Elizabeth A. Johnson, RN, PhD(c), Board Certified Geriatric Clinical Nurse Specialist, Doctoral Candidate, Indiana University School of Nursing; Department of Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA.
Tamilyn Bakas, RN, DNS, FAHA, Associate Professor, Department of Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA.
Linda S. Williams, MD, Chief of Neurology, Roudebush Veterans Administration Medical Center; Research Coordinator, VA Stroke QUERI; Associate Professor of Neurology, Indiana University School of Medicine; Research Scientist, Regenstrief Institute, Indianapolis, IN, USA.

Depression, the most frequent neuropsychological problem after stroke, is greatly influenced by the complex relationships between the neurobiological and psychological changes that occur after stroke. Post-stroke depression leads to negative rehabilitation outcomes including less participation in therapy, extended recovery time, significantly decreased quality of life, and increased utilization of health care resources. Because of the high prevalence of post-stroke depression, all stroke survivors should be screened early in the rehabilitation process. Use of a biopsychosocial framework acknowledges the multifactorial etiology of post-stroke depression and contributes to effective, evidence-based treatment. Attention to the needs of the family caregivers further promotes successful post-stroke rehabilitation.
Key words: stroke, depression, risk factors, recovery, treatment.

Scott B. Patten, MD, PhD
Associate Professor,
Departments of Community Health Sciences and Psychiatry,
University of Calgary, Population Health Investigator,
The Alberta Heritage Foundation for Medical Research,
Calgary, AB.

Stroke has the potential to disrupt several facets of a person's life including communication, emotional regulation, cognitive function and coping skills.¹ Furthermore, stroke does not just impact on the individual but also on his or her family members and other social networks of which he or she is a part. Stroke has been regarded as form of "double-jeopardy"¹ in the sense that the condition creates many new problems and challenges for those afflicted, and simultaneously detracts from the afflicted persons' capacity to cope with those challenges. It can also lead to disruptions in those same social connections that would normally support adaptation to loss.

Understanding the role of psychosocial factors in recovery from stroke requires adopting a conceptual viewpoint that transcends the traditional biomedical perspective. A suitable framework is provided by the World Health Organization's International Classification of Impairments, Disabilities and Handicaps (WHO-ICIDH). The WHO system differentiates among impairment, disability and handicap. According to the WHO, impairment is defined as any loss or abnormality of structure or function.

David J. Gladstone, BSc, MD
Stroke Fellow, Sunnybrook and
Women's College Health Sciences Centre,
University of Toronto,
Toronto, ON.

Cynthia Danells, BScPT
Physiotherapist and Research
Associate,
Sunnybrook and Women's College Health Sciences Centre,
University of Toronto,
Toronto, ON.

Sandra E. Black, MD, FRCPC
Head, Division of Neurology,
Sunnybrook and Women's College Health Sciences Centre, and
Professor of Medicine (Neurology),
University of Toronto,
Toronto, ON.

Delaina Walker-Batson, PhD
The Stroke Center-Dallas,
Professor,
Texas Woman's University, and
Associate Clinical Professor,
Departments of Neurology and Radiology,
The University of Texas Southwestern Medical Center,
Dallas, Texas, USA.

Stroke is a Treatable Condition
Together with advances in the prevention and acute treatment of stroke, the field of stroke rehabilitation is becoming an increasingly exciting frontier for basic science and clinical development (see Table 1). The scientific basis of stroke recovery is becoming better understood, and the post-stroke period is being viewed as an important target for improved therapeutic intervention.