Psychological distress, social support and medication adherence in patients with ischemic stroke in the mainland of China

Abstract

Stroke research and rehabilitation have traditionally focused on the physical and functional impact of a stroke. Less attention has been given to the psychosocial factors associated with this chronic condition. By the few studies that have specifically focused on psychosocial factors in the context of stroke, poststroke depression is demonstrated to significantly influence stroke outcomes. Associations of stroke with psychological symptoms other than depression have rarely been evaluated. This study was aimed to investigate the changes of psychological stress, social support and medication adherence in patients with ischemic stroke in the mainland of China. In this study, 90 patients with hemiplegia one year after first-ever middle cerebral artery infarction (stroke group) in the Zhongnan Hospital of Wuhan University from June 2008 to June 2011 were recruited for interview. Ninety age- and sex-matched normal volunteers (control group) were also examined at the same period. The psychological distress was assessed by the Symptom Checklist 90 (SCL-90), the social support by the Social Support Rating Scale (SSRS), and medication adherence by Morisky's self-reported inventory, respectively. Group differences were analyzed using unpaired-t test and chi-squared test. The results showed that total mean scores of the SCL-90 in the stroke group were higher than those in the control group (P<0.01). Except two dimensions, paranoid ideation and psychoticism, mean scores of the rest dimensions (including somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety) of SCL-90 were significantly higher in the stroke group than those in the control group (P<0.05, or P<0.01). The objective support, subjective support, support availability and total social support scores in the stroke group were significantly higher than those in the control group (P<0.05, or P<0.01). Those in the "SCL-90 total scores >150 group" were significantly higher than in the "SCL-90 total scores <100 group" and the "SCL-90 total scores between 100 to 150 group" (P<0.05, or P<0.01). Those in the "SCL-90 total scores between 100 to 150 group" were significantly higher than in the "SCL-90 total scores <100 group" (P<0.05). In 90 patients with ischemic stroke, 26 (28.89%) patients obtained high medication adherence, 47 (52.22%) patients medium medication adherence, and 17 (18.89%) patients low medication adherence, respectively. Among these stroke patients, there were 17 (50.00%) patients with high medication adherence in the "SCL-90 total scores >150 group", 28 (75.67%) patients with medium medication adherence in the "SCL-90 total scores between 100 to 150 group", and 12 (61.16%) patients with low medication adherence in the "SCL-90 total scores <100 group", respectively. There was significant difference in the medication adherence rate among the different SCL-90 scores groups in these stroke patients (P<0.05 or P<0.01). It was led to conclude that ischemic stroke patients one year after hemiplegia have ps...

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“…Conversely, living alone and the lack of family support have been associated with lower compliance in several investigations. 26,33 Surprisingly, lower educational level was associated with improved adherence among in the present study. Other studies showed contrasting outcomes, such as in Nigeria, where stroke survivors with a tertiary educational level were 48 time more likely to be knowledgeable about stroke and more compliant to treatment than those with lower education.…”

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“…The selection criteria for cerebral infarction were based on the diagnostic code drafted at the Fourth Cerebral Vascular Disease Academic Conference in 1995, coupled with confirmation by cranial CT scan or MRI [3-5]. Exclusion criteria included transient ischemia attack, cerebral hemorrhage on admission or hemorrhage secondary to ischemic stroke, reversible ischemic neurologic deficit, ischemic stroke with an absence of symptoms, criteria consistent with ischemic stroke, but without sufficient clinical data.…”

“…Effective management including modern western medicine with one or more types of Chinese herb medicine was used, and physical rehabilitation was carried out after admission [1, 3-5]. Routine medications for all ischemic stroke patients in both groups included anti-platelet agents, antihypertensive, hypoglycemic and anti-hyperlipidemic drugs, as well as water-salt electrolyte formulations.…”

“…Routine medications for all ischemic stroke patients in both groups included anti-platelet agents, antihypertensive, hypoglycemic and anti-hyperlipidemic drugs, as well as water-salt electrolyte formulations. These medicines should be taken following the advice of a physician and according to symptoms of each patient [1, 3-5]. There was no significant difference between the two groups of patients in medications.…”

“…In the past 30 years, China has experienced a rapid economic development with an increasing elderly population and a corresponding increase in life expectancy. The number of people having strokes and stroke mortality rates have increased accordingly [2-5]. The official statistics data from 31 regions in China showed that stroke became the number one cause of death among both urban and rural residents, and the mortality rates of stroke were much higher in cities than in rural areas [6, 7].…”