http://www.annfammed.org/content/10/5/435.full
emailed Jennifer White with no response to these ideas.
Abstract
PURPOSE There has been
little exploration of the distinct trajectories of psychological
distress after stroke and the factors that
predict recovery from distress. These
trajectories may assist primary care physicians by providing insight
into disease onset,
progression, and resolution and may be a useful
way to conceptualize and understand the pattern of psychological
morbidity
in stroke over time. We undertook a longitudinal
qualitative study to explore poststroke psychological trajectories
METHODS The primary
data collection method was semistructured interviews with
community-dwelling stroke survivors in metropolitan
Newcastle, New South Wales, Australia. Our
sample included 23 participants (12 men, 10 women; age range 37 to 94
years) discharged
from a tertiary referral hospital after a
stroke; these participants subsequently participated in a total of 106
interviews
over 12 months. Qualitative outcomes were
participants’ perceptions at baseline, 3, 6, 9, and 12 months. Thematic
saturation
was achieved.
RESULTS Most
participants were male (54%) and had a partial anterior circulation
infarction stroke subtype (57%). Four different
longitudinal trajectories were identified:
resilience (n = 5); ongoing crisis (n = 5), emergent mood disturbance (n
= 3),
and recovery from mood disturbance (n = 10).
Recovery from mood disturbance was facilitated by gains in independence
and self-esteem
and by having an internal health locus of
control.
CONCLUSIONS Stroke
survivors experienced a variety of psychological trajectories.
Identifying distinct trajectories of psychological
morbidity may help primary care physicians
develop appropriately timed interventions to promote better mental
health. Interventions
require implementation over a longer duration
than the current outpatient services that, in Australia, are typically
provided
in the first few months after stroke.
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