How Important Is Mental Health During Stroke Recovery?

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Mental health challenges like depression often occur following an acute cerebrovascular accident (CVA) or a clinically established stroke. In fact, 30% of stroke survivors experience symptoms associated with post-stroke depression.¹ The onset of depressive symptoms can be immediate or may occur months after the initial stroke event at different stages in recovery. Therefore, understanding the role of mental health during stroke recovery is quite significant.

Post-Stroke Depression

Post-stroke depression (PSD) is a common yet frequently underdiagnosed condition that can occur following a stroke. It is often caused by an interplay of biopsychosocial alterations, such as neural dysfunction within the brain as well as psychological responses toward sudden changes regarding one's health and independence.²

Symptoms of PSD

• Constant sadness or unhappiness. An unhappy mood that doesn't lift even when positive things occur.
• Loss of interest. Lack of interest in previously enjoyable activities. Individuals may become more reclusive in social settings and ignore their interests or hobbies.
• Changes in sleep patterns. Difficulty falling asleep, waking up during the night, or excessive daytime drowsiness.
• Feelings of self-worthlessness or guilt. Persistent negative self-talk or guilt for no discernible reason.
• Suicidal ideation. In severe circumstances, individuals may experience recurrent thoughts of suicide or death.

Early detection and intervention can significantly improve mental health outcomes. Therefore, it is essential to understand that the presentation and severity of symptoms will differ and often depends on social, cognitive, and functional aspects, such as social support from family and the severity of stroke-related impairments. The identification of PSD symptoms can present challenges as they are sometimes incorrectly attributed to cognitive impairments and other clinical characteristics of stroke recovery. Therefore, it is important to consult with a mental health expert.

Impact on Recovery

Long-term rehabilitation efforts are often hindered by PSD and profoundly impact recovery. Several studies have demonstrated that PSD is related to poor functional recovery in activities of daily living (e.g., cooking and bathing)³ and cognitive abilities, including memory and problem-solving.¹ Additionally, research has found that PSD increases the probability of post-stroke mortality and the occurrence of subsequent strokes. In fact, the likelihood of experiencing another stroke within the first year is doubled for patients with PSD when compared to patients without depressive symptoms.⁴

Mental Health Services and Self-Help Strategies

Mental health specialists like doctors and therapists are available to support patients after a stroke by providing individualised treatment approaches, including psychotherapy, cognitive-behavioural therapy (CBT), and, in some cases, pharmacological interventions to effectively manage depressive symptoms. In addition to mental health services, there are several self-help strategies that can promote psychological well-being during stroke recovery:

• Mindfulness techniques: Nurturing a positive mindset through daily affirmations or mindfulness practices is beneficial for cultivating resilience and adaptability.
• Peer support: Connecting with other stroke survivors through support groups or online communities is a way to receive valuable emotional support and feel understood, and these interactions can afford chances for individuals to learn from others' experiences and feel less isolated.
• Acknowledging the small victories: By celebrating small victories and milestones and recognizing even the smallest progress, individuals can increase confidence and support a positive outlook.

Mental health should never be neglected in stroke recovery; it should be viewed as a vital part of the journey. Always bear in mind that depressive symptoms may arise at any time after a stroke; therefore, it's never too late to seek help and begin the journey toward psychological well-being.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.