Depression, a sequela of stroke, is underrecognized and underreported. The American Heart/Stroke Association estimated 1/3 of patients develop depression after a stroke. Depression after a stroke has negative influence on stroke recovery through decreased participation in rehabilitation, and increased morbidity and mortality. The American Heart/Stroke Association recommended that depression screening be conducted on stroke patient; however, there is a lack of guidance regarding the optimal time and tools for depression screening. The practice problem identified was the absence of depression screening in poststroke patients at the project site. The project question focused on identifying evidence-based approaches for depression screening in poststroke patients. The goal of the project was to develop clinical practice guidelines for depression screening poststroke. The framework used to develop the project was the John Hopkins Evidence-Based Nursing model. An expert panel was used to evaluate the developed clinical practice guidelines. Serving as participants, expert panelist were selected based on their background in stroke care management. Panelists evaluated the guidelines using the Appraisal of Guidelines for Research and Evaluation Instrument II standard instrument tool. Twenty-five percent of reviewers recommended using the guidelines and 75% recommended using the guidelines with minor modifications. Implementation of clinical practice guidelines support depression screening after stroke leading to increased awareness, education, recognition and reporting. The findings of this project have the potential for positive social changes by improving depression screening in stroke patients and increasing early recognition and reporting of depression poststroke.

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Postpartum depression (PPD) is a mood disorder that affects women shortly after the birth of their newborn. Prevalent symptoms include sadness, anxiety, fatigue, and lack of interest in activities that used to be pleasurable. Severe cases may include suicide ideation. While the pathogenesis and treatment methods are similar to major depressive disorder (MDD), it is not until recently that individual research has been performed to further understand PPD and its origins as well as efficacy of treatments on mothers with their wavering biology. Risk factors that are statistically significant in contributing to a higher risk of PPD include biological and genetic predispositions, environmental factors such as demographics, and most importantly, the mother’s previous mental history. Clinicians suggest treatment methods depending on the severity of the case and the mother’s lifestyle. Psychotherapy is the first-line treatment recommended to mothers with mild to moderate PPD; this is also a favorable choice for mothers breastfeeding as all antidepressants can secrete into breast milk. Antidepressants fall under several classifications, with selective serotonin reuptake inhibitors (SSRIs) being the optimal choice as they produce less side effects compared to the others. Mothers with a previous mental history or severe PPD are immediately recommended antidepressants as the therapy of choice. Electroconvulsive therapy (ECT), while controversial, has become a more prominent option for mothers with severe PPD or for patients who simply want results sooner. Meta-analyses performed explore the origin of PPD and compare treatments currently in place. Similar confounding variables arise time and time again in these studies; region, local demographics, and self-report surveys make it difficult to apply data from one city, much less another country, to another. Studies with a large population of people of color or areas where seeking mental health counseling is looked down upon show large numbers of subjects dropping out of studies midway. The accuracy of data from self-report surveys is also questionable. As research continues to find more effective treatments and better comprehend the biological aspect of PPD, an increased understanding of current studies may aid in the management of PPD.

Thesis (D.N.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / This study examined the effect that maternal post partum depressive affect had on an infant's affective development at three months of age. A sample of 26 mother-infant pairs, 13 with maternal depressive symptomatology and 13 with no depressive symptomatology were compared for differences in infant affective regulation and affective responses during an age appropriate stressful interaction - the still-face interaction. The implications of this data and the potential complexity of the relationship between maternal depressive affect and infant coping behavior are discussed. Recommendations for further propective research are proposed. [TRUNCATED] / 2031-01-01

In der vorliegenden Dissertation wurde anhand von post- hoc Analysen aus dem Datensatz des Interdisziplinären Netzwerkes Herzinsuffizienz (INH, Unique identifier: ISRCTN 23325295) die prognostische Bedeutung depressiver Symptome bei Patienten mit systolischer Herzinsuffizienz bestimmt. Dazu wurden n=852 Patienten untersucht, die zur Baseline alle einen PHQ-9 Fragebogen zur Erhebung ihrer depressiven Symptome ausgefüllt hatten. Es konnte gezeigt werden, dass sich die kürzere Version des PHQ-9, der PHQ-2, ebenso gut zum Screening für Depression eignete und auch ein prognostischer Marker für Tod jeder Ursache und Rehospitalisierung nach 540 Tagen war. Ein Dosis- Wirkungseffekt konnte für zunehmende depressive Symptome nachgewiesen werden. Der PHQ-9 eignete sich als Risikomarker für beide Geschlechter. Es zeigten sich signifikante Unterschiede in den Baseline Charakteristiken und dem depressiven Symptomprofil von Frauen und Männern. Die weiblichen Teilnehmerinnen hatten zusätzlich eine signifikant schlechtere Lebensqualität anhand des krankheitsspezifischen Kansas City Cardiomyopathy Questionnaires. Dafür hatten nur Männer mit vermehrten depressiven Symptomen auch ein erhöhtes Rehospitalisierungsrisiko. Depressive Symptome verschlechterten die Lebensqualität bei beiden Geschlechtern. Die Ergebnisse tragen dazu bei die Aufmerksamkeit für die häufig auftretenden und zu selten diagnostizierten depressiven Symptome bei Herzinsuffizienz zu erhöhen. Der PHQ-2 ist zudem weniger zeitintensiv und kann mündlich erfragt werden. Die Informationen aus den hier gezeigten Geschlechtsunterschieden könnten darüber hinaus in der Zukunft für individuellere Behandlungsziele und Unterstützungsangebote verwendet werden. / This thesis consists of post-hoc analyses from the Interdisciplinary Network for Heart Failure (INH, unique identifier: ISRCTN 23325295) to evaluate the prognostic meaning of depressive symptoms in patients with systolic heart failure. N=852 patients who had completed the PHQ-9 questionnaire for depressive symptom assessment at baseline were included. The PHQ-2 (extracted from the PHQ-9 and a shorter version) proved to be a valid screening tool and prognostic marker for all-cause death and rehospitalization after 540 days. A dose-response effect of depressive symptoms was shown. The PHQ-9 was a suitable risk predictor for both sexes. Some significant differences were found between men and women in baseline characteristics and depressive symptom profiles. Female participants had a worse quality of life according to disease-specific Kansas City Cardiomyopathy Questionnaire Scores. Only depressed men had a higher risk for rehospitalization. Depressive symptoms decreased quality of life for both men and women. The results raise awareness for the common yet under diagnosed depressive symptoms in heart failure patients. The PHQ-2 is less time consuming than the PHQ-9 and can be verbally used in any clinical interview. Information on gender-specific differences might help to develop more individual treatments und support programs in the future.

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