Exploring the acceptability and effectiveness of psychosocial interventions for stroke patients experiencing depression

Abstract

Post-stroke depression (PSD) is highly prevalent and has a significant impact on stroke patients’ recovery. The systematic review aimed to build on previous review evidence to investigate the effectiveness of psychosocial interventions on reducing depression levels post-stroke. Multiple electronic databases were searched using a combination of keywords related to depression, stroke and psychosocial interventions. Randomised controlled trials investigating the effect of psychosocial interventions on depression levels for adult stroke patients were included. Methodological quality of included studies was assessed using criteria developed by the authors. Sixteen studies were included, four of which found a significant benefit of psychosocial interventions over control conditions on mood. While the results suggest some psychosocial interventions may be effective in reducing depression post-stroke; confidence in these findings is limited due to methodological limitations within studies. The review identified a number of methodological limitations across all included studies which may explain why previous research has not found any benefit of psychosocial interventions for PSD. Therefore, the evidence base is currently insufficient and further research which utilises a robust methodology is needed before any reliable conclusions can be drawn regarding the effectiveness of psychosocial interventions for PSD. The empirical study aimed to explore participants’ experiences of an Interpersonal Psychotherapy (IPT) assessment and formulation post-stroke to investigate the acceptability of using this model with patients experiencing PSD and indicate if more detailed quantitative research is justified. Ten participants with post-stroke depression (PSD) received two assessment appointments with a Clinical Psychologist, generating an IPT formulation of their difficulties. Participants subsequently took part in a semi-structured interview about their experience of this process. The results of these interviews were transcribed and analysed using Framework Analysis. Participants were seen to link their difficulties post-stroke to three of the four IPT interpersonal focus areas; interpersonal disputes, role transitions and grief loss. Overall, participants found an IPT assessment and formulation to be acceptable and identified benefits of the sessions including: altering their viewpoint, increasing acceptance of impaired functioning, reducing frustration, increasing positive feelings and leading to improvements in their social support. IPT may therefore be a suitable intervention for PSD and further robust, quantitative research is justifiable. Results suggest acceptance and an altered viewpoint are common following an IPT assessment and formulation; therefore future IPT research should measure changes in these variables alongside mood and behaviour.