Making sense of depressive symptoms associated with stroke: A Q methodological study

This thesis aimed to investigate depressive symptoms associated with stroke.
Depression related to stroke is highly prevalent, not easy to diagnose, with important
consequences for prognosis. Specific beliefs patients hold about their physical illness are
well known to be important predictors of outcome, and there is now a growing literature on
the role of beliefs about mental illness as predictors of outcome. Much less is known about
how patients who have had a stroke make sense of their mood symptoms. Research
indicates that including depressed patients in decisions about their care results in better
outcomes; however, little is known about what treatments depressed stroke patients most
prefer, and how this relates to their beliefs about their mood symptoms. Therefore, the aims
of the current study were to: 1) Investigate patients' beliefs about their depressive symptoms
following a stroke to find out if there are similar patterns in the way they think about them,
and 2) to assess stroke patients’ preferences for treatment for their depressive symptoms and
to see how this relates to their beliefs about their low mood.

Q methodology was used. Twenty stroke patients were recruited who had endorsed depressive symptoms on standardized measures of mood. Patients sorted a wide range of statements about low mood associated with stroke and revealed four distinctive viewpoints:
1) depression due to external, physical factors, an emphasis on physical symptoms and social consequences; 2) highly determined with less worry, the importance of positive social support, helpful environment and a belief that depression will be over quickly; 3) past
depression, internal cause, out of control and lasting a long time; 4) strong need for independence and the meaning of physical aids. Frustration, anger and worry, but not out of control. These distinct viewpoints were also associated with quite distinct preferences for treatment. Clinical implications and future research directions were discussed.