'Feeling sad and useless': an investigation into personal acceptance of disability and its association with depression following stroke

Clin Rehabil. 2010 Jun;24(6):555-64. doi: 10.1177/0269215509358934. Epub 2010 May 18.

Abstract

Objectives: To study the association of acceptance of disability with depression following stroke and its ability to predict depression at follow-up.

Design: A prospective cohort mixed (quantitative and qualitative) design was used.

Setting and subjects: Patients admitted to a stroke unit were consecutively recruited. Eighty-nine participated at one month and 81 were followed up nine months post stroke.

Main measures: Depressive disorder was assessed using a structured clinical interview. Disability and acceptance of disability were measured using self-report scales. At one month post stroke, 60 consecutive participants also participated in open-ended interviews exploring their individual concerns about having had a stroke and their responses were analysed qualitatively.

Results: One-third of participants were found to have depression (29/89; 33% at one month and 24/81; 30% at nine months). Non-acceptance of disability remained associated with depression after controlling for age, gender, original stroke severity and current disability at one month (odds ratio (OR) = 1.27, 95% confidence interval (CI) 1.09-1.47) and nine months (OR = 1.46, 95% CI 1.22-1.75). Also, non-acceptance of disability measured at one month independently predicted depression measured at nine months (OR = 1.19, 95% CI 1.05-1.35). The qualitative findings illustrated a self-reproachful element to non-acceptance of disability. Patients with depression often said that they 'should still' be capable and sometimes referred to themselves as 'useless'; whereas patients who were not depressed commonly reported having accepted stroke-related disability.

Conclusions: These finding suggest that personal beliefs about accepting disability are associated with and predict emotional adaptation following stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Aged
  • Aged, 80 and over
  • Depression / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Stroke / complications
  • Stroke / physiopathology
  • Stroke / psychology*
  • Time Factors