Elayoubi Joanne, Haley William E, Nelson Monica E, Hueluer Gizem
School of Aging Studies, University of South Florida, Tampa, Florida, USA.
Department of Psychology, University of Bonn, Bonn, Germany.
medRxiv. 2023 Mar 8:2023.03.07.23286965. doi: 10.1101/2023.03.07.23286965.
Stroke commonly leads to disability and depression. Social connection and engagement can be protective against functional decline and depression in the general population. We investigated the effects of social connection and engagement on trajectories of function and depressive symptoms in stroke.
Participants were 898 individuals with incident stroke from the Health and Retirement Study between 1998-2012. Multilevel modeling was used to examine associations of social connection and engagement with changes in functional limitations in instrumental activities of daily living (IADLs) and depressive symptoms over time. Models controlled for age, gender, education, and race/ethnicity. Moderation analyses examined whether high social connection and engagement reduced depressive symptoms for survivors with high IADL impairment.
Social connection and engagement were generally associated with fewer IADL limitations and depressive symptoms at the time of stroke and after stroke. For example, participants who felt lonely and did not provide help to others before stroke had more IADL limitations. Pre-stroke volunteering was associated with less increase in IADL limitations with stroke and increase in having friends and providing help to others compared to one's pre-stroke status were associated with fewer IADL limitations after stroke. For depressive symptoms, participants who felt lonely and did not have a friend or partner before stroke had more depressive symptoms, and participants who had children residing nearby before stroke showed less increase in depressive symptoms. Moderation effects were not found for social connection and engagement on high IADL impairment and depressive symptoms.
Findings suggest that social connection and engagement may reduce the negative physical and psychological outcomes of stroke, both at baseline and after stroke. Efforts to enhance social engagement and diminish loneliness may both enhance population well-being and enhance resilience and recovery from stroke and other illnesses.
中风通常会导致残疾和抑郁。社会联系和参与可以预防普通人群的功能衰退和抑郁。我们研究了社会联系和参与对中风患者功能轨迹和抑郁症状的影响。
参与者为1998年至2012年间来自健康与退休研究的898例新发中风患者。采用多水平模型来检验社会联系和参与与日常生活工具性活动（IADL）功能限制变化及抑郁症状随时间变化之间的关联。模型对年龄、性别、教育程度和种族/民族进行了控制。调节分析检验了高社会联系和参与是否能减轻IADL严重受损幸存者的抑郁症状。
社会联系和参与一般与中风时及中风后的IADL限制和抑郁症状较少有关。例如，中风前感到孤独且未向他人提供帮助的参与者有更多的IADL限制。与中风前状态相比，中风前做志愿者与IADL限制增加较少有关，而有朋友并向他人提供帮助则与中风后IADL限制较少有关。对于抑郁症状，中风前感到孤独且没有朋友或伴侣的参与者有更多的抑郁症状，而中风前有孩子住在附近的参与者抑郁症状增加较少。未发现社会联系和参与对高IADL损伤和抑郁症状有调节作用。
研究结果表明，社会联系和参与可能会减少中风在基线期及中风后的负面生理和心理后果。加强社会参与和减少孤独感的努力可能既能提高人群的幸福感，又能增强从中风及其他疾病中恢复的能力和恢复力。
