Coping, problem solving, depression, and health-related quality of life in patients receiving outpatient stroke rehabilitation.
OBJECTIVE
To investigate whether patients with high and low depression scores after stroke use different coping strategies and problem-solving skills and whether these variables are related to psychosocial health-related quality of life (HRQOL) independent of depression.


METHODS
Cross-sectional study.


METHODS
Two rehabilitation centers.


METHODS
Patients participating in outpatient stroke rehabilitation (N=166; mean age, 53.06±10.19y; 53% men; median time poststroke, 7.29mo).


METHODS
Not applicable.


METHODS
Coping strategy was measured using the Coping Inventory for Stressful Situations; problem-solving skills were measured using the Social Problem Solving Inventory-Revised: Short Form; depression was assessed using the Center for Epidemiologic Studies Depression Scale; and HRQOL was measured using the five-level EuroQol five-dimensional questionnaire and the Stroke-Specific Quality of Life Scale. Independent samples t tests and multivariable regression analyses, adjusted for patient characteristics, were performed.


RESULTS
Compared with patients with low depression scores, patients with high depression scores used less positive problem orientation (P=.002) and emotion-oriented coping (P<.001) and more negative problem orientation (P<.001) and avoidance style (P<.001). Depression score was related to all domains of both general HRQOL (visual analog scale: β=-.679; P<.001; utility: β=-.009; P<.001) and stroke-specific HRQOL (physical HRQOL: β=-.020; P=.001; psychosocial HRQOL: β=-.054, P<.001; total HRQOL: β=-.037; P<.001). Positive problem orientation was independently related to psychosocial HRQOL (β=.086; P=.018) and total HRQOL (β=.058; P=.031).


CONCLUSIONS
Patients with high depression scores use different coping strategies and problem-solving skills than do patients with low depression scores. Independent of depression, positive problem-solving skills appear to be most significantly related to better HRQOL.
Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands. Electronic address: mvisser@rijndam.nl.
Marieke M
MM
Visser
Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands.
Majanka H
MH
Heijenbrok-Kal
Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands.
Adriaan Van't
AV
Spijker
Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.
Kristine M
KM
Oostra
Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands.
Jan J
JJ
Busschbach
Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Rotterdam Neurorehabilitation Research (RoNeRes), Rijndam Rehabilitation Center, Rotterdam, The Netherlands.
Gerard M
GM
Ribbers
D000223:Adaptation, Psychological; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011340:Problem Solving; D011788:Quality of Life / Q000523:psychology*; D012047:Rehabilitation Centers; D000071939:Stroke Rehabilitation
Coping skills; Depression; Quality of life; Rehabilitation; Stroke