Abstract DP099: When Social Interactions Undermine Stroke Recovery: Findings From the STRONG Study

Introduction: Social support promotes stroke survivors’ well-being and recovery. Yet family and friends often do not know how best to support survivors and may respond in ways that make survivors uncomfortable sharing their concerns. Whether these unhelpful interactions affect long-term recovery is unknown. The Social-Cognitive Processing model posits that when people inadvertently make patients uncomfortable expressing thoughts and feelings about serious medical concerns, it can leave patients feeling lonely and undermine well-being. We examine whether these early post-stroke “social constraints” on sharing predict loneliness and functional and cognitive disability 1-yr post-stroke. Methods: Adults with a new stroke enrolled in the STRONG ( S troke, s T ress, R ehabilitati ON , and G enetics) study at 28 US sites and were assessed 4 times over 1-year. Measures included 2 items from the Social Constraints Scale (90-d) that measure survivors’ degree of discomfort expressing their concerns; 3-item UCLA Loneliness scale (1-yr); modified Rankin Scale (mRS; 1-yr); and Telephone Montreal Cognitive Assessment (tMoCA; 1-yr). Analyses examined whether social constraints predicted 1-yr loneliness and functional and cognitive disability controlling for demographics, acute NIHSS score, and acute stress. Standardized betas are reported as effect sizes. Results: The 763 enrollees had age 63.1±14.9 yrs; acute NIHSS score 4 [2-9]; 41.2% Female; 69.4% White. Controlling for age, gender, acute NIHSS score, and acute stress, higher 90-d social constraints were associated with higher 1-yr loneliness (β =.27, p<.001) and were as strong a predictor of poorer 1-yr mRS scores (β=.21, p<.001) as was acute NIHSS score (β=.19, p<.001). Social constraints also predicted poorer 1-yr tMoCA scores (β=-.18, p<.001). Conclusions: Expressing one’s thoughts/feelings following a stroke may be important to achieving good post-stroke outcomes, as experiencing more social constraints on sharing them predicted greater loneliness, poorer functional ability, and poorer cognitive ability 1-yr post-stroke. Early assessment of social constraints may help identify patients who would benefit from interventions that create safe and open dialogue about survivors’ concerns. Helping their caregivers understand how to avoid constraining survivors’ sharing may also facilitate long-term recovery post-stroke.