Abstract
Background: Stroke is the second-leading cause of death and a major cause of serious long-term disability worldwide. Approximately 15 million people who suffer a stroke each year are at risk of developing depression. Post-stroke depressive symptoms (PSDS) affect one-third of stroke survivors. The prevalence of PSDS ranges from 17%–63.3% in Saudi stroke survivors. Depression after stroke is underestimated and underdiagnosed in the Saudi population. Stroke survivors use social support as a coping mechanism and as a protective factor against the adverse effects of stroke outcomes. Although social support and PSDS studies separately applied both quantitative and qualitative research methodologies, a gap in the literature exists for incorporating the voices of stroke survivors to describe the meaning behind social support and depressive behaviors. Aims: The purpose of this study was to describe the nature of PSDS and to compare the influence of perceived and received social support among stroke survivors in Saudi Arabia. The quantitative aim was to examine the influence of perceived social support, including emotional and informational, tangible, affectionate, and positive social interaction on PSDS among stroke survivors in Saudi Arabia. The qualitative aim was to explore the nature of PSDS and received social support as experienced by stroke survivors. The integrated aim was to characterize the contribution of perceived social support and received social support and PSDS in stroke survivors. Design: A convergent-embedded mixed methods design (QUAN + qual) was used in this study. The sample (n = 135) was recruited for the quantitative purpose from outpatient clinics and inpatient rehabilitation facilities in Saudi Arabia; a portion of participants (n = 34) was selected from the original sample for qualitative purposes. Inclusion was based on age (≥18 years old), stroke diagnosis or recurrence within one year, and ability to comprehend and communicate in Arabic. The data were gathered using a sociodemographic questionnaire, a set of structured instruments on PSDS, perceived social support, perceived stress level, functional independence measure (FIM), and in-depth interviews. Results: The major findings of this study were the following: (a) half of the sample (54%) had depressive symptoms (DS); (b) DS were negatively associated with perceived social support (r = -.65, p < .001) and the FIM (r = -.45, p < .001), whereas perceived stress was positively associated (r = .71, p < .001); (c) social support, stress level, and literacy were associated with DS (β = -.31, p < .001; β = .45, p < .001; β = .16, p = .01, respectively) and partially mediate the association of DS with functional independence; (d) there is a typology of experiencing DS and receiving social support, Satisfied and Deprived, and those with DS and social support, Discrepancies; (e) individuals who experienced discrepancies in DS and social support perceived social support as highly available, even though they received inadequate social support; and (f) two types of individuals emerged within the Discrepancy category: individuals who were Socially isolated and individuals who were Socially involved. Conclusion: The results of this mixed methods study show that a lack of social support was associated with DS. The integration of quantitative and qualitative data provided a broad, in-depth perspective on the nature of DS and social support influenced by individual’s life changes after stroke by characterizing the contribution of perceived social support, received social support, and DS, which led to the explanation of a DS typology. Future research is needed to examine the interventions to improve social support among caregivers and to reduce DS in stroke survivors.