Intimate Relationships and Stroke: Piloting a Dyadic Intervention to Improve Depression

Alexandra L Terrill, Maija Reblin, Justin J MacKenzie, Brian R W Baucom, Jackie Einerson, Beth Cardell, Lorie G Richards, Jennifer J Majersik, Alexandra L Terrill, Maija Reblin, Justin J MacKenzie, Brian R W Baucom, Jackie Einerson, Beth Cardell, Lorie G Richards, Jennifer J Majersik

Abstract

Stroke affects not only the survivor but also their romantic partner. Post-stroke depression is common in both partners and can have significant negative consequences, yet few effective interventions are available. The purpose of this study was to pilot test a novel 8-week remotely administered dyadic intervention (ReStoreD) designed to help couples better cope with stroke-related changes and reduce depressive symptoms. Thirty-four cohabitating survivor-partner dyads at least 3 months post-stroke and reporting some changes in mood were enrolled. Depressive symptoms were assessed pre- and post-intervention and at 3-month follow-up. Repeated measures analysis of variance was used to assess the effects of ReStoreD over time on depressive symptoms in stroke survivors and their partners. Twenty-six dyads completed the study. Although statistical significance was not reached, there was a large effect size for improvements in depressive symptoms for stroke survivors. There was no significant improvement for partners, and the effect size was minimal. Those with more significant depressive symptoms at baseline were more likely to benefit from the intervention. This pilot study established proof-of-concept by demonstrating that depressive symptoms can be lessened in stroke survivors and partners with more severe depressive symptoms. Future research will establish the efficacy of the intervention in a fully powered study.

Trial registration: ClinicalTrials.gov NCT03335358.

Keywords: caregiver; depression; dyadic intervention; positive psychology; post-stroke depression; stroke.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
CONSORT diagram.
Figure 2
Figure 2
Simplified APIM path model.

