Brief Psychosocial–Behavioral Intervention With Antidepressant Reduces Poststroke Depression Significantly More Than Usual Care With Antidepressant: Living Well With Stroke: Randomized, Controlled Trial
Open accessAbstract
Background and Purpose— Depression after stroke is prevalent, diminishing recovery and quality of life. Brief behavioral intervention, adjunctive to antidepressant therapy, has not been well evaluated for long-term efficacy in those with poststroke depression. Methods— One hundred one clinically depressed patients with ischemic stroke within 4 months of index stroke were randomly assigned to an 8-week brief psychosocial–behavioral intervention plus antidepressant or usual care, including antidepressant. The primary end point was reduction in depressive symptom severity at 12 months after entry. Results— Hamilton Rating Scale for Depression raw score in the intervention group was significantly lower immediately posttreatment ( P <0.001) and at 12 months ( P =0.05) compared with control subjects. Remission (Hamilton Rating Scale for Depression <10) was significantly greater immediately posttreatment and at 12 months in the intervention group compared with the usual care control. The mean percent decrease (47%±26% intervention versus 32%±36% control, P =0.02) and the mean absolute decrease (−9.2±5.7 intervention versus −6.2±6.4 control, P =0.023) in Hamilton Rating Scale for Depression at 12 months were clinically important and statistically significant in the intervention group compared with control. Conclusion— A brief psychosocial–behavioral intervention is highly effective in reducing depression in both the short and long term.
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In one included study, adverse effects were said to be monitored.
“In one study, adverse effects were said to be monitored (see Mitchell 2008 under Mitchell 2009).”
From Behavioural activation therapy for depression in adults with non-communicable diseases (2020) · cites this paper as Mitchell 2008 under Mitchell 2009
The Discussion (page unavailable) says that the separate AIM trial monitored medication side effects by telephone. The Methods describe medication diaries and follow-up for Mitchell’s own Living Well with Stroke trial, but do not say that adverse effects were monitored in that trial, which the parenthetical appears to identify. (LLM, conf=0.82)
Experimental — accuracy not yet measuredParticipants in the study by Mitchell and colleagues had a mix of gender, age, and ethnicity.
“Participants in the study by Mitchell and colleagues had a mix of gender, age, and ethnicity (Mitchell 2009), while participants in the study by Hopko and colleagues were all women, with a mean age of 55 years, and mostly White American (Hopko 2011).”
From Behavioural activation therapy for depression in adults with non-communicable diseases (2020) · cites this paper as Mitchell 2009
The Results section reports that participants were 59% male and ranged in age from 25 to 88 years, supporting a mix of gender and age. The passages in our copy do not establish a mix of ethnicities; searches for ethnicity and race did not find a participant breakdown. No page number is available in the indexed copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOne study used a mental health specialist to deliver the intervention (Mitchell 2009).
“One study used a mental health specialist to deliver the intervention (Mitchell 2009), while the other used clinical psychology doctoral students (specialists in training) (Hopko 2011).”
From Behavioural activation therapy for depression in adults with non-communicable diseases (2020) · cites this paper as Mitchell 2009
The Methods > Design section describes the intervention as nurse-delivered, and Methods > Study Protocol says participants met with a study interventionist nine times. Our copy does not identify that nurse or interventionist as a mental health specialist, so it supports who delivered the intervention only at a less specific level. (LLM, conf=0.84)
Experimental — accuracy not yet measuredTreatment as usual in this case primarily involved the provision of medical care after stroke.
“Treatment as usual in this case primarily involved the provision of medical care after stroke.”
From Behavioural activation therapy for depression in adults with non-communicable diseases (2020) · cites this paper as Mitchell 2009
One study compared behavioural activation with an antidepressant (sertraline in the first instance) versus treatment as usual with an antidepressant (Mitchell 2009).
“One study compared behavioural activation with an antidepressant (sertraline in the first instance) versus treatment as usual with an antidepressant (Mitchell 2009).”
From Behavioural activation therapy for depression in adults with non-communicable diseases (2020) · cites this paper as Mitchell 2009
One study did not report comorbidities in mental health (Mitchell 2009).
“One study did not report comorbidities in mental health (Mitchell 2009), while in the other study, 55/80 participants (69%) had depression and an anxiety disorder (Hopko 2011).”
From Behavioural activation therapy for depression in adults with non-communicable diseases (2020) · cites this paper as Mitchell 2009
The two included studies evaluated the Living Well with Stroke intervention (Mitchell 2009) and brief behavioural activation for women with breast cancer (Hopko 2011).
“The two included studies were both RCTs and evaluated the Living Well with Stroke intervention (Mitchell 2009) and brief behavioural activation for women with breast cancer (Hopko 2011).”
From Behavioural activation therapy for depression in adults with non-communicable diseases (2020) · cites this paper as Mitchell 2009
In one study, participants were within four months poststroke (Mitchell 2009).
“In one study, participants were within four months poststroke (Mitchell 2009), while in the other study participants were receiving treatment for breast cancer (Hopko 2011).”
From Behavioural activation therapy for depression in adults with non-communicable diseases (2020) · cites this paper as Mitchell 2009
In the study by Mitchell and colleagues, some participants had moderate and others severe depression symptoms.
“In the study by Hopko and colleagues all participants had a moderate level of depression (Hopko 2011), while in the study by Mitchell and colleagues, some participants had moderate and others severe depression symptoms (Mitchell 2009).”
From Behavioural activation therapy for depression in adults with non-communicable diseases (2020) · cites this paper as Mitchell 2009
The Methods (Participants; Study Protocol) confirm that participants had clinically verified depression and that depression severity was assessed with the HRSD. The passages found do not classify participants as having moderate or severe depressive symptoms or give a distribution across those categories (searched: moderate, severe, and baseline depression severity). (LLM, conf=0.71)
Experimental — accuracy not yet measured
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- Authors
- Mitchell, P. H., Veith, R. C., Becker, K. J., Buzaitis, A., Cain, K. C., Fruin, M., Tirschwell, D., & Teri, L.
- Affiliations
- University of Washington (US)
- Venue
- Stroke
- Published
- 2009-09
- Volume
- 40
- Issue
- 9
- Pages
- 3073-3078
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- PMC
- PMC2777736
- OpenAlex
- W2040664278
- Cited by
- 177
- References
- 38
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 14 · 2023: 12 · 2022: 4 · 2021: 6 · 2020: 15 · 2019: 15 · 2018: 8 · 2017: 18 · 2016: 4 · 2015: 11 · 2014: 14 · 2013: 10 · 2012: 8
- FWCI
- 10.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (R01NR007755)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- post-stroke depression, ischemic stroke, antidepressants, adjunctive psychotherapy, depression severity, remission, long-term efficacy, stroke rehabilitation
- MeSH terms
- Adult, Aged, Aged, 80 and over, Antidepressive Agents, Depression, Female, Humans, Male, Middle Aged, Quality of Life, Time Factors, Stroke
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