Stroke survivors who feel uncomfortable discussing their thoughts and feelings about their condition and future face 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 close friends or family was as significant as stroke severity in predicting disability and poor physical function one year post-stroke.
Researchers analyzed data from 763 participants in the STRONG (Stroke, sTress, RehabilitatiON, and Genetics) study, conducted at 28 U.S. sites between 2016 and 2021. At three months post-stroke, participants answered questions about social constraints, including 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.
"When stroke survivors feel uncomfortable sharing their thoughts/feelings because they think talking about it will make others uncomfortable or that others won't want to hear their concerns, these constraints on sharing can be harmful for their health," said lead study author E. Alison Holman, Ph.D., a professor of nursing at the University of California Irvine.
One year after their stroke, participants who reported greater social constraints at three months experienced several challenges: they felt lonelier, had more difficulty with everyday activities like feeding or bathing, and experienced greater problems with thinking skills including memory, attention and language. The level of social constraint was just as effective at predicting overall disability and physical function one year later as the initial severity of the stroke.
"For many stroke-focused health care professionals, the severity of the stroke is the gold standard for understanding how well or poorly a person will be doing down the road," Holman said. She encouraged stroke researchers to inquire about patients' social environments early after stroke to understand potential influences on recovery.
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 suggest that supporting caregivers, family and health care professionals to provide safe spaces for stroke survivors to share feelings may enhance recovery. 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."
Patient perspective illustrates the importance of social support. Dipika Aggarwal, a neurologist who experienced a stroke at age 38, said, "Sharing my story helped me heal. It gave me hope to hear from others and feel less alone." Aggarwal, who now volunteers for the American Stroke Association, advises other survivors: "Don't keep things hush-hush. Seek support, allow yourself to be vulnerable and connect with people who understand what you're going through."
The study's implications are significant given stroke's impact on public health. According to the American Heart Association's 2026 Heart Disease and Stroke Statistics, stroke is now the fourth leading cause of death in the U.S. More information about stroke recovery is available at https://www.stroke.org. The researchers noted that if these results are confirmed in future studies, interventions could be designed to help stroke survivors face fewer social challenges.
