Short-Term Trajectories of Depressive Symptoms in Stroke Survivors and Their Family Caregivers

• Published in: Journal of stroke and cerebrovascular diseases Vol. 25; no. 1; pp. 172 - 181
• Main Authors: Malhotra, Rahul, MBBS, MD, MPH, Chei, Choy-Lye, PhD, Menon, Edward, FAMS (Rehab Med), Chow, Wai Leng, MBBS, GDFM, Quah, Stella, PhD, Chan, Angelique, PhD, Matchar, David Bruce, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Aged; Aged, 80 and over; Cardiovascular; caregivers; Caregivers - psychology; depression; Depression - epidemiology; Depression - etiology; Disability Evaluation; Disease Progression; Female; Follow-Up Studies; Humans; longitudinal studies; Male; Middle Aged; Models, Psychological; Neurology; Severity of Illness Index; Singapore; Singapore - epidemiology; Socioeconomic Factors; Stroke; Stroke - psychology; Survivors - psychology; caregivers; Stroke; Singapore; depression; longitudinal studies
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.012

Goal We utilize group-based trajectory modeling (GBTM) to delineate depressive symptom trajectories among stroke survivor–caregiver dyads, to identify predictors of the delineated trajectories, and to assess the influence of time-varying covariates (stroke survivor depressive symptoms and functional disability, caregiver depressive symptoms, and foreign domestic worker [FDW] assistance) on the level of the depressive symptom trajectories. Methods Data on 172 stroke survivor–caregiver dyads in Singapore, for whom depressive symptoms were assessed thrice (baseline/3 months/6 months), were utilized. GBTM was applied to delineate depressive symptom trajectories, and to identify their predictors and time-varying covariates. Findings Three stroke survivor depressive symptom trajectories ( low and decreasing [47.6%], low and increasing [43.1%], and high and increasing [9.3%]) and 2 caregiver depressive symptom trajectories ( low and stable [71.5%] and high and decreasing [28.5%]) were delineated. Caregivers with chronic diseases were more likely (odds ratio [95% confidence interval]: 8.09[2.04-32.07]) and those caring for older stroke survivors (0.94[0.90-0.98]) were less likely to follow the high and decreasing than the low and stable depressive symptom trajectory. An increase in stroke survivor functional disability and caregiver depressive symptoms led to a rise (~worsening) in stroke survivor depressive symptom trajectories. Whereas an increase in stroke survivor depressive symptoms led to a rise in caregiver depressive symptom trajectories, FDW assistance led to a decline (~improvement). Conclusion Care professionals should be mindful of heterogeneity in depressive symptom patterns over time among stroke survivor–caregiver dyads. Reciprocal association of depressive symptoms in the stroke survivor–caregiver dyad suggests that addressing mood problems in 1 member may benefit the other member, and calls for dyadic mental health interventions.