N725: Post-Stroke Depression Screening & Translational Research

This presentation addresses the critical issue of post-stroke depression and the importance of mandatory screening for patients. It highlights the prevalence of stroke and the significant neuropsychiatric sequelae, with a focus on post-stroke depression as the most common complication. The presentation emphasizes the adverse effects of post-stroke depression, including prolonged hospitalizations, increased suicidal ideation, and higher medication costs. It references treatment recommendations from organizations like the Canadian Best Practice Recommendations for Stroke and the World Health Organization. The presentation also assesses current compliance with screening recommendations, using the Planned Action Theory and Knowledge to Action Model to develop activities that initiate change. It identifies barriers to screening, such as cost and training, and proposes implementation strategies, including stakeholder discussions and referral system restructuring. The presentation concludes by emphasizing the significance of screening stroke patients for depression to ensure effective treatment and improved patient outcomes. Desklib offers a wealth of similar study resources for students.

Neuropsychiatric Sequela of Stroke:
Mandatory Depression Screening on the
Post-Stroke Patient
Presented by:

Prevalence of Stroke
 15 million strokes each year worldwide (WSO, 2012)
 More than 795,000 strokes each year in the US
(NINDS, 2004).
 Disability and stroke is mainly caused by Neural
symptoms
 Chronic disabilities are primarily caused by Stroke
 Neuropsychiatric sequelae of stroke:
– pathologic affect, post-stroke dementia, post-stroke
depression, post-stroke lethargy. (Hackett, Yapa, Parag, &
Anderson, 2005)

Post-stroke Depression
 The most common type of neuropsychiatric sequela of
stroke.
 Estimated to be the second leading cause of disability
by 2020 (WHO, 2013)
 Depression affects post-stroke patients by
approximately one-third (Hackett et al., 2005)
 Post-stroke patients are 2.4 times likely to die within 10
years of diagnosis (Jia et al., 2006).
 33% of all stroke survivors exhibit depression
symptoms at anytime (Hackett et al., 2005)

Effects of Post-Stroke Depression
 Prolonged hospitalizations and longer
stay at rehabilitation facilities.
 14% prevalence in suicidal ideation (Jia
et al., 2006)
 Increased medication cost by 63%
compared to stroke patients (Husaini et
al., 2013).

Treatment Recommendations for
Post-stroke Depression
 The Canadian Best Practice
Recommendations for Stroke (Lindsay et
al., 2008)
 World Health Organization (WH0, 2012)
 Advanced Disease-Specific Care Certification
Requirements for Comprehensive Stroke Center
(CSC)

Compliance with Recommendations
In 2018:
– 395 patients admitted for ischemic stroke,
hemorrhagic stroke or transient ischemic attack
– Only 2% screened for depression
Not all stroke patients admitted at SDMC are
screened for depression
50% compliance (Hart & Morris, 2008).

Planned Action Theory to Develop
Activities that Initiate Change
Knowledge Action Model
(Field, Booth, Ilott, & Gerrish, 2014)

Integrating theory and issue
 Identify Issue
 Adapt knowledge
 Examine barriers
 Choose implementations
 Observe knowledge
 Assess outcomes
 Sustain knowledge
(Field, Booth, Ilott, & Gerrish, 2014)

Integrating theory and issue
Identify Problem
Post-depression
stroke
Failure to screen
stroke patients for
depression
Treatment options
that work
Adapt knowledge
 Implement
recommendations
 Screen post-
depression stroke
patients
 Referrals

Integrating theory and issue…
Assess barriers
Cost of screening
Training
Referral system
Further research
Select implementation
 Discuss the
significance with
stakeholders and
management
 Restructure referral
system
 Monitor outcomes

Integrating theory and issue…
Monitor knowledge
Observation
Active
measurement
Evaluate outcomes
 Quantitative methods
 Qualitative methods
 Formulation of
question of interest

Integrating theory and issue…
Sustain Knowledge
Resources
Policy integration
Leadership
Benefits and risks