Prevalence of frequent mental distress and associated factors among stroke survivors

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Abstract
Stroke survivors face considerable risk for mental health complications including depression, anxiety, and mental distress. Despite evidence linking mental health to stroke, frequent mental distress (FMD), a broader public health marker of mental health burden, remains underexamined in stroke populations. This study aims to find the prevalence and associated factors of FMD among U.S. stroke survivors. Analysis was expanded to compare FMD with individuals who have a history of myocardial infarction (MI) and healthy adults. We conducted a cross-sectional analysis using Behavioral Risk Factor Surveillance System data from 2016 to 2023. FMD was defined in two different ways, with the standard threshold of ≥14 days of poor mental health in the past 30 days, and an alternative ≥6-day threshold. Weighted prevalence estimates and multivariate logistic regressions examined associations between social and demographic factors and FMD. Comparative analyses assessed differences in FMD between stroke and MI survivors with the healthy adult population as reference. FMD was most prevalent among stroke survivors who were younger adults (18–64) at 32.5%, females at 26.0%, and Hispanics at 28.7%. Geographically, the highest FMD rates occurred in West Virginia (29.0%) and Tennessee (27.6%), concentrated in the Stroke Belt and Appalachian regions. Stroke survivors had significantly greater odds of experiencing FMD than healthy adults in both unadjusted (4.36) and adjusted regression models (1.96). MI survivors also had greater odds of FMD compared to healthy adults (3.02 unadjusted, 1.69 adjusted), but FMD was less likely when compared to stroke survivors. Our findings suggest that FMD is more prevalent in younger adults, females, Hispanic individuals, and those residing in the Stroke belt and Appalachian states. FMD is also more prevalent among stroke survivors compared to individuals with MI or healthy adults. Future research is necessary for targeted mental health interventions in these specific subgroups.

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