A Meta-analysis of the Variables related to Depression in Korean Patients with a Stroke

Eun-Young Park; In-Soo Shin; Jung-Hee Kim

doi:10.4040/jkan.2012.42.4.537

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Park, Shin, and Kim: A Meta-analysis of the Variables related to Depression in Korean Patients with a Stroke

Original Article

J Korean Acad Nurs 2012;42(4):537-548.

Published online: 12 August 2012

DOI: https://doi.org/10.4040/jkan.2012.42.4.537

A Meta-analysis of the Variables related to Depression in Korean Patients with a Stroke

Eun-Young Park¹, In-Soo Shin², Jung-Hee Kim³

¹Department of Secondary Special Education, College of Education, Jeonju University, Jeonju, Korea

²Department of Education, College of Education, Jeonju University, Jeonju, Korea

³Department of Nursing, College of Medicine, Dankook University, Cheonan, Korea

Address reprint requests to : Kim, Jung-Hee Department of Nursing, College of Medicine, Dankook University, San 29 Anseo-dong, Cheonan 330-714, Korea Tel: +82-41-550-3877 Fax: +82-41-550-7902 E-mail: jhee90@dankook.ac.kr

Received 1 November 2011 Revised 14 November 2011 Accepted 23 July 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to use meta-analysis to evaluate the variables related to depression in patients who have had a stroke.

Methods

The materials of this study were based on 16 variables obtained from 26 recent studies over a span of 10 years which were selected from doctoral dissertations, master's thesis and published articles.

Results

Related variables were categorized into sixteen variables and six variable groups which included general characteristics of the patients, disease characteristics, psychological state, physical function, basic needs, and social variables. Also, the classification of six defensive and three risk variables group was based on the negative or positive effect of depression. The quality of life (ES= -.79) and acceptance of disability (ES=-.64) were highly correlated with depression in terms of defensive variables. For risk variables, anxiety (ES= .66), stress (ES= .53) showed high correlation effect size among the risk variables.

Conclusion

These findings showed that defensive and risk variables were related to depression among stroke patients. Psychological interventions and improvement in physical functions should be effective in decreasing depression among stroke patients.

Keywords: Stroke, Depression, Meta-analysis

References

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Figure 1.

Literature searches and results.

KISS=Korean studies information service system.

Table 1.

Summary of Characteristics of Studies Included Meta-analysis

Researchers (yr)	Publication	Sample size	Related variables	Type of residence	Depression measurement
Yang (2010)	Yes	328	ADL other diseases, acceptance of disabilities, family support,	Inpatients	GDSSF-K
			burden, treatment's environments
Suh et al. (2010)	Yes	293	Age, education, economic status, ADL, social support, nutrition, pain, fatigue, sleep, quality of life	Outpatients	BDI
Kim (2008)	Yes	31	Sexual behaviors, sexual knowledge, sexual satisfaction, intimacy	Outpatients	CES-D
Kim (2006)	Yes	104	ADL, religion, family support, acceptance of disabilities, age, income, periods since diagnosis, recurrence	Outpatients	CES-D
Kim et al. (2003)	Yes	128	Health perception, motor function, cognitive function, ADL	Outpatients	CES-D
Lee et al. (2010)	Yes	35	Cognitive function, ADL, upper motor function	Inpatients	BDI, HDRS
Kim (2005)	No	76	ADL, social support, quality of life	Inpatients &	BDI
				outpatients
Kim et al. (1995)	Yes	112	Internal stress, interpersonal stress, external stress, ADL	Inpatients & outpatients	BDI
Yoo et al. (2009)	Yes	53	Cognitive function, visual & auditory function	Outpatients	SDS
Park (1988)	No	64	Stress	Inpatients	SDS
Wi (2009)	Yes	100	Quality of sleep, satisfaction of sleep	Outpatients	GDSSF-K
Han (2004)	No	120	ADL, family support	Inpatients &	SDS
				outpatients
Oh (2010)	No	92	Health perception, ADL, quality of life	Inpatients & Outpatients	GDSSF-K
Kim (2006)	No	74	Cognitive function, ADL, IADL	Outpatients	BDI
Bang et al. (2009)	Yes	80	Acceptance of disabilities, social support, ADL, cognitive function	Inpatients	GDSSF-K
Kim et al. (2000)	Yes	254	Severity of stroke, cognitive function, ADL, social function,	Outpatients	CES-D
			social support, illness intrusiveness
Yoon et al. (2008)	Yes	84	Stress, anxiety	Outpatients	HDRS
Park et al. (1999)	Yes	122	ADL, cognitive function	Inpatients &	BDI
				outpatients
Park et al. (1995)	Yes	44	Cognitive function	Inpatients	SDS, GDSSF-K
Chu (2008)	No	31	Age, sex, education, paralysis, type of stroke, periods since diagnosis, cognitive function	Inpatients	GDSSF-K
Shin (2011)	No	123	Caregiver's burden	Inpatients	HDRS
Moon (2010)	No	103	Social support, acceptance of disability	Inpatients	BDI
Park (2007)	No	99	ADL, anxiety	Outpatients	BDI
Jang et al. (2008)	Yes	85	Dysphasia	Outpatients	CES-D
Kim et al. (2007)	Yes	251	ADL, quality of life	Outpatients	CES-D
Koo et al. (2004)	Yes	24	Physical function	Inpatients	BDI, GDSSF-K
					HDRS

ADL=Activities of daily living; BDI=Beck depression inventory; CES-D=The Center for Epidemiological Studies-Depression Scale; GDSSF-K=Geriatric Depression Scale Short Form Korea Version; HRDS=The Hamilton Rating Scale for Depression; SDS=Zung Self-Rating Depression Scale.

