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A STUDY ON DEPRESSION AND ITS SOCIODEMOGRAPHIC CO RELATES IN POST STROKE PATIENTS

1Ravi Rana, 2Ratandeep Rana, 3Sanjay Gupta, 4 Rakesh Kumar Paswan,

.Senior Resident, 1 Junior Resident 2, 4.S.N. Medical college, Agra, Professor (IMS, Varanasi) 3

 

Abstract

Background- Stroke represents a major public health problem in the India, but relatively little work has been directed toward identifying and treating the common neuropsychiatric disorders occurring after stroke.

Aim- Our study was aimed to find out the depression in post stroke patients. Also to study the relationship of different socio demographic factors associated with stroke patients & depressive disorder.

Material and Methods-100 stroke patients (1to 6 months after stroke) taken by simple random sampling, attending neurology OPD constituted the sample of the study. All these patients were evaluated on a specially designed proforma along with the suitable tools. Data so collected were subjected to the suitable statistical analysis.

Results & Conclusion- The result of the study revealed that more than half (52%) of patients were of age group 51-60 years with mean age 57.5 years, most of them were males (59%), married (80%), from urban area (58%).Tobacco abuse (smoking & chewing) was found in 53% of the stroke patients. Commonest psychiatric morbidity was depression which was found in (34%) of patients, in which 38.2% were suffering from mild depression, 38.2% were suffering from moderate depression and 23.6% of the patients were suffering from severe depression.

Key words:Stroke, Depression, and Tobacco.

Introduction

In India the incidence of stroke is likely to rise in the coming years due to increase population, increase in life expectancy, rapid urbanization, changing lifestyles involving sedentary habits, smoking, excess alcohol use, rising stress level in life.

The progressive decrease in stroke mortality observed in the last few decades, and the subsequent increase of survivors with residual impairments and disabilities, have been accompanied by a growing interest in the factors that could interfere with functional outcome and quality of life. 1 Depression is considered as the strongest predictor of poor quality of life among stroke survivors. 2

Depression is among the most common neuropsychiatric disorders occurring after stroke. 3, 4, 5 Despite its high frequency and negative influence on the overall recovery of stroke patients, post stroke depression (PSD) was under diagnosed by nonpsychiatric physicians in 50%–80% of cases. 6 It is estimated that about one-third of stroke patients develop one of the different types of depressive disorders. 7

Recent studies have concluded that neuropsychiatric complications (i.e., emotional, behavioral, and cognitive disorders) may have a negative effect not only on the social functioning and overall quality of life of stroke survivors, but also on the recovery of their motor functioning, as well. 8

Material & Methods

The aim of the study was to find out the relationship of different socio demographic factors associated with stroke patients, to find out the depression & its severity during the period of 1-6 months in post stroke patients.

Sample of study

To collect 100 cases of stroke, total 149 of established diagnosis of stroke confirmed by the Neurologist (based on CT finding) attending neurology OPD, were assessed. 49 patients were excluded from the study because of various reasons like (who were not well enough to complete the assessment & who came before 1 month or after 6 months of stroke). The sampling technique applied for taking the sample was Simple Random Sampling.

Inclusion Criteria

Subjects with confirmed diagnosis of stroke and they came first time for the treatment between 1-6 months after development of stroke. Subjects who had given written informed consent and who were stable enough to complete the assessment.

Exclusion Criteria

Patients were excluded who had history of less than one month or more than six month’s duration after stroke. Patient’s who had any other major medical or surgical illness, unwilling & non cooperative for Psychiatric evaluation.

Method of study

All subjects who fulfilled the inclusion & exclusion criteria were evaluated in detail by using especially designed semi structured proforma and following tools.

A. Specially Designed Semi structured Performa

Collect the socio-demographic and personal identification data. Historical data: including complaints, details of stroke like site, nature, severity, duration, associated physical illness, drug abuse, h/o psychiatric illness & Mental Status Examination

B. B. Beck’ Depression Inventory (B.D.I.) (A.T.BECK, 1994) 9 BDI is a self-rated scale in which individual rate their own symptoms of depression, it measures the severity of depression. The BDI is 0-21 item scale which evaluates key symptoms of depression including mood, pessimism, sense of failure, self dissatisfaction, guilt, punishment, self dislike, self accusation, suicidal ideas, crying, irritability, social withdrawal, indecisiveness, body image change, work difficulty, insomnia, fatigability, loss of appetite, weight loss, somatic preoccupation, and loss of libido.

Data so collected were displayed in tabulated form and were analyzed using suitable statistical analysis and conclusions were drawn.

