Dyadic adjustment for younger individuals following stroke: A cross-sectional study.

Dyadic Adjustment for Younger Individuals Following Stroke: A Cross-Sectional Study - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Rehabil Psychol . Author manuscript; available in PMC: 2026 Jun 6. Published before final editing as: Rehabil Psychol. 2026 Jun 4:10.1037/rep0000676. doi: 10.1037/rep0000676 Dyadic Adjustment for Younger Individuals Following Stroke: A Cross-Sectional Study Jordan Kwamanakweenda 1 , Masaru Teramoto 1 , Alexandra L Terrill 1, 2 Author information Copyright and License information 1 Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, USA 2 Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA ✉ Corresponding author: Jordan Kwamanakweenda, University of Utah, 85 Medical Drive N, Salt Lake City, UT 84132, u6054790@utah.edu PMC Copyright notice PMCID: PMC13240646  NIHMSID: NIHMS2158675  PMID: 42241052 The publisher's version of this article is available at Rehabil Psychol Abstract Objective: Stroke recovery and associated outcomes have an impact on both persons with stroke and their care partners. The current study examined differences between younger and older couples coping with stroke, as well as focusing on how depression and satisfaction outcomes for one member of the dyad impacted the other. Design: This cross-sectional secondary analysis examines baseline data from a pilot study involving 34 couples coping with stroke, originally part of an 8-week positive psychology intervention designed to foster resilient romantic relationships. Participants completed self-reported ratings of depressive symptoms (Patient Health Questionnaire) and satisfaction with social roles (PROMIS Satisfaction with Social Roles-Short Form 7a v1). Results: Younger persons with stroke were more likely to be unemployed, have children under 18, and report lower education levels, while older participants were more often male and had longer relationships. Significant inverse correlations were found between depressive symptoms (PHQ-9) and satisfaction with social roles (PROMIS-SSR), particularly among younger dyads. Actor–partner interdependence models (APIMs) revealed that younger stroke survivors’ social role satisfaction was inversely related to both their own and their care partners’ depressive symptoms, whereas in older dyads, only care partners’ outcomes showed significant negative associations. Conclusions: This study highlights differences between younger and older couples coping with stroke, revealing that younger dyads exhibit more influence amongst one another as well as worse recovery outcomes. The findings underscore factors that can impact long-term recovery and life participation for both persons with stroke and their care partners. Keywords: Stroke, dyadic coping, depression, satisfaction with social roles, care partners Stroke as a Shared Experience Stroke recovery is a complex, multi-phase process involving medical intervention, rehabilitation, and lifestyle changes to improve quality of life and restore functioning. Like many chronic illnesses, stroke also impacts friends and family of the persons with stroke. Relationship dynamics often shift, with partners and family members assuming caregiving responsibilities and roles. Both the person who experienced the stroke and their support network may face uncertainty regarding recovery, long-term health, and the possibility of another stroke ( Lawrence & Kinn, 2013 ). Among the most difficult challenges for individuals providing care are the cognitive and behavioral changes that can follow injury for a person with stroke ( Quinn et al., 2014 ). Evidence suggests that depression and anxiety among care partners are associated with the burden of providing care and fear of stroke recurrence ( Hu et al., 2018 ). Additionally, depression levels in care partners can increase the likelihood of depression in persons with stroke and vice versa (Epstein-Lubow et al., 2009; Perrin et al., 2008), highlighting the interrelatedness of emotional well-being in close relationships and the importance of attending to both the person with stroke’s and the care partner’s needs. Studies have found both positive and negative impacts on relationships due to stroke ( Bright et al., 2023 ). For example, a study of older couples post-stroke in Germany identified themes such as the partnership taking a backseat to the disease, struggling to adapt to changing tasks and roles, loss of intimacy, and a desire to reestablish balance in the partnership ( Niedling & Hamel, 2023 ). A