Feeling lonely and dissatisfied – Understanding Social Network Functioning in Stroke Survivors

doi:10.21203/rs.3.rs-3403581/v1

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Feeling lonely and dissatisfied – Understanding Social Network Functioning in Stroke Survivors

https://doi.org/10.21203/rs.3.rs-3403581/v1

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Background: Post-stroke social networks are associated with functional recovery. However, there is little information on the social networks of stroke survivors and whether institutionalized and community-dwelling stroke survivors view their social relationships differently.

Purpose: To i) understand social networks of stroke survivors and any influencing sociodemographic factors, as well as to iii) compare differences between institutionalized and community-dwelling stroke survivors.

Methods: Stroke survivors were recruited from eight healthcare institutions in Singapore. Stroke Social Network Scale (SSNS) was administered to assess the social network functioning. Multidimensional State Boredom Scale (MSBS) was used to evaluate state boredom levels.

Results: 160 stroke survivors completed the study. Stroke survivors reported a mean(SD) of 53.7(17.2) on the SSNS total score. Institutionalized stroke survivors reported significantly lower SSNS scores than community-dwelling stroke survivors, (U=1856.5, z=-4.234, p<.001). Nearly a third (30.6%, n=45) of the stroke survivors reported feeling lonely. Only 28.1% (n=45) stroke survivors reported being ‘Very Satisfied’ with their overall social network. Compared to community-dwelling stroke survivors, institutionalized stroke survivors felt more lonely (40.7%) and only 25% were very satisfied with their social networks with all p<.05.

Conclusions: Stroke survivors had poor functioning social relationships. This study identified that the perceived social support of institutionalized stroke survivors was poorer than community dwelling stroke survivors. A large proportion of stroke survivors reported feeling lonely and were not satisfied with their social networks. Identifying those at risk may be a means to prevent loneliness, increase social network satisfaction to improve well-being and quality of life.

Health sciences/Health care

Health sciences/Medical research

Health sciences/Neurology

Health sciences/Risk factors

Health sciences/Signs and symptoms

stroke

social support

social network

loneliness

boredom

After a stroke, approximately 90% of stroke survivors suffer from some sort of disability¹.These stroke impairments often impede stroke survivors’ abilities to return to their baseline activity levels before the stroke and often experience disruptions in their relationship with their family members. These caused reduced contact with their wider network ^2–4.As stroke survivors undergo many changes in their lives, shifts in post-stroke psychological and social functioning was found to be linked to mood disorders, which were prevalent in one-third of stroke survivors across all chronicity ^5,6. Indeed, post-stroke mood disorders were found to be associated with poor social functioning and quality of life ⁷. Perceived social support was found to be associated with reducing mood disorders like depression ⁸. Perceived lack of social connection, also known as loneliness, occurs when an individual view their social connection with others as poor and social needs are inadequate and not satisfactory ^9,10. Higher levels of loneliness evident in stroke survivors puts them at risk of cognitive decline, high morbidity and mortality ^11–13. Furthermore, social support and engagement was found to be associated with rate of post-stroke functional recovery ¹⁴ Previous research found that unsatisfactory social needs had an influence on quality of life ¹⁵.

Previous research displayed the positive relationship between social support and participation ¹⁶. Stroke survivors tend to have reduced participation in social activities, and it increased the probability for stroke survivors to be homebound and inactive ^17–19. A decrease in participation was also found to be associated with depression in the post-stroke chronic phase ^20–22. Withdrawal from social activities was found to be a predisposing factor of boredom in stroke survivors ²³. Identified factors contributing to boredom were personal factors (e.g., physical and cognitive limitations, personality and emotional state) and environmental factors (e.g., rehabilitation environment and social environment). These findings further emphasised that social support was a key factor in post-stroke prognosis. All in all, this is an important issue to address as participation in social activities aids in an improved well-being and functional recovery ^24–28.

Despite the importance of social support and its association with health-related quality of life, little research was done to understand the current perceived social support of stroke survivors. A previous study compared the level of functioning relationships between healthy individuals and stroke survivors using the Stroke Social Network Scale (SSNS) and found that stroke survivors fared significantly much worse than healthy individuals. Stroke survivors with and without aphasia scored 18 and 6.1 points lower than healthy individuals respectively ²⁹. However, the sample size was small (n=71).

