Improving behavioral health access and engagement in post-stroke depression support among adult stroke survivors

Problem: Post-stroke depression (PSD) is a common and frequently underrecognized complication of stroke recovery that is associated with poorer functional outcomes, reduced quality of life, increased healthcare utilization, and elevated suicide risk. At Trinity Health in Muskegon, MI, routine inpatient assessment utilized the Columbia-Suicide Severity Rating Scale (C-SSRS), which captures suicidality but does not assess a broader range of depressive symptoms. Purpose: The original purpose of this Doctor of Nursing Practice evidence-based practice/quality improvement project was to evaluate whether dual screening with the Patient Health Questionnaire-9 (PHQ-9) and the C-SSRS would improve identification of PSD compared with screening using the C-SSRS alone in adult post-stroke inpatients. The broader organizational aim was to improve identification of patients at risk for PSD and strengthen connections to psychosocial support services, including outpatient stroke survivor support groups. Methods: The project was guided by the Iowa Model of Evidence-Based Practice and the Plan-Do-Study-Act cycle. The original design proposed implementation of a dual-screening protocol at admission and prior to discharge. However, before implementation, administrative transitions and shifting institutional priorities at Trinity Health led to a pivot project. The implemented intervention focused on structured inpatient outreach, bedside PSD education, promoting the Stroke Survivor Support Group, attending monthly support group meetings, and delivering a PowerPoint presentation on PSD, common symptoms, crisis resources, and coping strategies. Results: During implementation, 48 stroke patient opportunities were identified and 35 patients received bedside PSD education, representing 72.9% of identified opportunities. Of the 13 missed opportunities, eight involved duplicate patients who had already been seen and five involved patients who were inappropriate to meet with alone because of aphasia. Patients who received education ranged in age from 43 to 89 years, with a mean age of 69.3 years and a median age of 76 years; 60.0% were female and 40.0% were male. Stroke Survivor Support Group attendance included one patient at the first meeting, five at the second, and two at the third, for a total of eight patients across three sessions. Family-member attendance totaled three at the second meeting only. Conclusions: Although the original dual-screening protocol was not implemented, the revised intervention demonstrated that structured inpatient outreach is feasible and creates meaningful opportunities to increase awareness of post-stroke depression (PSD) and available psychosocial resources during stroke recovery. Embedding behavioral health education and referral into stroke care pathways promotes sustained improvements in patient engagement and continuity of care. These findings support integrating PSD education and support group promotion into routine inpatient stroke care. Future efforts should focus on standardizing identification of eligible acute stroke patients, strengthening discharge-linked referral processes, and evaluating how inpatient outreach influences outpatient support group engagement following discharge.

Authors dc:creator

• Peake, Andrea N. (Andrea Nicole)
• Birdsey, Montaigne R.

Contributors dc:contributor

• Jones-Brown, Natalie

• Cerebrovascular disease--Patients--Care
• Cerebrovascular disease--Patients--Psychology
• Depression, Mental--Diagnosis
• Hospital patients--Care
• Patient education
• Self-help groups

Statement dc:rights

• In Copyright

Language dc:language

English

Identifier

dnp:99
oclc:1601633978
local:R_6jXtiFgGk8PbmGR

OAI identifier oai:identifier

oai:d.lib.msu.edu:dnp_99