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Original Article
A Meta-analysis of the Variables related to Depression in Korean Patients with a Stroke
Eun-Young Park1, In-Soo Shin2, Jung-Hee Kim3
Journal of Korean Academy of Nursing 2012;42(4):537-548.
DOI: https://doi.org/10.4040/jkan.2012.42.4.537
Published online: August 12, 2012

1Department of Secondary Special Education, College of Education, Jeonju University, Jeonju, Korea

2Department of Education, College of Education, Jeonju University, Jeonju, Korea

3Department of Nursing, College of Medicine, Dankook University, Cheonan, Korea

1Department of Secondary Special Education, College of Education, Jeonju University, Jeonju, Korea

2Department of Education, College of Education, Jeonju University, Jeonju, Korea

3Department of Nursing, College of Medicine, Dankook University, Cheonan, Korea

Address reprint requests to : Kim, Jung-Hee Department of Nursing, College of Medicine, Dankook University, San 29 Anseo-dong, Cheonan 330-714, Korea Tel: +82-41-550-3877 Fax: +82-41-550-7902 E-mail: jhee90@dankook.ac.kr
• Received: November 1, 2011   • Revised: November 14, 2011   • Accepted: July 23, 2012

Copyright © 2012 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to use meta-analysis to evaluate the variables related to depression in patients who have had a stroke.
  • Methods
    The materials of this study were based on 16 variables obtained from 26 recent studies over a span of 10 years which were selected from doctoral dissertations, master's thesis and published articles.
  • Results
    Related variables were categorized into sixteen variables and six variable groups which included general characteristics of the patients, disease characteristics, psychological state, physical function, basic needs, and social variables. Also, the classification of six defensive and three risk variables group was based on the negative or positive effect of depression. The quality of life (ES= -.79) and acceptance of disability (ES=-.64) were highly correlated with depression in terms of defensive variables. For risk variables, anxiety (ES= .66), stress (ES= .53) showed high correlation effect size among the risk variables.
  • Conclusion
    These findings showed that defensive and risk variables were related to depression among stroke patients. Psychological interventions and improvement in physical functions should be effective in decreasing depression among stroke patients.
  • Keywords: Stroke; Depression; Meta-analysis
Figure 1.
Literature searches and results.
jkan-42-537f1.jpg

KISS=Korean studies information service system.

Table 1.
Summary of Characteristics of Studies Included Meta-analysis
Researchers (yr) Publication Sample size Related variables Type of residence Depression measurement
Yang (2010) Yes 328 ADL other diseases, acceptance of disabilities, family support, Inpatients GDSSF-K
burden, treatment's environments
Suh et al. (2010) Yes 293 Age, education, economic status, ADL, social support, nutrition, pain, fatigue, sleep, quality of life Outpatients BDI
Kim (2008) Yes 31 Sexual behaviors, sexual knowledge, sexual satisfaction, intimacy Outpatients CES-D
Kim (2006) Yes 104 ADL, religion, family support, acceptance of disabilities, age, income, periods since diagnosis, recurrence Outpatients CES-D
Kim et al. (2003) Yes 128 Health perception, motor function, cognitive function, ADL Outpatients CES-D
Lee et al. (2010) Yes 35 Cognitive function, ADL, upper motor function Inpatients BDI, HDRS
Kim (2005) No 76 ADL, social support, quality of life Inpatients & BDI
outpatients
Kim et al. (1995) Yes 112 Internal stress, interpersonal stress, external stress, ADL Inpatients & outpatients BDI
Yoo et al. (2009) Yes 53 Cognitive function, visual & auditory function Outpatients SDS
Park (1988) No 64 Stress Inpatients SDS
Wi (2009) Yes 100 Quality of sleep, satisfaction of sleep Outpatients GDSSF-K
Han (2004) No 120 ADL, family support Inpatients & SDS
outpatients
Oh (2010) No 92 Health perception, ADL, quality of life Inpatients & Outpatients GDSSF-K
Kim (2006) No 74 Cognitive function, ADL, IADL Outpatients BDI
Bang et al. (2009) Yes 80 Acceptance of disabilities, social support, ADL, cognitive function Inpatients GDSSF-K
Kim et al. (2000) Yes 254 Severity of stroke, cognitive function, ADL, social function, Outpatients CES-D
social support, illness intrusiveness
Yoon et al. (2008) Yes 84 Stress, anxiety Outpatients HDRS
Park et al. (1999) Yes 122 ADL, cognitive function Inpatients & BDI
outpatients
Park et al. (1995) Yes 44 Cognitive function Inpatients SDS, GDSSF-K
Chu (2008) No 31 Age, sex, education, paralysis, type of stroke, periods since diagnosis, cognitive function Inpatients GDSSF-K
Shin (2011) No 123 Caregiver's burden Inpatients HDRS
Moon (2010) No 103 Social support, acceptance of disability Inpatients BDI
Park (2007) No 99 ADL, anxiety Outpatients BDI
Jang et al. (2008) Yes 85 Dysphasia Outpatients CES-D
Kim et al. (2007) Yes 251 ADL, quality of life Outpatients CES-D
Koo et al. (2004) Yes 24 Physical function Inpatients BDI, GDSSF-K
HDRS

