Two-thirds of stroke survivors are in complete mental health despite the impact of their stroke, according to a large, nationally representative Canadian study.

This study conducted by researchers at the University of Toronto's Factor-Inwentash Faculty of Social Work sheds new light on factors associated with complete mental health among stroke survivors. Having a confidant and being free of chronic pain were important predictors. In contrast, a history of childhood maltreatment and a lifetime history of mental illness decreased one's likelihood of achieving complete mental health after a stroke.

Professor Esme Fuller-Thomson, lead author of the study and Sandra Rotman Endowed Chair and Director of the Institute for Life Course and Aging at the University of Toronto, said: "It is so heartening to learn that the vast majority of stroke survivors are in optimal mental health, indicating amazing resiliency. Many research studies, including my own earlier publications, have focused on post-stroke depression and suicidal thoughts. This is a paradigm shift to examine stroke survivors who are mentally flourishing.

"Our definition of 'complete mental health' sets a very high bar, requiring that respondents were happy and/or satisfied with their life on an almost daily basis and that they were free of suicidal thoughts, substance dependence, depression and anxiety disorder for the past year."

The study found that stroke survivors with at least one confidant were four times more likely to be in complete mental health in comparison to those who were socially isolated. This suggests targeted interventions for socially isolated and lonely patients may be particularly helpful in optimising well-being after a stroke.

Stroke survivors with chronic and disabling pain had much lower odds of complete mental health. Other research indicates that post-stroke pain is often underdiagnosed and undertreated. These findings highlight the importance of health professionals vigilantly assessing and treating stroke survivors for chronic pain.

"It appears that childhood adversities cast a very long shadow over many, many decades. In this sample of Canadians aged 50 and older, stroke survivors who had a history of childhood physical abuse, sexual abuse or chronic parental domestic violence were only half as likely to be in complete mental health in comparison to those without these childhood traumas." said Fuller-Thomson.

The study published in the Journal of Aging and Health was based upon a nationally representative community sample of 11,157 Canadians aged 50 and older, of whom 300 were stroke survivors. Those living in long term care facilities were not included in the survey, so the study does not include some of the most seriously impaired stroke survivors.