Partners, adult children of stroke survivors at higher risk for mental health conditions

Key takeaways:

• The study included more than 1.9 million Danish partners or adult children of stroke survivors.
• Risk for depression in partners of stroke survivors was greater after severe or moderate stroke.

The risk for mental health conditions and self-harm or suicide was higher among partners and adult offspring of stroke survivors vs. the general population and family of myocardial infarction survivors, according to a study in Denmark.

“Family members of stroke survivors may assume essential roles in the stroke recovery progress, often acting as informal caregivers,” Nils Skajaa, PhD, MSc, from the department of clinical epidemiology at Aarhus University, and colleagues wrote in JAMA Network Open. “Caring for loved ones after illness can be grueling and may lead to chronic stress, fatigue, social isolation and deleterious behavioral changes.”

Seeking to investigate whether partners and adult children of stroke survivors are at increased risk for depression, substance use disorders, anxiety disorders and self-harm or suicide, researchers conducted a population-based cohort study using data from Danish nationwide administrative and clinical registries. They compared these family members with partners or children of survivors of myocardial infarction and matched individuals from the general population.

After identifying patients hospitalized with stroke from May 2004 to December 2021, researchers included 1,923,732 individuals in their cohort: 70,917 partners of stroke survivors (median age, 68 years; 65% women), 70,664 partners myocardial infarction (MI) survivors (median age, 65 years; 73% women), 354,570 partners from the general population (median age, 68 years; 65% women), 207,386 adult children of stroke survivors (median age, 45 years; 48% women), 183,309 adult children of MI survivors (median age, 42 years; 48% women) and 1,036,886 adult children from the general population (median age, 45 years; 48% women).

Researchers used the Aalen-Johansen estimator to determine propensity score-weighted 3-year absolute risks, risk differences and RRs for psychiatric conditions among the cohorts.

According to results, the 3-year absolute risk among partners of stroke survivors was 1% for depression, 0.7% for substance use disorders, 0.3% for anxiety disorders and 0.04% for self-harm or suicide. Researchers reported that the risk for depression among partners was greater after severe or moderate stroke vs. mild stroke.

Among adult children of stroke survivors, the 3-year absolute risk was 0.6% for depression, 0.6% for substance use disorders, 0.2% for anxiety disorders and 0.05% for self-harm or suicide. Compared with offspring from the general population cohort, RRs for children of stroke survivors were 1.07 (95% CI, 0.99-1.14) for depression, 1.11 (95% CI, 1.05-1.19) for substance use disorders, 1.1 (95% CI, 0.97-1.25) for anxiety and 1.42 (95% CI, 1.11-1.84) for self-harm or suicide. The RR for self-harm or suicide was 1.28 (95% CI, 0.91-1.77) compared with the cohort of MI offspring.

The absolute risks and RRs for adult children of stroke survivors were smaller than those reported in the partner analyses.

“Although Denmark has a strong welfare and health care system where stroke is well managed and stroke severity is relatively mild, no support system exists specifically for family members of stroke survivors,” Skajaa and colleagues wrote, “and the high relative risks for self-harm or suicide found in this study for both partners and adult children are concerning.”