A Follow-up Study of Psychological Problems After Stroke

Gurr, B.
1
, Muelenz, C.
2
, Ibbitson, J.
1


1
Neuropsychology Department, Poole Stroke Unit, Poole, United Kingdom;
2
Psychology Department, Johannes Gutenberg University, Mainz, Germany
Design
This poster shows the results of a study into levels of patients psychological
distress post-stroke, both during admission and following discharge into the
community. More than 50% of the sample showed heightened psychological
distress during admission which decreased slightly at follow-up. The study
highlights the importance of mood assessments for all stroke patients and the
need for specialist psychological interventions for those with chronic post-stroke
psychological distress.

77 stroke patients were identified as suffering psychological distress during
the study period via the units mood screening pathway (Gurr, 2011).
Consequently, formal mood assessments were applied (Hospital Anxiety and
Depression Scale HADS, revised cut-off scores applied, Sagen et al.
2009).

Hospital sample
77 stroke patients with raised psychological distress. Age range: 30 to 95.

Follow-up after discharge sample
42 patients out of the 77 baseline participants were available for
reassessment after discharge. Age range: 30 to 95.

Hospital Sample
46 patients (59.7%) above cut-off for depression
52 patients (67.5%) above cut-off for anxiety
HADS total mean score: 15.90

Follow-up sample

22 participants (52.38%) above cut-off for depression at time 1 compared to
23 participants (54.76%) at time 2.
27 participants (64.28%) above cut-off for anxiety at time 1 compared to 22
participants (52.38%) at time 2.
Total HADS mean scores lower at time 2 (10.48) than at time 1 (12.95), this
difference was, however, non-significant (anxiety, p = .065;
depression, p = .364).
Patients who only participated at time 1 had non-significantly raised HADS
scores (15.90) in comparison to the patients who were also followed up
(12.95).
References
Sample
The study
1. Background
2. Method
3. Results
4. Discussion
Ninth World Congress on Brain Injury
March 21-25, 2012, Edinburgh
Contact: Dr Birgit Gurr Consultant Neuropsychologist
Neuropsychology Service Dorset Healthcare, University Foundation Trust
Poole Community Clinic Shaftesbury Road Poole BH15 2NT
birgit.gurr@dhuft.nhs.uk
Psychological distress after stroke
150.000 people in the United Kingdom have a stroke each year. Psychological
disturbances are common after stroke. The incidence of poststroke depression
ranges from 5% to 63% and is associated with poor cognitive abilities,
dysphasia, low-level participation in daily activities, and social isolation.
Poststroke anxiety has an incidence of 14% to 21% and is associated with
reduced engagement in activities of daily living, and comorbid depression
symptoms result in poorer physical and social outcomes. Psychological
distress following stroke can impact on all aspects of recovery and adds to
health and social care cost.
Outcomes demonstrate that an identified subgroup of stroke survivors
presented with depression and anxiety scores above the HADS cut-off for
stroke survivors both in the hospital phase and after discharge into the
community.

Patients unavailable for further assessments (due to death or very severe
impairments) had slightly higher psychological distress which indicates a
possible link between stroke severity and distress.

These results highlight the importance of mood assessment and monitoring
for all stroke patients and the need for access to specialist psychological
interventions for those with chronic post-stroke distress.
The study was conducted within a structured timeframe resulting in different
follow-up intervals. There may have been an interference with normal
adjustment parameters for some patients.
Patients not demonstrating psychological distress during their inpatient stay
were not included. It is possible that these patients may have developed
distress at a later stage.
Gurr, B. & Muelenz, C. (2011). A Follow-up Study of Psychological Problems after Stroke. Topics in Stroke
Rehabilitation, 18(5), 461-469.
Sagen, U., Vik, T.G., Moum, T., Mrland, T., Finset, A., Dammen, T. (2009). Screening for anxiety and
depression after stroke: comparison of the Hospital Anxiety and Depression Scale and the Montgomery and
sberg Depression Rating Scale. Journal of Psychosomatic Research, 67(4), 325332.
Figure 1: HADS outcomes at time 1
for hospital and follow-up sample

Data collection and follow-up period for patients
Data collection took place in the outpatient clinic, in participants homes or over
the telephone. The follow up period was 6-12 months after discharge from
hospital.

Study compared psychological distress

Time 1 comparison (figure 1): split the 77 baseline group into those who
participated at both assessment times (follow-up sample) and those who were
unavailable later (hospital sample)
Time 1 and time 2 comparison (figure 2): includes only the follow-up sample.
Comparison between baseline in hospital (time 1)
and after discharge (time 2).
0
2
4
6
8
10
12
14
16
M
e
a
n

S
c
o
r
e

Follow-up sample Hospital sample
0
2
4
6
8
10
12
14
16
M
e
a
n

S
c
o
r
e

Time 1 Time 2
Figure 2: HADS outcomes in follow-
up sample at time 1 and time 2
Study limitations Outcomes