PoStDAM
PoStDAM (Post-Stroke Depression: Early Assessment for improved Management)
In this prospective longitudinal study at the Department of Neurology, Klinikum Ernst von Bergmann Potsdam, 226 staff, people who had suffered a stroke in the stroke unit were recruited and followed up by telephone after 6 and 36 months. The primary aim of the study was to develop an early risk assessment scale for post-stroke depression (PSD) for use in the acute phase. In addition, the connection between PSD and changes in self-concept, so-called self-discrepancy, which has already been frequently reported in other neurological diseases, was investigated.
As part of the study, the Post-Stroke Depression Risk Scale (PoStDeRiS) was developed to predict depression after 6 months. The PoStDeRiS uses information for this purpose about the presence of previous depression (yes/no), everyday impairments (activities of daily living) and a short depression screening in the acute phase (Patient Health Questionnaire-2). These economically recordable data are transformed into a sum score and serve as a risk assessment within the first week after stroke with adequate sensitivity and specificity as well as a high negative predictive value. The positive predictive value in this study was limited, which requires validation of the PoStDeRiS in another study and the addition of further economic measures to the scale.
The relationship between self-concept and depression 36 months after stroke was clearly pronounced. The current self-concept showed a stronger influence than the self-discrepancy, i.e. the subjective change in self-concept after stroke. In addition, self-concept showed a stronger correlation with depressive symptoms than everyday impairment, which has consistently been the strongest predictor of PSD in studies to date.
In addition, an innovative, visualised single-item instrument for recording self-discrepancy was tested for the first time after stroke: the Inclusion of Other in the Self Scale (IOSS). This showed similar reliability and validity to a questionnaire that is considered the gold standard for recording self-discrepancy after brain injury, but with 36 items it is less economical and may be of limited use for people affected by stroke due to cognitive-verbal impairments. These results point to the relevance of self-concept in the development of PSD and the potential of the IOSS in early diagnosis.
Publications:
Ladwig, S., Ziegler, M., Südmeyer, M. & Werheid, K. (2022). The Post-Stroke Depression Risk Scale (PoStDeRiS): Development of an acute-phase prediction model for depression 6 months after stroke. Journal of the Academy of Consultation-Liaison Psychiatry, 63(2), 144-152. https://doi.org/10.1016/j.jaclp.2021.08.003
Ladwig, S., Werheid, K., Südmeyer, M. & Volz, M. (2023). Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1093918
Ladwig, S. & Werheid, K (under review). Self-concept, self-discrepancy and depressive symptoms three years after stroke: A cross-sectional evaluation of predictive value, the role of subdomains, and individual importance.
Heckmann, K., Werheid, K. & Ladwig, S. (submitted). The Inclusion of the Other in the Self-Scale (IOSS) as a valid self-discrepancy measure after stroke.
Contact person:
Dr Simon Ladwig (simon.ladwig@uni-bielefeld.de)