Links Between Depression, Anxiety, Coping and Quality of Life After a Stroke: Depressive and Anxiety Symptoms and Individual Coping Strategies of the Acute Phase in the Fourth Month as a Factor Influencing Mental Health and Quality of Life

Introduction and literature review With 130 000 cases per year in France in 2010, stroke is one of the most common neurological diseases, often leaving many disabling sequelae physical and cognitive levels (currently live 500 000 disabled following a stroke) and leading and a loss of significant autonomy in these patients. However, many stroke survivors soon find a range comparable to their previous state. Investigators can then ask ourselves about the impact of this life event in these people who apparently do not show visible effects: what about the psychological repercussions of stroke in these patients healthy; what is changed in their daily lives, particularly in their mental functioning after this brutal confrontation with their own mortality? Research on psychology and psychiatric disorders post-stroke indicate a frequency of occurrence of depression in 30-40% of patients, while the occurrence of anxiety disorders in 20% to 30% of patients. Depression and anxiety after stroke is influenced by the presence of sequels, but in a preliminary study (see Psycho-stroke current study) with patients with no impairment of their independence three months after stroke Investigators observed the presence of depressive and anxious symptoms.

The psychological health influences the patient's quality of life overall. Recent results have thus demonstrated that post-stroke depression increased the risk of short- and long-term mortality. It therefore seems essential to identify risk factors and influence of depression and anxiety after stroke, particularly in patients rapidly and almost completely recovering from the aftermath of their accident, to prevent the emergence and to support them.

In the scientific literature, individual coping strategies or coping strategies, and their development are identified as a factor of influence of post-stroke psychological health. Thus, an active coping centered on the problem would be associated with better mental health status, while a passive coping centered on managing emotions would instead be a poor prognostic factor. However, the clinical understanding of the everyday process of adaptation among survivors of stroke is limited by the assessment methods conventionally used in the research, which questioned the memory "in general" of the subject.

Modern techniques and increasingly used, as Experiences Sampling Method (ESM) or the Ecological Momentary Assessment (EMA) allow the assessment of individual functioning in more ecologically being carried out in the natural environment of the subject and greatly limit through retrospective recall. The application of these methods to a population of stroke survivors has already been validated and one study also shows that the active behaviors (work, sport) would be a post-stroke depression risk factor, whereas the presence of a social environment (among friends, relatives) would be a protective factor. However, this study is only interested in certain types of behavior, comparable to some coping strategies (active coping, social support research) but not representative of a whole, while other studies specifically interested in the evaluation of coping with this method but not with stroke patients. It seems interesting to use a similar methodology to observe in vivo finer and more accurate adaptation strategies in stroke survivors, and thus have an ecological representation of their coping.

The other factor of influence that Investigators chose to investigate in our study relates to the symptomatic forms of depression and anxiety. It is important first to note that the somatic and cognitive consequences of stroke are close to some depression and anxiety manifestations. This symptomatic overlap makes it difficult locating and diagnosing these disorders. Determine their specific seems necessary, and would involve the identification of symptoms of these psychopathological that would significantly associated with depression and anxiety lasting and intense.