Kocsis, J. Imipramine and social-vocational adjustment in chronic depression. The American Journal of Psychiatry, 8 , — Ware, J. Boston: Health Assessment Laboratory. Weissman, M. Social adjustment scale — self-report technical manual. The assessment of social adjustment by patient self-report. Archives of General Psychiatry, 33 , — One aspect of the two studies reported request. This fact notwithstanding, the WSAS Use of the WSAS to date has been limited to Rate each of the following questions on a 0 to 8 scores obtained by clinicians at the begin- self-reported impairment in patients with scale: 0 indicates no impairment at all and 8 indicates ning and end of treatment for the subset depression, anxiety or alcohol misuse dis- very severe impairment.
No information regarding the poten- 1. Because of my [disorder], my ability to work is both methods were highly convergent with tial of this instrument to assess functional impaired. With increasing recog- 2. Bristol: John 3. Wright [now published by I. Marks, Institute of Psychiatry, London]. An bars, clubs, outings, visits, dating, home examination of theory and applications. Journal of Applied Mundt, J. Psychiatric impaired and 8 means very severely impaired.
Endicott, J. Because of my [disorder], my private leisure measure. Administration of the Hamilton Depression Rating Scale using interactive voice response technology. MD activities done alone, such as reading, gardening, Frisch, M. Because of my [disorder], my ability to form and Goodman,W. Saintfort, F. Judgments of quality of life of individuals with severe those I live with, is impaired. Handicap was scored using the modified Rankin scale.
SI-ADL scale explores eight items rated from 0 to 1: using the telephone, shopping, cooking, housework, laundry, transportation, medication and finances. SI-ADL was used as a total score, 8 representing normal activity. Self-estimated work and social dysfunctioning was assessed with the WSAS, which explores five domains: ability to work, home management, social leisure, private leisure and ability to form and maintain close relationships with others. The five items of the WSAS were rated from 0 no impairment to 8 very severely impaired , and the scores obtained for each item are summed in a total score.
A score of 0 reflects normal functioning, and a score of 40 the worst score possible. We applied a similar categorisation of WSAS into three categories as those reported in other diseases. We also measured SF with a complementary approach, provided by the families, medical evaluation and professional status. To obtain an assessment of the behavioural and social dysfunctioning, spouses or a family member filled the Iowa Scale of Personality Changes ISPC , which estimates affective, behavioural and social disturbances that may occur after a brain lesion, and assesses the extent of changes from premorbid levels.
A rating of 1 reflected excellent, and a rating of 7 reflected severe disability. The difference between prestroke and current ratings provided a measure of the extent of the changes.
The two assessments were made when assessing the WSAS, and we used the mean of the changes within the 29 items as a measure of personality changes. For medical evaluation, experienced stroke neurologists in charge of the patients rated globally SF into three categories unaware of the WSAS rating of the patients: no social dysfunctioning, mild to moderate social dysfunctioning, severe social dysfunctioning.
We collected information on profession and working status before stroke, at inclusion and 1 year after stroke. Moreover, the occurrence of conjugal life problems since stroke was recorded as present or absent. We used ordinal regression modelling to approach which domains were expressed by the WSAS. The parallel regression assumption of the ordinal logistic model was assessed with the Brant test.
The level of significance was chosen at 0. The demographic and clinical characteristics are listed in table 1. The distribution of our population was almost equivalent within the three categories of the WSAS table 2. The included patients represented those with lower age and lower residual disability, as shown on fig 1. The surfaces of each polyhedron constituting the pyramid of the selection of the patients fig 1 are proportional to the percentages of the subpopulations of acute stroke admitted to the stroke unit.
In our population, the mean WSAS was Moreover, as a generic scale, WSAS allows comparisons across diseases. When comparing WSAS scores in our patients with stroke mean Considering that unipolar depression has been ranked within the top 10 of disability-adjusted life years DALYs in the world, in terms of disease-related handicap, 23 these findings highlight the burden of stroke, even with a good clinical outcome.
Scales commonly used in stroke such as the NIHSS 18 measure neurological deficit, or basic daily activities with the Barthel index. They are widely used, either alone 25 or in combination 26 in clinical trials 27 and in routine practice, but they have obvious limitations in higher-order and social functioning. The extensive and validated quality of life QOL questionnaire SF explores many domains such as physical functioning, physical role, bodily pain, general health, vitality, SF, emotional role and mental health.
The rate of SF dysfunctioning may be considered as surprisingly high, relative to the clinical findings table 1. First, our patients were young Although age was associated with a better outcome, a recent study has reported that age was inversely associated with mental and physical health at 1 year poststroke, which was attributed to higher expectations of health and recovery in young patients. Second, the low depression score mean BDI within the minimal range and mean HAD score was at the edge of depression should have led to a better self-estimated SF.
Third, the high MMSE at 7. Therefore, although our population represents the subset of mild handicapped patients with stroke under 65 years old, the high rate of social dysfunction highlights the fact that SF was perceived to be problematic by these patients with stroke. However, it could be argued that patients may have overestimated their social dysfunctioning. The highly significant link between working status and social dysfunctioning was confirmed when assessing patients returning to work 1 year after stroke.
SF has been recently evaluated using quality-of-life scales SF Ethnicity, ischaemic heart disease and cognitive impairment were independent factors of mental health, a subscore including SF. While bivariate statistics showed only a trend toward significance for the NIHSS, multivariate modelling kept the NIHSS at admission in the model after adjustment for depression and anxiety, because severe strokes predicted mostly poor SF.
HAD included the psychological components depression and anxiety, which are the most robust predictors of inadequate SF and have been reported as predictive factors of recovery in many studies. The role of cognitive impairment in recovery and quality of life has been well documented. Our findings are consistent with other studies, although our population was younger and less impaired regarding physical and cognitive aspects. We have detected that you are using Internet Explorer to visit this website.
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