Change Over Time in the Structural Equation Model of Factors Related to Depression in Stroke Survivors Living at Home Since Discharge from the Acute Phase

Abstract

Purpose: To clarify the changes in causal factors related to depression over time among stroke survivors living at home since discharge using structural equation model analysis. Methods: This was a longitudinal study using secondary data from the Stroke Recovery in Underserved Population database. This study used the Functional Independence Measure and the Center for Epidemiologic Studies Depression Scale to assess based on data collected at three time points: at discharge, 3 months after discharge, and 12 months after discharge. Structural equation modelling analysis was performed after conducting exploratory factorial and confirmatory factorial analysis. Results: The results of factorial and structural equation modelling analysis showed that all factor loadings and model fits were acceptable. Upon comparing the three times points, the structural equation model related to depression changed. At discharge, depressive symptoms were mainly impacted by personal relationships; at three months after discharge, they were mainly impacted by physical symptoms; at 12 months after discharge, they were mainly impacted by living activities and cognitive function. Locomotion and three items related to depressive symptoms commonly appeared at all three time points. Conclusion: The factors related to depression symptoms change over time post discharge. Therefore, this study suggests that an effective rehabilitation for ensuring that stroke survivors living at home can experience high quality of life should focus, at the physical level, on activities with gaps between performance and capability for, for example, locomotion and sphincter control; at the psychological level, on ensuring that stroke survivors have access to appropriate personal relationships without stress, and intervenors should consider survivors’ depressive symptoms at each relevant time point.