Self-concept and depression after stroke

Depressive symptoms (DS) after stroke are associated with marked negative consequences for rehabilitation. Identifying determinants of DS is needed to enable prediction and develop psychological interventions. A promising candidate may be self-concept and changes thereof, so called self-discrepancy. Consulting recent self-concept models, we investigated the role of self-concept subdomains and their individual importance.
Within a prospective longitudinal study, 120 stroke survivors were interviewed via telephone three years post-ictus to assess present and past self-concept, self-discrepancy, self-concept subdomains, and DS. Association of self-concept measures and DS was investigated using an ANCOVA. Controlling for established determinants (age, sex, history of depression, functional independence, social support), multiple regression analyses were used to examine the independent influence of self-concept measures, and the role of subdomains and importance-weightings.
Self-discrepancy showed a significant interaction with DS (F(1, 118)=32.69, p<.001, η² =.22). DS showed a stronger association with present (r=-.72) than with past self-concept (r=-.34) and self-discrepancy (r=-.47; all p<.001). Age, history of depression, social support, and present self-concept were independent predictors of DS while functional independence was not (∆F(1, 113)=48.04, p<.001). Importance-weighting of subdomains did not affect explained variance, though the number of self-concept subdomains showing significant association with DS increased.
Findings propose appraisals of self-concept as independent predictors of DS after stroke, even surpassing functional independence three years post-stroke. Considering individual importance of subdomains reveals their differential influence. The results suggest to investigate the use of general self-concept for prediction, and to consider the individual relevance of subdomains in psychological interventions after stroke.