Table 2.

Effect Size of Defensive Sub-variables related to Depression

Related variables	Sub-variables	K	Q	p	−95% CI	ES	+95% CI	SE	FSN
General characteristics	Education	2	2.3	.126	−.25	−.14	−.03	.05	1
	Income	2	5.9	.015	−.23	−.13	−.03	.00	1
	Subtotal	5	12.4	.015	−.23	−.16	−.09	.03	3
Disease	Length of time since diagnosis	3	7.8	.020	−.13	−.03	.06	.00	−
characteristics	Subtotal	3	1.5	.477	−.24	−.16	−.08	.04	2
Psychological	Acceptance of disability	3	2.3	.320	−.73	−.64	−.56	.04	16
	Quality of life	5	6.7	.156	−.85	−.79	−.73	.03	35
	Subtotal	8	15.3	.032	−.75	−.70	−.64	.02	48
Social	Social support	4	6.5	.089	−.28	−.20	−.13	.03	4
	Subtotal	7	15.9	.015	−.26	−.21	−.15	.02	8
Physical function	ADL	17	29.4	.030	−.32	−.27	−.23	.02	29
	Motor	3	3.5	.184	−.38	−.24	−.10	.07	4
	Cognition	26	73.7	< .001	−.49	−.44	−.39	.03	88
	Subtotal	41	66.4	.011	−.38	−.35	−.31	.02	103
Basic needs	Sleep	3	.8	.674	−.53	−.44	−.35	.04	10
	Sexuality	4	1.5	.691	−.55	−.36	−.18	.09	11
	Subtotal	5	1.5	.832	−.50	−.37	−.23	.06	14
Random effects	Over all	91	91.9	.482	−.42	−.35	−.27	.03	228

K=Number of the effect size; ES=Effect size; ADL=Activities of daily living; FSN=Fail safe N; CI=Confidence interval.

Table 3.

Effect Size of Defensive and Risk Variables according to Categories

Variable	Categories	Subcategories	K	Q	p	−95% CI	ES	+95% CI	SE	FSN
Defensive	Publishing	Unpublished	11	16.3	.090	−.40	−.33	−.26	.03	26
		Published	50	97.3	< .001	−.36	−.33	−.30	.01	115
	Study quality	Justified sample size	10	30.0	< .001	−.30	−.26	−.21	.02	11
		Unjustified sample size	52	84.7	.004	−.38	−.35	−.32	.02	130
	Type of residence	Inpatient	16	25.9	.080	−.36	−.29	−.22	.03	30
		Outpatient	37	64.6	.002	−.38	−.35	−.32	.01	94
	Measurements	BDI	16	23.3	.155	−.36	−.32	−.27	.02	35
		CES-D	17	39.8	< .001	−.32	−.28	−.24	.02	31
		GDSSF-K	12	22.3	.022	−.40	−.34	−.28	.03	29
		HDRS	4	6.7	.082	−.50	−.32	−.14	.09	9
		SDS	13	29.6	.003	−.48	−.41	−.33	.03	41
Risk	Publishing	Unpublished	6	14.1	.015	.28	.38	.49	.05	17
		Published	9	25.1	.002	.23	.28	.33	.02	16
	Study quality	Justified sample size	4	6.2	.100	.08	.14	.20	.03	2
		Unjustified sample size	11	23.0	.011	.39	.46	.52	.03	40
	Type of residence	Inpatient	7	7.3	.291	.08	.14	.19	.02	3
		Outpatient	5	7.8	.098	.24	.31	.38	.03	11
	Measurements	BDI	2	0.0	.927	.34	.47	.61	.06	8
		CES-D	5	16.2	.003	.27	.34	.41	.03	12
		GDSSF-K	6	6.1	.298	.07	.13	.19	.03	2
		HDRS	3	10.8	.005	.31	.43	.55	.05	10

K=Number of the effect size; ES=Effect size; BDI=Beck depression inventory; CES-D=The Center for Epidemiological Studies-Depression Scale; GDSSF-K=Geriatric Depression Scale Short Form Korea Version; HRDS=The Hamilton Rating Scale for Depression; SDS=Zung Self-Rating Depression Scale; FSN=Fail safe N; CI=Confidence interval.

Table 4.

Effect Size of Risk Sub-variables related to Depression

Related variables	Sub-variables	K	Q	p	−95% CI	ES	+95% CI	SE	FSN
General characteristics	Age	3	3.4	.186	−.11	−.03	.05	.04	−
	Subtotal	4	6.9	.077	−.09	−.01	.06	.04	−
Disease characteristics	Number of occurrence	2	1.2	.271	.11	.21	.32	.05	2
	Subtotal	3	1.6	.454	.11	.21	.31	.05	3
Psychological	Burden	3	0.6	.732	.11	.18	.25	.03	3
	Stress	5	3.3	.516	.44	.53	.62	.04	22
	Anxiety	2	0.4	.541	.51	.66	.80	.07	11
	Subtotal	8	16.7	.020	.44	.51	.58	.03	33
Random effects	Over all	24	19.4	.675	.20	.32	.45	.06	55

K=Number of the effect size; ES=Effect size; FSN=Fail safe N; CI=Confidence interval.

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