Preventing depression among stroke survivors

Research has shown that engaging in enjoyable or meaningful activities can help prevent depression after stroke. Now an interprofessional team of researchers at UTHealth Houston will use a new federal grant to test an intervention using video chats to encourage mood-enhancing behaviors among older, low-income stroke survivors.

Cizik School of Nursing at UTHealth Houston Associate Professor Jennifer E.S. Beauchamp, PhD, RN, FAAN, is principal investigator on a five-year, $6.48 million grant from the National Institute of Mental Health, part of the National Institutes of Health, that will fund the study “BehavioraL ActIvation for the PreVention of Post-strokE Depression in LoW-incomE OLder Stroke Survivors (LIVE-WEL) (R01MH140091).” Beauchamp is director of the Mental Health Program at the UTHealth Houston Institute for Stroke and Cerebrovascular Diseases.

About a third of stroke survivors develop depression, and up to 60% experience some level of depressive symptoms. If left untreated, subthreshold depression often progresses to post-stroke depression (PSD), Beauchamp explained. Patients with PSD are at heightened risk for subsequent strokes, neurological deficits, diminished functioning, poor quality of life, and premature death from all causes including suicide.

“Low-income, older stroke survivors face financial strains on top of typical age-related life stressors such as disabilities, bereavement, managing multiple medications, and loss of independence,” said Beauchamp, the Nancy B. Willerson Distinguished Professor in Nursing.

Behavioral activation focuses on identifying behaviors that positively affect mood. Patients are encouraged to do things that make them feel good. The technique is a core component of cognitive behavioral therapy but can be delivered independently by lay counselors who are not licensed therapists.

Through the LIVE-WEL study, community health workers who are trained as lay counselors will deliver a behavioral activation intervention via remote, video-enabled sessions with survivors within three months of their first stroke. About 300 low-income patients aged 55 and older will be recruited from the Stroke Transitions Education and Prevention Program in the Department of Neurology at McGovern Medical School at UTHealth Houston. They will participate in a randomized, controlled trial with half receiving behavioral activation and the other half receiving usual care. The intervention will include five weekly videoconferences and homework assignments with a series of follow-up calls and assessments for an additional nine months.

The study aims to assess the effectiveness of the tele-intervention in reducing depressive symptoms, anxiety, emotional distress, the proportion of stroke survivors who develop PSD, and the number of health care visits among participants.

“Our goal is that this intervention will improve overall quality of life for stroke survivors,” Beauchamp said. “If intervention effectiveness is demonstrated, it could have a profound affect on prevention of post-stroke depression.”

Co-investigators on the project from McGovern Medical School at UTHealth Houston are Professor Sean I. Savitz, Director of the UTHealth Houston Institute for Stroke and Cerebrovascular Diseases; Professor Anjail Z. Sharrief, MD, PhD, Director of Stroke Prevention for the institute; Professor Ron Acierno, PhD, Executive Director of the UTHealth Houston Trauma and Resilience Center; and Assistant Professor Robert Suchting, PhD, in the Louis A, Faillace, MD, Department of Psychiatry and Behavioral Sciences. Also serving as co-investigators are Professor Belinda Reininger, DrPH, Regional Dean of the UTHealth Houston School of Public Health in Brownsville; and Professor Namkee G. Choi, PhD, of the Steve Hicks School of Social Work at The University of Texas at Austin.