Stroke Survivors’ Partners, Adult Children at Higher Mental Health Risk

The risk for mental health conditions and self-harm or suicide is higher among partners and adult children of stroke survivors vs the general population, according to study results published in JAMA Network Open.

Researchers conducted a nationwide, population-based cohort study using data collected from Danish administrative and clinical registries to determine the impact of stroke survivorship on the mental health of immediate family members.

Patients aged 18 and older who were hospitalized with a first-time stroke between May 2004 and December 2021 who were discharged from the hospital alive were identified in the Danish Stroke Registry. Stroke survivors’ partners and adult children were then identified using linked information in the Civil Registration System. Two exposed cohorts (stroke-partner and stroke-offspring cohorts) were assembled, as well as 2 unexposed comparison cohorts for each of the exposed cohorts (general population-partner and general population-offspring cohorts, as well as myocardial infarction [MI]-partner and MI-offspring cohorts). The Aalen-Johansen estimator was used to calculate propensity score-weighted 3-year absolute risks, risk differences, and risk ratios (RRs) for depression, substance use and anxiety disorders, and self-harm or suicide among partners or children of stroke survivors vs partners or children of survivors of MI and matched individuals from the general population.

A total of 1,923,732 individuals were included in the study. The stroke-partner cohort comprised 70,917 people (median age, 68; women, 65%; ischemic stroke, 91%; mild severity, 72%), the general population-partner cohort comprised 354,570 people (median age, 68; women, 65%), and the MI-partner cohort comprised 70,664 people (median age, 65; women, 73%).

The stroke-offspring cohort comprised 207,386 adult children (median age, 45; women, 48%; ischemic stroke, 91%; mild severity, 68%), the general population-offspring cohort comprised 1,036,886 adult children (median age, 45; women, 48%), and the MI-offspring cohort comprised 183,309 adult children (median age, 42; women, 48%).

The 3-year absolute risk among the stroke-partner cohort for depression, substance use disorders, anxiety disorders, self-harm or suicide, and the composite outcome of any diagnosis of a mental health condition was 1.0%, 0.7%, 0.3%, 0.04%, and 4.1%, respectively. The RR point estimates for the assessed outcomes ranged from 1.14 to 1.42 vs the general population-partner cohort and from 1.04 to 1.09 vs the MI-partner cohort.

The elevated risk for depression in the stroke-partner cohort was more pronounced after severe or moderate stroke vs mild stroke.

The 3-year absolute risk among the stroke-offspring cohort for depression, substance use disorders, anxiety disorders, self-harm or suicide, and the composite outcome of any diagnosis of a mental health condition was 0.6%, 0.6%, 0.2%, 0.05%, and 2.2%, respectively. Both the absolute risks and RRs for adult children of stroke survivors were smaller vs those reported in the partner analyses.

Stroke severity did not significantly impact the association with depression among adult children.

Limitations of the study included the possibility of nondifferential misclassification of outcomes and residual confounding.

“In summary, this study highlights the potential consequences of stroke among family members, particularly partners, and its findings may possibly serve as a quantitative foundation for the development of future stroke rehabilitation services,” the researchers concluded.

Disclosure: Some study authors declared affiliations with pharmaceutical or biotech companies. Please see the original reference for a full list of author disclosures.