Automated interactive voice response (IVR) call systems can provide systematic monitoring and self-management support to depressed patients, but it is unknown if stroke patients are able and willing to engage in IVR interactions. We sought to assess the feasibility and acceptability of IVR as an adjunct to post-stroke depression follow-up care. The CarePartner program is a mobile health program designed to optimize depression self-management, facilitate social support from a caregiver, and strengthen connections between stroke survivors and primary care providers (PCPs). Ischemic stroke patients and an informal caregiver, if available, were recruited during the patient’s acute stroke hospitalization or follow-up appointment. The CarePartner program was activated in patients with depressive symptoms during their stroke hospitalization or follow-up. The 3-month intervention consisted of weekly IVR calls monitoring both depressive symptoms and medication adherence along with tailored suggestions for depressive symptom self-management. After each completed IVR call, informal caregivers were automatically updated, and, if needed, the subject’s PCP was notified. Of the 56 stroke patients who enrolled, depressive symptoms were identified in 13 (23 %) subjects. Subjects completed 74 % of the weekly IVR assessments. A total of six subjects did not complete the outcome assessment, including two non-study-related deaths. PCPs were notified five times, including two times for suicidal ideation and three times for medication non-adherence. Stroke patients with depressive symptoms were able to engage in an IVR call system. Future studies are needed to explore the efficacy of an IVR approach for post-stroke self-management and monitoring of stroke-related outcomes.
Post-stroke depression Self-management Mobile technology
This is a preview of subscription content, log in to check access.
Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000433. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Skolarus receives funding from NIH/NINDS K23 NS073685. Dr. Piette is a VA Senior Career Scientist and received additional support from grant number P30DK092926 from the US National Institutes of Health.
Compliance with Ethical Standards
Conflict of Interest
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Ayerbe L, Ayis S, Wolfe CDA, Rudd AG. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. Br J Psychiatry. 2013;202:14–21.CrossRefPubMedGoogle Scholar
House A, Knapp P, Bamford J, Vail A. Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke. 2001;32:696–701.CrossRefPubMedGoogle Scholar
Everson SA. Depressive symptoms and increased risk of stroke mortality over a 29-year period. Arch Intern Med. 1998;158:1133–8.CrossRefPubMedGoogle Scholar
Jia H, Damush TM, Qin H, Ried LD, Wang X, Young LJ, et al. The impact of poststroke depression on healthcare use by veterans with acute stroke. Stroke. 2006;37:2796–801.CrossRefPubMedGoogle Scholar
Williams LS, Kroenke K, Bakas T, Plue LD, Brizendine E, Tu W, et al. Care management of poststroke depression: a randomized, controlled trial. Stroke. 2007;38:998–1003.CrossRefPubMedGoogle Scholar
Hackett ML, Anderson CS, House AO. Management of depression after stroke: a systematic review of pharmacological therapies. Stroke. 2005;36:1092–7.CrossRefGoogle Scholar
Chen Y, Guo JJ. Meta-analysis of antidepressant treatment for patients with poststroke depression. Stroke. 2006;37:1365–6.CrossRefPubMedGoogle Scholar
Chemerinski E, Robinson RG, Kosier JT. Improved recovery in activities of daily living associated with remission of poststroke depression. Stroke. 2001;32:113–7.CrossRefPubMedGoogle Scholar
Schmid AA, Kroenke K, Hendrie HC, Bakas T, Sutherland JM, Williams LS. Poststroke depression and treatment effects on functional outcomes. Neurology. 2011;76:1000–5.CrossRefPubMedPubMedCentralGoogle Scholar
El Husseini N, Goldstein LB, Peterson ED, Zhao X, Pan W, Olson DM, et al. Depression and antidepressant use after stroke and transient ischemic attack. Stroke. 2012;43:1609–16.CrossRefPubMedGoogle Scholar
Paul SL, Dewey HM, Sturm JW, Macdonell RAL, Thrift AG. Prevalence of depression and use of antidepressant medication at 5-years poststroke in the north east Melbourne stroke incidence study. Stroke. 2006;37:2854–5.CrossRefPubMedGoogle Scholar
Piette JD. Interactive voice response systems in the diagnosis and management of chronic disease. Am J Manag Care. 2000;6:817–27.PubMedGoogle Scholar
Piette JD, Aikens JE, Trivedi R, Parrish D, Standiford C, Marinec NS, et al. Depression self-management assistance using automated telephonic assessments and social support. Am J Manag Care. 2013;19:892–900.PubMedGoogle Scholar
Corkrey R, Parkinson L. Interactive voice response: review of studies 1989–2000. Behav Res Methods Instrum Comput. 2002;34:342–53.CrossRefPubMedGoogle Scholar
Aikens JE, Trivedi R, Aron DC, Piette JD. Integrating support persons into diabetes telemonitoring to improve self-management and medication adherence. J Gen Intern Med. 2014;30:319–26.CrossRefPubMedPubMedCentralGoogle Scholar
Piette JD, Striplin D, Marinec N, Chen J, Trivedi RB, Aron DC, et al. A mobile health intervention supporting heart failure patients and their informal caregivers: a randomized comparative effectiveness trial. J Med Internet Res. 2015;17(6):e142.CrossRefPubMedPubMedCentralGoogle Scholar
Williams LS, Brizendine EJ, Plue L, Bakas T, Tu W, Hendrie H, et al. Performance of the PHQ-9 as a screening tool for depression after stroke. Stroke. 2005;36:635–8.CrossRefPubMedGoogle Scholar
Piette JD, Rosland A-M, Marinec NS, Striplin D, Bernstein SJ, Silveira MJ. Engagement with automated patient monitoring and self-management support calls: experience with a thousand chronically-ill patients. Med Care. 2013;51:216.CrossRefPubMedPubMedCentralGoogle Scholar
Jørgensen HS, Nakayama H, Raaschou HO, Vive-Larsen J, Støier M, Olsen TS. Outcome and time course of recovery in stroke. Part ii: Time course of recovery. The Copenhagen stroke study. Arch Phys Med Rehabil. 1995;76:406–12.CrossRefPubMedGoogle Scholar
Gillen R, Tennen H, McKee TE, Gernert-Dott P, Affleck G. Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients. Arch Phys Med Rehabil. 2001;82:1645–9.CrossRefPubMedGoogle Scholar