supportive network of family, friends, and medical providers is a good predictor of positive coping ( McCurley et al., 2019 ). As a result, there is growing interest in examining the relationships between persons with stroke and their care partners rather than focusing solely on individual outcomes. Targeting both members of a couple can improve outcomes, as research on cancer populations has shown interventions focusing on skills training and relationship counseling effectively improve behavioral, physical, interpersonal, and cognitive outcomes for both patients and care partners (Berry et al., 2017). Consequently, stroke is increasingly viewed as a shared experience among couples rather than solely an individual process for the person with stroke. Younger Persons Experience Stroke Differently While stroke has traditionally been viewed as a condition primarily affecting older adults, there has been an increase in younger adults with stroke with 20–44% of stroke occurring in individuals under the age of 65 ( Zhang et al., 2022 ). Many studies have defined young stroke as being anywhere from younger than 50–55 years of age ( Abedi et al., 2023 ; Bukhari et al., 2023 ; Takeshita et al., 2021 ). Compared to older adults, younger persons with stroke are more likely to experience ischemic strokes, with women being disproportionately impacted due to risk factors such as oral contraception use ( Bright et al., 2023 ). While overall younger and older persons with stroke share similar risk factors, younger individuals face unique challenges due to differences in life stage, societal expectations, and responsibilities such as childcare. Long-term changes in functioning can be detrimental, affecting physical, mental, emotional, and social aspects of life for the younger persons with stroke and their care partners ( Palmcrantz et al., 2012 ). These distinct challenges warrant unique considerations and implications for younger persons with stroke. Misconceptions that stroke primarily occurs in older adults contributes to delays in recognizing symptoms among younger individuals in turn leading to slowing down diagnosis and treatment ( Sič et al., 2025 ). Younger persons can often feel marginalized or “cast off” due to their age at which they experienced stroke, which in turn exacerbates emotional distress, mistrust of medical providers, and isolation ( Bright et al., 2023 ). Care has often been limited for young and midlife persons with stroke regardless of time since stroke, and they are more likely to be discharged directly home following acute intervention ( Leahy et al., 2016 ; Martinsen et al., 2015 ). These negative outcomes highlight the continued need for research and intervention developed for younger persons with stroke to learn more about their experience. Emerging trends highlight the multifaceted burden faced by younger persons with stroke. Younger persons with stroke report an altered sense of self ( Kulski et al., 2014 ), higher rates of depression and anxiety compared to those who are older as well as their healthy peers, challenges intertwined with cognitive impairments, more falls, greater disability, and higher mortality rates; all of which hinder recovery ( Maaijwee et al., 2016 ; Perna & Harik, 2020 ; Rutten-Jacobs et al., 2013 ). Many young persons with stroke feel they have aged significantly following injury ( Leahy et al., 2016 ; Zhang et al., 2022 ). Anxiety about additional strokes and the future in general can be a significant source of stress ( Shipley et al., 2018 ; Zhang et al., 2022 ). Younger persons with stroke and their care partners also experience change in social roles that may be different than in those who are older, for example, related to employment and parenting. Collectively, this can contribute to stress within a romantic relationship. Lastly, research suggests differences based on length of time together. Older couples who have been together longer tend to experience greater sense of loss in their partnership leading to a sense of feeling lonely while younger couples who have spent less time together express concern about autonomy in the relationship ( McCarthy & Bauer, 2015 ). A significant challenge in studying young stroke is the absence of a uniform definition of who is considered younger versus older ( Bright et al., 2023 ). This lack of consistency complicates research and clinical approaches to care. Studies have used various age points, as there is no universal cutoff age for younger and older strokes. Objective The current study aims to address a significant gap in our