Depression, Anxiety Hinder Quality of Life After Stroke

Rehab efforts should focus on coping styles to boost outcomes, study says

THURSDAY, Dec. 18, 2008 (HealthDay News) -- Many people who survive a subarachnoid hemorrhage stroke have a poor quality of life due to anxiety, depression and fatigue, Dutch researchers report.

A subarachnoid hemorrhage (SAH) stroke occurs when a blood vessel on the brain surface ruptures and bleeds into the space between the skull and the brain, but not into the brain. This study included 141 women and men, average age 51, living in the community two to four years after an SAH stroke.

Using the Stroke Specific Quality of Life scale, the researchers found that 32 percent of the survivors reported anxiety, 23 percent reported depression, and 67 percent reported fatigue. Overall, the best scores were in physical function, while the lowest scores were in emotional and social areas.

The study was published in the Dec. 19 online issue of Stroke.

"The major point is to look beyond physical symptoms and look at psychological symptoms and personality characteristics to evaluate quality of life. These characteristics are important to planning rehabilitation and targeting an intervention to help improve quality of life," study author Dr. Anne Visser-Meily, a rehabilitation specialist at the University Medical Center in Utrecht, said in an American Heart Association news release.

"When you analyze depression, anxiety and fatigue [in SAH survivors], you find there is a strong correlation with a passive coping style and neuroticism. Those with a passive coping style need psychological support to encourage them to be more independent," Visser-Meily said.

She and her colleagues also found that cognitive function is another important determinant of quality of life associated with coping style. Survivors were more likely to have neuropsychological problems if they had a passive coping style and were depressed.

"This emphasizes the need to take personality into account as a potential vulnerability factor for decreased QOL [quality of life]," Visser-Meily said.

A separate study also led by Visser-Meily found that coping is the most important predictor of psychological well-being of spouses of stroke survivors. The study, which included 211 stroke survivors and their spouses (average age 54), found that active coping strategies were associated with less stress and higher levels of participation, while a passive coping style was associated with negative outcomes.

While caregiver burden decreased significantly over time, 43 percent of spouses still scored above the cut-off point for burden three years after their partner's stroke. The study also found that the number of spouses with depressive symptoms decreased from 68 percent at the start of rehab to 53 percent at two months after rehab. But there was no further decrease in depressive symptoms, and there was a steady decline in relationship harmony and social relations.

"These findings highlight the need to monitor the long-term psychosocial functioning of the spouses of stroke patients as part of a family-centered approach," Visser-Meily said. "It is a very difficult job to be a caregiver. You not only have to manage the care of the stroke patient, you also have to take care of yourself. Not only burden, but also depressive mood, harmony in the relationship, and social relations need more attention in clinical practice."

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about post-stroke rehabilitation.

SOURCE: American Heart Association, news release, Dec. 18, 2008
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