Post-stroke social networks, depressive symptoms, and disability in Tanzania: A prospective study

Abstract

Background Evidence suggests that social networks improve functional recovery after stroke, but this work has not been extended to low- and middle-income countries (LMICs). Post-stroke depression interferes with functional outcome but is understudied in LMICs. Aims To determine the relationships between social networks, disability, and depressive symptoms in patients surviving 90-days post-stroke in Dar es Salaam, Tanzania. Methods Participants ≥ 18 years, admitted ≤ 14 days of stroke onset, were enrolled. Disability was measured using the modified Rankin Scale, social networks by the Berkman-Syme social network index, and depressive symptoms by the Patient Health Questionnaire-9 (PHQ-9) by telephone interview at 90 days. A Kruskal-Wallis test or Spearman's correlation coefficient was used to assess the associations between social networks, depressive symptoms, and disability. Results Of 176 participants, 43% (n = 75) died, with an additional 11% (n = 20) lost to follow-up by 90 days. Among 81 survivors, 94% (n = 76, 57% male, average age 54 years) had complete information on all scales (mean and median follow-up time of 101 and 88 days). Thirty percent (n = 23, 41.9%, 95% confidence interval 20.2) had at least mild depressive symptoms (PHQ-9 ≥ 5 points). Nearly two-thirds (n = 46, 61%) reported ≥ 3 close friends. A higher social network index score was associated with fewer depressive symptoms (p < 0.0001) and showed a trend towards significance with lower disability (p = 0.061). Higher depressive symptom burden was correlated with higher disability (r = 0.52, p < 0.0001). Conclusion Post-stroke social isolation is associated with more depressive symptoms in Tanzania. Understanding social networks and the associated mechanisms of recovery in stroke is especially relevant in the context of limited resources.

Nurses’ perceptions of barriers to collaborative care of communication difficulties and dysphagia in persons with stroke

“…This review found that almost one-third of 1483 stroke survivors (31% pooled frequency) met the cut-offs for depression in the various measures used. Other African prevalence studies confirm that at least one in three stroke survivors will experience PSD (Saadi et al 2018;Sarfo et al 2017b), whilst 1:5 will present with symptoms of severe anxiety (Ojagbemi et al 2017b). Over half will experience cognitive decline as a result of the stroke (Hackett et al 2005).…”

“…The other three studies all used prospective longitudinal single-cohort designs (Level III-3). Whilst and Gbiri et al (2015) included repeated measures, Saadi et al (2018) only measured participants at two time points.…”

“…In addition, being divorced significantly predicted depression. In their study of the relationships between depression, social support and disability, Saadi et al (2018) found that nearly one-third of the 81 stroke survivors in Tanzania who participated in their prospective study 90 days post-stroke reported at least mild depressive symptoms, using the Patient Health Questionnaire-9 (PHQ-9). Participants who had a weak social support network, and higher levels of disability, were also more likely to be depressed, although the study could not hypothesise on causality because of the cross-sectional study methods.…”

“…Furthermore, participants who experienced stigma, using the Stigma Scale for Chronic Illness, were also more likely to have a lower QoL (p = 0.03) and more likely to be depressed using the GDS (p = 0.01) and the CES-D (p = 0.03) (Sarfo et al 2017b). On the other hand, social support networks provide emotional, practical and educational support (Saadi et al 2018), which may explain why those with a good support system were also less likely to be depressed. Saadi et al (2018) also suggest that the financial support offered by social networks in Tanzania may be a contributing factor to reduced depression because most of their participants were still of working age.…”

“…On the other hand, social support networks provide emotional, practical and educational support (Saadi et al 2018), which may explain why those with a good support system were also less likely to be depressed. Saadi et al (2018) also suggest that the financial support offered by social networks in Tanzania may be a contributing factor to reduced depression because most of their participants were still of working age.…”