understanding of how younger couples coping with stroke may differ from those who are older, specifically in terms of depression and satisfaction with social roles. These outcomes were selected as they differ across lifespan in the general population with older individuals showing higher satisfaction with social roles and historically lower rates of depression ( Lee et al., 2023 ; Birditt & Fingerman, 2003 ). Additionally, differences in outcomes are also shown with other brain injury. However, previous research has tended to focus on individual outcomes rather than in the context of a dyad. This study is a secondary analysis of baseline data collected prior to participants taking part in a positive psychology-based dyadic intervention ( Terrill et al., 2018 ; 2022 ; 2023 ). Our first aim was to describe basic demographic and stroke characteristic differences between younger and older persons with stroke and their care partners as well as differences in outcome measures (depression and satisfaction with social roles). Consistent with past literature, we hypothesized (Hypothesis 1) that younger dyads would endorse higher levels of depression compared to older dyads, and (Hypothesis 2) that both members of the younger dyad would endorse lower levels of satisfaction with social roles. Our second aim was to use an actor-partner interdependence model (APIM) to examine the relationship between each partner’s satisfaction with social roles and their own depression scores, and how these scores are related to their partner’s depression scores. We hypothesized (Hypothesis 3) that each partner’s satisfaction with social roles score would be negatively associated with their own and their partner’s depression scores. Our third aim was to utilize an actor-partner interdependence model (APIM) to examine the differences between younger and older dyads in the relationship of their scores. For our third aim, we expected (Hypothesis 4) that there would be more pronounced effects in the younger group for the relationship between satisfaction with social roles and depression both for themselves and their partner. This hypothesis is based on previous literature suggesting that being younger at the time of stroke has longer-term implications on psychological functioning based on phase of life. Method Design This cross-sectional study is a secondary analysis of baseline data from a pilot study conducted as part of an 8-week positive psychology-based intervention aimed at decreasing depression and facilitating resilience in romantic, cohabitating partners following stroke ( Terrill et al., 2018 ). Details about the intervention and findings from the pilot trial are reported elsewhere ( Terrill et al., 2018 ; 2022 ; 2023 ). The pilot trial was registered in clinicaltrials.gov ( NCT#04845542 ); however, secondary analysis of the data was not preregistered. We report how we determined our sample size, all data exclusions (if any), all manipulations, and all measures in the study. Participants The target sample size for the pilot study was 24 dyads based on recommendations in the literature to provide proof-of-concept ( van Belle, 2002 ); a total sample size of 34 dyads was planned to account for attrition. Participants were recruited through university-affiliated outpatient neurology and rehabilitation clinics and community events. Participating couples consisted of a person who had a stroke at least three months prior to enrollment and their romantic care partner. Couples needed to be living together in the community for at least six months before enrolling. There was no minimum level of assistance required to be provided by the care partner nor was there a minimum level of functional disability for the person with stroke. However, potential participants were excluded if they could not understand and follow directions printed in English, if they had significant cognitive impairment, or any aphasia (e.g., fluent or severe aphasia) that would negatively impact their ability to participate meaningfully. While individuals with severe cognitive impairment and/or aphasia were excluded, those with mild to moderate cognitive impairments and/or nonfluent aphasia were included to allow for greater generalizability to the stroke population. Cognitive impairment was assessed using the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) or the Cognitive Assessment for Stroke Patients (CASP; Barnay et al., 2014) as appropriate. Procedure All participant dyads completed structured assessments in person at a university-affiliated clinic or community