The influence of psychiatric morbidity on return to paid work after stroke in younger adults: the Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003.
OBJECTIVE
Few data exist on the determinants of return to paid work after stroke, yet participation in employment is vital to a person's mental well-being and role in society. This study aimed to determine the frequency and determinants of return to work, in particular the effect of early psychiatric morbidity, in a population-based study of stroke survivors.


METHODS
The third Auckland Regional Community Stroke (ARCOS) study was a prospective, population-based, stroke incidence study undertaken in Auckland, New Zealand during 2002 to 2003. After a baseline assessment early after stroke, data were collected on all survivors at 1 and 6 months follow-up. Multiple variable logistic regression was used to determine predictors of return to paid work. Data are reported with odds ratios (OR) and 95% confidence intervals (CI).


RESULTS
Among 1423 patients registered with first-ever strokes, there were 210 previously in paid employment who survived to 6 months, of whom 155 (74%) completed the GHQ-28 and 112 (53%) had returned to paid work. Among those cognitively competent, psychiatric morbidity at 28 days was a strong independent predictor of not returning to work (Odds Ratio 0.39; 95% CI 0.22 to 0.80). Non-New Zealand European ethnicity (OR 0.40; 95% CI 0.17 to 0.91), prior part-time, as opposed to full-time, employment 0.36 (0.15 to 0.89), and not being functionally independent soon after the stroke 0.28 (0.13 to 0.59) were the other independent age- and gender-adjusted predictors of not successfully returning to paid work.


CONCLUSIONS
About half of previously employed people return to paid employment after stroke, with psychiatric morbidity and physical disability being independent, yet potentially treatable, determinants of this outcome. Appropriate management of both emotional and physical sequelae would appear necessary for optimizing recovery and return to work in younger adults after stroke.
Glozier
Nick
N
The George Institute for International Health, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia. nglozier@george.org.au
Hackett
Maree L
ML
Parag
Varsha
V
Anderson
Craig S
CS
D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D004185:Disability Evaluation; D004651:Employment / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D011613:Psychotherapy / Q000592:standards; D012050:Rehabilitation, Vocational; D018582:Sick Leave / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology / Q000523:psychology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome