Ecosystem focused therapy in poststroke depression: a preliminary study

• Published in: International journal of geriatric psychiatry 2012-10, Vol.27 (10), p.1053-1060
• Main Authors: Alexopoulos, George S., Wilkins, Victoria M., Marino, Patricia, Kanellopoulos, Dora, Reding, Michael, Sirey, Jo Anne, Raue, Patrick J., Ghosh, Samiran, O'Dell, Michael W., Kiosses, Dimitris N.
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adult and adolescent clinical studies; Aged; Aged, 80 and over; Biological and medical sciences; Clinical trials; Depression; Depressive Disorder - etiology; Depressive Disorder - prevention & control; Disability Evaluation; ecosystem focused therapy; Female; General aspects; Geriatric psychiatry; Geriatric psychology; Geriatrics; Health education; Humans; Linear Models; Male; Medical sciences; Mental depression; Mood disorders; Patient Education as Topic - methods; poststroke depression; Problem Solving; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Psychotherapy - methods; Remission; Replication; Social Support; speech; Stroke; Stroke - physiopathology; Stroke - psychology; Stroke Rehabilitation
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.2822

Objective Poststroke depression (PSD) occurs in the context of abrupt, often catastrophic disability that finds the patient and his or her family unprepared. We developed the Ecosystem Focused Therapy (EFT), a systematic intervention aimed to increase the PSD patient's and his or her ecosystem's abilities to address the “psychosocial storm” of PSD and utilize available treatments effectively and efficiently. This is a preliminary study of its efficacy. Design A total of 24 PSD patients were randomly assigned to receive weekly sessions of EFT or a comparison condition consisting of systematic Education on Stroke and Depression and their treatment for 12 weeks. Results Ecosystem Focused Therapy may be more efficacious than Education on Stroke and Depression in reducing depressive symptoms and signs, in leading to a higher remission rate, and in ameliorating disability in PSD. Reduction of disability in the early part of the trial mediated later improvement in depressive symptomatology. Similarly, reduction in depressive symptoms and signs early on mediated later improvement in disability. Conclusion These encouraging findings require replication. Beyond its potential direct benefits in PSD, EFT may provide an appropriate context for efficient and timely administration of pharmacotherapy and of physical, speech, and occupational therapy thus maximizing their efficacy. Copyright © 2012 John Wiley & Sons, Ltd.