Stress and traumatic events that can negatively impact subsequent stroke recovery experienced throughout life; Specifically, stroke survivors who were sexually assaulted at any point in their lives had poorer physical functioning and cognitive outcomes one year after the stroke, according to a preliminary study presented at the American Stroke Association’s International Stroke Conference 2024. in Phoenix, February 7-9, and is the world’s premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.
Knowing what happened in the patient’s life is important when caring for them post-stroke. Screening for lifetime stress and trauma is important when caring for a patient who has had a stroke because those experiences often have far-reaching effects and can predict how well a person does over time.”
E. Alison Holman, Ph.D., Lead study author, Professor of Nursing and Psychological Sciences at the University of California, Irvine
The researchers examined data from the Stroke (Stroke, Stress, Rehabilitation, and Genetics) study to investigate specific types of stress that may contribute to adverse physical functioning and cognitive outcomes one year after stroke. In the robust study, stroke survivors were assessed four times a year. Assessments included the Lifetime Stress and Trauma Exposure Survey, which was completed approximately 90 days after the stroke. Participants were exposed to 31 different types of stressful and/or traumatic events in their lifetime, including seeing a loved one injured or killed; sexual harassment; mental and physical abuse in childhood of divorce; and poverty. Additionally, one year after stroke, participants were assessed for physical function and cognitive ability. Researchers assessed the relationship between lifetime stress and trauma exposure and functional and cognitive outcomes among 763 stroke survivors, with a mean age of 63 years.
The analysis found:
- Sexual assault was the traumatic event associated with a moderate reduction in the ability to perform activities of daily living and lower scores on the Modified Rankin Scale (describing a person’s ability to function) and the Telephone Montreal Cognitive Assessment Score one year after stroke. Controlling for age, sex, race, and National Institutes of Health Stroke Scale score (a measure of stroke severity) three months after stroke.
- Other adverse experiences – seeing a family member injured or killed; going through a divorce; and/or childhood physical abuse – were also associated with a moderate reduction in the ability to independently perform activities of daily living one year after stroke.
- These associations remained even when early post-stroke acute stress levels were accounted for in the analysis.
- In contrast, caring for a seriously ill loved one by telephone was associated with better scores on the Montreal Cognitive Assessment. Holman notes that people who care for others are more actively engaged in daily life, which can keep the mind sharp.
- Women were significantly more likely to report sexual assault and a seriously ill loved one.
Holman emphasized that health care professionals should be aware of the potential long-term physical health effects of sexual assault and other traumatic events that occur in a person’s life. Understanding these earlier life experiences and how patients respond to subsequent strokes may encourage more empathetic communication.
“Bad things happen to people, so the goal is to intervene soon after a stroke to prevent its worst effects. We should be able to use this information to allocate resources in an objective way to provide better support for people during post-stroke recovery,” he said. “Health care professionals can use psychological first aid techniques to support patients’ basic needs, help them, and refer them to resources such as a support group or community organization. Sometimes just acknowledging the experience itself is liberating.”
“This research raises our awareness of how important it is to manage stress and increase our physical and mental resilience,” said Randy Forker, PhD, MA, FAHA, vice chair of epidemiology and cardiovascular stroke nursing prevention at the American Heart Association. Science Committee, and Professor of Medicine, Institute for Informatics, Data Science and Biostatistics and Director, Center for Population Health Informatics at Washington University in St. Petersburg Louis, School of Medicine, Missouri. “Some of the ways we can strengthen our resilience and our well-being are by engaging in mindful meditation, social engagement and physical activity. As clinicians, researchers and caregivers, we need to ensure that we are giving stroke survivors the best possible chance to live longer,” “The Higher Life.” Dr. Forker was not involved in the research.
Study Details and Background:
- The study included 763 stroke survivors (mean age 63; 41.3% women; 60.9% white adults).
- The STRONG study was conducted at 28 stroke centers in the United States from 2016-2021.
- The findings of the current study build on robust research led by Holman and his colleague Steven Kramer, MD, previously published in the American Heart Association’s Stroke Journal (September 2023), which also suggested that cumulative traumatic stress exposure impairs recovery from stroke. .
The main study limitation was that severe stroke patients and those who could not speak English were excluded, so we do not know whether the results would apply to those patients. Additional research is needed to investigate potential mechanisms linking these traumatic events to poor outcomes after stroke. Holman suggests that it is important to examine both psychological and physiological processes that may explain the findings.