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Misconceptions about Stroke: Causal Attributions for Stroke-Related Symptoms Reflect the Age of the Survivor

Published online by Cambridge University Press:  12 July 2017

Charlotte Wainwright ,
John McClure Open the ORCID record for John McClure [Opens in a new window]  and
John McDowall
Charlotte Wainwright
Affiliation:
School of Psychology, Victoria University of Wellington, Wellington, New Zealand
John McClure*
Affiliation:
School of Psychology, Victoria University of Wellington, Wellington, New Zealand
John McDowall
Affiliation:
School of Psychology, Victoria University of Wellington, Wellington, New Zealand
*
Address for correspondence: John McClure, School of Psychology, Victoria University of Wellington, PO Box 600, Wellington, New Zealand. E-mail: john.mcclure@vuw.ac.nz.
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Abstract

With visible disabilities, observers tend to overgeneralise from the disability. In contrast, with invisible disabilities such as traumatic brain injury and stroke, observers often fail to allow for challenges resulting from the disability. Persons who have suffered a stroke claim that people misunderstand their symptoms and stigmatise them as a result of these symptoms. This misunderstanding, which happens particularly with young survivors of stroke, may reflect people's causal attributions for symptoms that follow a stroke. Using a scenario design, this cross-sectional study examined whether people attribute ambiguous symptoms that may result from stroke to other causes (the stroke survivor's personality and age) and whether these attributions reflect the age of the stroke survivor. Participants (N = 120) read scenarios describing a male who was aged either 22, 72, or whose age was unstated and who showed four symptom changes: fatigue, depression, irritability and reduced friendships. For each symptom change, participants rated three causal attributions: the person's age, his personality and stroke. The age of the person in the scenario affected attributions; when the person in the scenario was 22, participants attributed his symptoms significantly more to his personality than to his age or stroke, whereas when he was 72, participants attributed his symptoms more to his age than to his personality or stroke and when his age was unstated, they attributed his symptoms equally to age, stroke and personality. Because misattributions for stroke symptoms hinder rehabilitation, therapy can target people's misattributions to enhance rehabilitation for survivors of stroke.

Keywords

strokeageyoung stroke survivorsinvisible disordersattributionsrehabilitationstigmamisconceptions
Type
Articles
Information
Brain Impairment , Volume 18 , Issue 3 , December 2017 , pp. 299 - 309
Copyright
Copyright © Australasian Society for the Study of Brain Impairment 2017 

