Prevalence of frequent mental distress and associated factors among stroke survivors

Q: What are the key findings of this study?

Stroke survivors had higher odds of frequent mental distress compared to healthy adults, exceeding the odds seen in MI survivors.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Stroke survival and frequent mental distress (n=143370). Intervention: History of stroke vs. Healthy adults without major chronic conditions (and comparison with myocardial infarction survivors). Primary outcome: Frequent mental distress (FMD), defined as ≥14 days of poor mental health in the past 30 days (OR 1.96).

Q: What does this research mean for the field?

Stroke survivors have significantly higher odds of frequent mental distress compared to both healthy adults and myocardial infarction survivors, with elevated prevalence among younger adults, females, Hispanic individuals, and Stroke Belt residents. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hayley Clark; Ajith Kumar Vemuri; Alireza Vafaei Sadr; Vida Abedi; Ramin Zand

doi:10.1371/journal.pone.0361900

November 11, 2026PLoS ONEOpen Access

Prevalence of frequent mental distress and associated factors among stroke survivors

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Key result

Stroke history linked to ~96% higher odds of frequent mental distress vs. healthy adults.

OR 1.96
n=143,370

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Why the study?

Stroke survivors face considerable risk for mental health complications, but frequent mental distress (FMD), a broader public health marker of mental health burden, remained underexamined in stroke populations.

What is the prevalence of frequent mental distress (FMD) and its associated sociodemographic factors among U.S. stroke survivors, and how do the odds of FMD compare with myocardial infarction survivors and healthy adults?

Key Points

To evaluate the prevalence and sociodemographic correlates of frequent mental distress among stroke survivors and compare these rates with myocardial infarction survivors and healthy individuals.
Cross-sectional survey of 143,370 adult stroke survivors from the Behavioral Risk Factor Surveillance System (BRFSS) across all 50 U.S. states and territories from 2016 to 2023.
Frequent mental distress (FMD) was defined primarily as 14 or more days of poor mental health within the past 30 days, with a secondary threshold of 6 or more days.
Weighted prevalence estimates and multivariate logistic regression models adjusting for age, sex, race, body mass index, income, education, and health insurance were evaluated.
Frequent mental distress was significantly higher in stroke survivors aged 18 to 64 years than those aged 65 and older (32.5% vs. 14.6%, p < 0.00001), females (26.0% vs. 20.6%), Hispanic respondents (28.7%), and individuals earning under $15,000 annually (37.1% vs. 12.7% for $200,000 or more).
Compared to healthy adults, stroke survivors had higher odds of experiencing frequent mental distress in unadjusted (odds ratio 4.36) and adjusted models (odds ratio 1.96).
Myocardial infarction survivors also experienced increased odds of frequent mental distress compared to healthy adults (unadjusted odds ratio 3.02, adjusted odds ratio 1.69), but were less likely to report distress than stroke survivors.

Study Design

Type

Cross-Sectional (n=143,370)

Multicenter

Yes

Structured PICO

What is the prevalence of frequent mental distress (FMD) and its associated sociodemographic factors among U.S. stroke survivors, and how do the odds of FMD compare with myocardial infarction survivors and healthy adults?

P

Population

143,370 adult stroke survivors in the United States (51.8% female, 49.6% aged 18-64 years) surveyed in the 2016-2023 Behavioral Risk Factor Surveillance System.

E

Exposure

History of stroke (and sociodemographic/geographic risk factors including younger age 18–64, female sex, race/ethnicity, income, education, health insurance status, and Stroke Belt/Appalachian residence)

C

Comparator

Healthy adult population excluding respondents with stroke, MI, coronary heart disease, angina, asthma, cancer, COPD, arthritis, major depression, kidney disease, and diabetes; secondary comparison with MI survivors

O

Outcome

Prevalence and odds of frequent mental distress (FMD), defined as self-reported ≥14 days of poor mental health (stress, depression, and problems with emotions) during the past 30 dayspatient reported

Main Result

Odds Ratio: 1.96

Stroke survivors experience nearly double the adjusted odds of frequent mental distress compared to healthy adults and a higher burden than myocardial infarction survivors, particularly among younger, female, low-income, uninsured, and Stroke Belt/Appalachian residents.

