This Article Full Text Full Text (PDF) All Versions of this Article: 39/5/1526    most recent STROKEAHA.107.503219v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Glozier, N. PubMed PubMed Citation Articles by Glozier, N. Pubmed/NCBI databases Medline Plus Health Information Mental Health Stroke Related Collections Health policy and outcome research Behavioral/psychosocial - stroke Rehabilitation, Stroke

(Stroke. 2008;39:1526.)
© 2008 American Heart Association, Inc.

Original Contributions

The Influence of Psychiatric Morbidity on Return to Paid Work After Stroke in Younger Adults

The Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003

Nick Glozier, PhD; Maree L. Hackett, PhD; Varsha Parag, PhD; Craig S. Anderson, PhD for the Auckland Regional Community Stroke (ARCOS) Study Group

From the George Institute for International Health (N.G., M.L.H., C.S.A.), The University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; the Clinical Trials Research Unit (M.L.H., V.P., C.S.A.), School of Population Health, Faculty of Medicine and Health Sciences, The University of Auckland, New Zealand.

Correspondence to Dr Nick Glozier, The George Institute for International Health, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia. E-mail nglozier{at}george.org.au

Background and Purpose— Few data exist on the determinants of return to paid work after stroke, yet participation in employment is vital to a person’s mental well-being and role in society. This study aimed to determine the frequency and determinants of return to work, in particular the effect of early psychiatric morbidity, in a population-based study of stroke survivors.

Methods— The third Auckland Regional Community Stroke (ARCOS) study was a prospective, population-based, stroke incidence study undertaken in Auckland, New Zealand during 2002 to 2003. After a baseline assessment early after stroke, data were collected on all survivors at 1 and 6 months follow-up. Multiple variable logistic regression was used to determine predictors of return to paid work. Data are reported with odds ratios (OR) and 95% confidence intervals (CI).

Results— Among 1423 patients registered with first-ever strokes, there were 210 previously in paid employment who survived to 6 months, of whom 155 (74%) completed the GHQ-28 and 112 (53%) had returned to paid work. Among those cognitively competent, psychiatric morbidity at 28 days was a strong independent predictor of not returning to work (Odds Ratio 0.39; 95% CI 0.22 to 0.80). Non–New Zealand European ethnicity (OR 0.40; 95% CI 0.17 to 0.91), prior part-time, as opposed to full-time, employment 0.36 (0.15 to 0.89), and not being functionally independent soon after the stroke 0.28 (0.13 to 0.59) were the other independent age- and gender-adjusted predictors of not successfully returning to paid work.

Conclusions— About half of previously employed people return to paid employment after stroke, with psychiatric morbidity and physical disability being independent, yet potentially treatable, determinants of this outcome. Appropriate management of both emotional and physical sequelae would appear necessary for optimizing recovery and return to work in younger adults after stroke.

Key Words: stroke • work • employment • psychiatric morbidity • outcome • New Zealand