Managing post-stroke depression improves physical functioning

Although as many as a third of those who experience a stroke develop depression, a new study by researchers from the Regenstrief Institute, the schools of health and rehabilitation sciences and of medicine at Indiana University-Purdue University Indianapolis and the Richard L. Roudebush VA Medical Center is the first to look whether managing post-stroke depression improves physical functioning.

They researchers report that individuals who remain depressed three months after a stroke are more likely to have decreased functional capabilities than those whose depression was successfully treated. Functional capabilities include getting dressed, feeding oneself, and accomplishing other tasks. These capabilities increased significantly in those individuals who were treated for depression.

Post-stroke depression appears to be linked to chemical changes in the brain, clinical evidence indicates.

“The relationship between post-stroke depression and recovery of function after a stroke has not been well understood. Previous researchers have looked at both depression and function after stroke but they did not investigate whether identifying and managing depression improved ability to accomplish tasks of daily living and other function related issues,” said study first author Arlene A. Schmid, Ph.D., a Regenstrief Institute investigator, an assistant professor of occupational therapy at the IU School of Health and Rehabilitation Sciences and a VA Center of Excellence on Implementing Evidence Based Practice investigator.

The researchers in the new study report that successful depression management led to better functionality that might enable the individual to return to work or more thoroughly enjoy leisure functions while decreasing the caregiver burden.

“Restoring lost function after stroke is the number one reason individuals visit occupational therapists,” said Dr. Schmid. “Since treating depression helps improve function, occupational therapists should screen for post-stroke depression and, in conjunction with other members of the patient's health care team, help manage depression.”

In the Neurology study, whether an individual was depressed or not was determined through use of the Health Questionnaire-9 (PHQ-9), a widely used and easy to administer depression screening tool. The PHQ-9 was originally developed by Kurt Kroenke, M.D., a Regenstrief Institute investigator and IU School of Medicine professor of medicine. Dr. Kroenke, who is a co-author of the new study, has described the PhQ-9 as “a sort of a blood pressure cuff for depression.”

According to Dr. Schmid, since occupational therapists are trained in mental health issues and see patients frequently, occupational therapists could use the PHQ-9 to screen for depression after stroke and alert a post-stroke patient's physician to the individual's mental status.

In addition to improving functionality, management of depression would lower health care costs associated with functional impairment and other post-stroke treatment issues.

“Post-stroke depression often impacts quality of life after stroke more than even functional impairments. Since it is treatable with common medications, cognitive behavioral therapy and exercise, it is important to recognize it so patients can be treated. This study is one of the first to show not just the link between depression and worse function post-stroke, but that successfully treating depression symptoms actually improves post-stroke outcomes,” said Linda S. Williams, M.D., a Regenstrief Institute investigator, associate professor of neurology at the IU School of Medicine, and a VA Center of Excellence on Implementing Evidence Based Practice investigator.

Dr. Schmid and Dr. Williams participate in the VA's Stroke Quality Enhancement Research Initiative. Dr. Schmid is VA Career Development Award recipient.

Co-authors of “Post-stroke Depression and Treatment Effects on Functional Outcomes” in addition to Dr. Schmid, Dr. Kroenke and Dr. Williams are Hugh. C. Hendrie, MB, ChB, D.Sc., of the Regenstrief Institute, IU School of Medicine and the IU Center for Aging Research; Tamilyn Bakas, D.N.S., R.N., of the IU School of Nursing and the IU Center for Aging Research; and statistician Jason M. Sutherland, Ph.D., of the University of British Columbia.

The study was funded by the National Institute of Neurological Disorders and Stroke.