'Feeling sad and useless': an investigation into personal acceptance of disability and its association with depression following stroke.
OBJECTIVE
To study the association of acceptance of disability with depression following stroke and its ability to predict depression at follow-up.


METHODS
A prospective cohort mixed (quantitative and qualitative) design was used.


METHODS
Patients admitted to a stroke unit were consecutively recruited. Eighty-nine participated at one month and 81 were followed up nine months post stroke.


METHODS
Depressive disorder was assessed using a structured clinical interview. Disability and acceptance of disability were measured using self-report scales. At one month post stroke, 60 consecutive participants also participated in open-ended interviews exploring their individual concerns about having had a stroke and their responses were analysed qualitatively.


RESULTS
One-third of participants were found to have depression (29/89; 33% at one month and 24/81; 30% at nine months). Non-acceptance of disability remained associated with depression after controlling for age, gender, original stroke severity and current disability at one month (odds ratio (OR) = 1.27, 95% confidence interval (CI) 1.09-1.47) and nine months (OR = 1.46, 95% CI 1.22-1.75). Also, non-acceptance of disability measured at one month independently predicted depression measured at nine months (OR = 1.19, 95% CI 1.05-1.35). The qualitative findings illustrated a self-reproachful element to non-acceptance of disability. Patients with depression often said that they 'should still' be capable and sometimes referred to themselves as 'useless'; whereas patients who were not depressed commonly reported having accepted stroke-related disability.


CONCLUSIONS
These finding suggest that personal beliefs about accepting disability are associated with and predict emotional adaptation following stroke.
Townend
Ellen
E
School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, UK. Ellen.Townend@nhs.net
Tinson
Deborah
D
Kwan
Joseph
J
Sharpe
Michael
M
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D013997:Time Factors