Post-stroke depression and functional status: A meta analysis
Depression is known to negatively affect functional status and recovery potential for patients with many chronic diseases and for elderly patients. The purpose of this research was to better understand the relationship between depression, functional status, physical rehabilitation, and pharmacologic treatment of depression for post-stroke patients. It was proposed that depression and functional status were related to one another and could be mediated when they operated through the health care system.
A review of the stroke literature completed between 1990 and July 2000 resulted in the identification of 31 subject-studies that examined an association between depression and functional status in the post-stroke patient. Selected characteristics of the subject-studies including design, method, setting, location, quality, time, method of depression assessment, and method of functional status assessment were reviewed.
Meta-analytic methods were used to synthesize the results of the subject-studies. A small to moderate population Effect Size ESr of .25 (P = .000, k = 21, N = 2,310) with a Binomial Effect Size Display (BESD) of .37–.63 was found for a homogenous grouping of non-experimental studies examining the relationship between depression and functional status. A moderate to large ESr of .43 (P = .000, k = 5, N = 182), with a BESD of .29–.71, was found for a homogeneous grouping of experimental studies examining the relationship between depression and functional status when mediated by physical rehabilitation and pharmacologic treatment for depression. Significant associations between functional status and depression were identified for the prospective cohort studies, the general setting studies, the studies using clinical diagnosis of depression, and the studies using methods other than the Barthel Index for assessment of functional status. Examination of the post-stroke time trajectory revealed significant ESs for the acute time (r = .23), the 3-month time (r = .25), and the greater than 1 year time (r = .35).
Findings support a statistically and clinically significant relationship between depression and functional status, and pharmacologic treatment and physical rehabilitation mediate that relationship. The reciprocal interaction between depression and functional status is best approached through appropriate and timely treatment of both post-stroke manifestations.