ADL=Activities of daily living; BDI=Beck depression inventory; CES-D=The Center for Epidemiological Studies-Depression Scale; GDSSF-K=Geriatric Depression Scale Short Form Korea Version; HRDS=The Hamilton Rating Scale for Depression; SDS=Zung Self-Rating Depression Scale.

Table 2.
Effect Size of Defensive Sub-variables related to Depression
Related variables Sub-variables K Q p −95% CI ES +95% CI SE FSN
General characteristics Education 2 2.3 .126 −.25 −.14 −.03 .05 1
Income 2 5.9 .015 −.23 −.13 −.03 .00 1
Subtotal 5 12.4 .015 −.23 −.16 −.09 .03 3
Disease Length of time since diagnosis 3 7.8 .020 −.13 −.03 .06 .00 −
characteristics Subtotal 3 1.5 .477 −.24 −.16 −.08 .04 2
Psychological Acceptance of disability 3 2.3 .320 −.73 −.64 −.56 .04 16
Quality of life 5 6.7 .156 −.85 −.79 −.73 .03 35
Subtotal 8 15.3 .032 −.75 −.70 −.64 .02 48
Social Social support 4 6.5 .089 −.28 −.20 −.13 .03 4
Subtotal 7 15.9 .015 −.26 −.21 −.15 .02 8
Physical function ADL 17 29.4 .030 −.32 −.27 −.23 .02 29
Motor 3 3.5 .184 −.38 −.24 −.10 .07 4
Cognition 26 73.7 < .001 −.49 −.44 −.39 .03 88
Subtotal 41 66.4 .011 −.38 −.35 −.31 .02 103
Basic needs Sleep 3 .8 .674 −.53 −.44 −.35 .04 10
Sexuality 4 1.5 .691 −.55 −.36 −.18 .09 11
Subtotal 5 1.5 .832 −.50 −.37 −.23 .06 14
Random effects Over all 91 91.9 .482 −.42 −.35 −.27 .03 228

K=Number of the effect size; ES=Effect size; ADL=Activities of daily living; FSN=Fail safe N; CI=Confidence interval.

