title: Trajectories of psychological distress after stroke.
abstract: OBJECTIVE
  There has been little exploration of the distinct trajectories of psychological distress after stroke and the factors that predict recovery from distress. These trajectories may assist primary care physicians by providing insight into disease onset, progression, and resolution and may be a useful way to conceptualize and understand the pattern of psychological morbidity in stroke over time. We undertook a longitudinal qualitative study to explore poststroke psychological trajectories
  
  
  METHODS
  The primary data collection method was semistructured interviews with community-dwelling stroke survivors in metropolitan Newcastle, New South Wales, Australia. Our sample included 23 participants (12 men, 10 women; age range 37 to 94 years) discharged from a tertiary referral hospital after a stroke; these participants subsequently participated in a total of 106 interviews over 12 months. Qualitative outcomes were participants' perceptions at baseline, 3, 6, 9, and 12 months. Thematic saturation was achieved.
  
  
  RESULTS
  Most participants were male (54%) and had a partial anterior circulation infarction stroke subtype (57%). Four different longitudinal trajectories were identified: resilience (n = 5); ongoing crisis (n = 5), emergent mood disturbance (n = 3), and recovery from mood disturbance (n = 10). Recovery from mood disturbance was facilitated by gains in independence and self-esteem and by having an internal health locus of control.
  
  
  CONCLUSIONS
  Stroke survivors experienced a variety of psychological trajectories. Identifying distinct trajectories of psychological morbidity may help primary care physicians develop appropriately timed interventions to promote better mental health. Interventions require implementation over a longer duration than the current outpatient services that, in Australia, are typically provided in the first few months after stroke.
authors.affiliation: Hunter Stroke Service, Hunter New England Area Health Service, Australia.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: White
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sturm
authors.forename: Gregory
authors.initials: G
authors.lastname: Carter
authors.forename: Michael
authors.initials: M
authors.lastname: Pollack
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000150:complications*; D011446:Prospective Studies; D036301:Qualitative Research; D011788:Quality of Life; D055500:Resilience, Psychological; D012307:Risk Factors; D012649:Self Concept; D013315:Stress, Psychological / Q000150:complications*; D020521:Stroke / Q000150:complications / Q000523:psychology*; D013997:Time Factors