Kim
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Abstract

Objective: Long-term changes in specific depressive symptoms have rarely been studied in stroke patients. Such changes and the effects of social support and functional disability on specific symptoms after a long-term follow-up period (LTP) were investigated.

Methods: The Montgomery-Åsberg Depression Rating Scale (MADRS), ENRICHD Social Support Instrument, and modified Rankin Scale (mRS) for functional disability were administered at baseline, a 6-month follow-up, and an LTP (35-83 months). Effects of social support and poor functional outcome (mRS score of 3 to 6) on the 10 single items included on the MADRS were identified.

Results: Among 222 patients, mRS score, total MADRS score, and all single-item scores except "concentration difficulties," "inability to feel," and "suicidal thoughts" improved at the 6-month follow-up. From the 6-month follow-up to the LTP, the total MADRS score and half of the single-item scores worsened, although the functional outcome measure continued to improve. In multivariable linear regression tests, low social support was associated with "reduced sleep" (standardized β=0.20; 95% CI=0.06 to 0.34, p=0.005) and "pessimistic thoughts" (standardized β=0.16, 95% CI=0.03 to 0.30, p=0.019), and poor functional outcome was associated with all specific symptoms (standardized β values=0.18-0.43, all p<0.02) except "reduced sleep."

Conclusions: Although total MADRS and single-item scores improved in parallel with improvements in functional outcome at the 6-month follow-up, these scores worsened afterward. The lack of social support and presence of functional disability were both associated with total MADRS scores. However, specific symptoms were differentially affected, suggesting that tailored strategies should be applied to manage depression in stroke patients.

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脑卒中后抑郁症状的长期变化:功能障碍和社会支持的影响
目的:脑卒中患者特异性抑郁症状的长期变化很少被研究。在长期随访期(LTP)后,研究了这些变化以及社会支持和功能残疾对特定症状的影响。方法:在基线、6个月随访和LTP(35-83个月)进行Montgomery-Åsberg抑郁评定量表(MADRS)、enrichment社会支持量表和改良Rankin功能障碍量表(mRS)。社会支持和不良功能结局(mRS评分为3至6)对MADRS中包含的10个单项的影响被确定。结果:222例患者在6个月的随访中,mRS评分、MADRS总评分以及除“集中困难”、“感觉能力丧失”和“自杀念头”外的所有单项评分均有改善。从6个月的随访到LTP, MADRS总得分和一半的单项得分恶化,尽管功能结果测量继续改善。在多变量线性回归检验中,低社会支持与“睡眠减少”相关(标准化β=0.20;95% CI=0.06 ~ 0.34, p=0.005)和“悲观思想”(标准化β=0.16, 95% CI=0.03 ~ 0.30, p=0.019),功能预后差与所有特异性症状相关(标准化β值=0.18 ~ 0.43,所有p)。结论:尽管在6个月随访期间,MADRS总评分和单项评分在功能预后改善的同时得到改善,但这些评分在随访后恶化。缺乏社会支持和存在功能性残疾都与MADRS总分相关。然而,特定的症状受到不同的影响,这表明应该采用量身定制的策略来管理中风患者的抑郁。
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来源期刊
CiteScore
5.30
自引率
3.40%
发文量
67
审稿时长
6-12 weeks
期刊介绍: As the official Journal of the American Neuropsychiatric Association, the premier North American organization of clinicians, scientists, and educators specializing in behavioral neurology & neuropsychiatry, neuropsychology, and the clinical neurosciences, the Journal of Neuropsychiatry and Clinical Neurosciences (JNCN) aims to publish works that advance the science of brain-behavior relationships, the care of persons and families affected by neurodevelopmental, acquired neurological, and neurodegenerative conditions, and education and training in behavioral neurology & neuropsychiatry. JNCN publishes peer-reviewed articles on the cognitive, emotional, and behavioral manifestations of neurological conditions, the structural and functional neuroanatomy of idiopathic psychiatric disorders, and the clinical and educational applications and public health implications of scientific advances in these areas. The Journal features systematic reviews and meta-analyses, narrative reviews, original research articles, scholarly considerations of treatment and educational challenges in behavioral neurology & neuropsychiatry, analyses and commentaries on advances and emerging trends in the field, international perspectives on neuropsychiatry, opinions and introspections, case reports that inform on the structural and functional bases of neuropsychiatric conditions, and classic pieces from the field’s rich history.
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