Post-stroke depression is a major issue affecting approximately 33% of stroke survivors. A new study published in the current issue of Archives of Physical Medicine and Rehabilitation reports that the level to which survivors are uncertain about the outcome of their illness is strongly linked to depression. The relationship is more pronounced for men than for women.

"Male stroke survivors in the US who subscribe to traditional health-related beliefs may be accustomed to, and value highly, being in control of their health," says lead investigator Michael J. McCarthy, PhD, of the University of Cincinnati College of Health Sciences School of Social Work. "For these individuals, loss of control due to infirmity caused by stroke could be perceived as a loss of power and prestige. These losses, in turn, may result in more distress and greater depressive syndromes."

Thirty-six survivors (16 female, 20 male) who had experienced their first stroke within the preceding 36 months participated in the study. Survivors' depressive symptoms and ability to perform activities of daily living, such as bathing and cutting food with a knife and fork, were measured. The degree to which survivors were experiencing health ambiguity, or uncertainty about the outcomes of their illness, was evaluated by their agreement with statements such as "I don't know what's wrong with me," and "I have a lot of questions without answers."

Investigators found health ambiguity was significantly associated with greater depression for both sexes, and the association was stronger for male survivors than for females. "These findings suggest that reducing health ambiguity through proactive communication with patients and family members may be an effective approach for reducing survivor distress and, ultimately, for improving rehabilitation outcomes, Dr. McCarthy says. "The also reinforce the importance of rehabilitation professionals acknowledging that health-related beliefs can have a tangible impact on patient outcomes."

Dr. McCarthy notes that there was a wide variability in time since diagnosis in the study, and patients were likely at different points in recovery with respect to health ambiguity and depressive syndromes. The small sample size and lack of sample diversity may limit the generalizability of the findings to the broader stroke population. "Future research, with more socioeconomically diverse samples, should examine how gender-based health-related beliefs affect survivor outcomes, and explore the factors that protect female stroke survivors from the harmful effects of health ambiguity," he concludes.