There is a paucity in understanding the current social network in stroke survivors. This was especially the case in the challenges of recruiting stroke survivors for research studies, due to reasons such as availability of the stroke survivors (some might have returned to work), cognition problems which impede the ability to give informed consent, and less interest in participating in stroke research studies ³⁰. Furthermore, stroke studies often comprised either institutionalized stroke survivors or community-dwelling stroke survivors ^31–33. It is crucial for research to pave the way in understanding the current perspectives that institutionalized and community-dwelling stroke survivors have on their social relationships ³⁴.This would garner knowledge for future directions to work towards implementing strategies to improve and maintain social networks after stroke. However, there had been no studies comparing the two groups.

The primary aim of this study was to i) understand current social networks of stroke survivors. Following this, secondary aims were to ii) compare differences in social networks between community-dwelling and institutionalized stroke survivors; iii) identify any demographic factors influencing the perception of social support; as well as to iv) establish associations between social network and state boredom. Understanding any differences between stroke survivors residing in institutions or in the community-dwelling is crucial for future implementations targeted on decreasing risk of losing social network in the vulnerable population. This will allow a deeper understanding on the social needs of stroke survivors and guide healthcare institutions and policy makers to develop targeted strategies in supporting the recovery of stroke. Understanding any underlying factors contributing to risk of disconnection with social networks after stroke may allow healthcare professionals to pay attention to those at heightened risk of feeling isolated. To the authors’ knowledge, this was the first study to compare the social network of institutionalized and community-dwelling stroke survivors.

Study Design and Ethics

The study adopted a multi-centre, cross-sectional design. This studywas approved by the Singapore Institute of Technology-Institutional Review Board (Approval Reference: 2021131) and all procedures were in accordance with the latest Declarations of Helsinki. Data collection took place between November 2021 and April 2023.

Participants

Stroke survivors were recruited from eight healthcare institutions- Kwong Wai Shiu Hospital (KWSH), Ang Mo Kio-Thye Hua Kwan Hospital (AMK-THKH), Saint Luke’s Hospital (SLH), United Medicare Centre (UMC), Active Global (AG), Abilities Beyond Limitations and Expectations (ABLE), Methodist Welfare Services (MWS) and Saint Luke’s ElderCare (SLEC). All stroke survivors provided written informed consent. Stroke survivors were given a full explanation of the nature and purpose of the study and reminded that their participation was entirely voluntary. They were given sufficient opportunities to raise questions about the study and of what they would be expected to do. All assessments were conducted in Singapore Institute of Technology (SIT), public areas, or the clinical sites that the stroke survivors were with.

Inclusion criteria included people who were i) aged 21 years old and above; ii) experienced a confirmed first or recurrent stroke and ii) are medically stable. Stroke survivors were excluded if they i) were medically unstable; ii) had conditions that limited limb use prior to stroke; and iii) were unable to fully participate in the study (i.e., due to conditions like dementia). Stroke survivors who dropped out were replaced.

Demographics and Stroke Characteristics

Baseline sociodemographic data was collected from the stroke survivors, including age, gender and stroke characteristics. Stroke severity was assessed using the Fugl Meyer Assessment for Upper Extremity (FMA-UE), a widely used tool to assess the paretic upper limb function after stroke ³⁵. This tool was found to have good intra and inter-rater reliability and was scored out of 66 points ³⁶. Stratification was based on cut‐off scores previously defined with 51–66 (mild), 23–50 (moderate), and 0–22 (severe) ³⁷. Time since stroke was based on previously defined critical time points after stroke: 1-7 days (acute), 7 days to 3 months (early subacute), 3 to 6 months (late subacute), and more than 6 months (chronic) ³⁸.

Stroke Social Network Scale (SSNS)

Social network was assessed using the Stroke Social Network Scale to assess social network in the stroke population to measure self-reported post stroke social network functioning ²⁹. Stroke survivors were required to answer questions on the SSNS relating to the past month only and was scored out of 100. The 5 subdomain scores indicated levels of satisfaction with people of the inner circle, namely, satisfaction with social network, children, relatives, friends and groups. Higher scores reflect more functional social network. The SSNS included measures of 1) Size of network. 2) Composition of network. 3) Frequency of contact. 4) Proximity. 5) Satisfaction with network. In this paper, the qualitative components of Loneliness (‘How often do you feel lonely?’) and Satisfaction (i.e., ‘How would you rate your overall satisfaction with your social network?’) was analysed. The SSNS had been evaluated to have good internal acceptability, internal consistency, validity and responsiveness to change.

