The mediating role of perceived social isolation in feeding methods and depression among patients with dysphagia after ischemic stroke: A multicenter study

Abstract

Background

Feeding methods may influence post stroke depression. Perceived social isolation may mediate this underlying mechanism. In this study we explored the effects of perceived social isolation on the relationship between feeding methods and post stroke depression.

Methods

This observational study was conducted between 2022 and 2024. The subjects were ischemic stroke survivors with dysphagia. Information was collected, including 1) depression levels (Patient Health Questionnaire-9 items [PHQ-9]), 2) demographic characteristics, 3) clinical conditions, 4) treatment details, and 5) perceived social isolation. After matching the baseline and treatment-related variables, a mediation model was used to analyze the relationship among perceived social isolation, feeding methods, and depression levels.

Results

There were 2764 participants (44.54% using Nasogastric Tube feeding [NGT]). Before matching, the PHQ-9 score for all participants on day 10 was significantly lower than that at admission (P < 0.001). After matching confounding factors, the PHQ-9 score on day 10 for the Intermittent Oro-Esophageal tube feeding (IOE) users was significantly lower than that of the NGT users [(7.03 ± 2.52) versus (9.25 ± 5.55), n1 = n2 = 800, P < 0.001]. The mediation model showed that 1) compared to NGT, IOE can cause significantly lower perceived social isolation on day 10 (effect = 5.808, P < 0.001); 2) compared to NGT, IOE can significantly lower depression levels on day 10 (effect = 0.180, P < 0.001); and (3) perceived social isolation showed partial mediating effects, and the proportion of the mediation effect was 47.19% (1.046/2.218, P < 0.001).

Conclusions

Compared to NGT, IOE can significantly improve post stroke depression levels. Perceived social isolation mediated the relationship between feeding methods and post stroke depression.