Title: An exploratory randomized controlled trial of a depression recognition and treatment package (DepReT-Stroke) for families living with stroke
Funder: Department of Health (England)

Abstract: Background Stroke is a leading cause of death and disability, requiring considerable adjustment in the lives of those affected. Post Stroke Depression (PSD) is common and associated with poor long-term outcomes. It is often inadequately diagnosed and treated, despite an evidence base for effective treatments. Adherence with treatment is often poor, especially when prescribed without taking patient preferences into account. Many stroke survivors are able to remain living in the community, cared for by a family member. For the carer this has been strongly associated with elevated levels of depression. Carer participation in the rehabilitation process does achieve better functional ability, higher activity levels and higher quality of life in stroke survivors. Aims We aim at maximising the effectiveness of otherwise established depression treatments in stroke patients and/or carers by offering either the patients or their carers choice when selecting their depression treatment (either medication, psychological treatments or exercise) and by continuing to support them with a depression recognition and treatment package (DepReT-Stroke) of six structured 30 minute sessions with a nurse specialist (plus 2 booster sessions) at their home. The participants’ experience of DepReT-Stroke will be explored by semi-structured interviews with people with stroke, carers and involved health professionals to explore which aspects of the package are seen as most/least helpful and uncovering any potential barriers to using the package. Plan of Investigation A single-blinded randomised controlled cluster trial comparing DepReT-Stroke with treatment as usual in the treatment of depression in either people with stroke or their carers. Measures (to be completed at baseline and 6months, NICE recommended depression treatment duration) will include • Quality of life measured using the SF-36 (Medical Outcome Study 36 Item Short Form Health Survey) • Montgomery-Asberg Depression Rating Scale • Knowledge about Depression and Mania Inventory • Beliefs about Medicines Questionnaire • Zarit Carer Burden Inventory • Economic evaluation using the Client Service Receipt Inventory (CSRI) amended for use in older people • Qualitative evaluation of the families and health professionals’ experiences of using the package Potential Impact It is anticipated that families after stroke who are treated with DepReT-Stroke show improved HRQoL as measured using the SF36 compared to those families who receive treatment as usual (Primary research question). This will also be demonstrated by the participating patients and carers showing improved mood and knowledge about depression as well as more positive treatment attitudes. The immediate impact will be with the improvement in the families’ quality of life. We also expect carer burden to be reduced. However, poststroke depression and care depression is very common. So, beyond the direct impact on the family, we also expect to demonstrate that DepReT-Stroke is cost effective. (Secondary research questions). We will treat the family as a cluster in the analysis.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: STROKE;MENTAL HEALTH