Multidimensional State Boredom Scale (MSBS)

Boredom was assessed using the Multidimensional State Boredom Scale (MSBS) and included measures of five dimensions, comprising i) disengagement; ii) high arousal; iii) inattention; iv) low arousal; and v) time perception ³⁹. Each item on the questionnaire has a Likert-scale response format, from 1(‘strongly disagree’) to 7(‘strongly agree’). Higher scores indicate higher levels of boredom.

Data Analysis

Statistical analysis was performed using the IBM Statistical Package for the Social Sciences (SPSS) (Version 29.0). Descriptive statistics were used to describe the sociodemographic data and SSNS scores of all 160 stroke survivors. Normality of the data was assessed using the Shapiro-Wilk test as the total sample size was less than 2000 (n=160). Non-parametric tests were conducted for non-normal data distributions. Mann Whitney U test and the Kruskal Wallis test were used to assess for any differences in SSNS scores between the institutionalized and community-dwelling stroke survivors. Spearman’s rank correlation coefficient evaluated the association between SSNS and MSBS scores. Findings were reported at a statistical significance of p<.05.

A total of 160 stroke survivors, including 96 community-dwelling stroke survivors and 64 institutionalized stroke survivors, completed this study. One stroke survivor dropped out from the study due to an early transfer to another hospital. Demographic data are reported in Table 1. Majority of the stroke survivors were males (62.5%, n=100). Stroke survivors had a mean age of 65.7 and ranged from 24-64 years old (SD=12.8). Mean FMA-UE score was 40.3 (SD=20.5). Most of the stroke survivors were in the chronic phase of stroke (80%, n=128). 54% of the stroke survivors ambulated independently (54.4%, n=87).

Table 2 presents stroke survivors’ scores on the SSNS. Mean (SD) SSNS total scores indicating level of functioning relationships for the stroke survivors (n=160) were 53.7 (17.2) out of 100. This meant that stroke survivors had low perceived social support. Mean subdomain scores were as follows: ‘Children’ subdomain scores of 59.3 (SD=33.18), ‘Relatives’ subdomain scores of 35.9 (SD=28.3), ‘Friends’ subdomain scores of 35.6 (SD=28), ‘Groups’ subdomain scores of 35.1 (SD=36), and ‘Satisfaction with social network’ subdomain scores’ of 77.2 (SD=18.9). These results indicated that stroke survivors had poor functional relationships with their children, relatives, friends, and groups.

Institutionalized stroke survivors had significantly lower total scores on the SSNS than community dwelling-stroke survivors, (U=1856.5, z=-4.234, p<.001) (see Fig. 1). Institutionalized stroke survivors scored significantly lower than community-dwelling stroke survivors for ‘children’ subdomain (U=2139.5, z=-3.255, p=.001, z=-3.255), ‘relatives’ subdomain (U=2388.5, z=-2.401, p=.016), ‘friends’ subdomain (U=2304, z=-2.701, p=.007), ‘groups’ subdomain (U=2282, z=-2.914, p=.004), and ‘satisfaction’ domain (U=2261, z=-2.827 p=.005) with all p-values <.05. This difference meant that institutionalized stroke survivors had poorer perceived support with their social circle compared to community-dwelling stroke survivors.

30.6% (n=49) of the stroke survivors reported feeling lonely ‘Some of the time’, ‘Most of the Time’ and ‘All of the Time’. Only 28.1% (n=45) of the stroke survivors reported being ‘Very satisfied’ with their social network. The results indicated that despite the minority of stroke survivors feeling lonely for a great proportion of time and most of them were dissatisfied with their social network.

40.7% of institutionalized stroke survivors and 24% of community-dwelling stroke survivors reported feeling lonely ‘Some of the time’, ‘Most of the time’, and ‘All of the time’. 30.2% of institutionalized stroke survivors and 25.0% of community-dwelling stroke survivors were ‘Very satisfied’ with their social network. These results indicated that a greater proportion of institutionalized stroke survivors were found to be lonely more often and were less satisfied with their social networks than community-dwelling stroke survivors.

SSNS total scores and its subdomains did not differ significantly across stroke chronicity, stroke severities and other demographic factors. However, a significant difference in SSNS ‘group’ subdomain scores for all 160 stroke survivors was found between male and female stroke survivors, [U=2343.5, z =-2.451, r=-.19, p=.014]. Male stroke survivors had significantly lower SSNS ‘group’ subdomain scores (mean rank of 74.0) compared to females (mean rank of 91.4). This meant that female stroke survivors reported significantly higher ‘group’ subdomain scores than males. A significantly medium correlation was found between age and ‘friends’ subdomain scores (r=-.305, p<.001). This suggested that as age increased, ‘friends’ subdomain scores decreased.

