Research Reveals Pivotal Link Between Stress and Post-Stroke Functioning

By Nicholas Schou

A study led by the University of California, Irvine answers the previously unexplored question of how a person’s lifetime stress and trauma experiences, and their stress responses to the stroke may influence their recovery and functioning after a stroke.

The findings, “Lifetime and acute stress predict functional outcomes following stroke,” were published in the current issue of Stroke.

The STRONG (Stroke, Stress, Rehabilitation, and Genetics) study conducted between 2016 and 2021, involved 763 adults from 28 acute care hospitals in the United States who had recently suffered a radiologically confirmed stroke. Participants were interviewed at multiple time points, including during hospitalization for the stroke, and then at 3 months and 12 months post-stroke.

Key Findings:

*Lifetime Stress and Acute Stress Connection: The study discovered that individuals who had experienced higher levels of lifetime stress were more likely to exhibit elevated acute stress responses immediately following a stroke.

*Acute Stress Predicts Long-Term Outcomes: Acute stress experienced in the aftermath of a stroke was, in turn, found to be a significant predictor of long-term functional outcomes, including motor and cognitive impairment, as well as disability at both the 3-month and 12-month post-stroke intervals.

*Comparing Stress to Stroke Severity: Surprisingly, the research demonstrated that acute stress response was as strong a predictor of long-term functioning as the severity of the stroke itself. Acute stress even surpassed stroke severity in its predictive power for cognitive impairment.

“This study shows that lifetime trauma exposures in people who had a stroke may make them more vulnerable to problems recovering their ability to function in life: how well they can feed themselves, clothe themselves, move their bodies,” said E. Alison Holman, corresponding author and professor at the UCI Sue & Bill Gross School of Nursing. “We looked at patients’ prior trauma history and re-interviewed them a year following the stroke and saw that people who had more stressful/traumatic life experiences tend to have a stronger early reaction to the stroke.”

In addition to establishing this link between pre-stroke stress/trauma and long-term stroke recovery, the study also improves the understanding of early predictors of long-term patient recovery. “Traditionally, stroke severity has been the gold standard for predicting patient outcomes,” explained Holman. “We found that lifetime trauma exposure predicted patients’ early stress symptoms right after the stroke, and that this early post-stroke stress was as strong a contributor to long term recovery as the severity of the stroke itself. “

According to Holman, the study suggests that the stress experienced in the aftermath of the stroke, i.e., the patient’s ‘acute stress response,’ is as important to consider as the severity of the stroke itself in determining long-term outcomes. “Having a stroke is incredibly stressful,” said Holman. “That early stress response is something we can now think about as a target for interventions – a time to support patients emotionally to prevent downstream disability.”

While further study is needed to measure how immediate care in the wake of a stroke can impact long term recovery outcomes, Holman said the study offers an opportunity for additional investigation and opens the door to new possibilities in post-stroke care. “Our study reveals a unique opportunity for intervention to prevent long-term problems in stroke survivors,” she said. “Identifying and addressing acute stress in the early stages of recovery may significantly improve outcomes and the quality of life for stroke patients.”
This work was supported by the National Institutes of Health under award number R01 NR015591.