Recovery After Stroke : The Contribution of Depression and Social Networks

Stroke results in an estimated annual incidence in Australia of 48,000, resulting in 29,290 hospital admissions. About 50% of survivors of a first stroke have permanent residual disability. Within 5 years of a first stroke, 25% of survivors suffer a second stroke, and mortality at 10 yrs is around 82%. Depression is now recognized as not only a significant barrier to recovery, but a risk factor for recurrent stroke and post-stroke mortality. Yet the correct management of stroke risk factors can reduce stroke risk by as much as 80%. However, translation from research into community care has been disappointing. Many patients and carers express a lack of understanding about stroke, its causes and the effective secondary prevention measures available and so remain passive participants in the management process. There is limited evidence supporting the role of social networks and the emotional, social and environmental aspects in the recovery process

Methodology : We would like to report on a RCT with test, double re-test design undertaken in Melbourne Australia from the Royal Melbourne Hospital. The “experimental “ group of stroke survivors received a community focused, patient centred integrated care program in a monitored shared care arrangement with family medical practitioners. The “control” group received the normal care offered by the health service. The full sample consisted of 186 stroke patients,which included 102 males (55%). Average age was 65.9 years old (range 28-95), and almost half (48%) came from an Australian background.

Results 1.)Depression : At 12 months, 31/92 (34%) of the treatment group had depressive symptoms compared to 51/94 (54%) of the control group . This difference was significant (x2 = 8.0, p < .01) 2.)Depression and social support Although depression failed to correlate with the total social support ( MOS ) score, it did correlate with 3 individual questions: 1) ‘Is there someone to confide in or talk to about yourself or your problems?' (r2 = -.20, p = .009) 2)‘Do you have someone to get together with for relaxation?' (r2 = -.17, p = .027) 3)‘Is there someone to do something enjoyable with?' (r2 = -.15, p = .046).

Implications : Analysis of the data suggests that while physical and cognitive recovery occurs both spontaneously and within established linear models of rehabilitation, re-integration into social life does not , with significant correlations with depression, social support and resulting quality of life. This suggests that social workers practising with stroke survivors should include two approaches simultaneously in their work : 1)Shift to “strengthen existing systems “ within the stroke survivors social network 2)Support the stroke survivor to reframe and accept a “new” social identity This approach not only includes the exploration of previous affiliations, group and family memberships but links the stroke survivor, characterised by a reframed identity, with new informal support networks that will assist in meeting, or reframing the expectations of the old networks of work, family and social functioning