Abstract
In the first two years after stroke approximately one-third of the patients suffer from depression, also referred to as post-stroke depression (PSD). Patients with PSD suffer from symptoms, such as a diminished interest or pleasure (anhedonia), depressed mood, sleep disturbances, loss of energy, changes in appetite, feelings of inappropriate guilt,
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concentration difficulties, psychomotor retardation or agitation, and suicidal thoughts. PSD aggravates the burden of physical, psychological and social disability after a stroke and hinders patient participation in rehabilitation. Therefore, the timely recognition and diagnosis of PSD is essential for the optimization of patient recovery from stroke. In this thesis, first, the role of nurses in the daily care of depressed stroke patients is studied in a systematic literature review, focusing on the early detection of PSD and therapeutic interventions that they can use. The findings showed that nurses distinguished a screening role from an intervening role. They recognized symptoms of depression, however, they experienced the assessment of psychological status as difficult because of a lack of knowledge, skills, and training. Measurement scales supporting their observations were seldom used. We also investigated the clinical manifestation of PSD as compared to patients with symptomatic atherosclerotic diseases other than stroke or with patients in general practice. The findings demonstrated broadly similar symptom profiles in the three cohorts, showing that PSD is not a different type of depression. However, the stroke patients suffered more severely from these symptoms than the patients with other symptomatic atherosclerotic diseases or the patients in general practice. Subsequently, the clinimetric properties of the 9-item and the 2-item Patient Health Questionnaire (PHQ-9, PHQ-2) were investigated in daily nursing practice of hospitalized patients with stroke able to communicate adequately. The inter-rater reliability, the test re-test reliability and the internal consistency of the PHQ-9 were shown to be good. Nurses judged the PHQ-9 to be a brief and easy-to-use instrument in daily practice of nursing stroke care. The PHQ-9 performed best at a score ≥10 and the PHQ-2 at a score ≥2. Administering the PHQ-9 only to patients who scored ≥2 on the PHQ-2 improved the identification of depression. The timely detection of PSD, however, is complicated by a decrease in the length of hospital stay, resulting in a large proportion of patients who are discharged within two weeks after stroke. Therefore, we developed and validated the Post-Stroke Depression Prediction Scale (DePreS).This prediction rule enables clinicians to estimate the degree of the depression risk for an individual patient within the first week after stroke. The prediction could be used as the basis for a more selective screening process for PSD. In conclusion, to decrease the burden of PSD and the negative impact on patients' recovery health care providers, such as nurses, taking care of patients with stroke should use valid and reliable assessment tools in order to detect PSD, which needs to be followed by effective and efficient treatment.
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