Table 3.
Effect Size of Defensive and Risk Variables according to Categories
Variable Categories Subcategories K Q p −95% CI ES +95% CI SE FSN
Defensive Publishing Unpublished 11 16.3 .090 −.40 −.33 −.26 .03 26
Published 50 97.3 < .001 −.36 −.33 −.30 .01 115
Study quality Justified sample size 10 30.0 < .001 −.30 −.26 −.21 .02 11
Unjustified sample size 52 84.7 .004 −.38 −.35 −.32 .02 130
Type of residence Inpatient 16 25.9 .080 −.36 −.29 −.22 .03 30
Outpatient 37 64.6 .002 −.38 −.35 −.32 .01 94
Measurements BDI 16 23.3 .155 −.36 −.32 −.27 .02 35
CES-D 17 39.8 < .001 −.32 −.28 −.24 .02 31
GDSSF-K 12 22.3 .022 −.40 −.34 −.28 .03 29
HDRS 4 6.7 .082 −.50 −.32 −.14 .09 9
SDS 13 29.6 .003 −.48 −.41 −.33 .03 41
Risk Publishing Unpublished 6 14.1 .015 .28 .38 .49 .05 17
Published 9 25.1 .002 .23 .28 .33 .02 16
Study quality Justified sample size 4 6.2 .100 .08 .14 .20 .03 2
Unjustified sample size 11 23.0 .011 .39 .46 .52 .03 40
Type of residence Inpatient 7 7.3 .291 .08 .14 .19 .02 3
Outpatient 5 7.8 .098 .24 .31 .38 .03 11
Measurements BDI 2 0.0 .927 .34 .47 .61 .06 8
CES-D 5 16.2 .003 .27 .34 .41 .03 12
GDSSF-K 6 6.1 .298 .07 .13 .19 .03 2
HDRS 3 10.8 .005 .31 .43 .55 .05 10

K=Number of the effect size; ES=Effect size; BDI=Beck depression inventory; CES-D=The Center for Epidemiological Studies-Depression Scale; GDSSF-K=Geriatric Depression Scale Short Form Korea Version; HRDS=The Hamilton Rating Scale for Depression; SDS=Zung Self-Rating Depression Scale; FSN=Fail safe N; CI=Confidence interval.

Table 4.
Effect Size of Risk Sub-variables related to Depression
Related variables Sub-variables K Q p −95% CI ES +95% CI SE FSN
General characteristics Age 3 3.4 .186 −.11 −.03 .05 .04 −
Subtotal 4 6.9 .077 −.09 −.01 .06 .04 −
Disease characteristics Number of occurrence 2 1.2 .271 .11 .21 .32 .05 2
Subtotal 3 1.6 .454 .11 .21 .31 .05 3
Psychological Burden 3 0.6 .732 .11 .18 .25 .03 3
Stress 5 3.3 .516 .44 .53 .62 .04 22
Anxiety 2 0.4 .541 .51 .66 .80 .07 11
Subtotal 8 16.7 .020 .44 .51 .58 .03 33
Random effects Over all 24 19.4 .675 .20 .32 .45 .06 55

K=Number of the effect size; ES=Effect size; FSN=Fail safe N; CI=Confidence interval.

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        A Meta-analysis of the Variables related to Depression in Korean Patients with a Stroke
        J Korean Acad Nurs. 2012;42(4):537-548.   Published online August 12, 2012
        DOI: https://doi.org/10.4040/jkan.2012.42.4.537
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      A Meta-analysis of the Variables related to Depression in Korean Patients with a Stroke
      Image
      Figure 1. Literature searches and results.

      Figure 1.

