A study, published in the January 2016 issue of the Journal of Stroke and Cerebrovascular Diseases, has identified an interrelationship between depressive symptoms in stroke survivors and their family caregivers. Led by researchers from the Duke-NUS Medical School (Duke-NUS), the study is the first to identify and characterise distinct trajectories in depressive symptoms in stroke survivors and their caregivers, experienced over time. Findings support the importance of focusing not only on stroke survivors, during their post-stroke rehabilitation, but also closely monitoring their family caregivers.
Symptoms of depression, such as feeling lonely, talking less than usual and having trouble focusing on routine activities, adversely affect the health and quality of life of affected individuals and their families. Previous studies have shown that the risk of developing depressive symptoms increases among both stroke survivors and their family caregivers in the months to years after the stroke occurs. However, it was not known if both stroke survivors and their family caregivers exhibited the same, increasing pattern of depressive symptoms over time in the first year after the stroke.
To address this gap, Professor David Matchar and Assistant Professor Rahul Malhotra, from the Health Services and Systems Research (HSSR) Programme at Duke-NUS, led a team that followed up with 172 stroke survivors and their respective family caregivers in Singapore. The 172 pairs were first interviewed at a community hospital where the stroke survivors were receiving rehabilitation treatment, and then were interviewed twice, at their home, over a time span of one year after the stroke.
During each of the three interviews, the team administered a survey to participants that asked a series of questions regarding how they felt over the past week. An algorithm was then applied to the responses to quantify the depressive symptoms. Depressive symptoms of 16 and above on a scale denoted clinically significant depressive symptoms. Presence of clinically significant depressive symptoms suggests that the person is at risk for clinical depression and may benefit from diagnostic evaluation, and treatment, if diagnosed for clinical depression. Based on this data collected over time, the team was able to map the trajectories of depressive symptoms felt by stroke survivors and family caregivers.
The HSSR research team found that there was a variation in the manner in which depressive symptoms unfolded over time among stroke survivors and their family caregivers. On average, all stroke survivors interviewed were rated with depressive symptoms above 16 at the first interview, which later changed over the course of the year. Approximately half could expect their depressive symptoms to decrease and improve over time while the other half could see an increase in these symptoms. Among family caregivers, the majority (approximately 70%) was rated with depressive symptoms below 16 at the first interview and saw little to no change in depressive symptoms over time. However, 30% of the family caregivers exhibited depressive symptoms above the 16 cut-off mark at the first interview, which then gradually improved to below 16 over time.
The findings showed that when looking at the trajectories of stroke survivors and their respective family caregivers, increases in the depressive symptoms of one group often led to an increase in the depressive symptoms of the other. External factors were also observed to contribute to the trajectories of depressive symptoms in both groups. It was found that a loss in functional ability in stroke survivors would lead to an increase in their depressive symptoms. Among caregivers, it was found that the presence of a foreign domestic worker who contributed in caring for the stroke survivor caused a decrease in depressive symptoms felt by the caregiver.
“Our study shows that the mental health of stroke survivors and their family caregivers is interrelated,” said first author Dr Malhotra. “Health and social care professionals caring for stroke survivors should focus not only their patients but also make an effort to reach out to and converse with the family caregivers who are caring for their patients at home”.
The findings suggest that a “reduction in the functional ability of patients or increase in depressive symptoms in family caregivers of their patients over time should raise a ‘red flag’ in the mind of the health and social care professionals, prompting them to look out for depressive symptoms in their patients,” added Dr Matchar, senior author and Director of the HSSR Programme.
The research is supported by the Singapore Ministry of Social and Family Development’s Family Research Fund grant titled “Study of the Impact of Caring for Stroke Survivors on Family Structure and the Mental Health of Caregivers” (FRF-2008-5) and by the National Research Foundation Singapore under its Singapore Translational Research (STaR) Investigator Award (NMRC/STaR/0005/2009) and administered by the Singapore Ministry of Health’s National Medical Research Council.
The content including the methods, findings and results are solely the authors’ responsibility and do not represent the endorsement and views of the grant administering organizations.
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