Investigation Of Anxiety And Depression In Acute Phase And Convalescence Patients With Stroke And Research For Its Influencing Factors

ObjectivesTo applicate the Patient-Reported Outcome(PRO) in research for mental health in stroke patients; to develop and test the recovery satisfaction questionnaire of Patient-Reported Outcome(PRO); to investigate and do longitudinal comparison of the stroke patients’ mental health status in acute and recovery phase(the course of disease was three months and six months) and analyze its associated factors.MethodsThrough the literature review and consultation of specialist doctors, nursing experts and interview of some patients, the recovery satisfaction questionnaire was developed and the reliability and validity of the questionnaire was analyzed.The study was a prospective investigation. Hospitalized stroke patients in Department of internal medicine were included according to the inclusion and exclusion criteria by convenience sampling method. Baseline data was collected before discharge(acute period). At 3 months, 6 months after stroke(recovery period), the physical and mental status of patients were reevaluated by PRO questionnaire including body pain questionnaire, fatigue, Barthel index, social support scale, rehabilitation and satisfaction questionnaire, and HADS. The activity level of patients were recorded by self-reported physical activity diary and short version of IPAQ. Data were entered and analyzed using statistical software SPSS16.0.Results1 PRO recovery satisfaction questionnaire reliability and validity analysis There were 17 items in the recovery satisfaction questionnaire and factor analysis showed that it consisted of three dimensions: rehabilitation environment, recovery expectation and rehabilitation level. The varimax rotation factor analysis identified six principal factors and explain 75.044% variance. Total Cronbach’s alpha was 0.843, and the split half reliability coefficient was 0.906. Cronbach’s alpha of the dimensions were between 0.708~0.910, and split half reliability coefficient were 0.724~0.906.2 Comparative analysis of the mental health in stroke patients and its influencingfactors2.1 In this study, the anxiety score of patients was 6.9 ± 3.9, 6.1 ± 4.0, 6.1 ± 3.4 in the acute and recovery phase(at 3 month and 6 month after stroke) respectively, the incidence of anxiety symptoms were 33.3%, 26.1% and 22.5% in the follow-up, with no significant difference between groups(χ2=3.387, p=0.184); the score of depressive symptoms were 6.81 ± 4.2, 6.94 ± 3.8, 6.4 ± 2.6 respectively, and the incidence of depression was 32.4%, 37.8% and 36%, with no significant difference between groups(χ2=0.735, p=0.692).2.2 Sex(AOR=1.080, 95%C.I.=1.011~1.153, p=0.022),age(AOR=0.146, 95%C.I.=0.034~0. 630, p=0.010), social support(AOR=0.928, 95%C.I.=0.839~0.987, p=0.025) and NIHSS score on admission(AOR=1.248, 95%C.I.=1.046~1.491, p=0.014) were associated factors of anxiety symptom in patients with acute stroke, which explained 31.4% variance. Age(AOR=0.815, 95%C.I.=0.683~0.971, p=0.022), social support(AOR=0.933, 95%C.I.=0.881~0.988, p=0.019) and higher NIHSS score on admission(AOR=1.499, 95%C.I.=1.155~1.945, p=0.002) were related to depression in acute phase, which explained 40.7% variance of depression score.The influence factors of anxiety in stroke patients at 3 month were sex(AOR=5.423,95%C.I.=1.933~15.210,p=0.001),age(AOR=0.930,95%C.I.=0.867~0.997, p=0.041) and impact of fatigue on life(AOR=0.630, 95%C.I.=0.411~0.967, p=0.034). All of these explained the 32.3% variance of anxiety score. Social support(AOR=0.976,95%C.I.=0.918~0.996,p=0.032),BI(AOR=0.867, 95%C.I.=0.679~0.986, p=0.035), influence of fatigue on life(AOR=0.549, 95%C.I.=0.386~0.782, p=0.001), physical activity level(AOR=1.151, 95%C.I.=1.027~1.291, p=0.016) were associated with depression, which explained 33.6%variance. At 6 month, physical activity(AOR=1.317,95%C.I.=1.055~1.644, p=0.015), the effect of fatigue on life(AOR=0.356, 95%C.I.=0.173~0.734, p=0.005) can explain 43.8% variance of anxiety; rehabilitation satisfaction(AOR=0.857, 95%C.I.=0.781~0.941, p=0.001), social support(AOR=0.930,95%C.I.=0.867~0.997, p=0.041), BI score(AOR=0.974, 95%C.I.=0.955~0.993, p=0.007) and the effect of fatigue on life(AOR=0.391, 95%C.I.= 0.242~0.633, p<0.001) were the protective factors of depression in patients at 6 month, which can explain 46.7% variance of depression in stroke patients.Conclusion1 The Patient-Reported Outcome(PRO) is a measure of rehabilitation outcome from the patient’s perspective, which reflect the social psychological status and perceived health condition of the patients in acute and recovery phase of stroke effectively. As a part of PRO, the preliminary development of recovery satisfaction questionnaire has a good reliability and validity.2 Prevalence of anxiety in patients of the acute and recovery phase showed a trend to decrease with no significance, and depression had no statistical change despite of subtle fluctuation. Social support and body symptoms were not significantly changed during the 6 month follow-up, while activities of daily living, physical activity level and recovery satisfaction of the patients were improved.3 Social support is a protective factor on patient’s mental health in both acute and recovery phase of stroke, and BI is the protective factors of mental health in recovery period, the impact of fatigue on daily life is associated with anxiety and depression of patients, but the causal relationship needs further verification. The level of physical activity during the recovery period is a risk factor for patient’s mental health, suggesting that the medical staff and patients should pay attention to safety during activities. In a word, the influence factors of mental health in patients with stroke are given priority to disease characteristics and socio-demographic factors in acute period, and physical function and psycho-social factors in recovery period.