LEVEL OF DEPRESSION AND ITS IMPACT ON SLEEP QUALITY AMONG CHRONIC STROKE PATIENTS. A CROSS-SECTIONAL STUDY

Abstract

Background: Chronic stroke survivors frequently experience long-term physical, emotional, and cognitive impairments. Among these, post-stroke depression (PSD) is a common yet under-addressed complication, affecting an estimated 20% to 60% of individuals. Depression in this population not only impacts psychological well-being but also disrupts sleep, further compromising recovery and quality of life. Understanding the interplay between depression and sleep disturbances is essential for developing integrated care approaches in stroke rehabilitation.

Objective: To assess the level of depression and its association with sleep quality among individuals with chronic stroke.

Methods: This cross-sectional study was conducted at the Pakistan Society for the Rehabilitation of the Disabled (PSRD) over a six-month period. A total of 111 patients with chronic stroke (≥6 months post-stroke) were recruited using a non-probability convenience sampling method. Standardized tools were used for data collection: the Depression, Anxiety, and Stress Scale-21 (DASS-21) measured depressive symptoms, while the Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality. Data were analyzed using IBM SPSS version 25, with regression analysis applied to determine associations.

Results: Of the 111 participants, 17 (15.3%) had no depression, 21 (18.9%) had mild depression, 30 (27.0%) moderate, 29 (26.1%) severe, and 14 (12.6%) extremely severe depression. Sleep difficulties were reported as mild in 43 (38.7%), moderate in 52 (46.8%), and severe in 16 (14.4%) participants. A significant association was observed between depression severity and sleep quality (p < 0.001). Regression analysis revealed that increasing depression scores were predictive of higher PSQI scores (B = 0.354, 95% CI: 0.269–0.439, R² = 0.383), indicating worsening sleep quality.

Conclusion: The study concluded that greater severity of depression was significantly associated with poorer sleep quality in chronic stroke patients, highlighting the need for integrated psychological care in rehabilitation.