 

Observations

Table 1 Sociodemographic characteristics of study group

Variables

Participants (N=100)

Depression (n=34)

Significance

Age

(x2=3.898,df= 2,p>.05) Not significant

<40 yrs

11 (11%)

6(17.6%)

 

41-60 yrs

52 (52%)

19(55.8%)

 

>60 yrs

37 (37%)

9(26.4%)

 

Sex

Male

59 (59%)

21(61.7%)

(x2=.263,df= 1,p>.05) Not significant

Female

41 (41%)

13(48.3%)

Marital status

Married

80 (80%)

21(61.7%)

(x2=.10.825,df= 1,p<.05)

significant

Unmarried/ Divorced/Living alone

20 (20%)

13(38.2%)

Religion

Hindu

64 (64%)

22 (64.7%)

(x2=.067,df= 2,p>.05) Not significant

Muslim

22(22%)

7 (20.5%)

Sikh & Others

14 (14%)

5 (14.7%)

Domicile

Urban

58 (58%)

20(58.8%)

(x2=.12,df= 1,p>.05) Not significant

Rural

42 (42%)

14 (41.2%)

Education

Up to 5th class

10 (10%)

4(11.7%)

(x2=.192,df= 2,p>.05) Not significant

Below graduate

35 (35%)

12(35.2%)

Graduate & above

55 (55%)

18(52.9%)

Economic Status

Lower & Lower middle class

13 (13%)

8(23.5%)

(x2=4.890,df= 2,p>.05) Not significant

Middle Class

34(34%)

10(29.4%)

Upper middle & Upper Class

53 (53%)

16(47%)

Family Type

Nuclear

58 (58%)

11(32.3%)

(x2=15.763,df= 1,p<.05) significant

Joint

42 (42%)

23(67.6%)

         

 

Table-2 Distribution of patients according to severity of Depression on Beck’s Depression Inventory

Total no of stroke patients

100

Depressive patients

34(34%)

Mild( Score on BDI 10-18)

13(38.2%)

Moderate (19-29)

13(38.2%)

Severe (>29)

8(23.6%)

 

Results and Discussion

It is evident that more than half (52%) of the stroke patients belonged to age group 41-60 years followed by age group of >60 years (37%) and <40 years (11%), the mean age of stroke patients was 57.5 years. All the three age groups did not differ significantly with respect to depression. This may be explained by the fact that stroke patients were more common in 41-60 years age group. 59% of the stroke patients were male as compared to females (41%), No significant difference could be observed in depression among two sexes. Most of the patients (73.2%) were married with their spouse alive where as rest 26.8% patients were single i.e. who either was widows, widower, divorced or separated. Depressive disorders were significantly high in widows, widower, divorced or separated patients. It is obvious from the table that majority of the patients (60.4%) were Hindus, 23.2% were Muslim & 15.4% were Sikh & others. This is in accordance with the distribution of people belonging to population of these Indian religions. Religion wise no difference was found in depression.

58.1%of the stroke patients were from urban area where as rest 41.9% belonged to rural background. It is evident from the table that 15.1% of the patients were educated below 5th class, 36% patients were educated below graduate level, and rest 48.8% of patients were educated up to graduation level & above. When we compared the literacy level of our patients with other studies, we found that the proportion of patients educated up to 5th class was quite low as compared to our study. 13 % of the Patients belonged to lower & lower middle class, 34% belonged to middle class where as rest 53% patients belonged to upper middle & upper class. No significant difference could be observed in lower & higher income group patients as far as distribution of depressive disorders was concerned. It can be seen from the table that about two third of the patients (67.7%) belonged to nuclear family or living alone where as rest 32.3% belonged to joint family. Significant difference was found among two groups regarding depressive disorders. 10 More than half (53%) of the stroke patients were smoker.

Commonest psychiatric morbidity was depression which was found in (34%) of patients. Of those 34% subjects in study group who were suffering from depression, 38.2% were suffering from mild depression (BDI score 10-18), 38.2% were suffering from moderate depression (BDI score 19-29) and 23.6% of the patients were suffering from severe depression (BDI score >29). Morris PL & et al (1992), found that 38% of post stroke patients had depression (major or minor).11Whereas Aström M et al (1993), reported the prevalence of major depression as 25% at the acute stage and approximately the same at 3 months (31%).12, 13 Robinson RG et al (1987), found that 14% of post stroke patients had symptom clusters of major depression, 18% had symptom clusters of dysthymic or minor depression, and 68% did not meet the DSM III diagnostic criteria for depression. 14 Thus in this regard our study is in line with most of the above studies.

 

Conclusion

Stroke is quite common in India & commonly occurs in young`s as compared to the west15 Smoking is an independent risk factor for stroke, other risk factors are advancing age, male & being unmarried. Psychiatric illnesses are common in post stroke patients in which depression was the most common psychiatric illness which was found in one third of the patients. There is need for early detection & treatment of depression & other psychiatric illnesses in stroke patients who have psychiatric morbidity as high as more than 50%. Simultaneous treatment of psychiatric illnesses will improve the quality of life of the patients. More research work especially the interventional and follow-up studies after 1 to 2 year of stroke can be done to compare the early & late onset complications & course of illnesses.

 

References

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