Network analysis has been used to elucidate the relationships among depressive symptoms, but this approach has not been typically used in persons with stroke. Using a sample of 835 persons with stroke from Stroke Recovery in Underserved Populations 2005–2006 dataset, this study used network analysis to (1) examine changes in relationships between depressive symptoms over time, and (2) test whether baseline network characteristics were prognostic for depression persistence. Network analysis was performed on depressive symptoms collected at discharge from inpatient rehabilitation and at 3-months and 12-months post-discharge. The depressive symptom network at discharge was less connected than at both post-discharge follow-ups. Trouble focusing and feeling good as others were the most predictable symptoms at post-discharge, even though they were less connected to other depressive symptoms. Among participants with elevated baseline depression severity, those whose depression persisted 12 months later had more strongly connected networks at discharge than those who recovered 12 months later. This study was unable to determine the directionality of edges. The depression scale was administered differently across time points. These results suggest that baseline network connectivity can predict the course of post-stroke depression, similar to non-stroke populations. More broadly, the study highlights the importance of examining relationships between individual depressive symptoms rather than only sum-scores.

Objective: To investigate longitudinal, predictive associations between community participation, positive affect, social support, and functional independence for individuals post-stroke at 3 and 12 months post-discharge.Design: Longitudinal design.Subjects: Data from 544 participants were obtained from the Stroke Recovery in Underserved Populations (2005–06) database.Methods: A cross-lagged panel network analysis to identify the complex set of predictive relationships between community participation, positive affect, social support, and functional independence 3 months post-discharge to 12 months post-discharge.Results: Community participation, particularly religious/spiritual activities, was an early predictor of later motor (functional) independence and social support. In addition, positive affect was an early predictor of social support.Conclusion: While participation in social situations is a desired outcome post-stroke, the results of this study indicate the importance of identifying early factors that influence community participation throughout the recovery process. LAY ABSTRACTThe ability to participate in desired activities is a common outcome goal of rehabilitation for stroke survivors. However, there are many factors that influence success in achieving this goal, including support from family and friends, mental health, and functional independence. This study sought to understand how these factors influence each other and participation over time. The results indicate that early participation post-stroke is an important predictor of later motor independence and social support needs. The results indicate that, while participation is often viewed as a rehabilitation outcome, understanding participation as a predictor of other rehabilitation outcomes is also important.

Purpose: Depression assessment is challenging in persons with aphasia given their language impairment. Studies have used both self-report scales and by-proxy measures of depression in persons with aphasia. However, the validity of these measures has been called into question. The aim of this study was to conduct a preliminary investigation into aspects of validity of the community version of the Stroke Aphasia Depression Questionnaire (SADQ-10) and the Center for Epidemiological Studies Depression Scale–Revised (CESD-R). Method: Twenty-four participants with chronic aphasia completed the CESD-R, the Patient-Reported Outcomes Measurement Information System Global Mental Health scale (PROMIS GMH), and the Dynamic Visual Assessment of Mood Scales (D-VAMS) while their caregivers completed the SADQ-10. Internal consistency of the CESD-R and the SADQ-10 and the convergent validity of the CESD-R, SADQ-10, PROMIS GMH, and D-VAMS were examined. Results: The SADQ-10 and the CESD-R were internally consistent. The CESD-R was moderately correlated with the SADQ-10, PROMIS GMH, and D-VAMS. However, the SADQ-10 was not correlated with the PROMIS GMH and D-VAMS. Conclusions: We suggest both the CESD-R and the SADQ-10 be used together to screen for depression in persons with aphasia. Further studies with larger sample sizes need to be conducted to establish validity of other depression screening instruments in person with aphasia.

Background: Post-stroke depressive symptoms are prevalent and impairing, and elucidating their course and risk factors is critical for reducing their public health burden. Previous studies have examined the course of post-stroke depression, but distinct depressive symptom dimensions (eg, somatic symptoms, negative affect [eg, sadness], anhedonia [eg, loss of interest]) may vary differently over time. Objective: The present study examined within-person and between-person associations between depressive symptom dimensions across 3 timepoints in the year following discharge from in-patient rehabilitation hospitals, as well as the impact of multiple clinical variables (eg, aphasia). Methods: Stroke survivors completed the Center for Epidemiologic Depression Scale (CES-D) at discharge from post-stroke rehabilitation (“T1”) and at 3-month (“T2”) and 12-month (“T3”) follow-ups. Scores on previously identified CES-D subscales (somatic symptoms, anhedonia, and negative affect) were calculated at each timepoint. Random intercept cross-lagged panel model analysis examined associations between symptom dimensions while disaggregating within-person and between-person effects. Results: There were reciprocal, within-person associations between somatic symptoms and anhedonia from T1 to T2 and from T2 to T3. Neither dimension was predictive of, or predicted by negative affect. Conclusions: The reciprocal associations between somatic symptoms and anhedonia may reflect a “vicious cycle,” and suggest these 2 symptom dimensions may be useful indicators of risk and/or intervention targets. Regularly assessing depression symptoms starting during inpatient rehabilitation may help identify stroke survivors at risk for depression symptoms and facilitate early intervention.