Depression is a sufficiently common sequela of a completed ischemic stroke to warrant intervention to improve social and functional outcome after stroke. PSD is associated with worse social and functional outcome as much as ten years post-stroke, poorer cognitive status, increased medical costs, impaired rehabilitation response, delayed return to work, and increased long-term mortality. The primary aim of this study is to determine the effect of a nurse-delivered psychosocial/behavioral intervention on reduction of depression in community dwelling post-stroke patients. We expect the combined behavioral and pharmacologic intervention to be more effective than pharmacotherapy alone in sustaining the improvement in depression for the experimental group. Secondary aims are to examine the effect of the psychosocial/behavioral intervention time course and sustainability of response to treatment, effect on limitations in ability, limitation in participation and overall stroke impact in community-dwelling post-stroke patients. 150 patients at three University of Washington affiliated hospitals that comprise the UW Stroke Assessment and Treatment center, who are found to be depressed within the first four months following ischemic stroke will be invited to join the study, and randomly assigned to a problem-solving/pleasant events intervention provided by an advanced practice nurse, or to regular clinic follow-up. Both groups will receive standard antidepressant treatment and written materials from the American Stroke Association, and will be assessed for up to two years following the study. The primary outcome is reduction in depression at 12 months following stroke. Secondary outcomes are reductions in limitations in activity (Barthel Index), reduction in limitation in participation (Stroke Impact Scale) and overall stroke impact (Stroke Impact Scale) at 6, 12, and 24 months post- stroke. We hypothesize that all patients will improve their mood and functional ability related to their post-stroke standard treatment, but that those who receive the psychosocial intervention will have significantly greater improvement in mood, functional ability, social participation, and less overall stroke impact at all follow-up measurement.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
1R01NR007755-01A1
Application #
6466559
Study Section
Nursing Research Study Section (NURS)
Program Officer
Tully, Lois
Project Start
2002-03-01
Project End
2007-02-28
Budget Start
2002-03-01
Budget End
2003-02-28
Support Year
1
Fiscal Year
2002
Total Cost
$341,400
Indirect Cost
Name
University of Washington
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
135646524
City
Seattle
State
WA
Country
United States
Zip Code
98195
Kirkness, Catherine J; Cain, Kevin C; Becker, Kyra J et al. (2017) Randomized trial of telephone versus in-person delivery of a brief psychosocial intervention in post-stroke depression. BMC Res Notes 10:500
Mitchell, Pamela H (2016) Nursing Assessment of Depression in Stroke Survivors. Stroke 47:e1-3
Choi-Kwon, Smi; Mitchell, Pamela H; Kim, Jong S (2015) Nursing Interventions for Poststroke Fatigue. Stroke 46:e224-7
Kohen, Ruth; Cain, Kevin C; Buzaitis, Ann et al. (2011) Response to psychosocial treatment in poststroke depression is associated with serotonin transporter polymorphisms. Stroke 42:2068-70
Choi-Kwon, Smi; Mitchell, Pamela H; Veith, Richard et al. (2009) Comparing perceived burden for Korean and American informal caregivers of stroke survivors. Rehabil Nurs 34:141-50
Mitchell, Pamela H; Veith, Richard C; Becker, Kyra J et al. (2009) Brief psychosocial-behavioral intervention with antidepressant reduces poststroke depression significantly more than usual care with antidepressant: living well with stroke: randomized, controlled trial. Stroke 40:3073-8
Kohen, Ruth; Cain, Kevin C; Mitchell, Pamela H et al. (2008) Association of serotonin transporter gene polymorphisms with poststroke depression. Arch Gen Psychiatry 65:1296-302
Mitchell, Pamela H; Teri, Linda; Veith, Richard et al. (2008) Living well with stroke: design and methods for a randomized controlled trial of a psychosocial behavioral intervention for poststroke depression. J Stroke Cerebrovasc Dis 17:109-15