Post-stroke depression

Post- stroke depression is common, says American Heart Association/American Stroke Association statement

Statement co-authored by Pamela Mitchell, executive associate dean and professor at the UW School of Nursing

A new statement by the American Heart Association/American Stroke Association says that post-stroke depression (PSD) is common and affects about a third of all stroke survivors. People with PSD often have poorer outcomes, poor quality of life and may be predisposed to subsequent vascular events, and death.

Research team

Co-PIs Pamela Mitchell, Ph.D, R.N. (center) and Catherine Kirkness (second from left) in discussion with post-stroke depression clinical trial team at the UW School of Nursing. Other are Sylvia McKenzie, RN (left), Pam Weisman, ARNP (second from right), Ann Buzaits, ARNP (right).

Dr. Pamela Mitchell, executive associate dean and professor at the UW School of Nursing, was one of the statement’s authors. Authors were nominated on the basis of their previous work in relevant scientific areas and then appointed by the American Heart Association Stroke Council’s Scientific Statements Oversight Committee and the American Heart Association’s Manuscript Oversight Committee. Dr. Mitchell has led interdisciplinary teams from the UW in National Institute of Nursing Research funded clinical trials testing the effectiveness of brief behavioral interventions delivered by advanced practice nurses. On this basis, she was nominated by the Council of Cardiovascular and Stroke Nurses to this writing group.

Dr. Mitchell said, “It has been a pleasure working with the multidisciplinary writing group on this statement.  Its composition reflects the diverse UW research team that I have had the privilege of leading for the past decade, comprised of stroke neurologists, psychiatrists, nurse scientists, clinical psychologists and advanced practice nurses.”

This is the first statement from the AHA/ASA on post-stroke depression. The statement is the result of comprehensive literature and research review (including the studies of the UW team), clinical and epidemiological studies and expert opinion. The statement uses the Diagnostic and Statistical Manual of Mental Disorders definition of depression as it occurs in stroke survivors. The causes of PSD consist of both biological and psychosocial elements, as do potential treatments. The authors also examined risk factors for PSD, and found that physical disability, strove severity, a history of depression, and cognitive impairment were associated with developing PSD. Stroke survivors who lacked family or support systems were also at a higher risk for PSD.

Dr. Mitchell said, “This statement is timely because it clearly indicates the magnitude of the problem, with stroke and depression being the leading cause of disability in the US and the world.  But equally important, the statement clearly indicates that PSD is readily assessed by specialty and generalist nurses, physicians and other health care providers.  Further there is growing evidence that there are a variety of pharmacologic and nonpharmacologic treatments, such as antidepressants and ‘talking’ therapy available.”

It is the hope of the authors and the associations that outcomes for stroke survivors can be improved by addressing the prevalence and readily available treatment for PSD.