International Journal of Emergency Mental Health and Human Resilience
Open Access

Stroke is regarded as an acute onset of focal neurological deficits persisting for more than 24 hours. Ischemic strokes are found to be approximately 85% prevalent of all strokes, while as other 15% are of hemorrhagic type (Aali G, 2020). Ischemic strokes are further classified into five categories as due to atherosclerosis, cardioembolism, small artery occlusion ( lacunar strokes), a stroke of other determined etiologies, and stroke of undetermined etiology. Hemorrhagic strokes are further classified as subarachnoid or intracerebral hemorrhages. Subarachnoid hemorrhages are caused due to the rupture of an aneurysm, in the large intracranial arteries. Intracerebral hemorrhages are subclassified as lobar or deep (Ayerbe L,2013). It is documented about 25% to 50% of stroke survivors experience depressive symptoms poststroke (Ayotte BJ, 2010). Depression is a prevalent and severe mental illness characterized by sadness, loss of interest or pleasure, low self-worth, loss of sleep or appetite, tiredness, and difficulty concentrating (Carrozzino D,2020). Poststroke depressive symptoms have been associated with deficits in memory, executive function, and attention/psychomotor processing speed (Chatterjee K, 2010). Depression and diabetes interacted to increase the risk of dementia(Chen YK, et al, 2015).Depressive episode can increase risk for further episodes of stroke (Cumming TB 2016 & De Groot, 2003). Post-stroke fatigue is common and disturbing sequelae of stroke, with higher prevalence and may persist for many years after stroke (Furie KL, et al, 2011). Post-Stroke Fatigue (PSF) has been defined as an ‘overwhelming feeling of exhaustion or tiredness, which is unrelated to exertion, and does not typically improve with rest (GS Xiang, 2015).Prevalence of post-stroke fatigue varies between 25% and 85%; and is widely accepted that post-stroke fatigue affects 50% of people after stroke (Hamilton M, 1960).

Study Area/Setting: Our study was conducted with the collaboration of the Department of Neurology SKIMS Soura which is a super specialty where patients were examined in the outpatient department

Study Subjects: Study participants above 18 years of age, diagnosed cases of stroke by the department of neurology, and are on follow-up with the department of neurology more than 6 months post-stroke.

Aim and Objectives: The aim of our study was to examine the severity of depression and fatigue in post-stroke patients and the socio demographic variables of post-stroke patients.

Methodology: Our study was a cross-sectional done in collaboration with the Department of Neurology in the outpatient department at SKIMS Srinagar. The hospital has a wide catchment area that caters to all pockets of Kashmir Valley. Ethical clearance was obtained. 64 patients were recruited for the study, and examined after 6 months of stroke. Since the study was conducted in the outpatient clinic with written informed consent, diagnosed with stroke by the department of neurology. Inclusion criteria were patients diagnosed with stroke by the Department of Neurology and patients aged 18 years and above. Patients that were excluded from the study were a) having a past history of psychiatric disorder, B) substance use, C) poor cognitive function, severe medical or neurological disorders, and D) psychosocial stressors. History since the onset of stroke or in the past 6 months. As the study was outpatient-department based, patients who were admitted to the hospital were excluded.GB Prasad scale was used to assess economic status, and HAM-D was used to assess the severity of depression. A Fatigue Severity Scale (FSS) questionnaire was used to assess the severity of post-stroke Fatigue (Table 1).

Table 1. Indicates that in our study we had no participants in the age group of 18-35 years, N=18(28.12%) in the 36-55 years of age group, N=46(71.87%) in the age group of 55 years and above.

Data Collection Methods, Instruments Used, and Measurements: The participants were screened for of severity depression by using a HAM-D questionnaire face to face interviews were collected (Hasin DS, 2005 & Jiao JT, et al .2016). Which contain 21 items that are valuable for both research and clinical purposes, only the first 17 are used for scoring. Scores for each item range from 0 to 4, with 4 representing more severe signs of depressive episodes (Jonas BS,2000). The BG Prasad scale was used to assess the economic status of participants (Katon W et al, 2015). The fatigue severity scale was used to assess the extent of fatigue causing distress to the study population, subjective contains nine items with scoring 0-5 0f each item, Score of 1-3 was considered as mild or no fatigue while a score of greater than 4 in each item was treated as moderate to severe fatigue in each item of scale (Knesevich JW, 1977).

