title: A study in persons later after stroke of the relationships between social participation, environmental factors and depression.
abstract: OBJECTIVE
  To explore the impacts of social participation and the environment on depression among people with stroke.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Structured interviews in the participants' homes.
  
  
  METHODS
  Community-dwelling persons with stroke in the rural areas of China ( N = 639).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Depression and social participation are inversely related. The physical environment, services/assistance, attitudes/support, and policies all impact post-stroke depression.
authors.affiliation: 1 School of Nursing, Youjiang Medical College for Nationalities, Baise, China.|2 School of Nursing, Sun Yat-sen University, Guangzhou, China.
authors.forename: Lifang
authors.initials: L
authors.lastname: Zhang
authors.affiliation: 3 Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.|4 Department of Rehabilitation Medicine, Shenzhen Sixth People's Hospital, Shenzhen, China.
authors.forename: Minghong
authors.initials: M
authors.lastname: Sui
authors.affiliation: 3 Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Tiebin
authors.initials: T
authors.lastname: Yan
authors.affiliation: 2 School of Nursing, Sun Yat-sen University, Guangzhou, China.
authors.forename: Liming
authors.initials: L
authors.lastname: You
authors.affiliation: 2 School of Nursing, Sun Yat-sen University, Guangzhou, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Li
authors.affiliation: 2 School of Nursing, Sun Yat-sen University, Guangzhou, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Gao
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D002681:China; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D004779:Environment Design; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D058992:Social Participation / Q000523:psychology*; D012959:Socioeconomic Factors; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation
keywords: China; Stroke; depression; environment; rehabilitation; social participation; structural equation modelling