      A Meta-analysis of the Variables related to Depression in Korean Patients with a Stroke
      Researchers (yr) Publication Sample size Related variables Type of residence Depression measurement
      Yang (2010) Yes 328 ADL other diseases, acceptance of disabilities, family support, Inpatients GDSSF-K
      burden, treatment's environments
      Suh et al. (2010) Yes 293 Age, education, economic status, ADL, social support, nutrition, pain, fatigue, sleep, quality of life Outpatients BDI
      Kim (2008) Yes 31 Sexual behaviors, sexual knowledge, sexual satisfaction, intimacy Outpatients CES-D
      Kim (2006) Yes 104 ADL, religion, family support, acceptance of disabilities, age, income, periods since diagnosis, recurrence Outpatients CES-D
      Kim et al. (2003) Yes 128 Health perception, motor function, cognitive function, ADL Outpatients CES-D
      Lee et al. (2010) Yes 35 Cognitive function, ADL, upper motor function Inpatients BDI, HDRS
      Kim (2005) No 76 ADL, social support, quality of life Inpatients & BDI
      outpatients
      Kim et al. (1995) Yes 112 Internal stress, interpersonal stress, external stress, ADL Inpatients & outpatients BDI
      Yoo et al. (2009) Yes 53 Cognitive function, visual & auditory function Outpatients SDS
      Park (1988) No 64 Stress Inpatients SDS
      Wi (2009) Yes 100 Quality of sleep, satisfaction of sleep Outpatients GDSSF-K
      Han (2004) No 120 ADL, family support Inpatients & SDS
      outpatients
      Oh (2010) No 92 Health perception, ADL, quality of life Inpatients & Outpatients GDSSF-K
      Kim (2006) No 74 Cognitive function, ADL, IADL Outpatients BDI
      Bang et al. (2009) Yes 80 Acceptance of disabilities, social support, ADL, cognitive function Inpatients GDSSF-K
      Kim et al. (2000) Yes 254 Severity of stroke, cognitive function, ADL, social function, Outpatients CES-D
      social support, illness intrusiveness
      Yoon et al. (2008) Yes 84 Stress, anxiety Outpatients HDRS
      Park et al. (1999) Yes 122 ADL, cognitive function Inpatients & BDI
      outpatients
      Park et al. (1995) Yes 44 Cognitive function Inpatients SDS, GDSSF-K
      Chu (2008) No 31 Age, sex, education, paralysis, type of stroke, periods since diagnosis, cognitive function Inpatients GDSSF-K
      Shin (2011) No 123 Caregiver's burden Inpatients HDRS
      Moon (2010) No 103 Social support, acceptance of disability Inpatients BDI
      Park (2007) No 99 ADL, anxiety Outpatients BDI
      Jang et al. (2008) Yes 85 Dysphasia Outpatients CES-D
      Kim et al. (2007) Yes 251 ADL, quality of life Outpatients CES-D
      Koo et al. (2004) Yes 24 Physical function Inpatients BDI, GDSSF-K
      HDRS
      Related variables Sub-variables K Q p −95% CI ES +95% CI SE FSN
      General characteristics Education 2 2.3 .126 −.25 −.14 −.03 .05 1
      Income 2 5.9 .015 −.23 −.13 −.03 .00 1
      Subtotal 5 12.4 .015 −.23 −.16 −.09 .03 3
      Disease Length of time since diagnosis 3 7.8 .020 −.13 −.03 .06 .00 −
      characteristics Subtotal 3 1.5 .477 −.24 −.16 −.08 .04 2
      Psychological Acceptance of disability 3 2.3 .320 −.73 −.64 −.56 .04 16
      Quality of life 5 6.7 .156 −.85 −.79 −.73 .03 35
      Subtotal 8 15.3 .032 −.75 −.70 −.64 .02 48
      Social Social support 4 6.5 .089 −.28 −.20 −.13 .03 4
      Subtotal 7 15.9 .015 −.26 −.21 −.15 .02 8
      Physical function ADL 17 29.4 .030 −.32 −.27 −.23 .02 29
