Coping, Problem Solving, Depression, and Health-Related Quality of Life in Patients Receiving Outpatient Stroke Rehabilitation

Objectives To investigate whether patients with high and low depression scores after stroke use different coping strategies and problem-solving skills and whether these variables are related to psychosocial health-related quality of life (HRQOL) independent of depression. Design Cross-sectional study. Setting Two rehabilitation centers. Participants Patients participating in outpatient stroke rehabilitation (N=166; mean age, 53.06±10.19y; 53% men; median time poststroke, 7.29mo). Interventions Not applicable. Main Outcome Measures Coping strategy was measured using the Coping Inventory for Stressful Situations; problem-solving skills were measured using the Social Problem Solving Inventory-Revised: Short Form; depression was assessed using the Center for Epidemiologic Studies Depression Scale; and HRQOL was measured using the five-level EuroQol five-dimensional questionnaire and the Stroke-Specific Quality of Life Scale. Independent samples t tests and multivariable regression analyses, adjusted for patient characteristics, were performed. Results Compared with patients with low depression scores, patients with high depression scores used less positive problem orientation (P=.002) and emotion-oriented coping (P<.001) and more negative problem orientation (P<.001) and avoidance style (P<.001). Depression score was related to all domains of both general HRQOL (visual analog scale: β=-.679; P<.001; utility: β=-.009; P<.001) and stroke-specific HRQOL (physical HRQOL: β=-.020; P=.001; psychosocial HRQOL: β=-.054, P<.001; total HRQOL: β=-.037; P<.001). Positive problem orientation was independently related to psychosocial HRQOL (β=.086; P=.018) and total HRQOL (β=.058; P=.031). Conclusions Patients with high depression scores use different coping strategies and problem-solving skills than do patients with low depression scores. Independent of depression, positive problem-solving skills appear to be most significantly related to better HRQOL.

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