References

    1. Towfighi A., Ovbiagele B., El Husseini N., Hackett M.L., Jorge R.E., Kissela B.M., Mitchell P.H., Skolarus L.E., Whooley M.A., Williams L.S. Poststroke Depression: A Scientific Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2017;48:e30–e43. doi: 10.1161/STR.0000000000000113.
    1. Villa R.F., Ferrari F., Moretti A. Post-stroke depression: Mechanisms and pharmacological treatment. Pharmacol. Ther. 2018;184:131–144. doi: 10.1016/j.pharmthera.2017.11.005.
    1. Owolabi M.O. What Are the Consistent Predictors of Generic and Specific Post-Stroke Health-Related Quality of Life? Cerebrovasc. Dis. 2010;29:105–110. doi: 10.1159/000262305.
    1. Kutlubaev M.A., Hackett M.L. Part II: Predictors of Depression after Stroke and Impact of Depression on Stroke Outcome: An Updated Systematic Review of Observational Studies. Int. J. Stroke. 2014;9:1026–1036. doi: 10.1111/ijs.12356.
    1. Hadidi N., Treat-Jacobson D.J., Lindquist R. Poststroke depression and functional outcome: A critical review of literature. Heart Lung. 2009;38:151–162. doi: 10.1016/j.hrtlng.2008.05.002.
    1. Ayerbe L., Ayis S., Crichton S., Wolfe C.D.A., Rudd A.G. The long-term outcomes of depression up to 10 years after stroke; the South London Stroke Register. J. Neurol. Neurosurg. Psychiatry. 2014;85:514–521. doi: 10.1136/jnnp-2013-306448.
    1. Loh A.Z., Tan J.S., Zhang M.W., Ho R.C. The Global Prevalence of Anxiety and Depressive Symptoms Among Caregivers of Stroke Survivors. J. Am. Med Dir. Assoc. 2017;18:111–116. doi: 10.1016/j.jamda.2016.08.014.
    1. McCarthy M.J., Bauer E. In Sickness and in Health: Couples Coping with Stroke across the Life Span. Health Soc. Work. 2015;40:e92–e100. doi: 10.1093/hsw/hlv043.
    1. van Heugten C., Visser-Meily A., Post M., Lindeman E. Care for carers of stroke patients: Evidence-based clinical practice guidelines. J. Rehabil. Med. 2006;38:153–158. doi: 10.1080/16501970500441898.
    1. Perrin P.B., Heesacker M., Hinojosa M.S., Uthe C.E., Rittman M.R. Identifying at-risk, ethnically diverse stroke caregivers for counseling: A longitudinal study of mental health. Rehabil. Psychol. 2009;54:138–149. doi: 10.1037/a0015964.
    1. Perrin P.B., Heesacker M., Stidham B.S., Rittman M.R., Gonzalez-Rothi L.J. Structural equation modeling of the relationship between caregiver psychosocial variables and functioning of individuals with stroke. Rehabil. Psychol. 2008;53:54–62. doi: 10.1037/0090-5550.53.1.54.
    1. McCarthy M.J., Lyons K.S., Powers L.E. Expanding Poststroke Depression Research: Movement Toward a Dyadic Perspective. Top. Stroke Rehabil. 2011;18:450–460. doi: 10.1310/tsr1805-450.
    1. Bakas T., Clark P.C., Kelly-Hayes M., King R.B., Lutz B.J., Miller E.L. Evidence for Stroke Family Caregiver and Dyad Interventions: A statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke. 2014;45:2836–2852. doi: 10.1161/STR.0000000000000033.
    1. Bakas T., McCarthy M., Miller E.T. State-of-the-Science Nursing Review: Update on the State of the Evidence for Stroke Family Caregiver and Dyad Interventions. Stroke. 2017;48:e122–e125. doi: 10.1161/STROKEAHA.117.016052.
    1. Terrill A.L., Reblin M., MacKenzie J.J., Cardell B., Einerson J., Berg C.A., Majersik J.J., Richards L. Development of a novel positive psychology-based intervention for couples post-stroke. Rehabil. Psychol. 2018;63:43–54. doi: 10.1037/rep0000181.
    1. Seligman M.E.P., Steen T.A., Park N., Peterson C. Positive Psychology Progress: Empirical Validation of Interventions. Am. Psychol. 2005;60:410–421. doi: 10.1037/0003-066X.60.5.410.
    1. Dunn D.S., Dougherty S.B. Prospects for a Positive Psychology of Rehabilitation. Rehabil. Psychol. 2005;50:305–311. doi: 10.1037/0090-5550.50.3.305.
    1. Alschuler K.N., Arewasikporn A., Nelson I.K., Molton I.R., Ehde D.M. Promoting resilience in individuals aging with multiple sclerosis: Results from a pilot randomized controlled trial. Rehabil. Psychol. 2018;63:338–348. doi: 10.1037/rep0000223.
    1. Cohn M.A., Pietrucha M.E., Saslow L.R., Hult J.R., Moskowitz J.T. An online positive affect skills intervention reduces depression in adults with type 2 diabetes. J. Posit. Psychol. 2014;9:523–534. doi: 10.1080/17439760.2014.920410.
    1. Müller R., Gertz K.J., Molton I.R., Terrill A., Bombardier C.H., Ehde D., Jensen M.P. Effects of a Tailored Positive Psychology Intervention on Well-Being and Pain in Individuals with Chronic Pain and a Physical Disability: A feasibility trial. Clin. J. Pain. 2016;32:32–44. doi: 10.1097/AJP.0000000000000225.
    1. Bolier L., Haverman M., Westerhof G.J., Riper H., Smit F., Bohlmeijer E. Positive psychology interventions: A meta-analysis of randomized controlled studies. BMC Public Health. 2013;13:119. doi: 10.1186/1471-2458-13-119.
