摘要

中風是常見的神經系統疾病之一，也是老年人常見的疾病和死亡和殘障的原因。近年來，在越南，中風已經成為嚴重的健康問題，是癌症和心血管疾病之後死亡的第三大原因。
中風通常突然發生並伴有局灶性神經症狀，意識障礙。如果疾病的急性期通常會留下許多身體和精神上的後遺症，並極大地影響患者的生活品質。在中風後產生的精神障礙中，憂鬱症是最常見的表現。憂鬱症會對患有中風的人產生不利影響，例如冗長的復原時間 - 住院時間，生活品質下降，死亡風險增加，認知能力下降等。
中風後憂鬱是老年人中風最常見的神經系統併發症。這是一個描述性研究，探討中風後憂鬱症的發生率及相關因素的，包括年齡，性別，教育程度，日常活動，社會支持等變數。 2019年1月至4月，隨機選擇了120名參與者參與這項研究。資料收集在金蘭醫院和傳統醫院進行 - 越南慶和省恢復使用四個問題：人口統計學，中風後憂鬱量表（PSDRS），0.85可靠性，修訂巴塞爾指數（MBI） ，可靠性為0.94，認知社會支持量表（MSPSS），其可靠性為0.87. 使用頻率，百分比，平均值，標準差及皮爾森相關性來分析數據。
結果顯示，老年人中風後會出現憂鬱症。中風患者年齡在60至93歲之間，平均為68.43歲（SD = 7,375）。日常活動和社會支持活動與中風後憂鬱症顯著相關（r = -.567，r = -652，p <0.01）。然而，年齡，性別，婚姻狀況與中風後憂鬱之間的關係沒有顯著差異。因此，建議減少這些老年人中風後憂鬱的護理措施應考慮這些因素。研究顯示，醫護工作者需要採取措施支持患者，並與家屬溝通協調，更應注重患者的心理和情感方面問題，尤其是溝通。
關鍵詞：中風，抑鬱症，老年人。

Abstract

Stroke is one of the common neuropathy, which is a common medical condition in the elderly and a major cause of death and disability for people with the disease. In Vietnam in recent years, brain stroke has become a serious health problem for people, the third leading cause of death after cancer and cardiovascular disease.
Stroke usually occurs suddenly and severely with focal neurological symptoms, disturbed consciousness. If the acute phase of illness usually leaves many physical and mental sequelaes and greatly affects the quality of life of the patient. In mental disorders after stroke, depression is the most common manifestation. Depression adversely affects people with brain stroke such as prolonged rehabilitation time - hospital stay, reduced quality of life, increased risk of death, cognitive decline.
Depression after stroke is the most common neurological complication of stroke in older people. This descriptive study investigates the incidence of depression after stroke and examines its relationship with related factors including age, gender, education level, daily activities, Social support of these elders. One hundred and twenty participants were randomly selected to participate in this study from January to April 2019. Data collection was conducted at Cam Ranh Hospital and Traditional Medicine Hospital- Khanh Hoa Province Rehabilitation, Vietnam using four questions: Demographic, Post-stroke Depression Assessment (PSDRS), with .85 reliability, revised Bathel Index (MBI) , with reliability of .94, Multi-dimensional scale of Cognitive Social Support (MSPSS), with its reliability of .87. Frequency, percentage, average value, standard deviation were used to analyze the data.
The results show that older people may also experience depression after a stroke. People with brain stroke are between 60 and 93 years old with an average of 68.43 years (SD = 7.375). Activities of daily living and social support are significantly correlated with depression after stroke (r = -.567, r = -.652, p <.01, respectively). However, there is no statistical significance in the relationship between age, gender, marriage level and depression after stroke. Therefore, it is recommended that nursing interventions to reduce post-stroke depression in these older people should consider these factors. Research shows that health workers need to take measures to support patients, to coordinate with relatives, families and society to pay more attention to the psychological and emotional issues of patients, especially communication. with them, learn to grasp the happenings, the state, the psychology of the patients, to timely encourage the patients to be assured of treatment.
Keywords: Stroke, post-stroke depression, older.

