‘Feeling sad and useless’: an investigation into personal acceptance of disability and its association with depression following stroke

OBJECTIVES: To study the association of acceptance of disability with depression following stroke and its ability to predict depression at follow-up. DESIGN: A prospective cohort mixed (quantitative and qualitative) design was used. SETTING AND SUBJECTS: Patients admitted to a stroke unit were consecutively recruited. Eighty-nine participated at one month and 81 were followed up nine months post stroke. MAIN MEASURES: 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.