Ecosystem focused therapy in poststroke depression: a preliminary study

Abstract

Objective Post stroke depression (PSD) occurs in the context of abrupt, often catastrophic disability that finds the patient and his/her family unprepared. We developed Ecosystem Focused Therapy (EFT), a systematic intervention aimed to increase the PSD patient’s and his/her ecosystem’s ability to address the “psychosocial storm” of PSD and utilize available treatments effectively and efficiently. This is a preliminary study of its efficacy. Design A total of 24 PSD patients were randomly assigned to receive weekly sessions of EFT or a comparison condition consisting of systematic Education on Stroke and Depression and their treatment (ESD) for 12 weeks. Results EFT may be more efficacious than ESD in reducing depressive symptoms and signs, in leading to a higher remission rate, and in ameliorating disability in PSD. Reduction of disability in the early part of the trial mediated later improvement in depressive symptomatology. Similarly, reduction in depressive symptoms and signs early on mediated later improvement in disability. Conclusion These encouraging findings require replication. Beyond its potential direct benefits in PSD, EFT may provide an appropriate context for efficient and timely administration of pharmacotherapy and of physical, speech, and occupational therapy thus maximizing their efficacy.

Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

“…88 The findings of the Living Well With Stroke Study RCTs were supported by a much smaller, multifaceted intervention, conducted during rehabilitation. 90 Twenty-four patients with ischemic or hemorrhagic stroke in a rehabilitation hospital were randomly assigned to receive 12 weekly sessions of ecosystem-focused therapy (n=12), which emphasized a familyfocused, problem-solving identification of valued activities and coordination of therapies. The comparison group (n=12) had 12 weekly sessions focused on education about stroke and depression and reviewed written materials.…”

“…At week 12, 66.7% of the ecosystem focused therapy participants had achieved remission of depression (HDRS<10), which was significantly greater than the 16.7% achieving remission in the control group. 90 The CALM trial (Communication and Low Mood) (N=105) 89 randomized stroke survivors with aphasia to receive up to 20 1-hour sessions of behavioral therapy over 3 months (n=51), delivered by an assistant psychologist supervised by a clinical psychologist and supported by an intervention manual developed from studies of cognitive behavioral therapy or usual care (n=54). Mean Stroke Aphasic Depression Questionnaire scores decreased from baseline to 6 months by 6 points in the intervention group compared with an increase of 1.9 points in the control group.…”

Models of Care for Late-Life Depression of the Medically Ill: Examples from Chronic Obstructive Pulmonary Disease and Stroke

“…Stroke afflicts 700,000 Americans each year and more than 20% of them subsequently develop depressive syndromes. (4) Post stroke depression (PSD) develops during the psychosocial and biological storm ensuing after stroke. The “storm” affects the patient and challenges the patient’s ecosystem.…”

“…The “storm” affects the patient and challenges the patient’s ecosystem. (4) The intervention model we describe below is based on a dissection of contributors to the “storm” and interventions targeting each if its components.…”

This issue: Clinical and Neurobiological Findings, Treatment Developments in Late-Life Depression

“…15 Despite availability of efficacious psychotherapies, few depressed older adults receive psychotherapy. Streamlining of psychotherapies is a necessary first step for increasing the utilization of psychotherapies by the existing workforce.…”