Social Constraints on Emotional Expression Linked to Poorer Stroke Recovery Outcomes

Stroke survivors who felt constrained in sharing their thoughts and feelings about their condition and future experienced slower physical and cognitive recovery, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2026. The study found that difficulty sharing feelings with family or friends was as significant as stroke severity in predicting disability and poor physical function one year later.

Researchers analyzed data from more than 700 participants in the STRONG (Stroke, sTress, RehabilitatiON, and Genetics) study conducted at 28 U.S. sites. At three months post-stroke, participants answered questions about social constraints, specifically whether they felt their primary support person didn't want to hear about their feelings or whether they had to keep feelings to themselves to avoid making others uncomfortable. One year after the stroke, those reporting higher social constraints at three months experienced greater loneliness, more difficulty with daily activities like feeding and bathing, and more problems with thinking skills including memory, attention, and language.

"The level of social constraint after 90 days was just as effective at predicting overall disability and physical function one year later as the initial severity of the stroke," said lead study author E. Alison Holman, Ph.D., a professor of nursing at the University of California Irvine. For stroke-focused health care professionals, stroke severity has traditionally been the primary indicator of recovery prognosis. The findings suggest that assessing patients' social environments early after stroke could provide valuable insights into potential recovery challenges.

American Stroke Association volunteer expert Amytis Towfighi, M.D., FAHA, noted that while social support is increasingly recognized as beneficial after stroke, less is known about how social constraints affect recovery. "This study is one of the first to assess their influence on long-term psychological, cognitive and functional outcomes," said Towfighi, who is also a professor of neurology at the Keck School of Medicine of USC. "The findings offer valuable insights that can inform interventions to improve post-stroke recovery."

The study included 763 participants with an average age of 63 years who had experienced mild to moderate strokes. Researchers assessed participants during initial hospitalization and at 3-, 6-, and 12-months post-stroke. Physical and cognitive function were measured using the modified Rankin Scale and Montreal Cognitive Assessment, while loneliness was assessed using items from the UCLA Loneliness Scale. After controlling for age, gender, race, stroke severity, and post-stroke stress, researchers found significant associations between social constraints at three months and poorer outcomes at one year.

Holman encourages caregivers to "make room, a safe space, for people to talk about their stroke, let them talk about their feelings and what they're going through so they can process what has happened." However, she cautions against forcing emotional expression, noting that not everyone needs to verbalize their emotions. The key is providing a safe place for sharing when needed. Researchers noted that if these results are confirmed in future studies, interventions could be designed to help stroke survivors face fewer social challenges during recovery.

Patient perspective illustrates the importance of these findings. Dipika Aggarwal, a neurologist who experienced a stroke at age 38, described how isolation during her recovery led to severe depression. "Sharing my story helped me heal. It gave me hope to hear from others and feel less alone," said Aggarwal, who now volunteers for the American Stroke Association. "The social, financial and psychological aspects of recovery are huge, and we don't talk about them enough." The research abstract will be presented at the International Stroke Conference in New Orleans, Feb. 4-6, 2026, and findings are considered preliminary until published in a peer-reviewed journal. More information about stroke recovery is available through resources like the American Stroke Association.