Psychological symptoms and personality characteristics affect quality of life after stroke

Anxiety, depression and fatigue may decrease long-term quality of life (QOL) for subarachnoid haemorrhage (SAH) stroke survivors, researchers reported in Stroke: Journal of the American Heart Association.

A subarachnoid haemorrhage occurs when a blood vessel on the brain’s surface ruptures and bleeds into the space between the skull and brain, but not into the brain.

In a study assessing 141 men and women living in the community two to four years after a SAH stroke, researchers found health-related QOL was related to psychological symptoms, such as mood disorders, fatigue, cognitive complaints, and to personality characteristics.

Depression, anxiety and fatigue were pronounced in a significant proportion of SAH survivors studied, with a strong association to decreased QOL.

Researchers found:

• 32 percent of the survivors reported anxiety;
• 23 percent reported depression; and
• 67 percent reported fatigue.

The patients – discharged from the University Medical Center, Utrecht, in The Netherlands to their own homes – were an average 51 years. Sixty-six percent were women.

“The major point is to look beyond physical symptoms and look at psychological symptoms and personality characteristics to evaluate quality of life,” said Anne Visser-Meily, M.D., Ph.D., lead author of the study and rehabilitation specialist at the Rudolph Magnus Institute of Neuroscience at University Medical Center in Utrecht. “These characteristics are important in planning rehabilitation and targeting an intervention to help improve quality of life.”

Researchers evaluated QOL scores using the well-established Stroke Specific Quality of Life scale. The scale has 49 items, merged into four domains reflecting physical, cognitive, emotional and social QOL. They also used other scales to help in evaluation.

Researchers found the best scores in the physical domain; the worse were in the emotional and social domains. All psychological symptoms and personality characteristics were strongly related to the total QOL score.

The study examined such personality characteristics as passive coping and neuroticism. “When you analyse depression, anxiety and fatigue, you find there is a strong correlation with a passive coping style and neuroticism,” Visser-Meily said. “Those with a passive coping style need psychological support to encourage them to be more independent.”

Cognitive function is another important determinant of QOL associated with coping style. Those who had a passive coping style and who were depressed reported more neuropsychological problems. “This emphasizes the need to take personality into account as a potential vulnerability factor for decreased QOL,” said Visser-Meily.

University Hospital has opened a special multidisciplinary outpatient clinic for those who have experienced SAH. In a new approach to care, nurses, physicians and psychologists are analysing physical and (neuro) psychological symptoms and tailoring rehabilitation programs for each patient.

Co-authors are: Marloes Rhebergen, medical student; Gabriel Rinkel, M.D., Ph.D.; Martine van Zandvoort, Ph.D.; and Marcel Post, Ph.D.

In a separate study also led by Visser-Meily, researchers noted that coping is the most important predictor of psychosocial well-being of spouses of stroke survivors. The study is one of the few longitudinal studies of the long term functioning of spouses of stroke patients. An analysis of 211 Dutch stroke

• Spouses who used active coping strategies experienced less stress and showed higher levels of participation and a passive coping style was associated with negative outcomes. 
• Caregiver burden decreased significantly from two months after rehab discharge to one year post stroke and also from one year post stroke to three years post stroke but still 43 percent scored above the cut-off point for burden three years post stroke.
• Spouses with depressive symptoms decreased from 68 percent at start of rehab to 53 percent at two months post rehab but not thereafter and harmony in the relationship and social relations decreased (negative course) continually in time.

“These findings highlight the need to monitor the long-term psychosocial functioning of the spouses of stroke patients as part of a family-centred approach” Visser-Meily said. “It is a very difficult job to be a caregiver. You not only have to manage the care of the stroke patient, you also have to take care for yourself. Not only burden, but also depressive mood, harmony in the relationship and social relations need more attention in clinical practice.”

Visser-Meily suggests psychosocial interventions by physicians caring for stroke patients long-term, teaching spouses how to actively cope with the consequences of stroke and how to decrease the negative consequences for family functioning and harmony in the relationship.

(Source: Stroke: Journal of the American Heart Association: American Heart Association: January 2009)