Assessment of depression and anxiety and their relationship with functional status in patients with stroke

Abstract

Aims: This study aimed to investigate the anxiety and depression levels and the relationship between functional status and depression, anxiety, pain, and quality of life in stroke patients. Methods: 65 stroke patients and 65 healthy controls were involved in the study. After recording the sociodemographic characteristics of all patients, anxiety, and depression levels were evaluated with the hospital anxiety depression (HAD) scale, and the quality of life with the Nottingham Health Profile (NHP) questionnaire. In stroke patients, functional status was evaluated with the functional ambulation categories (FAC), disease stages with the Brannstrom Staging system, and pain intensity with the visual analogue scale (VAS). Results: Anxiety levels were high in 33 patients (50.77%) in the stroke group and 16 patients (24.60%) in the control group. Depression levels were high in 35 patients (53.85%) in the stroke group and 25 patients (38,46%) in the control group. In the stroke group, the HAD anxiety, HAD depression, and HAD total scores of patients were statistically significantly higher compared to the control group (p:0.036, p:0.013, p: 0.010,respectively). When the quality of life of the patients was examined, the NHP energy level was statistically significantly lower in the stroke group (p:0.008). Examination of the stroke patients by their functional ambulation levels revealed statistically lower HAD anxiety, HAD depression, and HAD total scores with higher functional status (p:0.003, p: <0,001, p: <0,001, respectively). NHP pain, sleep, physical mobility, energy, distress subdomains, and NHP total scores were statistically significantly different with the functional status of patients. Negative correlations were found between FAC scores with pain, HAD anxiety, HAD depression, HAD total, and NHP total scores. Conclusion: Anxiety and depression levels are higher in stroke patients. And also there is an inverse relationship between functional status and the severity of pain, anxiety, depression, and quality of life.

Keywords

• anxiety
• depression
• functional status
• quality of life
• stroke

İnmeli hastalarda depresyon ve anksiyetenin değerlendirilmesi ve fonksiyonel durumla ilişkisinin araştırılması

Abstract

Amaçlar: Bu çalışmanın amacı inmeli hastalarda anksiyete ve depresyon düzeylerini ve fonksiyonel durum ile depresyon, anksiyete, ağrı ve yaşam kalitesi arasındaki ilişkiyi araştırmaktır. Yöntemler: Çalışmaya 65 inme hastası ve 65 sağlıklı kontrol dahil edildi. Tüm hastaların sosyodemografik özellikleri kaydedildikten sonra, anksiyete ve depresyon düzeyleri Hastane Anksiyete Depresyon (HAD) ölçeği ile, yaşam kalitesi ise Nottingham Sağlık Profili (NHP) anketi ile değerlendirildi. İnme hastalarında fonksiyonel durum Fonksiyonel Ambulasyon Kategorileri (FAC) ile, hastalık evreleri Brunnstrom Evreleme Sistemi ile ve ağrı şiddeti Görsel Analog Skalası (VAS) ile değerlendirildi. Sonuçlar: İnme grubundaki 33 hastada (%50,77) ve kontrol grubundaki 16 hastada (%24,60) anksiyete düzeyleri yüksek olarak saptandı. Depresyon düzeyleri, inme grubunda 35 hastada (%53,85) ve kontrol grubunda 25 hastada (%38,46) yüksek saptandı. İnme grubundaki hastaların HAD anksiyete, HAD depresyon ve HAD toplam puanları kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek saptandı (sırasıyla p:0.036, p:0.013, p:0.010). Hastaların yaşam kalitesi incelendiğinde, NHP enerji düzeyi inme grubunda istatistiksel olarak anlamlı derecede düşüktü (p:0.008). İnmeli hastalar fonksiyonel ambulasyon düzeylerine göre incelendiğinde, fonksiyonel durum arttıkça HAD anksiyete, HAD depresyon ve HAD toplam puanlarının istatistiksel olarak daha düşük olduğu görülmüştür (sırasıyla p:0.003, p: <0,001, p: <0,001). NHP ağrı, uyku, fiziksel hareketlilik, enerji, sıkıntı alt alanları ve NHP toplam puanları hastaların fonksiyonel durumları ile istatistiksel olarak anlamlı şekilde farklıydı. FAC skorları ile ağrı, HAD anksiyete, HAD depresyon, HAD toplam ve NHP toplam skorları arasında negatif korelasyon bulundu. Karar: İnmeli hastalarda anksiyete ve depresyon düzeyleri daha yüksektir. Ayrıca fonksiyonel durum ile ağrı şiddeti, anksiyete, depresyon ve yaşam kalitesi arasında ters bir ilişki vardır.

