Unmet Need for Social and Emotional Support and Lack of Recalled Screening Is Associated with Depression in the Long-Term Course After Stroke

Abstract

Purpose

Details on adequate care and prevalence of depression in long-term stroke aftercare are limited. We aimed to determine long-term depression rates after stroke and to test for an association between depression and inadequate screening, socio-economic complications and lack of sub-optimal care.

Patients and Methods

In this cross-sectional study, 57 patients were re-invited into the clinic 2–3 years after stroke. Patients were interviewed about recalled screening concerning depression and unmet needs. Depression, the patient’s social situation, and confounders were assessed by standardized scores.

Results

In our study, 20% (n = 11) of patients were classified as depressed by the HDRS-17 score result. However, only 36% of all patients recalled to have been previously screened for depression and only 43% of those patients also recalled out-patient screening. Patients classified as depressed reported significantly lower recalled screening rates (9% vs 43%; p = 0.036) and higher rates of self-reported unmet need with emotional problems (72% vs 18%; p < 0.001). Depression in our study was further associated with a worse socio-economic situation, fewer social contacts, unmet needs with regard to emotional problems and higher rates of recommendations to apply for additional social support.

Conclusion

Our data suggest that systematic out-patient screening for depression is lacking in stroke aftercare. Furthermore, the high rate of unmet emotional needs, the poor socio-economic situation and the higher rates of recommendations for social counselling and application for benefits suggest an undersupply of care in the out-patient setting that is more prominent in patients with depression and warrants further studies to investigate the underlying causes.

Keywords:

• health-care quality
• social-care
• risk management
• stroke
• depression

Acknowledgments

We thank Susanne Zöllner for help with data acquisition within the MAS-1 study and Dike Remstedt for help with data acquisition as well as for critically reviewing the English language and the wording of the manuscript.

Ethics and Informed Consent

All participants provided written informed consent and the study received full ethics committee and data protection approval by the institutional review board of Charité – Universitätsmedizin Berlin (reference EA1/183/14), and was registered on clinicaltrials.gov (NCT02320994).

Data Sharing Statement

Data are available based upon reasonable request from the corresponding author and the PI of the MAS study: Andreas Meisel: [email protected] and Inken Padberg: [email protected].

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

We acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charité – Universitätsmedizin Berlin. These sponsors had no involvement in any of the stages from study design to submission of the paper for publication.