Post-stroke depression (PSD) and post-stroke emotional liability (PSEL) : a systematic review of non-pharmacological interventions for PSD, and a qualitative study of specialist professionals' conceptualisation of PSEL
Picton, Hannah Kathryn
Aims: a review of the literature on non-pharmacological interventions for post-stroke depression (PSD) was completed with the aim of examining issues regarding the design and methodology of trials for non-pharmacological interventions for PSD. The empirical research study used a constructivist Grounded Theory approach to explore specialist stroke professionals' conceptualisations of post-stroke emotional lability (PSEL). The author also aimed to examine how staff experienced, understood and identified PSEL in clinical practice, and particularly how they differentiated it from PSD. Method: A systematic review of RCT and non-RCT studies was conducted to address the first aim. In relation to the second aim, a qualitative investigation of specialist professionals' conceptualisations of PSEL was conducted using Charmaz' (2006) version of constructivist Grounded Theory. Results: The systematic review highlighted the importance of appropriate sampling methods, multiple treatment design, rigorous data collection, the implementation and monitoring of interventions, assessment of participant suitability for the intervention, and issues related to long-term sustainability (follow-up) when designing and evaluating non-pharmacological interventions for PSD. The qualitative investigation yielded a conceptual model of how specialist professionals conceptualise and identify PSEL in their clinical practice. Conclusions and implications: The findings from the systematic review and the qualitative investigation highlighted a range of issues for specialist stroke services. The systematic review emphasised the importance of further evaluation and consideration of carefully planned randomised controlled trials for investigating non-pharmacological interventions for PSD. The qualitative study indicated a need for further guidance on the assessment and identification of PSEL, training for staff, and further examination of the caused of PSEL.