THE INFLUENCE OF DEPRESSION, SOCIAL ACTIVITY, AND FAMILY STRESS ON FUNCTIONAL OUTCOME AFTER STROKE

Background and Purpose. This study was designed to assess the quality of life after an active poststroke period of rehabilitation and to inv estigate the possibility of a return to a working environment for thos e still of working age. Methods: The study was conducted on 180 consec utive patients affected by stroke who were hospitalized for the first time and discharged at least 1 year before the study. The group consis ted of 65% men and 35% women with a mean age of 65.29 years (SD, 11.22 ). The period between the stroke and the interview ranged from 12 to 1 96 months, with a mean of 37.5 months. The average Rankin score on dis charge from the rehabilitation center was 2.718 (moderate handicap). T he interview took place at home after consent obtained by telephone. T he questionnaire included general and personal information regarding t he individuals, their socioeconomic position, and scales for daily act ivity, depression, social activity, and stress produced in the family. The control group consisted of 167 age-matched subjects. Results: A c lose correlation was observed in all patients between depression, soci al activity, and stress caused to relatives. The scores on the individ ual scales were clearly worse than those for control subjects. The pat ients received approximately 5 months of rehabilitation after the stro ke. Differences emerged between men and women for depression and socia l activities, with the women scoring worse. In reference to daily life , 70% of prestroke ability was required on average after rehabilitatio n. The daily activity score at the time of the interview was also stro ngly influenced by the discharge score. The majority of patients were retired. Of the total, 20.64% returned to work, but not always to the same job and often after readapting to new conditions. Of this populat ion, only 31.5% were women. With regard to the population aged younger than 65 years, 21.42% returned to work. Lesions in the dominant hemis phere do not necessarily seem to rule out return to work, even if asso ciated with aphasia. The main discriminating element was the ability t o understand language. The patients were often criticized by their coh abitants; the criticisms most often raised concerned apathy, irritabil ity, and self-centeredness. Sexual activity was depressed in almost al l cases. Conclusions. Despite the progress made in studying cerebral v asculopathies, patients in the aftermath of a stroke still seem to liv e unsatisfactorily, as they did many years ago. Useful measures includ e valid treatment against spasticity, psychological assistance, and gr eater social support.