Data Management And Analysis: Data has been analyzed using IBM SPSS statistics 24.0. Frequencies and percentages were used for qualitative variables.

In gender males N=37(57.81%),Females N=27(42.18%).All population is Muslim.Married N=45(70.31%).single,N=7(10.93%) and divorced N=12(18.75%).Education of participants as N=10(15.62%) had primary education,47(73.43%)had secondary, N=4(6.25%) were graduates and 3 (4.68%) were postgraduates. The majority of participants were employed (37%) and N=27(42.18%) were unemployed. As per economic status, N= 22(34.32%) had lower economic status,30 had middle and N=12(18.75%) belonged to higher economic status. Moreover, N=25(39.06%)had right hemisphere stroke,39 left-sided,N=52(81.25%) had an ischemic stroke, N=12(18.75%) had hemorrhagic stroke,12.% had frontal and remaining N=56(87.5%) had non frontal stroke.

Discussion

Stroke is one of the major causes of mortality and disability (Mpembi MN, 2013). post stroke fatigue results in a number of adverse consequences, and impacts on the well-being and quality of life affected (Narushima K, 2003). A depressive episode is commonly seen after stroke, that affects one-third of patients having a history of stroke with a cumulative incidence of 55% (Pennlert J, 2017).In our study majority of participants belong to the age group of greater than 55 years, finding of our study were consistent with the studies of international importance (Pikula A).In our study majority were females, and many studies have highlighted the higher ratio in a sociodemographic variable, our study had similar results with few studies of national and international level (Ressler KJ,2017& Robinson RG,2010& Salaycik KJ,2007).It may be also due to the fact that females have caregiver responsibility in families. In our study, the majority of the patients were married which is in contrast to studies done by (SharmaR,2013).It may be due to the breadwinner model role of the male population. The majority of the population had an education level above high school and from lower socioeconomic status. Our study had findings that were in resonance with other studies (Sreedharan SE,2013 & Townsend AL, 2001).It may be due to worries about future income resources and other life stressors. The majority of patients were employed which was in resonance with a study done by (Vincent-Onabajo G,2017).In our study Majority of participants had a left-sided ischemic non-frontal stroke that was echoed by many international studies (WahabKW, 2008).Our patients had mild depressive episodes in the majority that were in resonance with other studies done by (Wei N, 2015). The likely reason may be that our patients had lower volumfe ischemic stroke, not extending to greater areas, non-frontal regions, The severity of post-stroke fatigue in our patients was less than that in correspondence to few other international studies(Whyte EM,2004).Likely reason would be an early referral and early intervention would have lowered the post-stroke sequelae (Table 2).

Table 2.
Indicates N= 37 (57.81%) had mild depression, N=19 (29.68%) moderate, and 12.5% had severe depressive episodes. whereas 54.68% had no or mild fatigue and 45.31% had moderate to severe depressive episodes.

Implications:

➢Early diagnosis and intervention of comorbid depression and fatigue is likely to improve quality of life.
➢ Early intervention will prevent the recurrence of stroke and will lessen the severity of depression and fatigue.
➢Patients with a stroke history should be rehabilitated according to the severity of fatigue via vocational training and occupational therapies. ➢ Patients having a stroke should be classified on the severity of psychiatric morbidities so that required referrals may be made.

Limitations: Hospital-based study restricted to only one tertiary care center. Sample from periphery centers/secondary level that are managed at secondary level, should have been included. A follow-up study may be planned. Strengths Of The Study: Our study has assessed the severity of depression and post-stroke fatigue which enables us to categorize the patients on the severity and subsequently plan the type of rehabilitation and referral.

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