Keywords

• anksiyete
• depresyon
• fonksiyonel durum
• inme
• yaşam kalitesi

References

1. Rafsten L, Danielsson A, Sunnerhagen KS. Anxiety after stroke: a systematic review and meta-analysis. J Rehabil Med. 2018;28(50):769-778.
2. Altınbaş K, Oral ET, Soysal A, Arpacı B. Poststroke depression. J Clin Psy. 2006;9(3):148-153.
3. Chemerinski E, Robinson R. The neuropsychiatry of stroke. Psychosomatics. 2000;41(1):5-14.
4. Flick CL. Stroke rehabilitation. 4. Stroke outcome and psychosocial consequences. Arch Phys Med Rehabil. 1999;80(5): 21-26.
5. Jamil A, Csendes D, Gutlapalli SD, et al. Poststroke depression, an underrated clinical dilemma. Cureus. 2022;26;14(12):32948.
6. Darrel A, Kuhl AE. The DSM-5: classification and criteria changes. World Psychiatry. 2013;12(2):92-98.
7. Gilworth G, Phil M, Cert A, Sansam KA, Kent RM. Personal experiences of returning to work following stroke: an exploratory study. Work. 2009;34(1):95-103.
8. Watanabe Y. Fear of falling among stroke survivors after discharge from inpatient rehabilitation. Int J Rehabil Res. 2005;28(2):149-152.

9. Yang S, Chang MC. Poststroke pain. Semin Neurol. 2021;41(1):67-74.
10. Aydemir Ö, Güvenir T, Küley L. Validity and reliability of Turkish version of hospital anxiety and depression scale. Türk Psikiyatr. Derg. 1997;8(4):280-287.
11. Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Phys Ther. 1966;46(4):357-375.
12. Dobkin BH, Plummer D, Amato P, et al. International randomized clinical trial, stroke inpatient rehabilitation with reinforcement of walking speed (SIRROWS), improves outcomes. Neurorehabil Neural Repair. 2010;24(3):235-242.
13. Küçükdeveci AA, McKenna S, Kutlay S, Gürsel Y, Whalley D, Arasıl T. The development and psychometric assessment of the Turkish version of the nottingham health profile. Int J Rehabil Res. 2000;23(1):31-38.
14. Frank AJ, Moll JM, Hort JF. A comparison of three ways of measuring pain. Rheumatol Rehabil. 1982;21(4):211-217.
15. Chun HYY, Whiteley WN, Dennis MS, Mead GE, Carson AJ. Anxiety after stroke: the importance of subtyping. Stroke. 2018;49(3):556-564.
16. Kong K, Yang S. Health-related quality of life among chronic stroke survivors attending a rehabilitation clinic. Singapore Med J. 2006;47(3):213-218.
17. Ayis SA, Ayerbe L, Ashworth M, Wolfe CD. Evaluation of the hospital anxiety and depression scale (HADS) in screening stroke patients for symptoms: item response theory (IRT) analysis. J Affect Disord. 2018;228(1):33-40.
18. Thayabaranathan T, Andrew NE, Stolwyk R, Lannin NA, Cadilhac DA. Comparing the EQ-5D-3L anxiety or depression domain to the hospital anxiety and depression scale to identify anxiety or depression after stroke. Top Stroke Rehabil. 2022;29(2):146-155.
19. Knapp P, Dunn RA, Sahib N, et al. Frequency of anxiety after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke. 2020;15(3):244-255.
20. Guo J, Wang J, Sun W, Liu X. The advances of post-stroke depression: 2021 update. J Neurol. 2022;269(3):1236-1249.
21. Chau JP, Lo SH, Zhao J, et al. Factors associated with post-stroke depression in Chinese stroke survivors. J Stroke Cerebrovasc Dis. 2021;30(11):106076.
22. Astuti P, Kusnanto K, Novitasari F. Depression and functional disability in stroke patients. J Public Health Res. 2020;9(2):1835.
23. Naess H, Lunde L, Brogger J. The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: the bergen stroke study. Vasc Health Risk Manag. 2012;8(1):407-413.
24. Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis. 2015;39(3-4):190-201.
25. Jönsson AC, Lindgren I, Hallström B, Norrving B, Lindgren A. Prevalence and intensity of pain after stroke: a population based study focusing on patients’ perspectives. J Neurol Neurosurg Psychiatry. 2006;77(5): 590-595.
26. Klit H, Finnerup NB, Overvad K, Andersen G, Jensen TS. Pain following stroke: a population-based follow-up study. PloS One. 2011;6(11):27607.
27. Şahin Onat Ş, Ünsal Delialioğlu S, Kulaklı F, Özel S. The effects of central post-stroke pain on quality of life and depression in patients with stroke. J Phys Ther Sci. 2016;28(1):96-101.
28. Payton H, Soundy A. The experience of post-stroke pain and the impact on quality of life: an integrative review. Behav Sci. 2020;10(8):128.