Long-Term Life Participation in Young Stroke Survivors: Independent Associations With Depressive Symptoms, Communication Skills, Mobility, and Social Situation

Abstract

Background: Resuming active participation in valued areas of life is critical for stroke survivors; however, little is known about the possible components restricting life participation in young survivors. Here, we identified independent determinants of such long-term restrictions among potential stroke-related complications and explored the interplay between these potential explanatory variables.

Methods: Seven years after the index stroke, a consecutive cohort of young (18–54 years at onset) ischemic stroke survivors (n = 222) reported their self-rated participation according to the Stroke Impact Scale (SIS). Using linear regression and partial correlations, the independent association with the SIS participation score was analyzed for the following potential correlates: depressive symptoms, anxiety, cognition, mobility, activities of daily living, fatigue, neurological deficits, demographics, and vascular risk factors.

Results: Fifty-seven percent reported restrictions sometimes or more often for at least one of the seven SIS participation items, with the largest proportions reported for “controlling life” (40%), “work” (37%), and “active recreation” (37%). Communication (partial r = 0.39, p < 0.001), depressive symptoms (partial r = −0.30, p < 0.001), mobility (partial r = 0.20, p = 0.029), and social situation (living alone; partial r = −0.19, p = 0.02) were independently associated with participation. The structure of the interplay between the explanatory variables was further analyzed using a network model.

Conclusion: Participation restrictions among young ischemic stroke survivors in the long term are common and have been previously reported. Limitations in communication and depressive symptoms were important determinants of restricted participation as well as limited mobility and living alone, emphasizing the need for sustained interventions and support from a broad perspective for young stroke survivors.