Unmet Need for Social and Emotional Support and Lack of Recalled Screening Is Associated with Depression in the Long-Term Course After Stroke

Abstract

Inken Padberg,1 Benjamin Hotter,1,2 Andrea Liebenau,1 Petra Knispel,1,3 Sophie Lehnerer,1,2 Sabine Heel,4 Ian Wellwood,5 Andreas Meisel1–3 1Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; 2Neurocure Clinical Research Center, Department of Neurology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; 3Berliner Schlaganfall-Allianz e.V., Berlin, Germany; 4Zentrum für Ambulante Neuropsychologie und Verhaltenstherapie (ZANV), Berlin, Germany; 5Department of Public-Health and Primary Care, University of Cambridge, Cambridge, UKCorrespondence: Inken Padberg Tel [phone]Fax [phone]Email [email protected]: Details on adequate care and prevalence of depression in long-term stroke aftercare are limited. We aimed to determine long-term depression rates after stroke and to test for an association between depression and inadequate screening, socio-economic complications and lack of sub-optimal care.Patients and Methods: In this cross-sectional study, 57 patients were re-invited into the clinic 2– 3 years after stroke. Patients were interviewed about recalled screening concerning depression and unmet needs. Depression, the patient’s social situation, and confounders were assessed by standardized scores.Results: In our study, 20% (n =  11) of patients were classified as depressed by the HDRS-17 score result. However, only 36% of all patients recalled to have been previously screened for depression and only 43% of those patients also recalled out-patient screening. Patients classified as depressed reported significantly lower recalled screening rates (9% vs 43%; p =  0.036) and higher rates of self-reported unmet need with emotional problems (72% vs 18%; p <  0.001). Depression in our study was further associated with a worse socio-economic situation, fewer social contacts, unmet needs with regard to emotional problems and higher rates of recommendations to apply for additional social support.Conclusion: Our data suggest that systematic out-patient screening for depression is lacking in stroke aftercare. Furthermore, the high rate of unmet emotional needs, the poor socio-economic situation and the higher rates of recommendations for social counselling and application for benefits suggest an undersupply of care in the out-patient setting that is more prominent in patients with depression and warrants further studies to investigate the underlying causes.Keywords: health-care quality, social-care, risk management, stroke, depression

Keywords

• health care quality
• social-care
• risk management
• stroke
• depression