Limitations

BRFSS excludes institutionalized stroke survivors.
Stroke history and mental health symptoms were self-reported, which may lead to underreporting among older adults or those with severe disabilities.
Single-item non-diagnostic FMD measure cannot capture specific psychiatric disorders, symptom severity, or suicidality.
Lack of clinical detail in BRFSS prevented isolating very old stroke patients (≥85 years) or evaluating sleep quality and cognitive impairment.
No data on use and adherence to antidepressant medications.
BRFSS does not include data on institutionalized stroke survivors
Self-reported stroke history and mental health symptoms may lead to underreporting, particularly among those with cognitive impairments, aphasia, or stigma
FMD is a non-diagnostic single-item measure that cannot capture specific disorders, symptom severity, or suicidality
Lack of clinical detail in BRFSS prevented evaluating very old stroke patients (≥85 years), cognitive impairment, or sleep quality/obstructive sleep apnea
BRFSS lacks data on respondents' use and adherence to antidepressant medications

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May warrant enhanced mental health monitoring after stroke; extends prior associations via direct MI comparison in national data.

Abstract

Stroke survivors face considerable risk for mental health complications including depression, anxiety, and mental distress. Despite evidence linking mental health to stroke, frequent mental distress (FMD), a broader public health marker of mental health burden, remains underexamined in stroke populations. This study aims to find the prevalence and associated factors of FMD among U.S. stroke survivors. Analysis was expanded to compare FMD with individuals who have a history of myocardial infarction (MI) and healthy adults. We conducted a cross-sectional analysis using Behavioral Risk Factor Surveillance System data from 2016 to 2023. FMD was defined in two different ways, with the standard threshold of ≥14 days of poor mental health in the past 30 days, and an alternative ≥6-day threshold. Weighted prevalence estimates and multivariate logistic regressions examined associations between social and demographic factors and FMD. Comparative analyses assessed differences in FMD between stroke and MI survivors with the healthy adult population as reference. FMD was most prevalent among stroke survivors who were younger adults (18–64) at 32.5%, females at 26.0%, and Hispanics at 28.7%. Geographically, the highest FMD rates occurred in West Virginia (29.0%) and Tennessee (27.6%), concentrated in the Stroke Belt and Appalachian regions. Stroke survivors had significantly greater odds of experiencing FMD than healthy adults in both unadjusted (4.36) and adjusted regression models (1.96). MI survivors also had greater odds of FMD compared to healthy adults (3.02 unadjusted, 1.69 adjusted), but FMD was less likely when compared to stroke survivors. Our findings suggest that FMD is more prevalent in younger adults, females, Hispanic individuals, and those residing in the Stroke belt and Appalachian states. FMD is also more prevalent among stroke survivors compared to individuals with MI or healthy adults. Future research is necessary for targeted mental health interventions in these specific subgroups.

Discussion

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Cite This Study

Clark et al. (2026) conducted a cross-sectional in Stroke survival and frequent mental distress (n=143,370). History of stroke vs. Healthy adults without major chronic conditions (and comparison with myocardial infarction survivors) was evaluated on Frequent mental distress (FMD), defined as ≥14 days of poor mental health in the past 30 days (OR 1.96). Stroke survivors had higher odds of frequent mental distress compared to healthy adults, exceeding the odds seen in MI survivors.

synapsesocial.com/papers/6af5cd26a40bbe8669e89bbc https://doi.org/10.1371/journal.pone.0361900

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Prevalence of frequent mental distress and associated factors among stroke survivors

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prevalence of frequent mental distress and associated factors among stroke survivors

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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