Exploring the experience of psychological morbidity and service access in community dwelling stroke survivors: a follow-up study

Abstract

Purpose: Post-stroke depression occurs in one-third of stroke survivors with a similar risk of development across short, intermediate and long-term recovery stages. Knowledge of factors influencing psychological morbidity beyond the first year post-stroke can inform long-term interventions and improve community service access for stroke survivors. This paper aimed to identify the physical and psycho-social functioning status of stroke survivors beyond 12 months post-stroke. Qualitative processes explored the longer term experiences of psychological morbidity and service access needs. Method: A cross-sectional follow-up of participants from a prospective cohort study. In that study, patients and were followed for 12 months post-stroke. In this study, participants from that cohort study were interviewed up to five years post-stroke. Data generation and analysis were concurrent and were analysed thematically, employing a process of constant comparison. Results: Our sample included 14 participants, aged 58–89 years at an average of three years post-stroke (range 18 months to five years). Our qualitative key themes emerged as follows: physical impacts on post-stroke psychological morbidity, the experience of psychological distress, factors attenuating distress and service delivery implications. Conclusions: The experience of psychological morbidity persists beyond 12 months post-stroke, having a profound impact on community access, and social participation. Clinical implications are a need for long-term psychological monitoring post-stroke and for ongoing rehabilitation that addresses disability, community participation and social support.

Implications for Rehabilitation

• Psychological distress post-stroke is complex and persists over time, thus requiring longer term monitoring beyond the first 12 months of stroke onset.

• Longer term access to allied health can play a significant role in providing interventions that address distress and maintain community participation.

• If patients meet threshold scores at any time, then GPs should consider initiating appropriate treatment, including pharmacotherapy, referral to psychotherapy and referral to community stroke rehabilitation.

• Outcomes
• post-stroke depression
• qualitative
• rehabilitation
• stroke

Acknowledgements

We thank all the participants in the study and staff from the Hunter Stroke Service and the University of Newcastle who also supported the study.