Stroke can result in substantial changes to people's social networks, says new study

Researchers from City have developed a new framework to explore why people's social networks change following a stroke.

The study, which is published in The Gerontologist, found that following a stroke around one third of participants changed their social network type. The most common change was participants moving from a more diverse network with plentiful contact with both family and friends to a family-based network. Such changes were often due to either disability, or due to feelings of depression/hesitancy about leaving home.

As a result, the authors recommend that stroke services should consider the social impact of stroke, and how best to support those in restricted network types in order to reduce the social isolation and loneliness which can follow.

Stroke is a serious, life-threatening condition. Every year around 110,000 people have a stroke in England and it is the third largest cause of death after heart disease and cancer. It is also the leading cause of adult disability in the UK.

Following a stroke, a person is at risk of losing contact with friends and their wider social network. The social relationships a person has can profoundly impact on mood, life satisfaction, and physical health.

To investigate the change in social networks, the City researchers recruited participants from two acute stroke units and they were followed up after two weeks and six months post stroke. In-depth interviews were also conducted 8 to 15 months following the stroke.

Of the recruited participants, 71 were followed up at six months, and 29 completed in-depth interviews. These 29 participants were then classified into one of the following network types both pre-stroke and post stroke: diverse; friends-based; family-based; restricted-supported (participants had limited social ties, but felt well supported by one or two family members, e.g. a grown up child); restricted-unsupported (these participants had limited social ties with no close family).

In particular, the main shift that took place post-stroke was participants moving out of a diverse network into a family-based one. Yet despite the general trend for friendship loss, the friends-based network type appeared relatively stable: these participants had well-developed friendship circles prior to the stroke, and fewer family resources to turn to. Another trend was that the restricted-unsupported network type, where people had limited social contact, became more populated post stroke, rising from 3 percent pre-stroke to 17% six months post-stroke.

The research found that physical disability, particularly where a person becomes housebound, is an obstacle to maintaining a diverse network. However, other factors also appeared to be important, such as the availability of locally based friends and local supportive groups, as well as the psychological impact of illness and whether a person felt vulnerable and withdrawn.

Dr Sarah Northcott, lead author of the paper and a Research Fellow based at the Division of Language and Communication Science at City, University of London, said:

"Following a stroke a person's social network is vulnerable to change. This can happen due to the physical and psychological impact of having a stroke, as well as the tendency to lose contact with friends rather than family.

"Our research found that it is not only physical disability that causes a person to shift network type, but also the psychological impact of stroke, such as depression, causing a withdrawal from social interaction. It also highlights the important role that friends and family can play in enabling a person to 'live successfully' following stroke.

"By using our social network framework we hope it will enable people to understand how relationships change following stroke, and provide appropriate support to enable people post-stroke to re-engage socially in a way that's right for them, as well as receive the therapy and emotional support they need."