Prevalence, determinants and prognostic implications of post-stroke depression and caregiver burden

Abstract

The development of depression in stroke survivors and stroke caregivers is of major concern as it largely affects the rehabilitation process. In addition, more emphasis is increasingly devoted to the burden of stroke caregivers as it would significantly affect the process of post-stroke rehabilitation. Although the prevalence, determinants, and prognostic implications of post-stroke depression and caregiver burden were explored in various settings in the past years, the ever-changing dynamics of the local stroke-caregiving community means that a more updated review is warranted. Furthermore, recent studies attempt to explore the feasibility of using an objective predictor of post-stroke depression and caregiving burden, which could minimise bias in selecting high-risk individuals for further interventions. Cerebral small vessel disease burden in stroke patients serves to be a potential candidate, which is increasingly recognized for its importance in the physical and psychological well-being of stroke patients. This dissertation involves a cross-sectional study of 188 dyads of stroke survivors and primary stroke caregivers. It aims to explore three issues, 1) prevalence, determinants and prognostic implications of post-stroke depression, 2) prevalence and determinants of post-stroke caregiver burden and caregiver depression, and 3) relationship of cerebral small vessel disease with post-stroke depression and caregiving burden. In the first part, 188 stroke patients were retrospectively analyzed with respect to their baseline clinical characteristics and depression score quantified by the Patient Health Questionnaire-9. 66% of stroke patients suffered from depressive symptoms with 30% classified as moderate-severe. Predictors of post-stroke depression were underlying dementia, low Barthel Index score, and poor functional recovery. In terms of the prognostic implication, post-stroke depression was found to be independently associated with recurrent stroke and major cardiovascular adverse events. In the second part, 188 stroke caregivers were retrospectively analyzed with respect to their baseline characteristics, depression score, and caregiving burden quantified by the Zarit burden interview. 49% of caregivers suffered from depression and 56% suffered from severe caregiving burden. History of depression and poor functional outcome in stroke patients, severe caregiving burden, caregiver employment status, and duration of caregiving experience was found to predict caregiver depression. For caregiving burden, patients’ Barthel Index and functional outcomes, and severity of depression in caregivers, were found to be determinants. In the third part, brain magnetic resonance imaging (MRI) of 74 stroke patients was retrieved and analysed with respect to the total small vessel diseases burden. None of the individual MRI markers were found to be associated with post-stroke depression and caregiving burden. However, a possible association between total small vessel diseases score and post-stroke depression was observed. In conclusion, this dissertation provides a review of the local prevalence and determinants of post-stroke depression and stroke caregiving burden. It also demonstrates the prognostic implications of post-stroke depression and the possible link between total small vessel disease burden and post-stroke depression. Enhancing the understanding of the prevalence and determinants of post-stroke depression and stroke caregiving burden, and the implications of post-stroke depression, serves to be future guidance to improve the stroke rehabilitation process.