location where confidentiality was protected. Persons with stroke and romantic care partners completed the self-report measures in separate rooms to ensure privacy when answering potentially sensitive questions. A trained research assistant was available in each room to answer any questions. Data was entered and maintained in REDCap (Research Electronic Data Capture tools; Harris et al., 2009), a highly secure, web-based application designed to support data collection, and then analyzed by an investigator who did not conduct any of the assessments. Montreal Cognitive Assessment (MoCA): The MoCA (Nasreddine et al., 2005) is a screening tool for cognitive impairment that assesses various domains, including attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. For this study, the MoCA-BLIND (same tasks as the full MoCA except visual items are removed) was used as participants were screened over the phone. The total possible score for the MoCA-BLIND is 22, with 18 or above considered “normal” (Wittich et al., 2010). Individuals needed to score 14/22 or above to meet eligibility criteria. Cognitive Assessment for Stroke Patients (CASP): The nine-item CASP (Barnay et al., 2014) was administered in-person instead of the MoCA for potential participants with expressive aphasia. The measure assesses cognitive functions across six areas: language, praxis, short-term memory, temporal orientation, spatial/visuo-construction neglect, and executive function. A maximum of 36 points is possible, with 30/36 considered “normal” (C. Benaim, personal communication, October 4, 2018). Individuals needed to score 24/36 or above to meet eligibility criteria. Potential participants were also excluded if their care partner had a history of stroke or other major neurological conditions, or if either partner was not interested in participating. The University of Utah Institutional Review Board approved all study procedures prior to data collection. All participants provided their own written informed consent. For our current study, we classified dyads in the younger group as being younger than 55 and dyads in the older group as 55 and older based on extant literature (both theoretical and data-driven). Dyads were classified as younger or older based on the age of the person with stroke. Measures Assessment measures consisted of gathering demographic and basic medical information. Additionally, self-report questionnaires were completed. The following outcome measures were used in the current analyses: Patient Health Questionnaire (PHQ-9): The PHQ-9 (Kroenke et al., 2001) is a psychometrically sound self-report instrument for depressive symptoms, developed and validated for measuring depression severity. The measure includes nine items prompted by “Over the last 2 weeks, how often have you been bothered by any of the following problems?” Examples include “Little interest or pleasure in doing things” and “Feeling down, depressed, or hopeless.” Questions are rated on a 4-point scale from 0 (not at all) to 3 (nearly every day). Scores range from 0 to 27, with higher scores indicating more severe depressive symptoms. Severity is categorized into five levels: 0–4 (minimal to no symptoms), 5–9 (mild depression), 10–14 (moderate depression), 15–19 (moderately severe depression), and 20–27 (severe depression). Persons with stroke and their care partners completed the PHQ-9 independently. PROMIS Satisfaction with Social Roles-Short Form 7a v1: The Patient-Reported Outcomes Measurement Information System Satisfaction with Social Roles Short-Form 7a v1.0 is a 7-item self-report measure of individuals’ perceptions of their satisfaction with their ability to complete tasks for themselves and others. Questions are rated on a 5-point scale from 1 (not at all) to 5 (very much), with higher scores indicating greater satisfaction. Raw scores are converted to T-scores for interpretation. Participants also have the option to answer, “does not apply” and “prefer not to answer.” Example questions include “I am satisfied with my ability to do things for my family” and “I am satisfied with my ability to perform my daily routine.” Persons with stroke and their care partners completed the PROMIS measure independently. Analysis Participants, persons with stroke and their care partners, were classified by age group (dichotomous variable with < 55 years of age or ≥ 55 years of age). Specifically, dyad age group (< 55 years of age or ≥ 55 years of age) was defined based on the stroke patient’s age. First, an association of age group between persons with stroke