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.

脑卒中后的抑郁症状（DS）与康复的显著负面后果相关。识别DS的决定因素对于实现预测和开发心理干预措施至关重要。一种有希望的候选因素可能是自我概念及其变化，即所谓的自我差距。参考最新的自我概念模型，我们研究了自我概念子领域及其个体重要性所扮演的角色。
在一项前瞻性纵向研究中，对120名卒中幸存者在发病后三年通过电话进行了访谈，以评估当前的自我概念、自我差距、自我概念子领域和DS。使用ANCOVA调查了自我概念测量与DS之间的关联。在控制已确立的决定因素（年龄、性别、抑郁症病史、功能独立性、社会支持）的情况下，使用多重回归分析来检验自我概念测量、子领域及其重要性加权的独立影响。
自我差距与DS显示出显著的交互作用（F(1, 118)=32.69, p<.001, η² =.22）。DS与当前自我概念（r=-.72）的关联比过去自我概念（r=-.34）和自我差距（r=-.47；所有p<.001）更强。年龄、抑郁症病史、社会支持和当前自我概念是DS的独立预测因素，而功能独立性则不是（∆F(1, 113)=48.04, p<.001）。子领域的重要性加权并未影响解释方差，尽管与DS显示出显著关联的自我概念子领域的数量增加了。
研究结果提出，评估自我概念作为卒中后DS的独立预测因素，甚至在卒中后三年超过功能独立性。考虑子领域的个体重要性揭示了它们不同的影响。结果建议调查使用一般自我概念进行预测，并在卒中后的心理干预中考虑子领域的个体相关性。