A REVIEW ON THE FACTORS INFLUENCING DEPRESSION IN STROKE PATIENTS IN NATIONAL HOSPITAL, ABUJA

CHAPTER ONE

INTRODUCTION

Background of the study 

A stroke is a medical emergency that happens when a blood clot blocks the brain's blood supply or when a brain blood artery bursts. This may cause permanent brain damage, a lifetime of impairment, or possibly the person's death. Stroke has a protracted healing period and is a leading cause of chronic adult impairment. In addition, it ranks as the second most common cause of death globally (Wales, 2023). Stroke-related deaths and disabilities were expected to have cost 143 million years of healthy living globally in 2019. This accounted for 5.7% of Disability-Adjusted living Years (DALYs). Every year, almost 6 million people worldwide pass away from strokes, leaving 5.5 million with severe disabilities. In addition, the annual medical costs associated with treating a single stroke patient are very significant, contributing to the massive socioeconomic loss caused by stroke. One of the most prevalent psychiatric conditions that follow a stroke is post-stroke depression (PSD), which is a typical sequel of stroke (Ferdinand, 2020).

One typical neuropsychiatric issue that stroke survivors deal with is post-stroke depression. It is typified by enduring depressive and dismal feelings as well as a loss of interest in once-enjoyed activities. Research indicates that approximately one-third of stroke survivors experience depression following the onset of their stroke. Individuals with post-stroke depression have more severe cognitive impairment, a lower quality of life, inferior rehabilitation outcomes, and a higher mortality risk than post-stroke patients without depression. The physical, cognitive, and social functioning of stroke survivors is severely hampered by post-stroke depression, which not only hinders the recovery and well-being of the affected individual but also places a heavy burden on their family and the larger community. Early recognition and effective management of depression in stroke patients are crucial to prevent adverse outcomes and improve rehabilitation potential (Akpoti, 2022).

Numerous studies have demonstrated a strong correlation between stroke survivors' quality of life and depression. According to the global burden of illness study, the dual burden of depression and stroke has been identified as the primary factor contributing to the overall number of years lost to disability. Numerous studies have found a positive correlation between the severity of the first PSD diagnosis and the recovery outcome after a stroke, with higher mortality rates and better survival and quality of life when antidepressant drugs and psychoeducation are used. The prevalence of PSD varies widely in the literature; two recent studies conducted in Nigeria reported PSD to be 22.9% and 42.9%, respectively, while another study conducted in Tanzania found PSD to be 30%. According to a recent systematic analysis, the prevalence of post-stroke depression across the Middle East and North Africa ranged from 17 to 73% (Miel, 2021).

There are several biological, psychological, and social risk factors for post-stroke depression. The most researched risk variables for post-stroke depression were age and sex; nevertheless, opinions regarding how these factors affected post-stroke depression remained debatable. Numerous studies have shown that factors associated to stroke, including the kind, stage, severity, and location of the lesion, are significant predictors of depression following a stroke. Post-stroke depression was also linked to decreased cognitive performance, functional dependency, physical pain, and incapacity to work. Understanding patients' modifiable lifestyle and behaviours is equally crucial to lower the incidence of post-stroke depression, even if previous research has mostly focused on general and stroke-related factors as drivers of post-stroke melancholy. 

Odon (2021) found a substantial correlation between stroke survivors' depression symptoms and smoking and undergoing stroke treatment. According to Ayerbe et al., post-stroke depression and low exercise levels are related. Family ties play a vital role in social support, which is another important element in the fight against post-stroke depression, particularly for the elderly. Good family functioning was found to be a significant protective factor against post-stroke depression at different stages of the stroke, according to a longitudinal study by Wang (2020). It is crucial to remember that there is still a dearth of data, especially in Nigeria, about the relationship between post-stroke depression and family dynamics and personal lifestyle hence the need for this study.

 Statement of the problem

The prevalent and incapacitating mental illness known as depression has a substantial impact on stroke sufferers' quality of life. According to research conducted in Nigeria, depression is common among stroke survivors, although it is still underdiagnosed and undertreated (Owolabi & Toriola, 2021). Post-stroke depression (PSD) burden can lead to greater mortality, higher rates of disability, and poor rehabilitation outcomes (Ogungbite et al., 2022). There is a lack of thorough research on the various factors that contribute to depression in stroke patients within the Nigerian healthcare system, despite the increasing acknowledgement of depression as a major issue in stroke rehabilitation.