      Motor 3 3.5 .184 −.38 −.24 −.10 .07 4
      Cognition 26 73.7 < .001 −.49 −.44 −.39 .03 88
      Subtotal 41 66.4 .011 −.38 −.35 −.31 .02 103
      Basic needs Sleep 3 .8 .674 −.53 −.44 −.35 .04 10
      Sexuality 4 1.5 .691 −.55 −.36 −.18 .09 11
      Subtotal 5 1.5 .832 −.50 −.37 −.23 .06 14
      Random effects Over all 91 91.9 .482 −.42 −.35 −.27 .03 228
      Variable Categories Subcategories K Q p −95% CI ES +95% CI SE FSN
      Defensive Publishing Unpublished 11 16.3 .090 −.40 −.33 −.26 .03 26
      Published 50 97.3 < .001 −.36 −.33 −.30 .01 115
      Study quality Justified sample size 10 30.0 < .001 −.30 −.26 −.21 .02 11
      Unjustified sample size 52 84.7 .004 −.38 −.35 −.32 .02 130
      Type of residence Inpatient 16 25.9 .080 −.36 −.29 −.22 .03 30
      Outpatient 37 64.6 .002 −.38 −.35 −.32 .01 94
      Measurements BDI 16 23.3 .155 −.36 −.32 −.27 .02 35
      CES-D 17 39.8 < .001 −.32 −.28 −.24 .02 31
      GDSSF-K 12 22.3 .022 −.40 −.34 −.28 .03 29
      HDRS 4 6.7 .082 −.50 −.32 −.14 .09 9
      SDS 13 29.6 .003 −.48 −.41 −.33 .03 41
      Risk Publishing Unpublished 6 14.1 .015 .28 .38 .49 .05 17
      Published 9 25.1 .002 .23 .28 .33 .02 16
      Study quality Justified sample size 4 6.2 .100 .08 .14 .20 .03 2
      Unjustified sample size 11 23.0 .011 .39 .46 .52 .03 40
      Type of residence Inpatient 7 7.3 .291 .08 .14 .19 .02 3
      Outpatient 5 7.8 .098 .24 .31 .38 .03 11
      Measurements BDI 2 0.0 .927 .34 .47 .61 .06 8
      CES-D 5 16.2 .003 .27 .34 .41 .03 12
      GDSSF-K 6 6.1 .298 .07 .13 .19 .03 2
      HDRS 3 10.8 .005 .31 .43 .55 .05 10
      Related variables Sub-variables K Q p −95% CI ES +95% CI SE FSN
      General characteristics Age 3 3.4 .186 −.11 −.03 .05 .04 −
      Subtotal 4 6.9 .077 −.09 −.01 .06 .04 −
      Disease characteristics Number of occurrence 2 1.2 .271 .11 .21 .32 .05 2
      Subtotal 3 1.6 .454 .11 .21 .31 .05 3
      Psychological Burden 3 0.6 .732 .11 .18 .25 .03 3
      Stress 5 3.3 .516 .44 .53 .62 .04 22
      Anxiety 2 0.4 .541 .51 .66 .80 .07 11
      Subtotal 8 16.7 .020 .44 .51 .58 .03 33
      Random effects Over all 24 19.4 .675 .20 .32 .45 .06 55
      Table 1. Summary of Characteristics of Studies Included Meta-analysis

      ADL=Activities of daily living; BDI=Beck depression inventory; CES-D=The Center for Epidemiological Studies-Depression Scale; GDSSF-K=Geriatric Depression Scale Short Form Korea Version; HRDS=The Hamilton Rating Scale for Depression; SDS=Zung Self-Rating Depression Scale.

      Table 2. Effect Size of Defensive Sub-variables related to Depression

      K=Number of the effect size; ES=Effect size; ADL=Activities of daily living; FSN=Fail safe N; CI=Confidence interval.

      Table 3. Effect Size of Defensive and Risk Variables according to Categories

      K=Number of the effect size; ES=Effect size; BDI=Beck depression inventory; CES-D=The Center for Epidemiological Studies-Depression Scale; GDSSF-K=Geriatric Depression Scale Short Form Korea Version; HRDS=The Hamilton Rating Scale for Depression; SDS=Zung Self-Rating Depression Scale; FSN=Fail safe N; CI=Confidence interval.

      Table 4. Effect Size of Risk Sub-variables related to Depression

      K=Number of the effect size; ES=Effect size; FSN=Fail safe N; CI=Confidence interval.

      Table 1.

      Table 2.

      Table 3.

      Table 4.

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