Mental states of stroke survivors, caregivers are interlinked: Study

SINGAPORE — The mental health of a stroke patient and that of his caregiver are linked, with an increase in depressive symptoms in one party often associated with the same in the other.

Findings of a study, which tracked 172 pairs of stroke patients and caregivers for up to a year, suggest that professionals caring for patients post-stroke should also reach out to their caregivers, especially if they find patients showing symptoms of depression, said Duke-NUS Medical School researchers who led the study.

Stroke is among the most common causes of death here and studies have shown about 30 per cent of survivors having clinical depression after stroke.

Past studies have found that a depressed caregiver was more likely to have a depressed stroke survivor and vice versa, but there is a lack of studies assessing how depressive symptoms progress over time in patient-caregiver pairs, said Assistant Professor Rahul Malhotra of Duke-NUS Medical School, who led the study with Professor David Matchar.

The 172 pairs were interviewed thrice between November 2010 and December 2012. The stroke survivors were aged 71 on average while the caregivers — mainly children and spouses — were aged 50 on average.

They were first interviewed at Saint Andrew’s Community Hospital while the patients were undergoing rehabilitation, and subsequently at home.

All stroke survivors were found to be at risk of depression initially, and about half could expect their depressive symptoms — which include feeling lonely, talking less than usual and having trouble focusing on routine activities — to decrease with time.

Among caregivers, seven in 10 were found to be at a low risk of depression and remained stable over time, while the remainder had a higher risk of depression initially and gradually improved.

Where one party’s depressive symptoms went up significantly, an increase was also seen for the other. The researchers also found that the loss of functional ability in stroke survivors led to an increase in their depressive symptoms. Having a foreign domestic worker to help care for a patient caused a decrease in depressive symptoms in the caregiver.

The study, supported by the Ministry of Social and Family Development and National Research Foundation, did not cover foreign domestic workers and Prof Matchar said this is because internationally, the definition has traditionally been that of a family caregiver.

“But in Singapore, it’s actually a very important issue. We don’t address (it) as often as we should, taking into account the fact that foreign domestic workers are often the ones bringing patients to the doctor and providing support services day to day.”

Helping only a stroke survivor or caregiver may have an indirect impact on the other, but help would be more effective if offered to both parties at the same time, said Asst Prof Malhotra.

Although depression can hit caregivers of people with various disabilities, Prof Matchar said depression is common in stroke survivors and stroke itself can cause depression. “It’s especially of importance in stroke, because stroke is so commonly associated with depression,” he added.

Guidelines in countries such as Australia state that all stroke patients should be screened for depression. There is no explicit mention of it in Singapore’s clinical practice guidelines on Stroke and Transient Ishaemic Attacks, said Asst Prof Malhotra.