Poor Quality of Life and Low Social Support are Predictive of Depressive Symptoms in Chronic Stroke

Background: Depression is a common yet often unrecognized consequence of stroke, affecting between 20-50% of all survivors. Reported underlying factors affecting depression in acute and chronic stroke include: functional disability, lesion location, time since stroke, female gender, age, cognitive impairment, history of major depression, low social support, poor quality of life, and inferior sleep quality.

Purpose: To examine potential independent predictors of depressive symptoms in chronic stroke.

Methods: Cross-sectional design using baseline data from the first 100 community-dwelling stroke survivors enrolled in an exercise intervention study. Eligible subjects included men and women aged ≥ 50 years and at ≥ 3 months post-stroke. Prior to their baseline study visit; subjects completed a comprehensive, self-administered health survey including medical history and valid/reliable questionnaires: Center for Epidemiological Studies Depression (CES-D) scale, Multidimensional Scale of Perceived Social Support, Medical Outcomes Study SF-36, and Pittsburgh Sleep Quality Index. At the baseline visit, functional disability (Modified Rankin Scale), and cognitive impairment (Mini-Mental Status Exam) were assessed using standardized procedures. Multiple linear regression was conducted to explore potential independent predictors of depressive symptoms.

Results: Subjects (n=100) were on average 70±10 years old, and 39±49 months post-stroke. The majority reported an ischemic stroke (68%), were married (59%), White/European-American (78%), men (54%), college-educated (79%), and annual income ≥$50,000 (32%). Hemiparesis was common (right-side=39%, left-side=42%). A total of 35% of subjects had a CES-D scores ≥16, with 21% reporting a history of major depression. Approximately 64% of the variance in depressive symptoms, could be explained by the optimal combination of the independent variables in the model: functional disability, lesion location, time since stroke, gender, age, cognitive impairment, history of major depression, social support, quality of life, and sleep quality (R2=0.64, F12,87=12.97, p<0.01). Only poor quality of life (t1,87=-6.99, p<0.01) and low social support (t1,87=-2.14, p=0.04) contributed uniquely and significantly to the severity of depressive symptoms among these stroke survivors.

Conclusion: Depressive symptoms are prevalent in chronic stroke survivors, even among an educated and economically advantaged population. Our findings are similar to reports by others that poor quality of life and low social support are major contributors to depressive symptoms in chronic stroke; and should be routinely assessed and monitored to improve long-term rehabilitation efforts, promote wellness and community reintegration.