Group cognitive behavioural therapy for stroke survivors with depression and their carers

Abstract

Background: Depression in stroke survivors is common, leads to poorer outcomes and often not treated. A group cognitive behavioural therapy (CBT) program (Brainstorm) for stroke survivors with depression, and their carers has been running as part of usual care since 2007.

Objective: To evaluate the implementation and acceptability of Brainstorm, a closed group intervention consisting of up to 10 sessions of education, activity planning, problem solving and thought challenging.

Methods: Participating stroke survivors and their carers complete assessment measures at baseline, post-treatment and 1-month and 6-months follow-up. A mixed models for repeated measures data was conducted with depression and anxiety scores for stroke survivors (Beck Depression Inventory-II; Hospital Anxiety and Depression Scale) and the assessment of depression, anxiety and carer burden for carers. Acceptability was assessed by session attendance and written and open participant feedback upon completion of the program.

Results: Forty-eight community dwelling stroke survivors and 34 carers attended Brainstorm, with a median attendance of 88% of sessions. Follow-up assessments were completed by 77% (post-treatment), 46% (1-month) and 38% (6-month) of stroke survivors. Stroke survivors’ depression scores decreased from baseline to post-treatment (p<.001); maintained at 1-month (p<.001) but not at 6-month (p=.056). Anxiety scores decreased between baseline and 1-month (p=.013). Carer burden, depression and anxiety scores at 1-month and 6-month follow-up, for carers, were all reduced when compared with baseline (p<.05).

Conclusion: The Brainstorm group intervention for depression in stroke survivors appears to have been effectively implemented and is acceptable to stroke survivors and carers.

Keywords:

• Cognitive behaviour therapy
• depression
• group therapy
• stroke
• anxiety
• carers

Disclaimer Statements

Contributors AT, JAH, ALS, JHW, MLH: Intervention development and assessment design. SKW, AT, JAH, ALS: Group co-facilitators, data collection and entry. SKW, MEV: Data cleaning. SKW, MEV, AT, SAH: Data analysis and interpretation, manuscript preparation. All authors contributed to development of the final manuscript.

Funding

Development of the Brainstorm program was funded by the Hunter Stroke Service. During the completion of this work, MLH received a National Health and Medical Research Council Population Health Career Development Award 632925 (2010 -13) and a National Heart Foundation Future Leader Fellowship, Level 2, 100034 (2014 -17). These funding bodies had no role in the conduct or reporting of this study.

Conflicts of interest

The authors declare no conflict/s of interest. The authors alone are responsible for the content and writing of the paper.

Acknowledgements

The authors wish to thank the facilitators of the Brainstorm program, the stroke survivors and carers who participated in the program, and the services from which they were referred. Acknowledgments and thanks also to Hunter Stroke Service and Community Stroke Team staff involved in program development and implementation.

Funding

Development of the Brainstorm program was funded by the Hunter Stroke Service. During the completion of this work, MLH received a National Health and Medical Research Council Population Health Career Development Award 632925 (2010–13) and a National Heart Foundation Future Leader Fellowship, Level 2, 100034 (2014–17). These funding bodies had no role in the conduct or reporting of this study.

Ethical approval

Analysis of the outcome data and publication and dissemination of results were approved by the Hunter New England Human Research Ethics Committee [13/05/ 15/5.06] and the University of Newcastle Human Research Ethics Committee [H-2013-0166]. As the outcome measures were given as part of a service evaluation project, completion of the measures was deemed sufficient consent, as participants who completed the measures did so with full knowledge that the results would be used to evaluate the program.