Significant differences in the SSNS total score were also observed between the different groups of level of assistance in ambulation (see Fig 2.), x²(4)=21.208, p<.001. Post-hoc pairwise comparisons revealed a significant difference in SSNS scores between stroke survivors who ambulated independently/with supervision and those who ambulated with maximal assistance, z=-2.350, p=.019. A significant difference was also shown between stroke survivors who ambulated independently/with supervision and those who were non-ambulatory, z=-4.189, p<.001. These results indicated that stroke survivors who ambulated with max assistance or those who were non-ambulant had significantly lower SSNS total scores than stroke survivors who ambulated independently/with supervision.

An association between SSNS and MSBS total scores revealed a weak correlation between SSNS total score and MSBS total score (r=-.262, p<.001) (see Fig. 3). A moderate correlation was found between SSNS ‘Satisfaction’ subdomain score and MSBS total score, r=-.401, p<.001.

This was the first large-scale study to investigate and understand social network functioning in the stroke population. The current study compared the social network functioning of 160 stroke survivors to understand the social support of stroke survivors. This study was required as there was little information about the social network functioning of stroke survivors, and no studies attempted to compare the differences in social network perception between institutionalized and community-dwelling stroke survivors. Stroke survivors were purposefully recruited to capture a wide spectrum of stroke chronicity and stroke severity. To the authors’ knowledge, this was the first study to compare the social networks of institutionalized and community-dwelling stroke survivors and assess the differences in perception of social support between the two groups.

One of the key findings of this study was that the means of SSNS total score and subdomain scores for all 160 stroke survivors were low. When comparing the results of the SSNS scores in this study with previous research investigating SSNS scores between healthy individuals and those with stroke (with or without aphasia), stroke survivors consistently had poorer social network functioning than healthy controls (see Fig. 4) ⁴⁰. Nevertheless, the low scores observed in this study was concerning as it suggested that stroke survivors had vulnerable social networks and low perceived social support. This finding was comparable with previous research that stroke survivors were prone to having decreased contact with their social network ^2,3. This was not surprising as stroke survivors experience shifts in their social network, which might indicate a heightened risk to lose social connections after stroke ⁴¹.

Compared to community-dwelling stroke survivors, a key finding was that institutionalized stroke survivors had poorer social network. Previous research suggested that following a stroke, admission into an institution removes the stroke survivor from their familiar environments and this may induce loneliness, reduced contact with their social network ^40,42,43. Patients typically spend more than half of their day being alone and interactions with hospital staff were brief, infrequent and recovery oriented ^44,45. This suggested that institutionalized stroke survivors were more susceptible to feeling disconnected with more extensive social relationships during their inpatient stay. The differences between instutionalised and community stroke survivors in perception of social network further highlighted that future research studies need to understand them as two separate groups. There is a need to focus on building and maintaining social networks of stroke survivors to increase satisfaction, reduce loneliness and boredom. Such strategies may include encouraging more social interactions in rehabilitation centres or institutions, in hopes of increasing social participation. While more focus had been placed on physical recovery, stroke services can incorporate more activities associated with social, emotional and mental well-being.

Despite finding that approximately one-third of stroke survivors in the current study reported feeling lonely often, this result should not be overlooked as a statistical irrelevance. Stroke survivors were found to be at least 70% more susceptible to feeling lonelier than healthy individuals ¹³ Less than one-third of stroke survivors were very satisfied with their social network. A previous research found that over half of the stroke survivors in Singapore reported being dissatisfied with their social relationships, feeling lonely and longed for more contact with their children ⁴⁶. Furthermore, results from the current study showed that institutionalized stroke survivors felt more lonely and were less satisfied with their social network compared to community-dwelling stroke survivors. This finding further emphasised that there is a need to pay attention to the more vulnerable instutionalised stroke survivors.

Stroke survivors who were ambulating independently or with supervision had significantly better social network functioning than stroke survivors who ambulated with maximal assistance and those who were non-ambulant. In addition, previous research attempted to explain the rationale behind changes in a person’s network type and identified that the ability to leave the house was one of the factors in enabling stroke survivors to maintain contact with people ⁴⁷. This suggested that mobility statuses affected the maintenance of social relationships. Having a reduction in more extensive social contact was a significant factor in increasing the risk of depression. More focus needs to be placed on those who are less mobile to encourage more social engagements despite their mobility statuses.

