A study in persons later after stroke of the relationships between social participation, environmental factors and depression

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To explore the impacts of social participation and the environment on depression among people with stroke.


Cross-sectional survey.


Structured interviews in the participants’ homes.


Community-dwelling persons with stroke in the rural areas of China (N = 639).


Not applicable.

Main measures:

Depression (Hamilton Rating Scale for Depression-6), activity and social participation (Chinese version of the World Health Organization’s Disability Assessment Schedule 2.0), environmental barriers (Craig Hospital Inventory of Environmental Factors), neurological function (Canadian Neurological Scale).


A total of 42% of the variance in depression was explained by the environmental barriers, neurological function, activity, and social participation factors studied. Social participation, services/assistance, and attitudes/support were directly related to depression; their standardized regression coefficients were 0.530, 0.162, and 0.092, respectively (p ≤ 0.01). The physical environment, policies, and neurological function indirectly impacted depression. Depression influences social participation in turn, with a standardized regression coefficient of 0.29 (p ≤ 0.01).


Depression and social participation are inversely related. The physical environment, services/assistance, attitudes/support, and policies all impact post-stroke depression.

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