Psychosocial problems, quality of life, and functional independence among Indian stroke survivors

Abstract

Background and purpose: Data regarding psychosocial problems and quality of life (QoL) among stroke survivors from developing countries are scarce. The purpose of this study is to examine QoL, anxiety, depression, and functional independence of stroke survivors and the relationship of these variables with stroke characteristics.

Methods: This was a prospective hospital-based study. Patients were interviewed after ≥ 1 month post stroke. World Health Organization QoL-BREF was used to assess QoL. Anxiety and depression measures were recorded using the Hospital Anxiety Depression Scale, and functional independence was evaluated using the Functional Independence Measure. Demography, stroke severity (measured by the National Institute of Health Stroke Scale), and stroke outcome (measured by the modified Rankin scale) were also documented. Univariate and multivariate analysis were completed using SPSS Statistics version 17.0 (SPSS, Inc, Chicago, Ill).

Results: One hundred sixty-two patients participated (men = 113, 69.8%); mean age was 54.3 ± 12.9 years (range, 21-88 years). The mean duration of follow-up was 18.3 ± 24.9 months (range, 1-180 months), and the mean National Institute of Health Stroke Scale score was 2.1 ± 2.1 (range, 0-10). Presence of anxiety (odds ratio [OR] 0.20, CI 0.80-0.51, P=0.001), depression (OR 0.22, CI 0.10 to 0.47, P < 0.0001), and functional dependence in Functional Independence Measure (OR 3.56, CI 1.70 to 7.42, P = 0.001) were predictors of impaired QoL in the multivariate logistic regression analysis. Anxiety was seen in 39 patients (24%), and 60 patients (37%) had depression. Poor outcome predicted depression in logistic regression model (OR 4.40, CI 1.80 to 10.76, P = 0.001). Functionally dependent patients were more likely to be older (OR 0.94, CI 0.92 to 0.97, P = 0.001) and had severe stroke (OR 0.69, CI 0.53 to 0.88, P = 0.004).

Conclusions: Presence of anxiety, depression, and functional dependence were associated with impaired QoL. There was low prevalence of anxiety and depression. Older age and stroke severity resulted in increased functional dependence.