The influence of early depressive symptoms, social support and decreasing self-efficacy on depression 6 months post-stroke

Abstract Background Post-stroke depression (PSD) is the most frequent mental disorder after stroke, affecting about 30% of stroke survivors. Despite extensive research, little is known about the influence of general self-efficacy (GSE) on PSD. We investigated the effect of GSE on depression six months post-stroke while controlling for established risk factors. Methods Eighty-eight patients from two rehabilitation centers with first-ever ischemic stroke were assessed around 8 weeks and 6 months after stroke. Baseline assessment included demographic variables, GSE scale, physical disability (Barthel-Index), stroke severity (modified NIH Scale), pre-stroke mental illness, cognitive status (Mini-Mental-State-Test), social support (F-SozU Questionnaire) and depressiveness (Geriatric Depression Scale, GDS). Follow-up assessment included DSM-IV depression, GDS and GSE. The influence of each risk factor on PSD was analyzed by binary hierarchical regression. Results Baseline depressiveness (OR=1.41, p p =.03) predicted PSD. Decreasing GSE was associated with high baseline GSE ( r =.51, p (OR =1.39, p ) . Limitations Patients' range of impairment may have been limited as sufficient speech comprehension and capacity for interview participation were required. Causal relationship between decreasing GSE and increasing GDS cannot be assumed based on correlations. Discussion Decreasing GSE was linked to PSD, especially in patients with high baseline GSE. This effect may be due to dissatisfaction with recovery following high expectations. Early depressive symptoms and low social support predicted PSD. Early screening for depressive symptoms and focusing on self-efficacy might help to prevent later depression.