Addressing Poststroke Depression
Enhancing Screening, Prevention, and Management Through Evidence-Based Practices
Poststroke depression is the most common emotional disorder following an acute ischemic stroke, impacting about one-third of stroke survivors at different stages. This condition not only increases morbidity and mortality rates but also hampers rehabilitation efforts, reduces overall quality of life, and potentially prolongs hospital stays.
Common symptoms of poststroke depression include loss of interest, restlessness, altered sleep patterns, behavioural changes, feelings of worthlessness, distraction, and at times, suicidal thoughts. Timely recognition and treatment of these symptoms are crucial to prevent worse long-term outcomes.
Recognising patients at high risk of poststroke depression could facilitate early detection of symptoms, particularly in the initial months critical for neurological and functional recovery. Early prevention and intervention may decrease the incidence of poststroke depression, improve the quality of life of patients, and reduce disease recurrence.
Reported risk factors for poststroke depression include being female, age, living alone, prior stroke history, cognitive impairment, functional dependence, and a history of depression before stroke. Physical disability and previous depression history emerge as the most influential risk factors.
A number of guidelines and JBI evidence summaries have been developed to aid nurses in screening, preventing, and managing poststroke depression in stroke patients. Various screening tools, such as the Centre of Epidemiological Studies Depression Scale, Hamilton Depression Rating Scale, and Patient Health Questionnaire-9, are recommended for their high sensitivity and specificity, with the Hamilton Depression Rating Scale being widely utilised.
In China, nursing management of poststroke depression often relies on nurses' experience and subjective judgment rather than evidence-based strategies. Prioritising the development and implementation of evidence-based approaches is therefore crucial to improve the screening, prevention, and management of poststroke depression.
A best practice implementation project was conducted in a neurology ward at the Fifth Affiliated Hospital of Zunyi Medical University, China. This initiative aimed to improve screening, prevention, and management of poststroke depression by increasing the adherence to evidence-based practices. Guided by the JBI evidence implementation framework, the project used JBI PACES for clinical audits and GRiP (Getting Research into Practice).
The paper documenting this best practice implementation is available in the December 2023 issue of JBI Evidence Implementation:
Screening, prevention, and management of patients with poststroke depression in a tertiary hospital in China: a best practice implementation project
Tan, Jing; Brancatisano, Olivia; Cadilhac, Dominique A.; Deng, Bo; Wu, Yanni; Li, Yan; Liu, Ning
JBI Evidence Implementation. 21(4):325-334, December 2023.