Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3103 — Patient and Family Caregiver Characteristics that Predict Development of Post-Stroke Depression

Williams LS (Indianapolis COE) , Bakas T (Indiana University School of Nursing), Plue LD (Indianapolis COE), Brizendine E (Indiana University School of Medicine), Tu W (Indiana University School of Medicine), Hendrie H (Indiana University School of Medicine), Kroenke K (Indianapolis COE)

Objectives:
Patient characteristics have been associated with the development of post-stroke depression (PSD) but few studies have examined the association of patient and caregiver characteristics and PSD.

Methods:
Patients were enrolled in a longitudinal cohort study assessing depression outcomes at baseline (1-2 months post-stroke), 3, and 6 months. Non-depressed subjects were matched 1:1 to depressed subjects. Family caregivers were eligible but not required to enroll. These data include only those subjects who had an enrolled caregiver, and only baseline study assessments. Variables measured in all subjects included: depression symptoms (PHQ-9), social support, medical comorbidity, self esteem, sense of control, and optimism. Patient-specific variables included stroke severity (NIH stroke scale). Caregiver-specific variables included the Bakas Caregiving Outcome Scale (BCOS) and the Oberst Caregiving Burden Scale. Variables were compared between depressed and non-depressed subjects using Chi-square and t-tests. Stepwise multiple logistic regression was used to determine patient and caregiver variables related to the presence of patient PSD.

Results:
Of 392 enrolled patients, 227 had an enrolled caregiver; of these 112 patients (49%) were depressed. Patient variables associated with PSD included: younger age (61 vs. 65 years, p = .01); history of depression (57% vs. 26%, p < .001); increased medical comorbidity; decreased social support; and lower self esteem, optimism, and sense of control. Caregiver variables related to patient PSD were younger caregiver age (51 vs. 56 years, p = .01), increased caregiver depression symptoms (PHQ-9 score 6.5 vs. 4.0, p < .001), worse overall outcome (BCOS 55.5 vs. 58.2, p = .03), and lower caregiver optimism, self esteem, and sense of control. Variables independently related to patient PSD were patient age, medical cormobidity, history of depression, and self esteem; as was caregiver self esteem.

Implications:
In addition to patient age, prior history of depression, and medical comorbidity, low patient and caregiver self esteem are associated with patients’ PSD. Stroke severity, social support, and caregiver burden were not associated with developing PSD.

Impacts:
Both patient and caregiver characteristics are associated with patients’ depression outcomes after stroke. Successful detection and treatment of PSD may be enhanced by including interventions to improve both patient and caregiver self esteem post-stroke.