Janet Millen, 75, at her home in Ottawa on May 31. Millen had a stroke in 2006, and still struggles with aphasia, a difficultly with language.Dave Chan/The Globe and Mail
As the number of people affected by stroke in Canada grows, the Heart and Stroke Foundation is calling for increased awareness and access to services for the mental-health effects of the condition – particularly in women.
New data from the non-profit organization show that more than 920,000 people in Canada are living with the effects of stroke, and 108,000 new strokes occur in the country every year. And women face worse outcomes than men.
In a report released Thursday, Heart and Stroke said 32 per cent more women died of stroke than men in 2019. Women who survive are 60 per cent less likely than men to regain their independence in their daily lives, and report having worse quality of life, it said. And the report’s review of existing research found women are 20 per cent to 70 per cent more likely than men to experience depression after a stroke, and are also more likely to experience anxiety.
While poststroke mental health issues affect all genders, for women, “it has a stronger impact on them in so many ways and it’s something that has not been addressed nearly as much as it should be,” said Patrice Lindsay, the organization’s director of health systems.
Although new technologies and therapies mean more lives are now saved when people experience a stroke, there is still a lack of programs and services to help them afterward, she said.
The rise in strokes in Canada is primarily driven by the country’s aging population, Dr. Lindsay said, but she pointed out that more strokes are occurring among younger people as well. Risk factors have become more prevalent at earlier ages, she said. For example, hypertension is now seen in people in their 40s and 50s, about a decade earlier than it appeared previously, and type II diabetes is also occurring in young people.
Women fare worse for multiple reasons. According to the report, they are at highest risk of stroke at three critical times of their lives – during pregnancy, after menopause and in older age – and a general lack of awareness means they do not always get timely care. On average, women live longer than men, and older women have the most strokes, particularly severe ones, the report said.
It added that women, in general, earn less than men and may be less likely to have extended health benefits, which can hamper their ability to access and afford poststroke recovery services.
Mental-health issues are “extremely common” after stroke, since both involve the brain, said Abe Snaiderman, director of neuropsychiatry at the Toronto Rehabilitation Institute at the University Health Network. Yet even though most people recognize the signs of a stroke, such as face drooping or slurred speech, many don’t know that stroke survivors can also suffer from anxiety, irritability, insomnia and depression, he said.
Dr. Snaiderman, who is also a spokesperson for Heart and Stroke, said anywhere between 30 per cent to 60 per cent of people who experience a stroke will go on to develop depression or anxiety – the vast majority of them, women.
The reasons for this gender disparity aren’t entirely clear, though there are biological, psychological and social factors involved, he said. Socially, for example, women tend to take on the role of caregiving, and often don’t have time or resources to take care of themselves, Dr. Snaiderman said, explaining this is particularly the case for single mothers and racialized women.
If left unaddressed, poor mental health can hamper recovery and even kill, particularly when people feel they are a burden to their families, he said. This is because conditions such as depression can prevent them from participating in rehabilitation, taking medication and rejoining society.
Janet Millen of Ottawa said she has felt depressed and isolated at times after a stroke in 2006, at age 58, left her with the aphasia disorder.
Many people don’t understand aphasia, which involves difficulty processing language, she said. And even though she has worked hard to retrain her brain, and her aphasia is now no longer apparent to others, she finds it impossible to participate in group conversations.
“I’m sitting like a lump because I cannot keep up,” said Ms. Millen, now 75. “I get days when I feel very, very low with that.”
Ms. Millen, who wrote Still Me!, a book about her stroke experience, said she is fortunate to be able to rely on her husband, children and friends, and advised other stroke survivors to seek support.
“You do it alone? Forget it,” she said. “It’s not going to happen.”