Mental health support after stroke: A qualitative exploration of lived experience.

Abstract

Purpose: Unmanaged mental health problems following a stroke can be detrimental to recovery. We aimed to explore the lived experience of (a) poststroke mental health difficulties, (b) help-seeking for mental health, including factors that influenced treatment access and utilization, and (c) receiving treatment and support. Research Method: Individual semistructured interviews were conducted in 2022 with 13 participants (62% female, age at stroke 35-76 years) who had experienced mental health difficulties following their stroke. Data were analyzed using reflexive thematic analysis with a critical realist approach. Results: Six themes were identified. Mental health challenges poststroke were diverse in nature. Attitudes and previous experiences relating to mental health influenced the inclination to seek help. Participants valued an individualized approach to the provision and timing of psychoeducation. Accessibility of services was impacted by financial and transportation barriers, as well as availability of services and appropriately trained clinicians. Participation in support groups was a positive experience for most participants. Lived experience of mental health treatment ranged from positive to negative, and participants conveyed helpful and unhelpful aspects. Conclusions: Findings highlight the importance of early screening and psychoeducation provision for poststroke mental health difficulties, alongside accessible community-based mental health support services throughout the stroke recovery journey. Having varied options for mental health support and treatment may aid stroke survivors in finding an approach that personally works for them. Additionally, it may be helpful to train clinicians to tailor mental health treatment to accommodate stroke-related impairments (e.g., cognitive, sensorimotor). Impact and ImplicationsAlthough poststroke mental health problems are common and can hinder recovery, existing research primarily examines mental health treatment access and utilization within the general population. This study expands on the existing limited quantitative evidence in the stroke population by investigating previously unexplored qualitative insights. This study offers a holistic understanding of the diverse nature and progression of mental health difficulties after stroke, as well as the challenges stroke survivors encounter when seeking mental health support. It highlights additional factors that require attention to ensure equitable treatment access and elucidates the perceived quality and effectiveness of mental health services and supports. It is important to screen for mental health problems and provide psychoeducation throughout the stroke recovery journey, starting in the hospital. Various formal and informal support options should be made available, tailored to individual preferences and stroke-related consequences. Engaging social supports (e.g., family, friends, stroke peers) in mental health management may be beneficial.