A Brief Behavioral Intervention Can Reduce Depression in Stroke Survivors (1)
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A nurse-led behavioral 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 individualized counseling 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. This study was funded by the National Institute of Nursing Research (NINR), a component of the National Institutes of Health (NIH).
A stroke occurs when the blood supply to a part of the brain becomes blocked or interrupted, leading to brain damage in the affected area. Stroke survivors can experience a range of aftereffects, including impaired mobility or paralysis, pain, speech and language problems, and altered cognition. As many as one-third of stroke survivors also develop post-stroke depression (PSD), which may include intense feelings of loss, anger, sadness, and/or hopelessness.
Compared to 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 health care 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 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 percent were male. In addition, over 70 percent had experienced at least one episode of depression prior to their stroke, and 60 percent 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 nine counseling sessions over two 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.