According to recent studies, 16% to 85% of persons recuperating from a stroke have at least one psychosocial symptom, such as sadness, worry, tension, exhaustion, and/or a lower quality of life. Critical nursing interventions, including as regular mental health screenings, education, symptom management, and follow-up care, are critical to lowering the detrimental effects of a stroke on a patient’s mental health; yet, only a tiny proportion of patients receive therapy.
Nurses have an important role in assisting patients with emotional and social health difficulties, or psychosocial health, following a stroke, and enhanced screening and assessment for psychosocial requirements are required to provide optimal patient care. These findings are highlighted in a new statement by the American Stroke Association, a part of the American Heart Association, titled “Nursing’s Role in Psychosocial Health Management After a Stroke Event,” which was published today in the Association’s peer-reviewed scientific journal Stroke.
Despite tremendous breakthroughs in stroke prevention and treatment, stroke remains the world’s second greatest cause of death and a major cause of disability. The latest research indicates that 16% to 85% of stroke survivors experience psychosocial symptoms, such as depression, anxiety, stress, fatigue and/or a decreased quality of life during their recovery.
Stigma often surrounds discussions about psychosocial health. Therefore, it is crucial for nurses and all health care professionals to create a safe and therapeutic environment for patients and offer hope and comprehensive education on the topic.
Patricia A. Zrelak
“Stigma often surrounds discussions about psychosocial health. Therefore, it is crucial for nurses and all health care professionals to create a safe and therapeutic environment for patients and offer hope and comprehensive education on the topic,” said Chair of the scientific statement’s writing group Patricia A. Zrelak, Ph.D., R.N., FAHA, a regional stroke program quality nurse consultant for Kaiser Permanente Northern California and a member of the American Heart Association’s Council on Cardiovascular and Stroke Nursing.
The scientific statement provides a complete overview of the most recent information published from 2018 to 2023 on psychological health in stroke patients. The declaration discusses the impacts, underlying causes, screening, diagnosis, and treatment of five major emotional and social health issues: depression, stress, anxiety, exhaustion, and quality of life. The scientific statement intends to provide a framework for nursing care throughout a patient’s recovery from a stroke, from preventing harmful mental health conditions to detecting and addressing symptoms.
“Emotional, cognitive, behavioral and/or personality changes may occur after a stroke,” Zrelak said. “These conditions can emerge immediately after a stroke or have a delayed onset, sometimes occurring more than a year later, and they may also fluctuate in intensity over time. In addition, psychosocial symptoms are interrelated, and patients who experience one are at higher risk of developing other mental health conditions. Effective and regular screening are vital for early detection and treatment.”
Depression
Depression affects about 30% of stroke survivors and is particularly common within the first three months after a stroke. Symptoms of depression may include persistent sadness, anxious or “empty” mood; restlessness and irritability; loss of interest or pleasure in hobbies and activities; difficulty in concentrating and thinking; increased or decreased sleep; changes in appetite; and weight gain or loss. Post-stroke depression worsens cognitive and functional recovery and increases the risks of death and/or another stroke.
The AHA/ASA Guidelines for the Early Management of Patients With Acute Ischemic Stroke recommend routine depression screening for all patients after a stroke. Nurses can help educate stroke survivors and their families on symptom recognition, prevention and treatment options, such as medication management and/or cognitive behavioral therapy.
Stress
A 2022 study found that post-stroke stress and post-traumatic stress disorder (PTSD) affects about one in six (about 16.5%) stroke survivors. These conditions may increase the risk of additional health issues, including anxiety and poor medication adherence. Screening stroke patients for stress and PTSD should occur when they are hospitalized and continue during rehabilitation and outpatient visits after hospital discharge.
Nursing interventions that may help lower patients’ distress include stroke education and self-management strategies, such as mindfulness and meditation. Nurses may also consider stroke survivors’ coping styles. People with high-anxious coping styles face a significantly higher risk of experiencing PTSD after a stroke in comparison to people with low-anxious coping styles.
Anxiety
The frequency of anxiety ranges from 20%-25% in the first months after stroke, increasing to 32% as the year progresses, with a five-year prevalence of 34%. Factors such as younger age at the time of the stroke, lower income, inability to work, social isolation, previous mental health conditions and/or severity of the stroke are factors that increase the risk of developing anxiety. Anxiety is also linked to a higher risk and severity of depression.
Standard screening for anxiety and prompt detection may lead to early treatment, greater patient engagement and improved recovery for stroke survivors. Although established clinical guidelines for treating general anxiety exist, more research is needed on anxiety interventions after different types of strokes.
Fatigue
Post-stroke fatigue may develop anytime, however, it is most common within the first six months after a stroke. Symptoms of fatigue may include reduced physical and mental energy levels that interfere with daily activities and difficulty with self-control, emotions and memory. Women and people with depression, sleep problems, anxiety and/or multiple health conditions are at higher risk for developing post-stroke fatigue.
More research is needed for effective management strategies for post-stroke fatigue, as there are currently no proven treatments. However, interventions focused on improving general physical fitness may help prevent, reduce or treat post-stroke fatigue and other components of psychosocial health.
Quality of Life
Returning to the same quality of life after a stroke is challenging and even more so after a severe stroke. Physical strength, speech, depression, anxiety and the ability to return to work and social activities are factors that contribute to a stroke survivor’s quality of life. However, conditions such as chronic pain can negatively impact recovery and return to independent living.
Physical activities that also include interpersonal engagement, such as yoga and tai chi, have shown positive effects on patients’ quality of life. Nurses can help stroke survivors improve their post-stroke quality of life by linking patients to social services in their local area, such as post-stroke support groups and community-based organizations.
“Mental and emotional well-being are crucial for recovery, and nurses play an important role in supporting patients after a stroke,” Zrelak said. “It’s important to engage stroke survivors and their caregivers so they are aware of these psychosocial conditions and ways they can help. Early detection of symptoms and treatment have the potential to improve post-stroke recovery.”
The statement also cites existing data that reveals that stroke outcomes fluctuate dramatically across racial and ethnic groups. Social determinants of health, such as structural racism, socioeconomic position, poor housing, and/or limited access to health care, particularly mental health services, can all have an impact on stroke survivors’ rehabilitation.
Zrelak continued, “The stroke care team is critical in addressing these health disparities, using targeted interventions and customized treatments to improve mental health support and overall care coordination for those most at risk.” More study is needed to assist us understand how to effectively support people’s psychosocial well-being after a stroke, so they can return to their normal daily activities and have a higher quality of life.”
