Intimate Relationships and Stroke: Piloting a Dyadic Intervention to Improve Depression.

Alexandra L. Terrill,Justin J. MacKenzie,Jennifer J. Majersik,Brian R. W. Baucom,Beth Cardell,Maija Reblin,Lorie G. Richards,Jackie Einerson

doi:10.3390/ijerph19031804

Abstract

Stroke affects not only the survivor but also their romantic partner. Post-stroke depression is common in both partners and can have significant negative consequences, yet few effective interventions are available. The purpose of this study was to pilot test a novel 8-week remotely administered dyadic intervention (ReStoreD) designed to help couples better cope with stroke-related changes and reduce depressive symptoms. Thirty-four cohabitating survivor–partner dyads at least 3 months post-stroke and reporting some changes in mood were enrolled. Depressive symptoms were assessed pre- and post-intervention and at 3-month follow-up. Repeated measures analysis of variance was used to assess the effects of ReStoreD over time on depressive symptoms in stroke survivors and their partners. Twenty-six dyads completed the study. Although statistical significance was not reached, there was a large effect size for improvements in depressive symptoms for stroke survivors. There was no significant improvement for partners, and the effect size was minimal. Those with more significant depressive symptoms at baseline were more likely to benefit from the intervention. This pilot study established proof-of-concept by demonstrating that depressive symptoms can be lessened in stroke survivors and partners with more severe depressive symptoms. Future research will establish the efficacy of the intervention in a fully powered study.

Highlights

One-third of persons with stroke experience post-stroke depression (PSD), characterized by low mood, decreased energy, inability to feel pleasure in normally pleasurable activities, fatigue, and changes in appetite, concentration, and sleep [1]
We hypothesized that participating in the intervention would significantly improve depressive symptoms in both persons with stroke and care partners, and that improvements would be maintained at the 3-month follow-up
A growing body of evidence supports a biopsychosocial model for both etiology and treatment approaches [12,13,14,39], and recent recommendations highlight the need for interventions supporting the psychosocial needs of stroke survivor–care partner dyads [12,13,14]

Summary

Introduction

One-third of persons with stroke experience post-stroke depression (PSD), characterized by low mood, decreased energy, inability to feel pleasure in normally pleasurable activities (anhedonia), fatigue, and changes in appetite, concentration, and sleep [1]. The etiology of PSD is not well understood [2], though it is likely a combination of the physical and neurocognitive effects of the stroke itself, in addition to the psychological and social effects of a chronic medical condition. Depression occurs in up to 60% of stroke care partners [7]. Often a spouse/partner [8], provide emotional support to the person with stroke and help with symptom management and/or other care tasks. Care partner depression can contribute to social isolation and declines in their own personal health [9], as well as interfere with rehabilitation and increase the likelihood of re-hospitalization of the person with stroke [10]

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Discussion

Conclusion