Table of contents
Recommendation Letter from the Thesis Advisor i
Thesis/Dissertation Oral Defense Committee Certification ii
Acknowledgments iii
摘要 iv
Abstract vi
Chapter 1: Introduction 1
Background and statement of the problem 1
Research purposes 4
Research Hypothesis 4
Chapter 2: Literature Review 5
Overview of stroke in older adults 5
Stroke in Vietnam 7
Pathologic mechanism of stroke 8
Psychological factors after stroke 9
Physical injury after stroke 10
Post stroke depression 10
Norepinephrine alterations 11
Serotonergic alterations 11
Diagnosis of post stroke depression 13
Types and symptoms of post stroke depression 14
Post stroke depression in Vietnam 15
Factors related to post stroke depression 15
Conceptual framework 19
Conclusion 20
Chapter 3: Methodology 22
Research design 22
Setting 22
Sampling 22
Sample size 23
Instruments 24
Data Collection 27
Ethical considerations 27
Data Analysis 28
Chapter 4: Results 29
Demographic characteristics of the older adults 29
Descriptions of post stroke depression, activities of daily living, social support 31
Descriptions of activities of daily living 31
Descriptions of social support 32
The relationship between the demographic and post stroke depression 33
Relationship between the level of depression and the level of independence in daily life and the level of the social support 34
Chapter 5: Discussion 35
Summary 35
Research results 36
Discussion 36
Chapter 6: Conclusion 41
The reality of depression in people with stroke 41
Factors related to depression in people with stroke 42
Implications for Nursing 42
Strengths and Limitations 43
Recommendation for Future Research 44
References 45
Appendix 55
Appendix A: Agreement Form (English version) 55
Appendix B: Agreement Form (Vietnamese version) 56
Appendix C: Questionnaire (English version) 57
Appendix D: Questionnaire (Vietnamese version) 66
Appendix E: IRB 76
76

List of tables
Table 1: Demographic characteristics of the older adults (N=120) 29
Table 2: Descriptions of post stroke depression (N =120) 31
Table 3: Descriptions of activities of daily living (N=120) 32
Table 4: Descriptions of social support 32
Table 5: The relationship between demographic and post stroke depression (N=120) 33
Table 6: The relationship between depression and independence in daily life and social support (N=120) 34

References
Aben I, Verhey F, Honig A et al (2001). Research into the specificity of depression after stroke: a review on an unresolved issue. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 25(4), pp. 671-689
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. 4th. Retrieved from https://www.google.com.vn/webhp? sourceid=chrome
World Health Organization [WHO]. (2015). Definition of age. Retrieved from http://www.who.int/healthinfo/survey/ageingdefnolder/en/
Alajbegovic, A., Djelilovic-Vranic, J., Nakicevic, A., Todorovic, L., & Tiric-Campara, M. (2014). Post stroke depression. Medical archives (Sarajevo, Bosnia and Herzegovina), 68(1), 47-50. doi:10.5455/medarh.2014.68.47-50
National Stroke Association (2014). Stroke. Retrieved from http://www.stroke.org/understand-stroke/what-stroke/ischemic-stroke
Vietnam Neurology Association (2015). Quality standards for stroke management in Vietnam. Retrieved from http://hoithankinhhocvietnam.com.vn/
Bedard, M., Weaver, B., & Richardson, J. (2001). Changes in physical functioning in institutionalized older adults. Disabil Rehabil, 23(15), 683-689.
Berg, A., Palomaki, H., Lehtihalmes, M., Lonnqvist, J., & Kaste, M. (2003). Poststroke depression: an 18-month follow-up. Stroke, 34(1), 138-143. doi:10.1161/01.str.0000048149.84268.07
Brodaty, H., Withall, A., Altendorf, A., & Sachdev, P. S. (2007). Rates of depression at 3 and 15 months poststroke and their relationship with cognitive decline: the Sydney Stroke Study. The American Journal of Geriatric Psychiatry, 15(6), 477-486. doi:10.1097/JGP.0b013e3180590bca
Brown, C., Hasson, H., Thyselius, V., & Almborg, A. H. (2012). Post-stroke depression and functional independence: a conundrum. Acta Neurol Scand, 126(1), 45-51. doi:10.1111/j.1600-0404.2011.01595.x
Cassidy, E., O'Connor, R., & O'Keane, V. (2004). Prevalence of post-stroke depression in an Irish sample and its relationship with disability and outcome following inpatient rehabilitation. Disabil Rehabil, 26(2), 71-77. doi:10.1080/09638280410001650142
Cha, E. S., Kim, K. H., & Erlen, J. A. (2007). Translation of scales in cross-cultural research: issues and techniques. Journal of Advanced Nursing, 58(4), 386-395. doi:10.1111/j.1365-2648.2007.04242.x
Chau, J. P., Thompson, D. R., Chang, A. M., Woo, J., Twinn, S., Cheung, S. K., et al. (2010). Depression among Chinese stroke survivors six months after discharge from a rehabilitation hospital. Journal of Clinical Nursing, 19(21-22), 3042-3050. doi:10.1111/j.1365-2702.2010.03317.x
Chiu, H. C., Chen, C. M., Huang, C. J., & Mau, L. W. (2005). Depressive symptoms, chronic medical conditions and functional status: a comparison of urban and rural elders in Taiwan. International Journal of Geriatric Psychiatry, 20(7), 635-644. doi:10.1002/gps.1292
Chuong, T.V. (2010). Rehabilitation of patients with hemiplegia due to stroke. Medical Publishing House: Ha Noi.
