Each year in the UK 80,000 people survive their first stroke. Many of these people will suffer
psychosocial difficulties including depression, anxiety and social maladjustment. Such
problems are often not identified or treated effectively. It would therefore be useful to
establish their nature and frequency, to identify those patients at particular risk and to develop
We attempted to address these issues in the context of a randomised controlled trial of a
Stroke Family Care Worker (SFCW), an intervention we hoped would reduce psychosocial
We assessed a consecutive series of stroke patients who were referred to a teaching hospital
within one month of stroke. Having collected detailed baseline data, patients were then
randomised either to receive care from, or avoid contact with. the SFCW. Six months after
onset we assessed, blind to treatment allocation, patients' psychosocial and physical outcomes
using standardised measures. These included, the Oxford Handicap Scale, the Barthel Index.
the Frenchav Activities Index, the General Health Questionnaire -30 item, the Social
Adjustment Scale. the Recovery Locus of Control Scale, the Medical Coping Modes
Questionnaire. the Mental Adjustment to Stroke Scale, the Hospital Anxiety and Depression
Scale, the Patient Satisfaction Scale, and a service and equipment use questionnaire.
In this thesis I describe the psychosocial outcome of 417 patients six months after stroke, and
address some of the issues involved in measuring these aspects of outcome. I go on to
examine independent factors which may be related to poor outcomes to increase our
understanding of their aetiology and to identify those at greatest risk. Finally I compare the
outcomes of patients treated by our SFCW and those who were not to establish the
effectiveness of this intervention in alleviating psychosocial problems.