A systematic review of therapeutic interventions for poststroke depression and the role of nurses

Abstract

Aims and objectives: This systematic review explores the nursing role in the management of poststroke depression and identifies effective non-pharmacological interventions that nurses can use in the daily care of patients with stroke.

Background: Depression is a common complication poststroke and affects one-third of patients with stroke. It has a negative impact on functional recovery and social activities and is associated with increased morbidity and mortality. Detection and diagnosis of poststroke depression is inconsistent, and many depressed patients are under-treated. Although nurses recognise that observation and assessment are parts of their role in rehabilitation care, little is known about their role in assessing depression or the interventions they can use.

Design: A systematic review was conducted using the Cochrane method.

Methods: Literature for the period 1993-2008 was searched in the electronic databases of CINAHL, Medline (PubMed), Nursing Journals (PubMed) and PsycINFO using the following keywords: cerebrovascular accident, stroke, depression, poststroke depression, treatment, therapy, treatment outcome, management.

Results: Fifteen articles and one systematic review were identified. There was strong evidence that information provision reduces the severity of depression. Other interventions with positive effects on the occurrence or severity of poststroke depression were as follows: life review therapy, motivational interviewing, a specific nursing support programme and physical exercise.

Conclusion: Depression after stroke is an important problem with adverse effects on the patient's ability to participate in rehabilitation and on rehabilitation outcome. The interventions described can be implemented in nursing care of patients with poststroke depression. The variety of such interventions and the diversity of their nature and design are consistent with the practice of rehabilitation nursing.

Relevance to clinical practice: The findings of this review enable nurses to intervene effectively to reduce the occurrence and severity of depression in patients with stroke.