Psychological distress among stroke survivors in the US: An analysis of the National Health Interview Survey

Chaitali Dagli; Pranali G Patel; Katherine Gonzalez; Mrudula Nair; Nada Al-Antary; Chen Lin; Eric Adjei Boakye

doi:10.1016/j.annepidem.2025.06.019

Psychological distress among stroke survivors in the US: An analysis of the National Health Interview Survey

Ann Epidemiol. 2025 Jun 30:109:8-13. doi: 10.1016/j.annepidem.2025.06.019. Online ahead of print.

Authors

Chaitali Dagli¹, Pranali G Patel¹, Katherine Gonzalez², Mrudula Nair³, Nada Al-Antary³, Chen Lin⁴, Eric Adjei Boakye⁵

Affiliations

¹ Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
² California University of Science and Medicine School of Medicine, Colton, CA, USA.
³ Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
⁴ Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
⁵ Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA; Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA; Henry Ford Health + Michigan State University Health Sciences, Detroit, MI, USA; Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing, MI, USA. Electronic address: eadjei1@hfhs.org.

PMID: 40602697
DOI: 10.1016/j.annepidem.2025.06.019

Abstract

Purpose: We investigated the association between stroke diagnosis and psychological distress among adults in the United States.

Methods: This cross-sectional study utilized data from the 2021 National Health Interview Survey, including adults aged 18 years or older. The exposure variable was self-reported stroke diagnosis (yes/no). Propensity score matching (1:1) was performed to create a cohort of 947 stroke survivors and 947 controls. The outcome variable was psychological distress, assessed using the six-item Kessler Psychological Distress Scale and classified as none/low, moderate, or severe. Weighted multinomial logistic regression models were used to examine the associations between stroke diagnosis and psychological distress.

Results: A total of 1894 respondents were included in the study, 19.3 % and 6.4 % experienced moderate and severe psychological distress, respectively. Respondents who experienced a stroke diagnosis had more than twice the odds of experiencing moderate distress (aOR_moderate=2.16, 95 % CI: 1.59-2.93) and more than three times the odds of severe distress (aOR_severe=3.12, 95 % CI: 1.76-5.49) compared to respondents without stroke diagnosis.

Conclusion: This study addresses an important gap in understanding the emotional and psychological burden among stroke survivors. Future studies should focus on addressing psychological distress in stroke survivors to assess impact on quality of life and outcomes.

Keywords: Emotional distress; National Health Interview Survey; Propensity score matching; Psychological distress; Quality of life; Stroke.