and care partners was examined using Fisher’s exact test ( Fisher, 1935 ). Descriptive statistics were then calculated for the demographics and clinical characteristics, as well as the outcome measures, of the participants, including PHQ-9 and PROMIS-SSR scores. These variables were compared by dyad age group using Fisher’s exacts (for categorical variables) and Wilcoxon-Mann-Whitney rank-sum tests (for continuous variables) ( Mann & Whitney, 1947 ; Wilcoxon, 1945 ). Pearson’s correlation coefficients (r) were computed across PHQ-9 and PROMIS-SSR scores of the participants. Lastly, associations between PHQ-9 scores and PROMIS-SSR scores of the participants were examined through dyadic data analysis, using the actor-partner interdependence model (APIM) in the framework of structural equation modeling ( Acock, 2013 ; Gistelinck & Loeys, 2019; Kenny et al., 2020 ; Ledermann & Kenny, 2017 ). Standardized beta coefficients ( β ) and standard errors (SE) were calculated to aid in interpretations, using bootstrapping with 1,000 resamples for robust inferences ( Efron, 1979 ; Efron & Tibshirani, 1993; Mooney & Duval, 1993 ). β values, necessary to compute here to account for different units of measurement in PHQ and SSR ( Davvetas et al., 2020 ), can serve as effect sizes for structural equation modeling ( Armey et al., 2009 ; Flora et al., 2025 ), and therefore were interpreted in our APIMs as follows: 0.10–0.29 = small effect, 0.30–0.49 = medium effect, and ≥ 0.50 = large effect ( Cohen, 1988 ; Kline, 1998 ). All the analyses were performed using Stata/MP 19.0 (StataCorp LLC, College Station, TX), with an α level of 0.05 for statistical significance. Results Demographic Information and Clinical Characteristics for the Sample 34 dyads ( n = 68 persons) completed the study and thus were used in the current analyses. Of those, 16 (47.1%) persons with stroke and 19 (52.9%) care partners were younger than 55 years of age. There was a significant association between age group of persons with stroke and that of care partners ( p = .001). Specifically, 87.5% ( n = 14) of 16 persons with stroke younger than 55 years of age had care partners also younger than 55 years of age. Detailed demographics and clinical characteristics of comparing younger and older participant dyads are shown in Table 1 . Participants included in the current analyses were predominantly White (87.5% and 94.4%, respectively, in two groups). Table 1. Demographic Information for Younger and Older Participant Dyads Dyad age group Younger (< 55 years of age) Older (≥ 55 years of age) Role Variable n = 16 (47.1%) n = 18 (52.9%) p a Person with stroke Sex 0.038 Male 6 (37.5) 14 (77.8) Female 9 (56.2) 4 (22.2) Missing 1 (6.2) 0 (0.0) Ethnicity 0.999 White 14 (87.5) 17 (94.4) Asian 0 (0.0) 1 (5.6) Native Hawaiian or Pacific Islander 0 (0.0) 0 (0.0) Missing 2 (12.5) 0 (0.0) Education 0.039 Some high school 1 (6.2) 0 (0.0) High school degree or equivalent 2 (12.5) 3 (16.7) Some college 6 (37.5) 1 (5.6) College degree (2 year) 1 (6.2) 1 (5.6) College degree (4 year) 4 (25.0) 4 (22.2) Graduate degree (master’s degree or higher) 1 (6.2) 8 (44.4) Missing 1 (6.2) 1 (5.6) Employment < 0.001 Full-time 1 (6.2) 1 (5.6) Part-time 1 (6.2) 1 (5.6) Non-paid work (e.g., homemaker) 5 (31.2) 1 (5.6) Retired 1 (6.2) 13 (72.2) Unemployed 7 (43.8) 2 (11.1) Missing 1 (6.2) 0 (0.0) Retire early 0.524 Yes 2 (12.5) 8 (44.4) No 0 (0.0) 5 (27.8) Missing 14 (87.5) 5 (27.8) Volunteer 0.428 Yes 3 (18.8) 7 (38.9) No 8 (50.0) 8 (44.4) Missing 5 (31.2) 3 (16.7) Marital status 0.199 Yes 2 (12.5) 0 (0.0) No 13 (81.2) 18 (100.0) Missing 1 (6.2) 0 (0.0) Living with children 0.038 Yes 9 (56.2) 4 (22.2) No 6 (37.5) 14 (77.8) Missing 1 (6.2) 0 (0.0) Stroke location 0.591 Right hemisphere 5 (31.2) 6 (33.3) Left hemisphere 7 (43.8) 10 (55.6) Brainstem 4 (25.0) 2 (11.1) Type of stroke 0.564 Ischemic 11 (68.8) 13 (72.2) Hemorrhagic 3 (18.8) 2 (11.1) Unsure 2 (12.5) 0 (0.0) Missing 0 (0.0) 3 (16.7) Antidepressants 0.494 Yes 8 (50.0) 7 (38.9) No 7 (43.8) 11 (61.1) Missing 1 (6.2) 0 (0.0) Age (mean ± SD) 38.8 ± 9.1 65.8 ± 7.5 < 0.001 b Length of relationship (mean ± SD) 13.3 ± 8.7 33.5 ± 18.7 0.002 b Time since stroke (mean ± SD) 2.3 ± 1.9 4.4 ± 6.1 0.338 b Care partner Sex 0.038 Male 9 (56.2) 4 (22.2) Female 6 (37.5) 14 (77.8) Missing 1 (6.2) 0 (0.0) Ethnicity 0.469 White 14 (87.5) 17 (94.4) Asian 0 (0.0) 0 (0.0) Native Hawaiian or Pacific Islander 1 (6.2) 0 (0.0) Missing 1 (6.2) 1 (5.6) Education 0.687 Some high school 0 (0.0) 0 (0.0) High school or equivalent 2 (12.5) 3 (16.7) Some college 7 (43.8) 4 (22.2) College degree (2 year) 0 (0.0) 0 (0.0) College degree (4 year) 4 (25.0) 7 (38.9) Graduate degree (master’s degree or higher) 2 (12.5) 3 (16.7) Missing 1 (6.2) 1 (5.6) Employment 0.170 Full-time 8 (50.0) 6 (33.3) Part-time 3 (18.8) 2 (11.1) Non-paid work (e.g., homemaker) 1 (6.2) 1 (5.6) Retired 2 (12.5) 9 (50.0) Unemployed 1 (6.2) 0 (0.0) Missing 1 (6.2) 0 (0.0) Retire early 0.109 Yes 2 (12.5) 2 (11.1) No 0 (0.0) 7 (38.9) Missing 14 (87.5) 9 (50.0) Volunteer 0.696 Yes 4 (25.0) 7 (38.9) No 8 (50.0) 8 (44.4) Missing 4 (25.0) 3 (16.7) Marital status 0.438 Yes 1 (6.2) 0 (0.0) No 13 (81.2) 18 (100.0) Missing 2 (12.5) 0 (0.0) Living with children 0.014 Yes 9 (56.2) 3 (16.7) No 6 (37.5) 15 (83.3) Missing 1 (6.2) 0 (0.0) Antidepressants 0.413 Yes 2 (12.5) 5 (27.8) No 13 (81.2) 13 (72.2) Missing 1 (6.2) 0 (0.0) Age (mean ± SD) 41.8 ± 10.7 61.7 ± 9.9 < 0.001 b Length of relationship (mean ± SD) 12.0 ± 7.9 35.9 ± 17.1 < 0.001 b Open in a new tab Note: Values are frequency (%), unless specified otherwise. Dyad age group is based on stroke patient’s age. SD = standard deviation; N/A = not applicable. a From Fisher’s exact test (excluding missing/zero frequency data), unless specified otherwise. b From Wilcoxon-Mann-Whitney rank-sum test. Of the persons with stroke, there were several significant differences between the younger and older dyads. First, there were significantly more males with stroke in the older group than in the younger group (77.8% vs. 37.5%; p = .038). There were also significant differences in education with older participants more likely to have a bachelor’s degree or higher level of education ( p = .039). Younger persons with stroke were more likely to be unemployed ( p < .001) and were more likely to have children under the age of 18 living with them ( p = .038). Not surprisingly, persons with stroke aged 55 years or older ( p < .001) were significantly older and had a longer length of relationship ( p = .002). Of the care partners, there were significantly more males in the younger dyads than in the older dyads (56.2% vs. 22.2%; p = .038). Significantly more care partners in the younger group were living with children compared to those in the older group (56.2% vs. 16.7%; p = .014). It was again not surprising that care partners in the older dyads were significantly older ( p < .001) and had a significantly longer length of relationship ( p < .001). Differences in Outcomes Between Younger versus Older Participant Dyads Table 2 summarizes descriptive statistics for PHQ-9 and PROMIS-SSR scores by role and dyad age group. Care partners in the older dyads reported significantly higher satisfaction with social roles than their younger counterparts (56.5 ± 8.5; p = .015). No other outcome variables demonstrated statistically significant differences between younger and older participant dyads ( p > 0.05). Table 2. Outcomes between younger versus older participants Dyad age group Younger (< 55 years of age) Older (≥ 55 years of age) Role Outcome n = 16 (47.1%) n = 18 (52.9%) p a Person with stroke PHQ-9 b 9.8 ± 5.5 (3, 18) 7.1 ± 6.0 (0, 20) 0.171 PROMIS-SSR c 46.4 ± 7.6 (27, 58.2) 45.6 ± 7.9 (32.8, 60.4) 0.479 Care partner PHQ-9 d 6.4 ± 5.3 (0, 19) 4.6 ± 3.7 (0, 11) 0.426 PROMIS-SSR e 49.2 ± 6.6 (41.7, 65.6) 56.5 ± 8.5 (44.4, 65.6) 0.015 Open in a new tab Note: Values are mean ± standard deviation (minimum value, maximum value). Dyad age group is based on stroke patient’s age. PHQ-9 = Patient Health Questionnaire ratings of the person’s depression symptoms. Scores reported were completed by the person with stroke and their care partner. Higher scores indicate more depressive symptoms; PROMIS-SSR = Satisfaction with Social Roles ratings of person’s social role satisfaction converted to t-scores. Scores reported were completed by the person with stroke and their care partner. Higher scores indicate increased satisfaction with social roles. a From Wilcoxon-Mann-Whitney rank-sum test. b 3 missing data points. c 1 missing data point. d 2 missing data points. e 1 missing data point. Correlations in Outcomes by Younger versus Older Participant Dyads Among younger persons with stroke (< 55 years of age), their PHQ-9 scores were significantly and inversely correlated with their own PROMIS-SSR scores ( r = −0.680; p = .005). Further, PHQ-9 scores of care partners were significantly and inversely associated with PROMIS-SSR scores for persons with stroke ( r = −0.623; p = .013), as well as their own PROMIS-SSR scores ( r = −0.537; p = 0.039). For older persons with stroke (≥ 55 years of age), the only significant