Sociodemographic profile and social support for post-stroke depression in Kinshasa: A rehabilitation based cross-sectional study

Magloire Nkosi Mpembi, Samuel Mampunza ma Miezi, André Peeters, Marie-Pierre de Partz, Sévérine Henrard, Victoria Kubuta Massamba, Roland Nengi Nsam, Thierry Matonda ma Nzuzi, Jean Macq, Vincent Dubois, Eric Constant

Centre Neuro PsychoPathologique, Université de Kinshasa (UNIKIN), Kinshasa, Congo.
Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Brussels, Belgium.
Institut de Recherché Santé et Société, Université Catholique de Louvain (UCL), Brussels, Belgium.
Research Center in Epidemiology, Biostatistics and Clinical Trials, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.

DOI: 10.4236/ojepi.2013.3318                

Abstract

The World Health Organization has highlighted the emergence of non-communicable chronic diseases, including stroke, in developing countries. As a cause of death, stroke ranks first in Africa. Stroke is the foremost cause of neuropsychiatric disease, including post-stroke depression (PSD) which is a very common disease. Surveys of this condition in Congolese pa tients are virtually non-existent. The objectives of this study were to assess the prevalence of PSD in Congolese patients and identify associated sociodemographic factors. Age, sex, address, province of origin, social and professional status, education, religion and consumption habits were chosen as indicators or parameters of interest to be examined in this study. The results of descriptive analyses are presented as frequencies for categorical variables and as mean ± standard deviation for quantitative variables. The association between different variables was assessed using tables of comparisons of proportions and the Chi-square test. Logistic regression was performed to predict the occurrence of PSD. There were more male than female patients. The mean age was 54.67 ± 12.51 years. Nearly 3 fourths of the patients were aged less than 65. The family was the primary source of social support. The majority was satisfied by the social support received from the family. Just over half the study patients (53.6%) had mild to severe depression as assessed by the PHQ9. Univariate analysis and logistic regression indicated a statistically significant association between low educational level and the occurrence of PSD. However, there was no relationship between age, sex or drinking habits and the onset of PSD. The majority of the subjects were satisfied by the social support from their families. Depression was common after stroke with the occurrence of 53.6%. These results highlight the need to investigate, diagnose and treat PSD, which is a risk factor for morbidity and mortality after stroke.

Keywords

Stroke; Post-Stroke Depression; Kinshasa

1. INTRODUCTION

The World Health Organization (WHO) defines stroke as the rapid development of clinical signs of local or global cerebral dysfunction with symptoms lasting at least 24 hours or leading to death with no apparent cause other than the vascular origin [1]. There are two types of stroke, depending on the etiology: hemorrhagic stroke and ischemic stroke. Stroke now constitutes a public health problem throughout the world and is the second cause of death worldwide [2]. In the Western countries, stroke is the third largest cause of death after cancer and myocardial infarction [3,4] and remains the leading cause of dependency [4]. Africa is currently experiencing an epidemiological transition. The World Health Organization has highlighted the emergence of non-communicable chronic diseases, including stroke, in developing countries [5]. As a cause of death, stroke ranks first in Africa, above infectious diseases [2]. Eighty-seven percent of stroke deaths worldwide occur in developing countries [2]. In addition to the dependency of survivors on others, stroke is the foremost cause of neuropsychiatric disease, including post-stroke depression (PSD) [6-8]. The subject of many publications in Europe and the United States over the last few decades, to our knowledge PSD has not yet been explored in Congolese patients. This study was conducted to fill this gap.

The main objective of this work was to contribute to the epidemiological study of PSD. To achieve this general aim, the following specific objectives were set to assess the prevalence and to determine sociodemographic factors associated with the occurrence of PSD.

2. METHOD

2.1. Study Design and Population

This was a cross-sectional study involving 58 patients followed for post-stroke hemiplegia at the Centre de rehabilitation pour personnes handicapées de Kinshasa (CRPHK) between August 1 and 31, 2011. Patients with at least three months between the onset of their stroke and the date of the study were included. Exclusion criteria were: lack of consent; confusion or profoundly disturbed conscious state; and inability to understand and execute orders.

2.2. Description of Measures

Each patient underwent clinical, neurological and psychiatric examinations. The clinical history was also recorded. A diagnosis of depression was made in 56 of the 58 patients using the Patient Health Questionnaire PHQ9 [9]. Because of marked expressive aphasia, two patients were assessed using the stroke aphasic depression questionnaire SADQ [10]. Age, sex, address, province of origin, social and professional status, educational level, religion as well as alcohol and tobacco consumption were chosen as indicators or parameters of interest to be examined in this study.

2.3. Statistical Analysis

Data were analyzed using Epi Info 6.04 software and Stata/IC 11.2. The results of descriptive analyses are presented as frequencies for categorical variables and as mean ± standard deviation for quantitative variables even for non-normally distributed variables for comparison with other published studies. The statistical significance level adopted was 5%. Logistic regression was performed to identify predictors of the occurrence of PSD. Due to the sample size, two variables which were significant in univariate analysis (p < 0.05) were introduced into the multivariate model. The adequacy of the model was evaluated by Hosmer and Lemeshow test. Outliers were detected by the graph of standardized residuals based on the predicted values. The absence of collinearity was checked by the variance inflation factors.

3. RESULTS

The sociodemographic characteristics are shown in Table 1. There were more male than female patients (n = 37/58, 63.8% versus n = 21/58, 36.2%) in our cohort. The mean age was 54.7 ± 12.5 years, ranging from 23 to 75 years. Three quarters of patients (74.1%) were aged under 65.

Patients from the District of Lukunga, in which is situated the CHPRK, represented 41.4% of all patients (Figure 1) followed by those from the District of Funa.

The provinces of Bas-Congo and Bandundu were most represented with, respectively, 32.8% and 25.9% of pa-

Table 1. Sociodemographic characteristics.

Figure 1. Distribution of patients according the addresses.

Table 2. Distribution of patients according to province of origin.

tients (Table 2).

Patients with an income represented 58.6% (n = 34/58) of the study cohort and no income patients represented 41.4%. Nineteen of the patients (32.8%) had a primary school certificate and 15 (25.9%) had a high school diploma. Thirty-eight patients (65.5%) were members of traditional churches (Catholic, Protestant, Kimbanguism, Muslims). Forty-six patients (69%) reported using alcohol and 15 (25.9%) tobacco. Table 3 shows the social support received by the patients after their episode of stroke and reported by them. The family was the primary source of social support for the study subjects. The majority of the patients were satisfied by the social support received from the family, in the 4 types of social support, including listen and comfort, material support, advices, information and suggestions, and self-confidence recovery support. Just over half the study patients (53.6%) had mild to severe depression as assessed by the PHQ9.

Table 4 summarizes the relationship between demographic characteristics and PSD as evaluated by the PHQ9 (we defined PSD patients who were identified to have mild to severe depression).

For the subgroup of patients with moderate to severe depression (n = 12), there was a statistically significant relationship between PSD, age ≥ 65 years (p = 0.034) and low educational level (p = 0.02).

Table 5 shows the model built by logistic regression and adjusted for age (n = 56). Patients with a high educational level had a low likelihood of developing depresssion (OR [95% CI]: 0.21 [0.05; 0.92]).

Conflicts of Interest

The authors declare no conflicts of interest.

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