Disease-related Stigma After Hemorrhagic Stroke is Related to Functional Outcome and Female Sex
Alyssa Pullano1, Kara Melmed2, Aaron Lord2, Anlys Olivera3, Jennifer Frontera2, Koto Ishida1, Jose Torres1, Benjamin Brush2, Cen Zhang1, Leah Dickstein2, David Kahn2, Ting Zhou2, Ariane Lewis2
1Department of Neurology, 2Department of Neurology & Department of Neurosurgery, 3Department of Neurology & Department of Psychiatry, NYU Langone Medical Center
Objective:

The objective of this study was to determine factors associated with disease-related stigma after hemorrhagic stroke.

Background:

Stroke survivors may experience disease-related stigma. This can impede physical and social recovery. Improved understanding of disease-related stigma after hemorrhagic stroke may allow for interventions to reduce stigma and promote positive self-perception to ultimately improve care.

Design/Methods:
Patients with non-traumatic intracerebral or subarachnoid hemorrhage (ICH or SAH) admitted between January 2015 and February 2021 were assessed by telephone 3-months after discharge using the Quality of Life in Neurological Disorders (Neuro-QoL) inventory and modified Rankin Scale (mRS). We evaluated the relationship between disease-related stigma (Neuro-QoL Negative Disease-Related Stigma Short Form T-score > 50) and pre-stroke demographics, admission data, and poor functional outcome (3-month mRS score 3-5).
Results:

We included 89 patients in this study (56 ICH and 33 SAH). The median age was 63 (IQR 50-69), 43% were women, and 58% graduated from college. Admission median GCS score was 15 (IQR 13-15) and APACHE II score was 12 (IQR 9-17). 64% of patients had poor functional outcome and 31% had disease-related stigma. On univariate analysis, disease-related stigma was associated with female sex, college graduation, GCS score on admission, APACHE II score on admission, and 3-month mRS score (all p<0.05). On multivariate analysis, disease-related stigma was associated with female sex (OR = 3.75, 95% CI = 1.21-11.58, p = 0.02) and 3-month mRS score 3-5 (OR = 4.23, 95% CI = 1.21-14.75, p = 0.02).

Conclusions:

Poor functional outcome and female sex are associated with disease-related stigma 3-months after hemorrhagic stroke. Because disease-related stigma may negatively affect recovery, there is a need to improve understanding of the relationship between these factors and identify ways to prevent and address stigma.

10.1212/WNL.0000000000206342