Prestroke Living Situation and Depression Contribute to Initial Stroke Severity and Stroke Recovery

Abstract

Substantial evidence from both experimental and clinical studies has demonstrated that social isolation can increase stroke incidence and impair recovery. Social isolation leads to higher rates of recurrent stroke but is often not reported as a risk factor. We examined prospectively collected stroke center database variables, which included pre-stroke living situation, to determine if social isolation could be determined from existing data using living arrangement as a proxy. Patients were categorized into 4 groups hypothesized to represent increasing levels of social isolation: Living with Spouse, Living with Family, Living alone with visiting services and Living Alone. Initial stroke severity and recovery were measured using the National Institutes of Health Stroke Scale and Barthel Index, respectively. A multivariate model was used to determine the relationship between pre-stroke living situation, stroke severity and functional outcome. Patients living alone had less severe strokes on admission and better recovery at 3 months compared to the other cohorts. Patients living alone or those that lived with a spouse had less severe strokes on presentation and better recovery at both 3 and 12 months after stroke compared to the other cohorts. However, upon detailed examination, it was found that these patients also had significantly higher pre-stroke function. Pre-existing depression was significantly higher in women and depressed patients had poorer outcomes 3 months after stroke. Information regarding isolation is notably absent from most large stroke databases. A more comprehensive evaluation of social interaction should be obtained to more accurately measure social isolation.

The Impact of Pre-Stroke Depressive Symptoms, Fatalism, and Social Support on Disability after Stroke

“…One study showed that receiving help at home prior to stroke predicted poor outcome after stroke (12). Another showed that patients living alone or with a spouse had better outcomes than patients with visiting services or living with family; the latter two groups were found to have poorer pre-stroke function (33). While our results were non-linear and should be explored in future studies; they could be explained if higher levels of pre-stroke social support reflect poorer pre-stroke function.…”

Recovery Potential After Acute Stroke

“…Furthermore, it was found that stroke patients with a severe prestroke disability have a virtually 50% risk of deceasing. It seems that women are particularly liable of depression after stroke and that this is related to a greater stroke severity ( 159 ). Of note are patients with migraine that to a large proportion suffer from small vessel disease ( 160 ) or hemorraghic stroke ( 161 ).…”

The association of a heart attack or stroke with depressive symptoms stratified by the presence of a close social contact: findings from the National Health and Aging Trends Study Cohort

“…Despite all of the above, we have a relatively limited understanding of why depression may follow a heart attack or stroke. Although social support may have clinical management and prognostic implications for those experiencing a heart attack or stroke, social support measures such as social isolation are absent from many large stroke databases (Aron et al , ). While there is more information linking poor social support to depression post‐heart attack, these studies often are relatively small, are geographically limited, and/or do not prospectively evaluate social support prior to the heart attack (Frasure‐Smith et al , ; Dickens et al , ).…”