Key findings from this study supported previous that stroke survivors had decreased contact and felt dissatisfied with their relationships ^2,3. Maintaining social relationships had been found to be one of the key factors in raising health related quality of life and improving post-stroke functional recovery ⁴⁸. Developing strategies to increase post-stroke social engagement is imperative, even more so in institutionalized stroke survivors. Given that social support influences post-stroke recovery, strategies can focus on encouraging the maintenance of social relationships in hopes of improving functional recovery, well-being and quality of life after stroke ⁴⁸.

Study strengths and limitations

A significant strength of this study included the large representative sample size. To the author’s knowledge, there had been no stroke studies investigating the social network functioning in the stroke population. The large sample size allowed our results to be generalised to the stroke population and pave the way for future stroke research. In addition, this was the first study to compare the social networks of both institutional and community-dwelling stroke survivors. This study highlighted that institutionalized and community-dwelling stroke survivors should be viewed as two separate groups, which may fuel future research in developing strategies to improve the social engagements of those who are more susceptible to feeling disconnected.

As with all questionnaires, the answers on the SSNS were self-reported by the stroke survivors and may be subjected to response bias. If stroke survivors in the current study provided inaccurate responses to conform to social norms, the results from our study may not be accurate. Another limitation included the absence of participants’ marital statuses. Previous research showed that marital status is one of the factors in influencing an individual’s views on their social relationships ^49,50. In addition, this study was conducted over the COVID-19 period. Lower scores observed could be attributed to the rules and regulations set by the relevant government bodies which was exceptionally more stringent in institutions to curb the spread of the virus and may be a confounding factor.

This study demonstrated that stroke survivors overall had poorer social functioning than healthy individuals. This meant that stroke survivors are prone to feeling more disconnected with their social networks after stroke. Institutionalized stroke survivors were less satisfied with their social networks than community-dwelling stroke survivors, which suggests that institutionalized stroke survivors are at a higher risk of losing contact with their friends and family. Our results indicate that approximately one in three stroke survivors experience loneliness. Only 28.1% of the stroke survivors were very satisfied with their social network. These findings emphasised the importance of providing social and emotional support for stroke survivors.

Considering that stroke survivors have long-term social needs, it is important to raise awareness so that health-care personnel can target those at risk. Stroke services can help stroke survivors by identifying any emotional or psychological symptoms resulting from social issues and provide or help them seek for the support that they require. Transition from a familiar neighbourhood into an institutional setting can often be difficult for the stroke survivor. Given that staff and patient interactions are centered on solely recovery, one way to improve the social support of stroke survivors is to build rapport with them by having active conversations with them. It is crucial that staff aid stroke survivors with the adjustment as much as possible, encourage social interaction in hope of decreasing loneliness, satisfaction, and loss of identity.

Data availability statement

The datasets generated during and/or analysed during the current study are not publicly available as the authors are still in the process of conducting analyses for the other data but are available from the corresponding author on reasonable request. Contact details of the corresponding author are indicated in page 1 of this document.

Acknowledgements

We would like to thank the stroke survivors who participated in our study, as well as our partner organisations from Kwong Wai Shiu Hospital, Ang Mo Kio-Thye Hua Kwan Hospital, St Luke’s Hospital, United Medicare Centre, Abilities Beyond Limitations and Expectations (ABLE), Active Global, Methodist Welfare Services and St Luke’s ElderCare. We would like to thank our co-investigators Juliana Wang, Geetha Kunasaigaran, Teng Zhe Wei, Sakinah Rafiq Tan Hui Ling, Tan Yi Wei, Amoz Choy Zheng Rong, Jacelyn Tham Jie Ling, Yeoh Xintong Velene, Lim Tongli, Chong Wei Xin Edgar, Heng Yi Xuan Chermaine, Huang Yi Jing and Lim Jia En Joanne for their contribution to this project.

Author Contribution Statement

Co-Investigator J.E.K: collection of data; analysis of data; interpretation of data; and wrote the main manuscript text.

Principal Investigator P.L.C: conception of the study; design of the study; co-ordination of the study; collection of data; analysis of data; interpretation of data; and commented on written drafts of the manuscript.

All authors reviewed and approved the final manuscript.

Funding

This work was supported by the Singapore Institute of Technology Ignition Grant.

Competing Interests

The Author(s) declare(s) no competing interests.

