Post-stroke depression keeps nearly as many patients from returning to work as physical disability, George Institute researchers have reported in Stroke: Journal of the American Heart Association.

In an Australian/New Zealand collaborative study that followed 210 men and women who had paying jobs in the month before their stroke, 55 per cent returned to work within six months.

"It can be quite heartening to families and clinicians that more than half of stroke patients go back to work," said lead author Dr Nick Glozier of The George Institute. "But physicians should continually assess patients’ mood after stroke, because it’s an important predictor of whether patients will go back to work."

Stroke is often considered a disease related to ageing and measured in terms of fatality and dependency, but the social impact is often overlooked. In high-income nations, about 20 per cent of strokes occur in people young enough to still be in the workforce, according to the study.

"A striking number of people have strokes when they are of working age, and returning to employment is vital to their well-being and role in society. Since younger adults have responsibilities for generating an income and supporting family members, return to work is a key goal in recovery," he said.

Researchers used data from the third Auckland Regional Community Stroke (ARCOS) study examining the outcomes of people who were alive at least six months after a first stroke in 2002-2003.

The other strong predictor of not returning to work was physical disability. A week following their strokes, patients were assessed with the Barthel scale, which rates the ability to independently perform basic self-care and daily living activities. Of those working at six months, 71 per cent had been rated as "independent" on the Barthel index. In contrast, of those who did not return to work, only 32 per cent had been rated physically "independent."

"If someone is functioning pretty well after a stroke, ask about vocational rehabilitation. Stroke guidelines from various countries identify vocational rehabilitation as a priority research area, but they don’t have the research evidence to make firm recommendations, so this aspect of post stroke care can be hit and miss," Glozier said.

A month after the patients had a stroke, nurses asked the patients about their psychological symptoms using the General Health Questionnaire, a tool widely used to screen for post-stroke depression and psychological distress. Of those working six months after stroke, 43 per cent had post-stroke depression, compared with 64 per cent of those who were not working.

Patients were more likely to have post-stroke depression if they were younger, had a more severe stroke, or had previously been treated for depression, according to the study.

"There is some evidence that antidepressants work in post-stroke depression, and there are indications that we may be able to prevent depression with psychological intervention, such as cognitive behavioral therapy-style motivational interviewing," Glozier said.

In the study, only 30 per cent of people with post-stroke depression had received any treatment six months after their stroke. Patients were also less likely to return to work if they worked only part-time prior to the stroke, and were of non-European ancestry, according to the study.

"If family members pick up on someone being depressed after a stroke, ask the physician to assess them and intervene if necessary," Glozier said. "Post-stroke depression can be successfully treated, and treatment can help the patients, their families and society."

Glozier said future studies should assess both unpaid and paid work and the specific requirements of different types of work.