Study
This project aims to better understand psychological consequences of stroke in patients who have very little or no after-effects and get back to a motor and cognitive health states almost similar to their state prior to stroke.
The goal is to study the links existing between different depressive and anxious symptoms (cognitive, emotional and physical); coping strategies and quality of life from acute phase to the end of fourth month after stroke.
Population:
Individuals admitted to a hospital stroke unit with a diagnosis of first-ever ischemic or hemorrhagic stroke (made by a neurologist based on clinical and neuroradiological data) and presenting a prognostic of fast and good recovery (based on NIHSS score) will participate in the study. Persons with past or present dementia or psychotic disorder, severe aphasia, visual or motor disabilities limiting a correct participation in the study will be excluded from it.
Procedure:
The study is composed of four times:
• T0: during hospitalization in neurology unit (during first two weeks after stroke)
• T1: at hospital discharge (approximately 2 weeks after stroke)
• T2: 2-month after stroke
• T4: 4-month after stroke
At T0, patients will be seen by a psychologist who will evaluate depressive and anxious symptoms during a structured interview, using MINI (Sheehan et al., 1998); MADRS (Montgomery & Asberg, 1979) and HAM-A (Hamilton, 1959).
At T1 and T2, patients will answer self-evaluating questionnaires to assess depression, anxiety, coping and quality of life, using BDI-II (Beck et al., 1994); HADS (Zigmond & Snaith, 1983); Brief-COPE (Carver et al., 1997) and WHOQOL BREF (WHOQOL Group, 1994).
At T3, patients will be seen again by a psychologist and will answer the same questionnaires.
At T1, T2 and T3, ambulatory measures of depression symptoms, anxiety symptoms and coping strategies (17 items) will be made using smartphone application movisensXS, 5 times a day during 7 days.
Hypothesis:
Principal objective is to find if there are any elements allowing to screen stroke patients at risk to develop poor psychological health.
First hypothesis concerns type of symptoms of depression and anxiety:
• Cognitive and emotional symptoms (such as sadness, anhedonia and pessimism for depression and fear, worry, irritability for anxiety) during acute phase of stroke will be associated with higher levels of depression and anxiety and lower level of quality of life at two and four months after stroke.
• Physical symptoms (such as fatigue, agitation, muscular tension) of depression and anxiety will not be associated with levels of depression, anxiety and quality of life at two and four months after stroke.
Second hypothesis concerns coping strategies:
• Problem focused coping strategies (such as active coping, planning, seeking of instrumental social support) will be associated with lower levels of depression and anxiety and higher level of quality of life at two and four months after stroke.
• Emotion-focused coping (such as seeking of emotional social support, positive reinterpretation, acceptance, denial, turning to spirituality and religion) will be associated with higher levels of depression and anxiety and lower level of quality of life at two and four months after stroke.
Clinical implications:
Results would improve care of stroke-patients who have little or no after-effects of stroke in different ways:
• Prevention of post-stroke depression and anxiety by facilitating screening of these disorders among stroke patients.
• Orientation of care by targeting specific symptoms of those disorders and by developing coping strategies associated with better psychological health and reducing strategies associated with poorer psychological health.
• More generally, our aim is to improve the knowledge of how those stroke patients (who go back home fast) live the different steps after stroke.
