Verbal Indicators of Depression in Conversations with Stroke Survivors

TOPIC. This secondary analysis study examined patients' comments at 1 and 6 months poststroke when they had scores of [greater than or equal to] 16 on the Center for Epidemiologic Studies--Depression Scale. Stroke survivors' depressive comments were matched with items of two well-established depression instruments. METHODS. A qualitative study using content analysis to analyze the data (N = 7). FINDINGS. Verbal indicators of depression were evident in patients' comments, and depressive themes were identified. Depression instrument items were congruent with minor themes, except for spirituality. CONCLUSIONS. The analysis provides guidance for assessment of stroke survivor depression. It provides direction for designing interventions to decrease depression after stroke. Search terms: Depression, stroke, qualitative study ********** Stroke is a major cause of long-term disability in the United States (American Heart Association, 2000). Depression is readily understood to be a common experience after stroke, and is partially related to coping with poststroke sequelae such as hemiplegia, poor balance, visual difficulties, and aphasia. Estimates of poststroke depression range from 20% to 50% (Robinson, 2002). Depression affects the motivation that is needed for improving functional independence after stroke. Investigators have reported strong relationships between symptoms of depression and functional outcome in patients from 3 months to 2 years after stroke (Herman, Black, Lawrence, Szekely, & Szalai, 1998; Parikh et al., 1990). These studies highlight the need to screen all stroke survivors for depression, as lower independent functioning is associated with depression symptoms. Within the context of limited healthcare resources, the ability to identify a subgroup of poststroke survivors who are vulnerable to ongoing or serious depression is critical. Information about major clinical depression in the poststroke population can alert the psychiatric nursing community to those who are at risk for psychosocial morbidity. With increased knowledge about stroke-survivor depression, clinical nurses can intervene more effectively to reduce the severity of depression and improve functional ability with their patients. Therefore, the purpose of this secondary analysis study was to examine comments made by stroke survivors while interpreting their conversational elements as indicators of depression. Additionally, the study compared comments made by stroke survivors that pointed to depression with items of two well-established depression instruments. The research questions were: (a) What were the depressive themes evident in the comments made by poststroke survivors, who were depressed at 1 and 6 months poststroke and who scored [greater than or equal to] 16 on the Center for Epidemiologic Studies Depression Scale (CES-D) (Radloff, 1977)? and (b) Do comments made by depressed stroke survivors correspond with items on two depression instruments, CES-D and Geriatric Depression Scale (GDS) (Brink et al., 1982)? Depression indicators emerged in patients' conversations with a nurse investigator during a larger study (Robinson-Smith, Johnson, & Allen, 2000). Identifying comments that suggest depression may help other nurses identify stroke survivors at risk for severe or sustained depression. Background Poststroke Depression The first year after stroke is considered a crucial time for recovery from depression. Astrom, Adolfsson, and Asplund (1993) examined depression, functional ability, and social network over a period of 3 years after stroke. Factors that contributed to serious depression in the first year poststroke included left anterior brain stroke, dysphasia, living alone, and dependence in activities of daffy living. At follow-up in the second and third year poststroke, chronic depression was most likely to occur in those stroke survivors who had not recovered from depression at 1 year following the stroke diagnosis. …