The development and maintenance of depression in stroke patients is influenced by a number of factors, including biological, psychological, and social factors. Depression symptoms may be brought on by the physical disabilities' emotional strain and the neurological damage from the stroke itself (Adeyemo et al., 2023). The difficulty of adequately controlling PSD is further exacerbated by the poor accessibility and availability of mental health care in Nigeria (Obiako & Kadiri, 2022). The heightened susceptibility of stroke patients to depression has also been linked to socioeconomic variables, including financial difficulties brought on by medical expenses, social isolation, and insufficient social support networks (Nwafor & Emeka, 2021).

There is a need for more research into the precise elements impacting depression in Nigerian stroke survivors because the country is experiencing an increase in the incidence of stroke and there is a dearth of knowledge regarding the psychological impacts of stroke, particularly depression. The results of this research may help design customised intervention plans that would enhance the mental health and general quality of life of stroke victims in the nation.

1.3 Objectives of the Study 

The primary objective of this study is to review the factors influencing depression in stroke patients in National Hospital, Abuja. Specifically the study seeks:

To identify the level of prevalence of depression among stroke patients receiving treatment at National Hospital, Abuja.

To examine the factors contributing to depression in stroke patients at National Hospital, Abuja.

To assess the impact of impairments caused by stroke on the mental health of patients at National Hospital, Abuja.

To propose recommendations for improving the mental health care provided to stroke patients to reduce the incidence of depression in patients at National Hospital, Abuja.

1.4 Research Questions

The following research questions will be answered in this study:

What is the level of prevalence of depression among stroke patients receiving treatment at National Hospital, Abuja?

What are the factors contributing to depression in stroke patients at National Hospital, Abuja?

What are the impact of impairments caused by stroke on the mental health of patients at National Hospital, Abuja?

What are the recommendations for improving the mental health care provided to stroke patients to reduce the incidence of depression in patients at National Hospital, Abuja?

1.5 Research Hypothesis

The stated hypothesis will validate this study:

Ho1: There are no significant factors influencing depression in stroke patients in National Hospital, Abuja.

Ha1: There are significant factors influencing depression in stroke patients in National Hospital, Abuja.

1.6 Significance of the study

This study tries to improve understanding of how different factors—such as biological, psychological, and social factors—intersect to influence mental health outcomes by identifying the components that lead to depression in stroke patients. This knowledge is essential for creating focused therapies that can lessen depression and improve patient recovery.

Moreover, this study will be extremely helpful to healthcare experts, especially those working in the fields of neurology and rehabilitation. Improved diagnosis and treatment approaches for medical professionals will result from a deeper comprehension of the causes of post-stroke depression. This information may be used to identify patients who are at risk early on and provide appropriate interventions or psychological support. 

The review has important ramifications for families and carers of stroke survivors as well. Understanding the causes that contribute to depression can help carers better support their loved ones, who frequently play a crucial role in the healing process. Through early symptom recognition and an appreciation of the complex nature of depression, they can work more productively with medical professionals to manage the patient's emotional health.

Finally, this study will inform future research in post-stroke care and add to the body of knowledge in academia. It will serve as a foundation for additional research on cutting-edge therapies, strengthening rehabilitation plans, and refining regulations pertaining to stroke victims' mental health assistance. 

1.7 Scope of the study

The study aims to review the factors influencing depression in stroke patients in National Hospital, Abuja. Empirically, this study assesses the level of prevalence of depression among stroke patients receiving treatment, the factors contributing to depression in stroke patients, the impact of impairments caused by stroke on the mental health of patients and propose recommendations for improving the mental health care provided to stroke patients to reduce the incidence of depression in patients.

1.8 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint was the scanty literature on the subject owing that it is a new discourse thus the researcher incurred more financial expenses and much time was required in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. Additionally, the researcher will simultaneously engage in this study with other academic work. However in spite of the constraint all these constraint were downplayed to give the best.

1.9 Definition of terms

Factors: Factors are the elements or conditions that contribute to a particular outcome or influence a situation. They are the causes or components that affect how something happens or functions.

Depression: Depression is a mental health condition characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. It can also affect a person’s thoughts, behavior, and physical health, leading to changes in sleep, appetite, and energy levels.

Stroke patients: Stroke patients are individuals who have suffered from a stroke, which occurs when the blood supply to part of the brain is interrupted or reduced, causing brain cells to be damaged or die. Stroke patients may experience various physical, cognitive, or speech impairments, depending on the severity and location of the stroke.

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