Study finds relation between depressed mental state of stroke survivors and caregivers

SINGAPORE- Researchers from the Duke-NUS Medical School have found that symptoms of depression in stroke survivors and their family caregivers are connected: the worse the depressive symptoms of the survivor, the higher the likelihood of the caregiver being depressed and vice versa.

Researchers say this relationship is significant as depression in stroke patients can increase recovery time and even mortality rates. Furthermore, symptoms of depression, such as feeling lonely and having trouble focusing on routine activities, adversely affect the health and quality of life of stroke survivors and their families.

The study published in this month's issue of the Journal of Stroke and Cerebrovascular Diseases followed 172 stroke survivors and their respective family caregivers at the St Andrew's Community Hospital in Singapore. The 172 pairs were interviewed three times over the course of a year, post-stroke.

Both stroke survivors and caregivers had to rate the frequency of their depressive symptoms on a scale of zero to three for a total of 20 statements such as I felt lonely or I had crying spells.

The maximum score was 60 but a score of 16 and above denoted clinically significant depressive symptoms. On average, all stroke survivors rated above 16 on the scale during the first interview.

Survivors were then sorted into three categories for their depressive symptoms, high and increasing, low and increasing and low and decreasing. The average starting score for the high and increasing category was 38 and above on the scale. For the low categories, it was 20. Caregivers were sorted into two categories, high and decreasing and low and stable where the average starting score for the high category was 28 and the low category, 11.

"Our results show that an increase in depressive symptoms for stroke survivors results in higher risk of caregivers having depression and vice versa," said Dr Rahul Malhotra who, along with Dr David Matchar, led the team of researchers.

They also found the presence of foreign domestic workers as caregivers alleviated depressive symptoms in family caregivers, added Dr Matchar.

In the high and increasing category of stroke survivors, almost half of their respective caregivers were classed in the high and decreasing category. In the low and increasing category of patients, one third of their caregivers also started with higher levels of depressive symptoms that improved as they learnt to cope. But in the low and decreasing category of survivors, only 18 per cent of their caregivers were in this high and decreasing category.

"The mental health of stroke survivors and their family caregivers is interrelated," said Dr Malhotra. "Health and social care professionals caring for stroke survivors should also make an effort to reach out to family caregivers. For example, nurses at rehabilitation clinics could survey accompanying caregivers to find out if they are showing any depressive symptoms."

He added that informational brochures could be printed, with contact numbers for caregivers needing additional help.

"The stigma of depression can prevent caregivers from seeking help. But caregivers need to take care of themselves, not just for their own sake but also for their patients."