correlation was between PHQ-9 scores for care partners and their own PROMIS-SSR scores ( r = −0.495; p = 0.044). Actor-Partner Interdependence Models for Outcomes by Younger versus Older Participant Dyads The APIMs revealed some interesting findings. For younger persons with stroke (< 55 years of age), SSR scores were significantly and inversely associated with their own PHQ-9 scores ( β = −0.66; p < 0.001; large effect; Figure 1a ). For older persons with stroke (≥ 55 years of age), SSR scores for care partners were only significantly and inversely associated with their own PHQ-9 scores ( β = −0.47; medium effect; p = 0.048; Figure 1b ). Figure 1a. Open in a new tab Actor-partner interdependence model for younger persons with stroke (< 55 years of age; N = 15) Note: Values are standardized coefficient (SE). * p < 0.05. Figure 1b. Open in a new tab Actor-partner interdependence model for older persons with stroke (≥ 55 years of age; N = 18) Note: Values are standardized coefficient (SE). * p < 0.05. Discussion The present study aimed to enhance understanding of age-related differences in personal and stroke characteristics among dyads and to examine how members of these dyads influence each other regarding depressive symptoms and satisfaction with social roles. Results suggest that there are demographic and stroke characteristic differences shown between couples younger than 55 compared with those 55 and older. Additionally, these results examine how partners within dyads can influence each other and impact stroke recovery leading to potential changes in relationship dynamics showing more pronounced impact for younger couples. Younger couples may face greater uncertainty related to significant changes regarding their perception of a shared future as they likely expect to have more time together. This in turn contributes to the stronger influence on each other as they may feel that their future is now in jeopardy. For older couples, it is often expected that aging comes with health concerns therefore they may anticipate these events. Additionally, having a longer relationship and more time since the stroke may be linked to better satisfaction with social roles and lower depression, likely because these factors indicate greater adjustment over time and a deeper shared history and trust for the couple. Due to the nature of the small sample size, we were unable to address this analysis-wise but have taken it into consideration as a confounding variable. These findings have been consistent with previous literature which shows unique challenges for younger persons with stroke related to changes in role responsibilities that are associated with difficulties with mood functioning. These shifts in role responsibilities are often more significant for younger individuals compared to older individuals who may no longer be working or taking care of individuals under the age of 18. As a result, important considerations regarding how couples cope with stroke particularly with higher expected role loss amongst younger dyads which may have a greater emotional impact on both members warrants attention. Young persons with stroke often find their social roles upended, struggling to reclaim duties at home and in the community due to lingering physical or cognitive impairments, lack of accommodations, or stigma ( Bright et al., 2023 ; Zhang et al., 2022 ). These disruptions are typically more pronounced in people under 55, who may also face complex decisions around starting or expanding a family—especially women of reproductive age who may be weighing fertility or other parenting plans against post-stroke limitations ( Kuluski et al., 2014 ). Being that individuals younger than 55 are more likely to have children under the age of 18 in the home, there typically is more caretaking required. Parents may face physical impairments that reduce their ability to engage in play with their children, or cognitive challenges that interfere with assisting with homework or managing their child’s schedule. Inability to parent in a way in which one was previously familiar can lead to an increase in mood symptoms for both parents and their children. Return to work is considered one of the most important quality of life indicators in recovery from chronic illness ( Figueredo et al., 2020 ). While many persons with stroke strive to reintegrate into the workforce, unemployment rates remain disproportionately high, even several years post-stroke. A study of young persons with stroke found that the highest risk of receiving unemployment benefits