Psychological Symptoms Decrease Long-Term Quality of Life After Stroke

Marlene Busko

December 23, 2008

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December 23, 2008 — Depression, anxiety, and fatigue strongly predict decreased quality of life in patients who survive aneurysmal subarachnoid hemorrhage (SAH), a new study reports.

In a separate study, the same researchers found that coping strategy is the most important predictor of psychosocial well-being among spouses of patients with stroke.

These findings, from J.M. Anne Visser-Meily, MD, from the University Medical Center Utrecht, in Utrecht, the Netherlands, and colleagues, are published in the December 18 Online First issue of Stroke.

"The major point is to look beyond physical symptoms and look at psychological symptoms and personality characteristics to evaluate quality of life," Dr. Visser-Meily said in a statement. "These characteristics are important in planning rehabilitation and targeting an intervention to help improve quality of life."

Psychological Factors Affect Recovery

Decreased quality of life in patients who survive SAH has been linked to decreased physical abilities, but psychological and personality factors might also play a role, the researchers write.

To identify the effect that psychological factors have on health-related quality of life after SAH, they performed a cross-sectional study of 141 individuals who had survived SAH 2 to 4 years earlier and were living in the community. The patients were a mean age of 51 years, and 66% were women.

The participants completed a questionnaire based on the Stroke Specific Quality of Life scale to evaluate health-related quality of life.

They had a mean total score of 4, indicating a relatively satisfactory overall quality of life, but this was because of high scores for physical health and lower scores for emotional and social health.

There were 67% of patients who reported fatigue, 32% who reported anxiety, and 23% who reported depression.

"Assessment of personality characteristics may be needed to target interventions for these symptoms and to identify patients at risk for reduced long-term health-related quality of life," Dr. Visser-Meily told Medscape Psychiatry.

Patients with a passive coping style would especially benefit from education and counseling about how to deal with these changes, she added.

Caregivers' Coping Style Predicts Well-Being

In a separate study, the researchers report that during a 3-year period after a stroke in their spouse, their partners showed decreases in psychosocial functioning, and coping was the most important predictor of well-being.

The patients' spouses had less caregiver burden with time, but they also had a less harmonious relationship with their spouse; decreased social interactions; and, after having an initial decline in depression, showed increased depression.

"Monitoring of all aspects of psychosocial functioning of spouses is needed, not only in the first period after stroke, but also in the longer term," Dr. Visser-Meily told Medscape Psychiatry.

"A 'key professional' should assess the caregiver's social and emotional needs as part of the routine follow-up activities of a stroke service unit. During rehabilitation, more attention should be given to programs that focus on empowering spouses and improving their abilities to develop and maintain a social network," she added.

Few studies have addressed changes in the caregiving experience beyond the first year after a spouse has had a stroke, she said.

In an earlier study, the researchers identified that a "passive coping strategy" — that is, not seeking solutions or being proactive, but rather doing nothing and being depressed — was the most important predictor of a negative effect on quality of life.

"Coping styles are known to be related to psychosocial well-being of people who are confronted with a negative or stressful life event," said Dr. Visser-Meily.

To assess the changes in psychosocial functioning of spouses and examine how outcomes were related to coping strategies, the researchers evaluated 211 spouses of patients with stroke from initial inpatient rehabilitation of the patient to 3 years later.

The patients and spouses were relatively young (patients' mean age, 56 years; spouses' mean age, 54 years), and the patients were moderately disabled.

"Using a passive coping strategy was generally associated with negative outcomes, whereas using active coping strategies and seeking social support were associated with positive outcomes," the researchers report.

"Active coping can involve direct interventions, considering different solutions to the problem, trying to find out everything about the problem, and making plans," said Dr. Visser-Meily.

Caregiver burden decreased significantly from 2 months after discharge from the rehabilitation center to 1 year after the stroke and from 1 year to 3 years after the stroke, possibly because of adaptation to the caregiver role, according to the researchers.

The percentage of spouses with depressive symptoms decreased from 68% at the start of rehabilitation to 53% at 2 months after rehabilitation and remained at that high level.

The study authors have disclosed no relevant financial relationships.

Stroke. Published online December 18, 2008.

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