Environmental, Cognitive, and Neurological Predictors of Mental Health Following Pediatric Stroke: A Mixed Methods Framework

The current project explored mental health outcomes in pediatric stroke and the personal and environmental factors that can influence psychological risk or resilience. The investigation was approached from quantitative (Study 1) and qualitative (Study 2) paradigms in order to attain both breadth and depth of understanding. Study 1: Thirty-one children between the ages of 8-18 years with a history of ischemic stroke and 34 demographically-equivalent controls participated. Information on participants’ psychosocial functioning was collected via standardized questionnaires. Children also underwent performance-based testing of cognitive abilities. Medical record review provided information on stroke patients’ neurological, diagnostic/clinical, and brain injury characteristics. All parents completed inventories of parent mental health and family functioning. Statistical comparisons revealed that the stroke group was significantly more likely to have physical disability, learning disability, poorer executive functioning, and emotion regulation concerns. Clinically elevated anxiety symptoms were present in 45.2% of stroke participants. In the stroke group, linear regression models revealed that higher internalizing symptoms were predicted by poorer executive functioning, learning and language problems, reduced fine-motor speed, bullying, reduced social support, perinatal/neonatal stroke, and greater time since stroke. Parent mental health was the strongest environmental predictor of childhood behaviour. Results highlight internalizing symptomatology risk in pediatric stroke and the converging roles of neurological, cognitive, and social factors in determining psychological outcomes. Study 2: Individual interviews were conducted with 14 children with stroke history, and aimed to capture the lived experience of pediatric stroke survivors. Interviews were audio recorded, transcribed verbatim, and qualitatively analyzed using reflexive Thematic Analysis methodology. Coding, theme generation, and data visualization were completed using NVivo12 software. Prominent psychosocial themes encompassed social anxiety, test anxiety, hiding sadness, trouble with thinking, missing out, bullying, and isolation. Insight into adaptive coping mechanisms and personal values was present, as was emphasis on the importance of supportive peers and family. Taken together, findings across studies illustrate the profound impact that pediatric stroke can have on children’s psychosocial functioning, cognition, personal identity, and self-efficacy. Focus should be given to the coordination of services to meet multiple, complex needs in pediatric stroke patients at heightened risk for poor mental health outcomes.