Hi Nina,
Thank you for your question and sharing your story.
We do know there is an association between mental health and neurological symptoms in stroke recovery. Whilst the mechanism isn't fully clear, there are certain factors that highlight this association, and how it can influence a stroke survivor's quality of life post-stroke.
Stroke - depending on the location of the brain where it occurred - can affect how you process, understand and cope with emotions. Research have found that the severity of stroke impacts can increase the risk of depression, and mood issues other than depression can also arise following a stroke. We have included some evidence below:
Post-Stroke Depression: A Review | American Journal of Psychiatry - this review outlines research on physiological changes in the brain that might affect mood, including things like inflammation, genetic and epigenetic variations, white matter disease, cerebrovascular deregulation, altered neuroplasticity, and changes in glutamate neurotransmission.
In our Living Guidelines for Stroke Management, the chapter on 'Complications' has a section on ‘Mood Disturbance’. It mentions: “Mood is frequently affected following a stroke. Depression is the most common mood disturbance with a meta-analysis of 61 observational studies finding almost one-third of patients with depression after stroke (Hackett et al 2014 [140]). Anxiety is also common after stroke (19-24%) (Knapp et al 2020[142])... The consistently high proportion of stroke survivors with depression and other mood disorders emphasises the importance of screening and assessment for mood disturbance following stroke and specifically depression (Hackett et al 2014 [140]).”
Similarly, the experience of going through a serious health event like a stroke can directly impact someone’s mental health, such as through experiences in the health care system, feelings of grief, loss of independence and control, fear of future health, and adapting to life after stroke. These things can also be exacerbated by other personal challenges and prior experiences or mental health issues.
We also know that neurological changes following a stroke can also translate to personality and behaviour changes which can then influence quality of life. Hence, our Living Guidelines outline the following consensus-based recommendations:
- Behavioural changes after stroke can impact on a person’s ability to engage in meaningful activities and also their quality of life. Therefore, the impact of any behavioural changes on relationships, employment and leisure should be assessed and addressed across the lifespan.
- Stroke survivors and their families/carers should be given access to individually tailored interventions for personality and behavioural changes. This may include positive behaviour support programs, anger-management therapy and rehabilitation training and support in management of complex and challenging behaviour.
All of the things described above can turn into a cycle where stroke-related mental health impacts may reduce a stroke survivor's capacity to engage in rehabilitation or achieve optimal neurological recovery. Subsequently, the perceived lack of success with neurological recovery feeds back into the stroke survivor's mood. Ultimately, we can infer that over time this loop can negatively affect the stroke survivor's life, for instance, manifesting as limitations on daily routines due to low mood and low motivation, as well as due to persisting stroke-related physical, cognitive and/or behavioural changes.
Understanding the relationship between mental health and neurological symptoms may provide useful insight, however, we also want to emphasise that it is just as important to seek help and ongoing support. We have heard from survivors of stroke that Neuropsychologists have been helpful in providing support through the stroke recovery journey with consideration of mental health. Neuropsychologists, through comprehensive assessments, are able to connect organic changes in the brain to mental and psychological changes. Additionally, you can also seek support from a Clinical Psychologist who can assess and provide treatment for various mental health conditions, to help you process and cope effectively with any symptoms or impacts.
You may consult with your GP for a referral to a Neuropsychologist and/or Clinical Psychologist, and your GP will be able to help you determine which one of these professionals is most appropriate to your needs. To find a Neuropsychologist or Clinical Psychologist, ask your GP as they might be able to recommend someone in your local area. Otherwise, you can do a search here:
Find a Psychologist | APS and filter for either 'Clinical Neuropsychology' or 'Clinical Psychology', and plug in your location. Please note that there will be costs and likely a waitlist associated with seeing these health professionals, so we recommend speaking with your GP about these factors, as well as your private health insurer if you do have one.
If you would like more information on what has been discussed above, please feel free to reach out to Strokeline on 1800 787 653 or email
strokeline@strokefoundation.org.au. We are available Monday to Friday 9am to 5pm AEST.
