New grant at UTHealth Houston aimed at preventing depression among stroke survivors

Research has shown that engaging in enjoyable or meaningful activities can help prevent depression after stroke. Now an interprofessional team of researchers at UTHealth Houston has received a new federal grant to test an intervention using video chats to encourage mood-enhancing behaviors among older, low-income stroke survivors.

Jennifer E.S. Beauchamp, PhD, RN, associate professor at Cizik School of Nursing at UTHealth Houston, is principal investigator on the five-year, $6.48 million grant from the National Institute of Mental Health (R01MH140091), part of the National Institutes of Health. Beauchamp is director of the Mental Health Program at the UTHealth Houston Institute for Stroke and Cerebrovascular Diseases.

Approximately a third of stroke survivors develop depression, and up to 60% experience some level of depressive symptoms. If left untreated, subthreshold depression often progresses to post-stroke depression (PSD), Beauchamp said. Patients with PSD are at heightened risk for subsequent strokes, neurological deficits, diminished functioning, poor quality of life, and premature death from all causes including suicide.

“Low-income, older stroke survivors face financial strains on top of typical age-related life stressors such as disabilities, bereavement, managing multiple medications, and loss of independence,” said Beauchamp, the Nancy B. Willerson Distinguished Professor in Nursing.

Behavioral activation focuses on identifying behaviors that positively affect mood. Patients are encouraged to do things that make them feel good. The technique is a core component of cognitive behavioral therapy but can be delivered independently by lay counselors who are not licensed therapists.

Through the study, community health workers who are trained as lay counselors will deliver a behavioral activation intervention via remote, video-enabled sessions with survivors within three months of their first stroke. About 300 low-income patients aged 55 and older will be recruited from the Stroke Transitions Education and Prevention Program in the Department of Neurology at McGovern Medical School at UTHealth Houston. They will participate in a randomized, controlled trial with half receiving behavioral activation and the other half receiving usual care. The intervention will include five weekly videoconferences and homework assignments with a series of follow-up calls and assessments for an additional nine months.

The study aims to assess the effectiveness of the tele-intervention in reducing depressive symptoms, anxiety, emotional distress, the proportion of stroke survivors who develop PSD, and the number of health care visits among participants.

“Our goal is that this intervention will improve overall quality of life for stroke survivors,” Beauchamp said. “If intervention effectiveness is demonstrated, it could have a profound effect on prevention of post-stroke depression.”

The study is called BehavioraL ActIvation for the PreVention of Post-strokE Depression in LoW-incomE OLder Stroke Survivors (LIVE-WEL).  

Other UTHealth Houston co-investigators on the project include Sean I. Savitz, professor of neurology, director of the stroke institute, and the Frank M.Yatsu, MD Chair in Neurology; Anjail Z. Sharrief, MD, PhD, professor and director of Stroke Prevention for the institute; Ron Acierno, PhD, professor and executive director of the UTHealth Houston Trauma and Resilience Center, and the Louis A. Faillace, MD Chair in the Department of Psychiatry and Behavioral Sciences ; Robert Suchting, PhD, assistant professor in the Louis A, Faillace, MD, Department of Psychiatry and Behavioral Sciences; and Belinda Reininger, DrPH, professor and regional dean of the UTHealth Houston School of Public Health in Brownsville. 

Additionally, Namkee G. Choi, PhD, professor in the Steve Hicks School of Social Work at The University of Texas at Austin is part of the study.