Cully, J.A. (2002). Post-stroke depression within a sample of geriatric rehabilitation patients: A factor analysis of the geriatric depression scale. Saint Louis University,
De Ryck, A., Brouns, R., Geurden, M., Elseviers, M., De Deyn, P. P., & Engelborghs, S. (2014). Risk factors for poststroke depression: identification of inconsistencies based on a systematic review. Journal of Geriatric Psychiatry and Neurology, 27(3), 147-158. doi:10.1177/0891988714527514
Fancher, A. H. M. & Lynch. J. M. (2007). Cardiovascular system. In Matteson & McConnell (Eds.), Gerontological nursing concepts and practice (3th ed.): Michigan: Saunders Elsevier.
Farrell, C. (2004). Poststroke depression in elderly patients. Dimensions of Critical Care Nursing, 23(6), 264-269.
Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annu Rev Clin Psychol, 5, 363-389. doi:10.1146/annurev.clinpsy.032408.153621
Folkman, S. (2013). Stress: appraisal and coping: Springer.
Franzen-Dahlin, A., Billing, E., Nasman, P., Martensson, B., Wredling, R., & Murray, V. (2006). Post-stroke depression - effect on the life situation of the significant other. Scandinavian Journal of Caring Science, 20(4), 412-416. doi:10.1111/j.1471-6712.2006.00422.x
Fung, L. C., Lui, M. H., & Chau, J. P. (2006). Relationship between self-esteem and the occurrence of depression following a stroke. Journal of Clinical Nursing, 15(4), 505-506. doi:10.1111/j.1365-2702.2006.01328.x
Gaete, J.M., & Bogousslavsky, J. (2008). Post-stroke depression. Expert Rev Neurother, 8(1), 75-92. doi:10.1586/14737175.8.1.75
Gainotti, G., Azzoni, A., Razzano, C., Lanzillotta, M., Marra, C., & Gasparini, F. (1997). The Post-Stroke Depression Rating Scale: a test specifically devised to investigate affective disorders of stroke patients. Journal of Clinical and Experimental Neurospychology, 19(3), 340-356. doi:10.1080/01688639708403863
Glamcevski, M.T., 2nd, & Pierson, J. (2005). Prevalence of and factors associated with poststroke depression: a Malaysian study. Journal of Stroke and Cerebrovascular Diseases, 14(4), 157-161. doi:10.1016/j.jstrokecerebrovasdis.2005.03.006
Ha, V.T.T. (2014). The quality of life of a stroke patient after treatment and a number of related factors at Khanh Hoa Traditional Medicine and Rehabilitation Hospital in 2014. Thesis master of hospital management, public health university.
Hackett, M.L., & Anderson, C.S. (2006). Frequency, management, and predictors of abnormal mood after stroke: the Auckland Regional Community Stroke (ARCOS) study, 2002 to 2003. Stroke, 37(8), 2123-2128.
Hackett, M.L., & Pickles, K. (2014). Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke, 9(8), 1017-1025. doi:10.1111/ijs.12357
Haghgoo, H.A., Pazuki, E. S., Hosseini, A. S., & Rassafiani, M. (2013). Depression, activities of daily living and quality of life in patients with stroke. J Neurol Sci, 328(1-2), 87-91. doi:10.1016/j.jns.2013.02.027
Hama, S., Yamashita, H., Shigenobu, M., Watanabe, A., Hiramoto, K., Kurisu, K., et al. (2007). Depression or apathy and functional recovery after stroke. Int J Geriatr Psychiatry, 22(10), 1046-1051. doi:10.1002/gps.1866
Hoa, L. (2015). Surveying some common risk factors in cerebral vascular accident patients in the Department of Positive and Anti-Poisoning in Phu Yen Province General Hospital. Grassroots Research Project, Phu Yen General Hospital.
House, A., Dennis, M., Mogridge, L., Warlow, C., Hawton, K., & Jones, L. (1991). Mood disorders in the year after first stroke. Br J Psychiatry, 158, 83-92. doi:10.1192/bjp.158.1.83
House, J.S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540-545.
Huang, H.T., Chuang, Y. H., Hsueh, Y. H., Lin, P. C., Lee, B. O., & Chen, C. H. (2014). Depression in older residents with stroke living in long-term care facilities. J Nurs Res, 22(2), 111-118. doi:10.1097/jnr.0000000000000028
Hung, D.H. (2014). The risk of recurrence after ischemic stroke follows stratification of some related factors. Ho Chi Minh City University of Medicine and Pharmacy.
Johnson, J. L., Minarik, P. A., Nystrom, K. V., Bautista, C., & Gorman, M. J. (2006). Poststroke depression incidence and risk factors: an integrative literature review. J Neurosci Nurs, 38(4 Suppl), 316-327.
Kauhanen, M., Korpelainen, J. T., Hiltunen, P., Brusin, E., Mononen, H., Maatta, R., et al. (1999). Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke, 30(9), 1875-1880. doi:10.1161/01.str.30.9.1875
Keltner, N. L., Folks, D. G., Palmer, C. A., & Powers, R. E. (1998). Psychological foundations of psychiatric care. Danvers: Mosby.
Kouwenhoven, S. E., Kirkevold, M., Engedal, K., & Kim, H. S. (2011). Depression in acute stroke: prevalence, dominant symptoms and associated factors. A systematic literature review. Disabil Rehabil, 33(7), 539-556. doi:10.3109/09638288.2010.505997
Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping: Springer Publishing Company.
Li, S.-C., Wang, K.-Y., & Lin, J.-C. (2003). Depression and related factors in elderly patients with occlusion stroke. The journal of nursing research: JNR, 11(1), 9-18.
Linden, T., Blomstrand, C., & Skoog, I. (2007). Depressive disorders after 20 months in elderly stroke patients: a case-control study. Stroke, 38(6), 1860-1863. doi:10.1161/strokeaha.106.471805
Luc, T. V., Thinh, L. V., & et., N. T. X. a. (2010). Situation and status of stroke care in general hospitals from the provincial level upward in Vietnam. Clinical Medicine Journal, 38-43. doi:Luc
Mahoney, F. I., & Barthel, D. (1965). Functional evaluation: The barthel index. Maryland State Medical Journal,14, 56-61
Marasco, G., Iavarone, A., Ronga, B., Martini, V., Crispino, M., & Postiglione, A. (2011). Depressive symptoms in patients admitted to a semi-intensive stroke unit. Acta Neurologica Belgica, 111(4), 276.
Moskowitz, M. A., Lo, E. H., & Iadecola, C. (2010). The science of stroke: mechanisms in search of treatments. Neuron, 67(2), 181-198. doi:10.1016/j.neuron.2010.07.002
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., et al. (2016). Executive Summary: Heart Disease and Stroke Statistics--2016 Update: A Report From the American Heart Association. Circulation, 133(4), 447-454. doi:10.1161/cir.0000000000000366
Mpembi, M. N., Miezi, S. M. m., Peeters, A., Partz, M.-P. d., Henrard, S., Massamba, V. K., et al. (2013). Sociodemographic profile and social support for post stroke depression in Kinshasa: A rehabilitation based cross-sectional study. Open Journal of Epidemiology, 3(3), 111-117.
Nhung, N. T. T., Long, T. K., Linh, B. N., Vos, T., Anh, N. D., & Huong, N. T. (2011). Viet Nam burden of disease and injury study 2008. Hanoi: The Evidence Base for Health Policy in Viet Nam Project (VINE Project).
Nicholl, C. R., Lincoln, N. B., Muncaster, K., & Thomas, S. (2002). Cognitions and post-stroke depression. Br J Clin Psychol, 41(Pt 3), 221-231.
Nidhinandana, S., Sithinamsuwan, P., Chinvarun, Y., Wongmek, W., Supakasem, S., & Suwantamee, J. (2010). Prevalence of poststroke depression in Thai stroke survivors studied in Phramongkutklao Hospital. Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 93 Suppl 6, S60-64.
Nys, G. M., van Zandvoort, M. J., van der Worp, H. B., de Haan, E. H., de Kort, P. L., & Kappelle, L. J. (2005). Early depressive symptoms after stroke: neuropsychological correlates and lesion characteristics. J Neurol Sci, 228(1), 27-33. doi:10.1016/j.jns.2004.09.031
Pohjasvaara, T., Leppavuori, A., Siira, I., Vataja, R., Kaste, M., & Erkinjuntti, T. (1998). Frequency and clinical determinants of poststroke depression. Stroke, 29(11), 2311-2317.
