Category: Aging and Older Adults

Symposium

Physical Disability as a Predictor of Suicidal Ideation in Stroke Survivors Treated for Depression

Friday, November 17
1:45 PM - 3:15 PM
Location: Cobalt 501, Level 5, Cobalt Level

Keywords: Aging / Older Adults | Health Psychology | Suicide
Presentation Type: Symposium

Introduction:  Compared to the general population, rates of depression are twice as high in stroke survivors (Rickards, 2005).  Post-stroke depression (PSD) is associated with reduced health-related quality of life (Jeong et al., 2012) and weaker rehabilitation outcomes (Palucci et al., 2001).  PSD patients are likely to experience comorbid cognitive impairment and physical disability (Hackett and Anderson, 2005).  Past studies argue that physical illness, specifically perceived physical disability (PPD), is a potential risk factor for suicidal ideation (Kaplan et al., 2007; Russell et al., 2009).  However, few studies have examined the relationship between PPD and SI in patients with PSD and how treatment of PSD impacts the relationship.


Method: 30 PSD participants (mean age=69 years, range=52-88; 50% female) were administered the 24-item Hamilton Depression Rating Scale (HAM-D) for the assessment of depression and SI; disability, including PPD, was measured using the Stroke Impact Scale (SIS); and hopelessness was measured using the Beck Hopelessness Scale. Assessments were conducted prior to a 12-week course of psychotherapy for depressive symptoms, with a follow-up assessment at 24 weeks.  Bivariate correlations among study variables and stepwise linear regression tested if baseline PPD predicted SI at 24-week post-treatment.


Results: At baseline, participants’ scores were in the moderate depression range (=21.73, SD=7.44), 17 patients endorsed SI, with a mean PPD score of 49.20 (SD=21.06). At 24-week post-treatment, participants presented with mild depression (=12.57, SD=6.99), 9 patients endorsed SI, and PDD on average was 53.48 (SD=22.53). At baseline, PPD and SI were not significantly correlated (r=-0.133, p=0.500). However, baseline PPD was a significant predictor (b=-0.013, SE=0.006, p=0.045), along with baseline SI (b=0.298, SE=0.006, p=0.026), of SI at 24 weeks, controlling for baseline depression scores.  Hopelessness was not correlated with any variables at baseline, but was significantly correlated with SI, depression, and PPD at follow-up. 

Conclusions:  The current study supports previous findings that greater PPD is associated with SI.  PPD predicts SI six months later, independent of depressive symptoms and even after a course of psychotherapy targeting post-stroke depression. This suggests that stroke survivors with high PDD initially after their stroke may be at greater risk of SI in the future, regardless of the presence of other symptoms of depression. 

Victoria Wilkins

Assistant Professor
Weill Cornell Medicine

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