    1. Sin N.L., Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: A practice-friendly meta-analysis. J. Clin. Psychol. 2009;65:467–487. doi: 10.1002/jclp.20593.
    1. Cohn M.A., Fredrickson B.L. In search of durable positive psychology interventions: Predictors and consequences of long-term positive behavior change. J. Posit. Psychol. 2010;5:355–366. doi: 10.1080/17439760.2010.508883.
    1. Cook W.L., Kenny D.A. The Actor–Partner Interdependence Model: A model of bidirectional effects in developmental studies. Int. J. Behav. Dev. 2005;29:101–109. doi: 10.1080/01650250444000405.
    1. van Belle G. Statistical Rules of Thumb. Wiley & Sons; New York, NY, USA: 2002.
    1. Kroenke K., Spitzer R.L., Williams J.B. The Patient Health Questionnaire-2: Validity of a two-item depression screener. Med. Care. 2003;41:1284–1292. doi: 10.1097/01.MLR.0000093487.78664.3C.
    1. Nasreddine Z.S., Phillips N.A., Bédirian V., Charbonneau S., Whitehead V., Collin I., Cummings J.L., Chertkow H. The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment. J. Am. Geriatr. Soc. 2005;53:695–699. doi: 10.1111/j.1532-5415.2005.53221.x. Corrigendum in J. Am. Geriatr. Soc. 2019, 67, 1991.
    1. Barnay J.-L., Wauquiez G., Bonnin-Koang H., Anquetil C., Pérennou D., Piscicelli C., Lucas-Pineau B., Muja L., le Stunff E., de Boissezon X., et al. Feasibility of the Cognitive Assessment scale for Stroke Patients (CASP) vs. MMSE and MoCA in aphasic left hemispheric stroke patients. Ann. Phys. Rehabil. Med. 2014;57:422–435. doi: 10.1016/j.rehab.2014.05.010.
    1. Flowers H.L., Skoretz S.A., Silver F.L., Rochon E., Fang J., Flamand-Roze C., Martino R. Poststroke Aphasia Frequency, Recovery, and Outcomes: A Systematic Review and Meta-Analysis. Arch. Phys. Med. Rehabil. 2016;97:2188–2201.e8. doi: 10.1016/j.apmr.2016.03.006.
    1. Sexton E., McLoughlin A., Williams D.J., Merriman N.A., Donnelly N., Rohde D., Hickey A., Wren M.-A., Bennett K. Systematic review and meta-analysis of the prevalence of cognitive impairment no dementia in the first year post-stroke. Eur. Stroke J. 2019;4:160–171. doi: 10.1177/2396987318825484.
    1. Harris P.A., Taylor R., Thielke R., Payne J., Gonzalez N., Conde J.G. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform. 2009;42:377–381. doi: 10.1016/j.jbi.2008.08.010.
    1. Pilkonis P.A., Yu L., Dodds N.E., Johnston K.L., Maihoefer C.C., Lawrence S.M. Validation of the depression item bank from the Patient-Reported Outcomes Measurement Information System (PROMIS®) in a three-month observational study. J. Psychiatr. Res. 2014;56:112–119. doi: 10.1016/j.jpsychires.2014.05.010.
    1. Schalet B.D., Pilkonis P.A., Yu L., Dodds N., Johnston K.L., Yount S., Riley W., Cella D. Clinical validity of PROMIS Depression, Anxiety, and Anger across diverse clinical samples. J. Clin. Epidemiol. 2016;73:119–127. doi: 10.1016/j.jclinepi.2015.08.036.
    1. Virani S.S., Alonso A., Benjamin E.J., Bittencourt M.S., Callaway C.W., Carson A.P., Chamberlain A.M., Chang A.R., Cheng S., Delling F.N., et al. Heart Disease and Stroke Statistics—2020 Update: A Report from the American Heart Association. Circulation. 2020;141:e139–e596. doi: 10.1161/CIR.0000000000000757.
    1. White I.R., Horton N., Carpenter J., Pocock S.J. Strategy for intention to treat analysis in randomised trials with missing outcome data. BMJ. 2011;342:d40. doi: 10.1136/bmj.d40.
    1. Lee S.-Y., Song X.-Y. Evaluation of the Bayesian and Maximum Likelihood Approaches in Analyzing Structural Equation Models with Small Sample Sizes. Multivar. Behav. Res. 2004;39:653–686. doi: 10.1207/s15327906mbr3904_4.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Routledge Academic; New York, NY, USA: 1988.
    1. Cohen J. A power primer. Psychol. Bull. 1992;112:155–159. doi: 10.1037/0033-2909.112.1.155.
    1. Pucciarelli G., Vellone E., Savini S., Simeone S., Ausili D., Alvaro R., Lee C.S., Lyons K.S. Roles of Changing Physical Function and Caregiver Burden on Quality of Life in Stroke. Stroke. 2017;48:733–739. doi: 10.1161/STROKEAHA.116.014989.
    1. Tseung V., Jaglal S.B., Salbach N.M., Cameron J.I. Implementing Caregiver Support Programs in a Regional Stroke System. Stroke. 2019;50:3585–3591. doi: 10.1161/STROKEAHA.119.026660.
    1. Creasy K.R., Lutz B.J., Young M.E., Ford A., Martz C. The Impact of Interactions with Providers on Stroke Caregivers’ Needs. Rehabil. Nurs. 2013;38:88–98. doi: 10.1002/rnj.69.
    1. Jia Y., Shi J., Sznajder K.K., Yang F., Cui C., Zhang W., Yang X. Positive effects of resilience and self-efficacy on World Health Organization Quality of Life Instrument score among caregivers of stroke inpatients in China. Psychogeriatrics. 2021;21:89–99. doi: 10.1111/psyg.12635.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren