Psychological distress, social support and medication adherence in patients with ischemic stroke in the mainland of China

Abstract

Stroke research and rehabilitation have traditionally focused on the physical and functional impact of a stroke. Less attention has been given to the psychosocial factors associated with this chronic condition. By the few studies that have specifically focused on psychosocial factors in the context of stroke, poststroke depression is demonstrated to significantly influence stroke outcomes. Associations of stroke with psychological symptoms other than depression have rarely been evaluated. This study was aimed to investigate the changes of psychological stress, social support and medication adherence in patients with ischemic stroke in the mainland of China. In this study, 90 patients with hemiplegia one year after first-ever middle cerebral artery infarction (stroke group) in the Zhongnan Hospital of Wuhan University from June 2008 to June 2011 were recruited for interview. Ninety age- and sex-matched normal volunteers (control group) were also examined at the same period. The psychological distress was assessed by the Symptom Checklist 90 (SCL-90), the social support by the Social Support Rating Scale (SSRS), and medication adherence by Morisky’s self-reported inventory, respectively. Group differences were analyzed using unpaired-t test and chi-squared test. The results showed that total mean scores of the SCL-90 in the stroke group were higher than those in the control group (P<0.01). Except two dimensions, paranoid ideation and psychoticism, mean scores of the rest dimensions (including somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety) of SCL-90 were significantly higher in the stroke group than those in the control group (P<0.05, or P<0.01). The objective support, subjective support, support availability and total social support scores in the stroke group were significantly higher than those in the control group (P<0.05, or P<0.01). Those in the “SCL-90 total scores >150 group” were significantly higher than in the “SCL-90 total scores <100 group” and the “SCL-90 total scores between 100 to 150 group” (P<0.05, or P<0.01). Those in the “SCL-90 total scores between 100 to 150 group” were significantly higher than in the “SCL-90 total scores <100 group” (P<0.05). In 90 patients with ischemic stroke, 26 (28.89%) patients obtained high medication adherence, 47 (52.22%) patients medium medication adherence, and 17 (18.89%) patients low medication adherence, respectively. Among these stroke patients, there were 17 (50.00%) patients with high medication adherence in the “SCL-90 total scores >150 group”, 28 (75.67%) patients with medium medication adherence in the “SCL-90 total scores between 100 to 150 group”, and 12 (61.16%) patients with low medication adherence in the “SCL-90 total scores <100 group”, respectively. There was significant difference in the medication adherence rate among the different SCL-90 scores groups in these stroke patients (P<0.05 or P<0.01). It was led to conclude that ischemic stroke patients one year after hemiplegia have psychological distress, low level of social support and poor medication adherence in the mainland of China. Therefore, it is necessary to mobilize the government, medical institutions and various social support groups to offer psychological interventions to relieve the stress of patients with ischemic stroke, and improve their medication adherence.

Keywords

stroke / psychological distress / social support / medication adherence

References

[1] ZhangH, LiL, XuGY, et al. . Changes of c-fos, malondialdehyde and lactate in brain tissue after global cerebral ischemia under different brain temperatures. J Huazhong Univ Sci Technolog Med Sci, 2014, 34(3): 354-358 PMID: 24939298

[2] ModregoPJ, MainarR, TurullL. Recurrence and survival after first-ever stroke in the area of Aragon, Spain. A prospective cohort study. J Neurol Sci, 2004, 224(1–2): 49-55

[3] Lopez-BastidaJ, Oliva-MorenoJ, Worbes-CerezoM, et al. . Social and economic costs and health-related quality of life in stroke survivors in the Canary Islands, Spain. BMC Health Serv Res, 2012, 12(1): 315 PMCID: 3468368 PMID: 22970797

[4] JorgersenHS, KammersgaardLP, NakayamaH, et al. . Treatment and rehabilitation on a stroke unit improves 5-year survival. A community-based study. Stroke, 1999, 30(5): 930-933

[5] LiuM, WuB, WangWZ, et al. . Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol, 2007, 6(5): 456-464 PMID: 17434100

[6] FeiginVL. Stroke epidemiology in the developing world. Lancet, 2005, 365(9478): 2160-2161 PMID: 15978910

[7] XueGB, YuBX, WangXZ, et al. . Stroke in urban and rural areas of China. Chin Med J (Engl), 1991, 104(8): 697-704

[8] OparaJA, JaraczK. Quality of life of post-stroke patients and their caregivers. J Med Life, 2010, 3(3): 216-220 PMCID: 3018998 PMID: 20945810

[9] Scoring criteria of clinical neurological impairment in stroke patients.. Chin J Neurology, 1996, 29(6): 381-383

[10] ZhangJ, ZhangX. Chinese college students’ SCL-90 scores and their relations to the college performance. Asian J Psychiatr, 2013, 6(2): 134-140 PMID: 23466110

[11] DerogatisLR, ClearyPA. Factorial invariance across gender for the primary symptom dimensions of the SCL-90. Br J Soc Clin Psychol, 1977, 16(4): 347-356 PMID: 588890

[12] XuJ, WeiY. Social support as a moderator of the relationship between anxiety and depression: an empirical study with adult survivors of Wenchuan earthquake. PLoS One, 2013, 8(10): e79045 PMCID: 3820964 PMID: 24250754

[13] ShumakerSA, BronwellA. Toward a theory of social support: closing conceptual gaps. J Soc Issues, 1984, 40(1): 11-36

[14] MoriskyDE, GreenLW, LevineDM. Concurrent and predictive validity of a self reported measure of medication adherence. Med Care, 1986, 24(1): 67-74 PMID: 3945130

[15] MoriskyDE, AngA, Krousel-WoodM, et al. . Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich), 2008, 10(5): 348-354

[16] KerrSM, SmithLN. Stroke: An exploration of the experience of informal caregiving. Clin Rehabil, 2000, 15(4): 428-436

[17] HanB, HaleyWE. Family caregiving for patients with stroke: review and analysis. Stroke, 1999, 30(7): 1478-1485 PMID: 10390326

[18] MichelsN. The transition from hospital to home: an exploratory study. Home Health Care Serv Q, 1988, 9(1): 29-44 PMID: 10291783

[19] MagilvyJK, LakomyJM. Transitions of older adults to home care. Home Health Care Serv Q, 1991, 12(1): 59-70 PMID: 10117494

[20] GlassTA, MaddoxGL. The quality and quantity of social support: stroke recovery as psycho-social transition. Soc Sci Med, 1992, 34(11): 1249-1261 PMID: 1641684

[21] HackettML, YapaC, ParagV, et al. . Frequency of depression after stroke: a systematic review of observational studies. Stroke, 2005, 36(6): 1330-1340 PMID: 15879342

[22] RittmanM, BoylesteinC, HinojosaR, et al. . Transition experience of stroke survivors following discharge home. Top Stroke Rehabil, 2007, 14(1): 21-31 PMID: 17517571

[23] ZarboC, CompareA, BaldassariE, et al. . In sickness and in health: A literature review about function of social support within anxiety and heart disease association. Clin Pract Epidemiol Ment Health, 2013, 9(2): 255-262 PMCID: 3884151 PMID: 24403952

[24] RadGS, BakhtLA, FeiziA, et al. . Importance of social support in diabetes care. J Educ Health Promot, 2013, 2(1): 62 PMCID: 3908488 PMID: 24520558

[25] DiMatteoMR, GiordaniPJ, LepperHS, et al. . Patient adherence and medical treatment outcomes: A meta-analysis. Med Care, 2002, 40(9): 794-811 PMID: 12218770

[26] GladerEL, SjölanderM, ErikssonM, et al. . Persistent use of secondary preventive drugs declines rapidly during the first 2 years after stroke. Stroke, 2010, 41(2): 397-401 PMID: 20075360

[27] JinJ, SklarGE, Min Sen OhV, et al. . Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag, 2008, 4(1): 269-286 PMCID: 2503662 PMID: 18728716

[28] PoundP, GompertzP, EbrahimS. Illness in the context of older age: the case of stroke. Sociol Health Illn, 1998, 20(3): 489-506

[29] HaynesRB, AcklooE, SahotaN, et al. . Interventions for enhancing medication adherence. Cochrane Syst Rev, 2008CD000011

[30] KhanNA, YunL, HumphriesK, et al. . Antihypertensive drug use and adherence after stroke: are there sex differences. Stroke, 2010, 41(7): 1445-1449 PMID: 20508191