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Table 1. Participant Characteristics

Community-dwelling

(n=96)

Institutionalized

(n=64)

All

(n=160)

Age

Mean (SD)

Range

59.8 (13.2)

24-88

67.0 (11.0)

37-87

65.7 (12.8)

24-64

Gender

Female

Male

36(37.5%)

60 (62.5%)

24 (37.5%)

40 (62.5%)

60 (37.5%)

100 (62.5%)

Stroke type

Haemorrhagic

Ischemic

Both*

Not determined

44 (45.8%)

48 (50.0%)

1 (1.0%)

3 (3.1%)

19 (29.7%)

37 (57.8%)

4 (6.3%)

63 (39.4%)

85 (53.1%)

5 (3.1%)

7 (4.4%)

Hemisphere affected

Left

Right

Bilateral

40 (41.7%)

52 (54.2%)

4 (4.2%)

20 (31.3%)

36 (56.3%)
8 (12.5%)

60 (37.5%)

88 (55.0%)
12 (7.5%)

Fugl Meyer Assessment (FMA) Score

Mean (SD)

Range

40.9 (19.8)

8-66

39.4 (21.5)

5-66

40.3 (20.5)

5-66

Time since stroke

Acute

Early subacute

Late subacute

Chronic

2 (2.1%)

92 (95.8%)

1 (1.6%)

19 (29.7%)

8 (12.5%)

36 (56.3%)

1 (0.6%)

21 (13.1%)

10 (6.3%)

128 (80.0%)

Level of walking assistance

Independently

Supervision

Min A

Mod A

Max A

Non-ambulant

80 (83.3%)

14 (14.6)

1 (1.0%)

7 (10.9%)

10 (15.6%)

18 (28.1%)

4 (6.3%)

15 (23.4%)

10 (15.6%)

87 (54.4%)

24 (15.0%)

19 (11.9%)

4 (2.5%)

16 (10.0%)

10 (6.3%)

*Both=Stroke survivors who have suffered multiple strokes of both haemorrhagic and ischaemic strokes or suffered a haemorrhagic to ischemic stroke conversion. SD=Standard deviation, n=Sample size.

Table 2. SSNS Score for Community-dwelling, Institutionalized, and All stroke survivors

Community-dwelling

(n=96)

Institutionalized

(n=64)

All

(n=160)

SSNS total score

Mean (SD)

Range

58.2 (12.9)**

20.8-83

46.1 (19.9)**

0-92.4

53.7 (17.2)

0-92.4

‘Children’ subdomain

Mean (SD)

Median (IQR)

65.9 (32.1)*

75 (55.3)

49.3 (32.6)*

50 (32.6)

59.3 (33.2)

71.3 (62.5)

‘Relatives’ subdomain

Mean (SD)

Median (IQR)

39.7 (26.1)*

44.3 (44.3)

30.1 (30.7)*

25 (50)

35.9 (28.3)

37.7 (56.4)

‘Friends’ subdomain

Mean

Median (IQR)

40.7 (25.9)*

42.4 (40.9)

27.9 (29.4)*

20.9 (53.1)

35.6 (28.0)

38.5 (56.0)

‘Groups’ subdomain

Mean

Median

42 (24.7)*

50 (67.0)

35.4 (34.5)*

0 (62.4)

35.1 (36.0)

33 (66.5)

‘Satisfaction’ subdomain

Mean

Median

81.3 (14.1)*

83.3 (16.7)

71 (23.1)*

75.4 (22.3)

77.2 (18.9)

82.1 (20.0)

Loneliness frequency

Never lonely

A little of the time

Some of the time

Most of the time

All of the Time

Satisfaction with social network

Very satisfied

Fairly satisfied

A little satisfied

A little dissatisfied

Fairly dissatisfied

Very dissatisfied

45 (46.9%)

28 (29.2%)

15 (15.6%)

6 (6.3%)

2 (2.1%)

29 (30.2%)

45 (46.9%)

17 (17.7%)

4 (4.2%)

1 (1.0%)

24 (37.5%)

14 (21.9%)

6 (9.4%)

16 (25.0%)

26 (40.6%)

12 (18.8%)

3 (4.7%)

2 (3.1%)

5 (7.8%)

69 (43.1%)

42 (26.3%)

29 (18.1%)

12 (7.5%)

8 (5.0%)

45 (28.1%)

71 (44.4%)

29 (18.1%)

7 (4.4%)

3 (1.9%)

5 (3.1%)

*SSNS=Stroke Social Network Scale

SD=standard deviation, n=sample size, IQR=Interquartile range

*p<.05, **p<.001.

No competing interests reported.

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Feeling lonely and dissatisfied – Understanding Social Network Functioning in Stroke Survivors

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