was among individuals aged 35–44. Higher NIHSS scores at admission and longer follow-up periods were risk factors for unemployment ( Maaijwee et al., 2014 ). Gender disparities further complicate outcomes, with women facing worse functional and psychological outcomes despite similar stroke severity ( Synhaeve et al., 2016 ). Dependence on others, significant deficits, and pre-stroke sick leave further reduced return to work odds, while office-based jobs had a higher success rate of reintegrating back into similar roles than manual labor jobs ( Edwards et al., 2018 ; Westerlind et al., 2017 ). Although individuals aged 55 and older often encounter challenges when reentering the workforce, the effects of early retirement may be less significant depending on their life circumstances. Efforts to optimize recovery and improve outcomes must consider the complex interplay of physical, psychological, and social factors. Interventions such as cognitive rehabilitation, workplace accommodations, and relationship-centered support have shown promise regarding positive post-stroke outcomes. Additionally, increasing public awareness through education about young stroke outcomes remain critical to help increase community health literacy ( Fraser et al., 2023 ). While the person with stroke has often been the focus of recovery, clinicians should also consider impacts on the care partner. Psychoeducation focusing on mood changes after stroke, care partner impact, and the importance of fostering independence post-stroke should begin early in recovery and continue throughout. This education should be provided by a knowledgeable healthcare provider in a variety of ways that meets couples where they are at emotionally and regarding their understanding of stroke. In addition to education, intervention focusing on skills building, self-care, social interaction with couples who have experienced similar circumstances, caregiver specific interventions, and discussion regarding ideas about recovery are paramount. Education and intervention should be available to patients and their care partners both in-person and via telehealth. While the current study had many strengths, there were also several limitations that have been considered. First, the data used in this study was part of an exploratory pilot study. As a result, the sample size was relatively limited with a total of 34 couples participating. Second, participants in the sample were largely white and well-educated. Therefore, the results should be interpreted with caution as generalizability is limited. Additionally, the nature of the study did not allow for measurement of mental health and relational stressors prior to the injury. Lastly, being that the study is correlational and cross-sectional in nature, there is an inability to establish cause-and-effect relationships. Future research would benefit from increasing and diversifying the sample to be more representative of the general population that can expand upon these findings. Conclusion This paper highlights the multifaceted impact of stroke on persons with stroke and their care partners, suggesting importance of care considering age, life stage, psychosocial support, and systematic changes that includes support for care partners. Increased depression and lower satisfaction with social roles are particularly pertinent for younger dyads while also highlighting stronger effects that each member has on the other. Although this research is in the preliminary stages, it underscores the necessity for policies and resources that empower persons with stroke to regain independence, resume meaningful activities, and navigate the unique challenges of life after stroke along with supporting positive outcomes for their care partners. Supplementary Material Supplemental Material NIHMS2158675-supplement-Supplemental_Material.docx (18.3KB, docx) Impact Statement: Younger dyads coping with stroke are faced with unique challenges (e.g., family planning, childcare, return to work) compared to older couples, which should be considered throughout recovery. Personalized interventions targeting both members of the dyad are likely to lead to improved recovery outcomes post-stroke including reduced depressive symptoms and increased satisfaction with social roles. Author note: The contents of this paper were developed with support from funding from the National Institutes of Health NICHD/NCMRR under award number R03-HD091432 (PI: Terrill). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. 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