title: Ecosystem focused therapy in poststroke depression: a preliminary study.
abstract: OBJECTIVE
  Poststroke depression (PSD) occurs in the context of abrupt, often catastrophic disability that finds the patient and his or her family unprepared. We developed the ecosystem focused therapy (EFT), a systematic intervention aimed to increase the PSD patient's and his or her ecosystem's abilities to address the "psychosocial storm" of PSD and utilize available treatments effectively and efficiently. This is a preliminary study of its efficacy.
  
  
  METHODS
  A total of 24 PSD patients were randomly assigned to receive weekly sessions of EFT or a comparison condition consisting of systematic Education on Stroke and Depression and their treatment for 12 weeks.
  
  
  RESULTS
  Ecosystem Focused Therapy may be more efficacious than Education on Stroke and Depression in reducing depressive symptoms and signs, in leading to a higher remission rate, and in ameliorating disability in PSD. Reduction of disability in the early part of the trial mediated later improvement in depressive symptomatology. Similarly, reduction in depressive symptoms and signs early on mediated later improvement in disability.
  
  
  CONCLUSIONS
  These encouraging findings require replication. Beyond its potential direct benefits in PSD, EFT may provide an appropriate context for efficient and timely administration of pharmacotherapy and of physical, speech, and occupational therapy thus maximizing their efficacy.
authors.affiliation: Weill Cornell Medical College, Weill Cornell Institute of Geriatric Psychiatry, New York, USA. gsalexop@med.cornell.edu
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Wilkins
authors.forename: Patricia
authors.initials: P
authors.lastname: Marino
authors.forename: Dora
authors.initials: D
authors.lastname: Kanellopoulos
authors.forename: Michael
authors.initials: M
authors.lastname: Reding
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Sirey
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Raue
authors.forename: Samiran
authors.initials: S
authors.lastname: Ghosh
authors.forename: Michael W
authors.initials: MW
authors.lastname: O'Dell
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Kiosses
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000209:etiology / Q000517:prevention & control*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D010353:Patient Education as Topic / Q000379:methods; D011340:Problem Solving; D011613:Psychotherapy / Q000379:methods; D012944:Social Support; D020521:Stroke / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation