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Randomized Controlled Trial
. 2019 Jun 14;19(1):128.
doi: 10.1186/s12883-019-1349-8.

Prevention of mood disorder after stroke: a randomised controlled trial of problem solving therapy versus volunteer support

Kate Hill  1 , Allan House  2 , Peter Knapp  3 , Carrie Wardhaugh  4 , John Bamford  5 , Andy Vail  6
Affiliations
Randomized Controlled Trial

Prevention of mood disorder after stroke: a randomised controlled trial of problem solving therapy versus volunteer support

Kate Hill et al. BMC Neurol. .

Abstract

Background: Mood disorder after stroke is common but drug and psychosocial treatments have been assessed with disappointing results. Preventing mood disorder from developing in the first place could be a better approach and might reduce the need for pharmacotherapy in this predominantly older patient group. We used a brief problem-solving therapy and evaluated its effect in reducing mood disorder in the 12 months after stroke.

Methods: A 3-group, parallel, randomised controlled trial. Four hundred fifty patients with stroke were randomised within 1 month of hospital admission to problem-solving therapy from a psychiatric nurse, non-specific support given by volunteers or treatment-as-usual. Follow up took place at 6 and 12 months after stroke. Standardised measures of mood (Present State Examination, GHQ-28), cognitive state (mini-mental state examination) and function (Barthel ADL index, Frenchay Activities Index) were taken at baseline, 6 and 12 months after randomisation. Satisfaction with care was recorded at follow up.

Results: At 6 months, all psychological and activity measures favoured problem-solving therapy. At 12 months, patients in the problem-solving therapy group had significantly lower GHQ-28 scores and lower median Present State Examination symptom scores. There were no statistically significant differences in activity. The problem-solving therapy group were more satisfied with some aspects of care.

Conclusions: The results are encouraging and suggest it is possible to prevent mood disorder in stroke patients using a psychological intervention. The differences between the groups at 12 months may indicate a sustained impact of psychological therapies, by comparison with non-specific support.

Trial registration: ISRCTN: ISRCTN33773710 Registered: 23/01/2004 (Retrospectively).

Keywords: Cerebrovascular accident; Cognitive therapy; Depression; Mood disorders; Prevention; Problem solving; Stroke.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT Flow Diagram
See this image and copyright information in PMC

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