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| |  Brief Behavioural Intervention Can Reduce Depression in Stroke Survivors BETHESDA, Md -- August 7, 2009 -- A nurse-led behavioural intervention can reduce the incidence of depression in stroke survivors, according to the results of a study published in the recent issue of the journal Stroke. The intervention, called Living Well With Stroke (LWWS), provided individualised counselling sessions aimed at increasing pleasant social interactions and physical activity as a way to elevate mood, and was designed to be used alone or in conjunction with antidepressant medications. As many as one-third of stroke survivors develop post-stroke depression (PSD), which may include intense feelings of loss, anger, sadness, and/or hopelessness. Compared with stroke survivors without depression, those with PSD tend to have a poorer response to rehabilitation, a longer delay in returning to work, more social withdrawal, and increased use of healthcare services. They are also at higher risk for subsequent strokes, cardiac events, and death. While antidepressant medications have shown varying degrees of short-term efficacy for PSD patients, few studies have examined non-pharmacologic interventions or long-term outcomes. "In designing LWWS, we reasoned that changing the behaviours commonly associated with depression through an individualised counselling program would lead to a more effective and longer-lasting elevation of mood than is often seen with medications alone," said principal investigator Pamela Mitchell, PhD, RN, FAAN, National Institute of Nursing Research (NINR), National Institutes of Health (NIH), Bethesda, Maryland. In a clinical trial involving over 100 stroke survivors who exhibited symptoms of PSD, Dr. Mitchell's research team compared LWWS against usual post-stroke care. The study participants ranged in age from 25 to 88 years, and 59% were male. Over 70% of patients had experienced at least 1 episode of depression prior to their stroke, and 60% were taking an antidepressant medication at entry into the study. All participants received standard post-stroke information and continued to see their primary care provider for ongoing medical care. Those assigned to the LWWS program received 9 counselling sessions over 2 months with a specially trained stroke rehabilitation nurse. In these sessions, the nurse taught the participants problem-solving skills and helped them develop realistic treatment goals. In addition, several sessions were devoted to improving mood by helping the participants identify and increase their participation in pleasant social events and physical activities, such as being with family, listening to music, reading, solving a puzzle, or learning something new. "Individuals who have suffered a stroke often must make adaptations in their lives and learn to cope with new limitations, both physical and cognitive. Depression during the recovery period can interfere with their ability to fully engage in their treatment regimen or return to family and work," noted Dr. Patricia A. Grady, PhD, RN, FAAN, Director of the NINR. Depression scores in the LWWS group were significantly lower after treatment and at a 1-year follow-up compared with the control group. In addition, more participants in the LWWS group achieved remission -- with scores no longer meeting the criteria for depression -- compared with the control group both immediately after treatment (47% vs 19%), and at a 1-year follow-up (48% vs 27%). At 2 years, depression scores continued to decrease and remission rates continued to increase for both groups, although the gap narrowed so that the differences were no longer statistically significant. For both the intervention and control groups, patients in remission at 1 year had significantly higher scores in perceived ability, recovery, and social participation than those who were not. "The success of LWWS shows the importance of including behavioural strategies in the care of stroke survivors. We believe our study is the first to report a clinically significant reduction in depression in these patients over a long term," said Dr. Mitchell. "We also showed that achieving remission from depression by any means is an important treatment goal that could promote recovery and sociability." "This study has the potential to add another tool for healthcare professionals to use in helping individuals cope following a stroke," added Dr. Grady. "Also of note, the LWWS program included instruction to help family members and other informal caregivers identify resources and support services as a way to reduce their caregiving burden, an important aspect of comprehensive post-stroke care." SOURCE: National Institute of Nursing Research - National Institutes of Health
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