Trajectories of Psychological Distress After Stroke

Abstract

PURPOSE There has been little exploration of the distinct trajectories of psychological distress after stroke and the factors that predict recovery from distress. These trajectories may assist primary care physicians by providing insight into disease onset, progression, and resolution and may be a useful way to conceptualize and understand the pattern of psychological morbidity in stroke over time. We undertook a longitudinal qualitative study to explore poststroke psychological trajectories METHODS The primary data collection method was semistructured interviews with community-dwelling stroke survivors in metropolitan Newcastle, New South Wales, Australia. Our sample included 23 participants (12 men, 10 women; age range 37 to 94 years) discharged from a tertiary referral hospital after a stroke; these participants subsequently participated in a total of 106 interviews over 12 months. Qualitative outcomes were participants' perceptions at baseline, 3, 6, 9, and 12 months. Thematic saturation was achieved.RESULTS Most participants were male (54%) and had a partial anterior circulation infarction stroke subtype (57%). Four different longitudinal trajectories were identifi ed: resilience (n = 5); ongoing crisis (n = 5), emergent mood disturbance (n = 3), and recovery from mood disturbance (n = 10). Recovery from mood disturbance was facilitated by gains in independence and self-esteem and by having an internal health locus of control. CONCLUSIONS Stroke survivors experienced a variety of psychological trajectories. Identifying distinct trajectories of psychological morbidity may help primary care physicians develop appropriately timed interventions to promote better mental health. Interventions require implementation over a longer duration than the current outpatient services that, in Australia, are typically provided in the fi rst few months after stroke.

Tablet technology during stroke recovery: a survivor’s perspective

“…Patients who report being significantly overwhelmed may be less willing to learn new and challenging skills at an early stage post-stroke [28]. For some survivors, access to an iPad may be more appropriate many months after stroke onset and following greater time to adjust to significant life changes [29].…”

Exploring the experience of psychological morbidity and service access in community dwelling stroke survivors: a follow-up study

“…Longitudinal research can assist in understanding the complexity of the post-stroke experience of functioning, psychological morbidity and service access [19,20]. As part of a broader research program, we have completed a follow-up study of a larger longitudinal mixed-methods study exploring psychological morbidity post-stroke.…”

The Distress Management System for Stroke (DMSS): An approach for screening and initial intervention for post-stroke psychological distress

“…What is more, the DMSS can be used at different time points following stroke (i.e. from days to years after the event) given that distress can occur any time after stroke onset [1,2,6] , and in view of the fact that the problems covered by the Concerns Checklist are relevant to new-onset as well as long-standing strokes [14,15,33] .…”

“…'Family Problems' was replaced by 'Relationships' to help individuals to discriminate family from non-family relational distress) and the addition of two new categories, 'Mental Abilities' and 'Communication'. The latter categories were chosen because changes to cognition, and to receptive and expressive communication are prevalent after stroke, and have been shown to be among the most difficult to manage consequences of stroke illness [6,14] . Some cancer physical concerns were excluded from the DMSS (e.g.…”

“…[4][5][6] , and so the term captures well the spectrum of emotional changes experienced following stroke.…”