title: The positive effect of integrated care on depressive symptoms in stroke survivors.
abstract: BACKGROUND
  Depressive symptoms occur in approximately one-third of stroke patients. We sought to evaluate whether an integrated model of stroke care and secondary prevention reduced depressive symptomatology in stroke survivors.
  
  
  METHODS
  The integrated care (IC) model is a multifaceted program that provides ongoing collaboration between a specialist stroke service and primary care physicians, using telephone tracking, a bi-directional information feedback loop, management of vascular risk factors, and regular screening for depressive symptoms.
  
  
  RESULTS
  Patients exposed to the IC model exhibited significantly fewer depressive symptoms than controls at 12 months post stroke (as measured by the PHQ-9 screening tool; p = 0.006). At 12 months, 30/91 (33%) of the treatment group had depressive symptoms, compared to 52/95 (55%) of the control group (p = 0.003). With other variables adjusted for, the major associates of being depressed at 12 months were group allocation and physical disability.
  
  
  CONCLUSIONS
  The integrated care approach provides a framework for detecting and monitoring depressive symptoms, and appears to be protective against post-stroke depression.
authors.affiliation: Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia. jacquesjoubert@bigpond.com
authors.forename: Jacques
authors.initials: J
authors.lastname: Joubert
authors.forename: Lynette
authors.initials: L
authors.lastname: Joubert
authors.forename: Chris
authors.initials: C
authors.lastname: Reid
authors.forename: David
authors.initials: D
authors.lastname: Barton
authors.forename: Toby
authors.initials: T
authors.lastname: Cumming
authors.forename: Peter
authors.initials: P
authors.lastname: Mitchell
authors.forename: Molly
authors.initials: M
authors.lastname: House
authors.forename: Robert
authors.initials: R
authors.lastname: Heng
authors.forename: Graham
authors.initials: G
authors.lastname: Meadows
authors.forename: Mark
authors.initials: M
authors.lastname: Walterfang
authors.forename: Christos
authors.initials: C
authors.lastname: Pantelis
authors.forename: David
authors.initials: D
authors.lastname: Ames
authors.forename: Stephen
authors.initials: S
authors.lastname: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D019033:Delivery of Health Care, Integrated; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010351:Patient Discharge; D010353:Patient Education as Topic; D011569:Psychiatric Status Rating Scales; D020521:Stroke / Q000523:psychology* / Q000628:therapy; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria
chemical_list: D000928:Antidepressive Agents