Psychological Sequelae of Stroke: Examining Emotionalism Maintaining Factors and the Prevalence of Stroke-Induced Post-Traumatic Stress Disorder

Trigg, Emma (2021) Psychological Sequelae of Stroke: Examining Emotionalism Maintaining Factors and the Prevalence of Stroke-Induced Post-Traumatic Stress Disorder. Doctoral thesis, University of East Anglia.

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Background: Every two seconds, someone in the world sustains a stroke, yet research on the emotional consequences of stroke remains rather in its infancy. As such, stroke survivors and their carers must be advised regarding the treatment and prognosis of emotional difficulties, such as post-traumatic stress disorder (PTSD) and emotionalism, in the absence of robust evidence.

Methods: To examine the prevalence of PTSD after stroke or transient ischemic attack (TIA), an updated systematic review and meta-analysis was conducted. Subgroup analyses and meta-regression were used to explore high heterogeneity between the studies included in the review. To examine psychological factors related to emotionalism after stroke, empirical analyses of pre-existing data collected during a large, longitudinal cohort study (Testing for Emotionalism After Recent Stroke, TEARS) were undertaken. A series of logistic regression analyses were used to explore associations between demographic variables (age, sex, stroke type), psychological variables (anxiety, depression, cognition, daily functioning and emotionalism) measured at 2-weeks after stroke, and the presence of emotionalism at 6- and 12-months after stroke.

Results: A total of 18 studies (N =1815) were examined in the systematic review and metaanalysis. The pooled prevalence estimate of PTSD after stroke was 18% (95% CI= 14- 23%). Subgroup analyses and meta-regression revealed that prevalence was significantly higher in studies including only stroke (in comparison with mixed stroke and TIA samples), and studies assessing PTSD using a self-report measure (in comparison to clinical interview). This accounted for 22% of the heterogeneity between studies. The empirical study (N = 228) found that emotionalism and anxiety at baseline (2-weeks after stroke), were associated with a greater likelihood of experiencing emotionalism at 6- and 12-months. Younger age and worse cognitive impairment at baseline (2-weeks after stroke) were associated with a greater likelihood of drop-out from the TEARS study before the 6- and 12-month assessments.

Conclusions: The papers presented in this thesis demonstrate that PTSD and emotionalism are commonly experienced following stroke, both in the acute stages and later in the recovery journey. Given the impact of such emotional difficulties on rehabilitation and societal reintegration, is it clear that further exploration of the constructs related to the development and maintenance of these conditions is crucial in progressing towards much needed, evidence-based non-pharmacological interventions.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Jennifer Whitaker
Date Deposited: 16 Nov 2021 11:31
Last Modified: 16 Nov 2021 11:31


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