Uncertainty After Stroke Leads to Greater Depression in Male Survivors

CINCINNATI—A new study of stroke survivors has found that male stroke survivors are more affected by uncertainty about their health post-stroke, making them at greater risk for depression than female survivors.

The pilot study, led by UC assistant professor of social work Michael McCarthy, PhD, found a strong link between "health ambiguity,” or uncertainty about the outcomes of one’s illness, and depression among 36 survivors of stroke. The relationship between uncertainty and depression was more pronounced among men. 

Results of the study, "Gender, Health Ambiguity, and Depression among Survivors of First Stroke: A Pilot Study,” are published in the journal Archives of Physical Medicine and Rehabilitation.

"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 McCarthy. "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.”

McCarthy, along with collaborators at Portland State University and Oregon Health and Science University, interviewed 36 stroke survivors (16 women and 20 men) who had experienced their first stroke within the previous three years. Researchers measured survivors’ depressive symptoms and their ability to perform activities of daily living, such as bathing and cutting food with a knife and fork.

They evaluated interviewees’ health ambiguity or uncertainty by their agreement with statements like, "I don’t know what’s wrong with me,” and "I have a lot of questions without answers.”

While results showed that health ambiguity was significantly associated with greater depression for both sexes, the association was stronger for male survivors than for females.

With post-stroke depression affecting one-third of stroke survivors, McCarthy says the study reinforces the importance of proactive communication among rehabilitation professionals, patients and family members. He says it also underscores the tangible impact that health-related beliefs can have on patient outcomes.

"Clear communication that reduces health ambiguity may be an effective approach for reducing survivor distress and, ultimately, for improving rehabilitation outcomes,” says McCarthy.

He says future research should include more socioeconomically diverse samples and examine how both gender-based health-related beliefs affect survivor outcomes and what factors protect female stroke survivors from the harmful effects of health ambiguity.

UC co-authors include Elizabeth Bauer, UC social work graduate student.