Perceived Social Support is Related to Initial Severity of Post-Stroke Depression, but Not to Depression Improvement

Kammeyer R, Daggy J, Schmid AA, Williams LS. Perceived Social Support is Related to Initial Severity of Post-Stroke Depression, but Not to Depression Improvement. [Abstract]. Stroke; A Journal of Cerebral Circulation. 2015 Apr 1; 46(4):A147.

Background: Post-stroke depression (PSD) is a common occurrence after stroke, with multiple associated co-morbidities, and is often undermanaged. Perceived social support has been shown to be related to the presence of PSD; however, little is known about the relationship of social support and its specific dimensions to baseline PSD severity and depression improvement. Methods: We conducted a secondary analysis of data collected as part of a PSD cohort study in which depressed and non-depressed patients were matched 1:1 and enrolled at approximately one month post-stroke. PSD presence was assessed by a structured clinical interview, and PSD severity by the total PHQ-9 score. PSD improvement was measured at 12 weeks, and was defined as a PHQ-9 score < 5 or a decrease by at least 50% from baseline. We constructed multivariable regression models to assess the relationships between social support, as measured by the Medical Outcomes Study Social Support Survey (MOS-SSS) and its subscales, clinical and demographic covariates, and PSD presence, severity, and improvement. Results: Among 385 ischemic stroke patients (203 non-depressed and 182 depressed), baseline MOS-SSS scores were associated with initial PSD presence (OR: 0.987, 95% CI = [0.976, 0.998]), but were not predictive of PSD improvement at 12 weeks (OR: 0.997, 95% CI = [0. 983, 1.011]). The positive social interaction dimension of social support was a significant contributor to variance in baseline PSD severity in all study participants (semi-partial R2: 8.65E-3, p = 0.03), especially in the depressed cohort (semi-partial R2: 2.66E-2, p = 0.02). Conclusions: Self-reported social support was independently associated with the presence and severity of PSD one month post-stroke. However, we did not find a relationship between baseline social support and subsequent depression improvement independent of other clinical and demographic factors. This suggests that depression interventions may be effective even in patients with low initial social support. Positive social interactions, in the form of leisure or recreational activities, may help to prevent or attenuate initial PSD severity. Key Words:Stroke recovery Disease management Patient education/teaching psychosocial aspects