Care management of poststroke depression: a randomized, controlled trial.

Full Abstract

BACKGROUND

AND PURPOSE:
Poststroke depression is a prevalent and disabling disorder, yet evidence regarding the effectiveness of treating poststroke depression is inconclusive. Our objective was to determine the effectiveness of the Activate-Initiate-Monitor care management program for the treatment of poststroke depression.

METHODS:
We conducted a prospective, randomized, outcome-blinded trial in 188 ischemic stroke survivors identified at the time of admission to one of 4 Indianapolis hospitals. Depression screening and enrollment occurred between 1 and 2 months poststroke. The Activate-Initiate-Monitor intervention was a care management program that included Activation of the patient to recognize depression symptoms and accept treatment, Initiation of an antidepressant medication, and Monitoring and adjusting treatment. Usual care subjects received nondepression-related education and were prescribed antidepressants at the discretion of their provider. The primary outcome measure was depression response, defined as a Hamilton Depression Inventory score <8 (remission) or a decrease from baseline of at least 50% at 12 weeks.

RESULTS:
Intervention and usual care groups did not differ on any key baseline measures. Both depression response (51% versus 30%, P=0.005) and remission (39% versus 23%, P=0.01) were more likely in the Activate-Initiate-Monitor intervention than in the usual care group. This difference in depression scores was present by 6 weeks and persisted through the 12-week assessment. Serious adverse events did not differ between the 2 groups.

CONCLUSIONS:
The Activate-Initiate-Monitor care management model is significantly more effective than usual care in improving depression outcomes in patients with poststroke depression.

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Author information

Author/s: Williams, Linda S (LS); Kroenke, Kurt (K); Bakas, Tamilyn (T); Plue, Laurie D (LD); Brizendine, Edward (E); Tu, Wanzhu (W); Hendrie, Hugh (H);

Affiliation: Roudebush VA Medical Center, Indianapolis, IN 46202, USA. linwilli(-atsign-)iupui.edu

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial

Journal: Stroke; a journal of cerebral circulation (Stroke), published in United States. (Language: eng)

Reference: 2007-Mar; vol 38 (issue 3) : pp 998-1003

Dates: Created 2007/02/27; Completed 2007/03/19; Revised 2007/11/21;

PMID: 17303771, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Evid Based Med. 2007 Oct;12(5):139. (PMID: 17909230)

CommentIn: Evid Based Nurs. 2007 Oct;10(4):117. (PMID: 17905769)

CommentIn: Stroke. 2007 Mar;38(3):850-1. (PMID: 17303770)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Antidepressive Agents - therapeutic use
Depressive Disorder - etiology; psychology; therapy
Disease Management
Female
Humans

Humans
Male
Middle Aged
Patient Care Management - methods
Prospective Studies
Stroke - complications; psychology; therapy

Associated Chemicals: Antidepressive Agents (0)

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