Qamar, Z. K. (2012). Depression among stroke patients and relation with demographic and stroke characteristics. Umeå International School of Public Health,
Salter, K., Mehta, S., Bhogal, S., Teasell, R., Foley, N., & Speechley, M. (2013). Post stroke depression. Retrieved from http://www.ebrsr.com/sites/default/files/ Chapter18_Depression_FINAL_16ed.pdf.
Sathirapanya, C., Sathirapanya, P., & Trichan, J. (2014). Prevalence, risk factors of stroke and post stroke depression in Phatthalung Province: A cross sectional study. Songklanagarind Medical Journal, 32(5), 275-282.
Schepers, V., Post, M., Visser-Meily, A., van de Port, I., Akhmouch, M., & Lindeman, E. (2009). Prediction of depressive symptoms up to three years post-stroke. Journal of rehabilitation medicine, 41(11), 930-935.
Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol, 42(8), 703-709.
Smarr K.L, Keefer A.L (2011). Measures of depression and depressive symptoms: Beck Depression Inventory‐II (BDI‐II), Center for Epidemiologic Studies Depression Scale (CES‐D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire‐9 (PHQ‐9). Arthritis care & research, 63(S11), S454-S466.
Sit, J. W., Wong, T. K., Clinton, M., & Li, L. S. (2007). Associated factors of post-stroke depression among Hong Kong Chinese: a longitudinal study. Psychol Health Med, 12(2), 117-125. doi:10.1080/14622200500358978
Tam, D. M. (2015). Research on clinical characteristics and some factors related to depression in patients after cerebral infarction. Doctoral thesis in Medicine, Hanoi University of Medicine and Pharmacy.
Tang, W. K., Chen, Y. K., Lu, J. Y., Chu, W. C., Mok, V. C., Ungvari, G. S., et al. (2011). Cerebral microbleeds and depression in lacunar stroke. Stroke, 42(9), 2443-2446. doi:10.1161/strokeaha.111.614586
Terroni, L., Sobreiro, M. F. M., Conforto, A. B., Adda, C. C., Guajardo, V. D., de Lucia, M. C. S., et al. (2012). Association among depression, cognitive impairment and executive dysfunction after stroke. Dementia & neuropsychologia, 6(3), 152-157. doi:10.1590/S1980-57642012DN06030007
Thanh, L. V. (2010). The World Stroke Day launching ceremony was held on October 14 in Ho Chi Minh City. Retrieved from http://www.youtube.com/watch?v=6iODTOCA4bY&feature=youtu.b
Thinh, L. V., Le, T., Nguyên, T., Nguyên, H., Dào, T., Nguyên, V., et al. (1999). Strokes in South Vietnam: an epidemiologic study. Rev Neurol (Paris), 155(2), 137-140.
Thomas, S. A., & Lincoln, N. B. (2006). Factors relating to depression after stroke. Br J Clin Psychol, 45(Pt 1), 49-61. doi:10.1348/014466505x34183
Townsend, N., Wickramasinghe, K., Bhatnagar, P., Smolina, K., Nichols, M., Leal, J., et al. (2012). Coronary heart disease statistics 2012 edition. British Heart Foundation.
Turner-Stokes, L. (2003). Poststroke depression: getting the full picture. Lancet, 361(9371), 1757-1758. doi:10.1016/s0140-6736(03)13445-9
Tuyen, L. T. T. (2015). Factors related to post stroke depression among older adults in Da Nang. Master thesis on medicine, Burapha University.
Vataja, R., Pohjasvaara, T., Leppavuori, A., Mantyla, R., Aronen, H. J., Salonen, O., et al. (2001). Magnetic resonance imaging correlates of depression after ischemic stroke. Arch Gen Psychiatry, 58(10), 925-931. doi:10.1001/archpsyc.58.10.925
Vickery, C. D., Evans, C. C., Sepehri, A., Jabeen, L. N., & Gayden, M. (2009). Self-esteem stability and depressive symptoms in acute stroke rehabilitation: methodological and conceptual expansion. Rehabil Psychol, 54(3), 332-342. doi:10.1037/a0016434
Williams, L. S., Ghose, S. S., & Swindle, R. W. (2004). Depression and other mental health diagnoses increase mortality risk after ischemic stroke. Am J Psychiatry, 161(6), 1090-1095. doi:10.1176/appi.ajp.161.6.1090
Yildirim, M. A., & Ones, K. (2019). Post stroke depression and related factors. Dusunen Adam: Journal of Psychiatry & Neurological Sciences, 32(1).
Zavoreo, I., Basic-Kes, V., Bosnar-Puretic, M., & Demarin, V. (2009). Post-stroke depression. Acta Clin Croat, 48(3), 329-333.
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of personality assessment, 52(1), 30-41.