POSTSTROKE PATIENTS IN REHABILITATION - THE RELATIONSHIP BETWEEN BIOLOGICAL IMPAIRMENT (CT SCANNING), PHYSICAL-DISABILITY AND CLINICAL DEPRESSION

A study of 128 consecutive patients with thromboembolic stroke in a re habilitation hospital from July 1988 to September 1990 found a prevale nce of major depression of 17%. The patient population was described a ccording to the principles of the World Health Organization's (WHO) In ternational Classification of Impairments, Disabilities and Handicaps (ICIDH) according to biological impairment, measured by computerized t omography (CT) scanning of the brain and side of hemiparesis and physi cal disability, measured by functional movement and activities of dail y living. Handicap, referring to the interaction between disability an ti the environmental situation, often defined as the subjective disadv antage of being ill, was not measured in this study. A stroke index wi th four items was generated from the parameters describing biological impairment and physical disability. The psychiatric rating scales (the 17-item Hamilton Scale for Depression (HAM-D), the Melancholia Scale [MES] and the Newcastle Diagnostic Depression Scale), and the new stro ke-index showed adequate coefficients of Cronbach's alpha and Loevinge r, suggesting that these scales have both adequate item correlation an d homogeneity (adequate hierarchical structure). The impairment disabi lity index of stroke thus seems to be a meaningful measurement of the specific factors of this disease. There was no correlation between the stroke index and the psychiatric rating scales measuring the emotiona l dimension of disability caused by the disease expressed as depressio n. The results suggest that the depression found among stroke patients is not a simple reaction to the physical disability of the stroke.