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References

Anderson, C.S., Linto, J., & Stewart-Wynne, E.G. (1995). A population-based assessment of the impact and burden of caregiving for long-term stroke survivors. Stroke, 26 (5), 843–849. doi: 10.1161/01.STR.26.5.843 Google Scholar
Block, C.K., West, S.E., & Goldin, Y. (2016). Misconceptions and misattributions about traumatic brain injury: An integrated conceptual framework. Physical Medicine and Rehabilitation, 8 (1), 58–68. https://doi.org/10.1016/j.pmrj.2015.05.022 Google Scholar
Campbell Burton, C., Murray, J., Holmes, J., Astin, F., Greenwood, D., & Knapp, P. (2013). Frequency of anxiety after stroke: A systematic review and meta-analysis of observational studies. International Journal of Stroke, 8 (7), 545–559. doi: 10.1111/j.1747-4949.2012.00906.x Google Scholar
Carod-Artal, F.J. (2010). Post-stroke depression: Can prediction help prevention?. Future Neurology, 5 (4), 569–580. doi: 10.2217/fnl.10.27 Google Scholar
Carod-Artal, F.J., Trizotto, D.S., Coral, L.F., & Moreira, C.M. (2009). Determinants of quality of life in Brazilian stroke survivors. Journal of Neurological Sciences, 284 (1), 63–68. doi: 10.1016/j.jns.2009.04.008 Google Scholar
Chamberlain, D.J. (2006). The experience of surviving traumatic brain injury. Journal of Advanced Nursing, 54 (4), 407–417. doi: 10.1111/j.1365-2648.2006.03840.x Google Scholar
Clark, M.S., & Smith, D.S. (1998). Knowledge of stroke in rehabilitation and community samples. Disability and Rehabilitation, 20 (3), 90–96. doi: 10.3109/09638289809166061 Google Scholar
Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59 (7), 614–625. doi: 10.1037/0003-066X.59.7.614 Google Scholar
Dam, H. (2001). Depression in stroke patients 7 years following stroke. Acta Psychiatrica Scandinavica, 103 (4), 287–293. doi: 10.1034/j.1600-0447.2001.103004287.x Google Scholar
Davis, C.G., Egan, M., Dubouloz, C.-J., Kubina, L.-A., & Kessler, D. (2013). Adaptation following stroke: A personal projects analysis. Rehabilitation Psychology, 48 (3), 287–298. Doi: 10.1039/a0033400 Google Scholar
Davis, N. (2005). Invisible disability. Ethics, 116 (1), 153–213. doi: 10.1086/453151 Google Scholar
Duncan, F., Greig, C., Lewis, S., Dennis, M., MacLullich, A., Sharpe, M., & Mead, G. (2014). Clinically significant fatigue after stroke: A longitudinal cohort study. Journal of Psychosomatic Research, 77 (5), 368–373. doi: 10.1016/j.jpsychores.2014.06.013 Google Scholar
Dunn, D.S., & Elliott, T.R. (2005). Revisiting a psychological classic: Wright's disability: A psychosocial approach. Rehabilitation Psychology, 50 (2), 183–189. doi: 10.1037/0090-5550.50.2.183 CrossRefGoogle ScholarPubMed
Dunn, D.S., & Elliott, T.R. (2008). The place and promise of theory in rehabilitation psychology research. Rehabilitation Psychology, 53 (3), 254–267. doi: 10.1037/a0012962 Google Scholar
Dyall, L., Feigin, V., Brown, P., & Roberts, M. (2008). Stroke: A picture of health disparities in New Zealand. Social Policy Journal of New Zealand, 33, 178–191.Google Scholar
Eagly, A.H., Wood, W., & Diekman, A.B. (2000). Social role theory of sex differences and similarities: A current appraisal. In Eckes, T. & Trautner, H. M. (Eds.), The Developmental Social Psychology of Gender (pp. 123–174). New York, NY: Psychology Press.Google Scholar
Farmer, J.E., & Johnson-Gerard, M. (1997). Misconceptions about traumatic brain injury among educators and rehabilitation staff: A comparative study. Rehabilitation Psychology, 42 (4), 273. doi: 10.1037/0090-5550.42.4.273 Google Scholar
Feigin, V.L., Lawes, C.M., Bennett, D.A., Barker-Collo, S.L., & Parag, V. (2009). Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review. The Lancet Neurology, 8 (4), 355–369. doi: 10.1016/S1474-4422(09)70025-0 Google Scholar
Feigin, V.L., Lawes, C.M.M., Bennett, D.A, & Anderson, C.S. (2003). Stroke epidemiology: A review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurology, 2 (1), 43–53. doi: 10.1016/S1474-4422(03)00266-7 Google Scholar
Fiske, S.T., Kenny, D.A., & Taylor, S.E. (1982). Structural models for the mediation of salience effects on attribution. Journal of Experimental Social Psychology, 18 (2), 105–127. doi: 10.1016/0022-1031(82)90046-4 CrossRefGoogle Scholar
Foster, L., McClure, J., McDowall, J., & Crawford, M.T. (2013). Attributions about persons with brain injury: The effects of knowledge and familiarity about brain injury. Brain Injury, 27 (4), 485–491. doi: 10.3109/02699052.2012.750747 Google Scholar
Gallagher, J., McClure, J., & McDowall, J. (2017). How information about stroke survivors’ symptoms affects people's attributions for ambiguous behaviours resulting from stroke. In preparation, Victoria University of Wellington.Google Scholar
Garcia, S.F., Hahn, E.A., Magasi, S., Lai, J.S., & Hammel, J. (2015). Development of self-report measures of social attitudes that act as environmental barriers and facilitators for people with stroke. Archives of Physical Medical Rehabilitation, 96 (4), 596–603.CrossRefGoogle Scholar
Gibb, B.E., & Alloy, L.B. (2006). A prospective test of the hopelessness theory of depression in children. Journal of Clinical Child and Adolescent Psychology, 35 (2), 264–274. doi:10.1207/s15374424jccp3502_10 CrossRefGoogle ScholarPubMed
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Gouvier, W.D., Steiner, D.D., Jackson, W.T., Schlater, D., & Rain, J.S. (1991). Employment discrimination against handicapped job candidates: An analog study of the effects of neurological causation, visibility of handicap, and public contact. Rehabilitation Psychology, 36 (2), 121–129. doi: 10.1037/h0079077 CrossRefGoogle Scholar
Grant, J.S., Elliott, T.R., Weaver, M., Bartolucci, A.A., & Giger, J.N. (2002). Telephone intervention with family caregivers of stroke survivors after rehabilitation. Stroke, 33 (8), 2060–2065. doi: 10.1161/01.STR.0000020711.38824.E3 Google Scholar
Groppo, E., De Gennaro, R., Granieri, G., Fazio, P., Cesnik, E., Granieri, E., & Casetta, I. (2012). Incidence and prognosis of stroke in young adults: A population-based study in Ferrara, Italy. Neurological Science, 33 (1), 53–58. doi: 10.1007/s10072-011-0654-9 Google Scholar
Guilmette, T.J., & Paglia, M.F. (2004). The public's misconceptions about traumatic brain injury: A follow up survey. Archives of Clinical Neuropsychology, 19 (2), 183–189. doi: 10.1016/S0887-6177(03)00025-8 Google Scholar
Hackett, M.L., Yapa, C., Parag, V., & Anderson, C.S. (2005). Frequency of depression after stroke: A systematic review of observational studies. Stroke, 36 (6), 1330–1340. doi: 10.1161/01.STR. 0000165928.19135.35 Google Scholar
Irwin, L.G., & Fortune, D.G. (2014). Schools-based interventions for reducing stigmatization of acquired brain injury: The role of interpersonal contact and visible impairment. Archives of Clinical Neuropsychology, 29 (2), 194–205, doi: 10.1093/arclin/act118 CrossRefGoogle ScholarPubMed
Joachim, G., & Acorn, S. (2000). Stigma of visible and invisible chronic conditions. Journal of Advanced Nursing, 32 (1), 243–248. doi: 10.1046/j.1365-2648.2000.01466.x Google Scholar
Jones, S.P., Jenkinson, A.J., Leathley, M.J., & Watkins, C.L. (2009). Stroke knowledge and awareness: An integrative review of the evidence. Age and Ageing, 39 (1), 11–22. doi: 10.1093/ageing/afp196 Google Scholar
Kim, J.S., Choi-Kwon, S., Kwon, S.U., Lee, H.J., Park, K.A., & Seo, Y.S. (2005). Factors affecting the quality of life after ischemic stroke: Young versus old patients. The Journal of Clinical Neurology, 1 (1), 59–68. https://doi.org/10.3988/jcn.2005.1.1.59 Google Scholar
Knapp, P. (2010). Mood and behavioural changes. In Williams, J., Perry, L. & Watkins, C. (Eds.), Acute stroke nursing (pp. 205–221). Oxford: Blackwell Publishing Ltd.Google Scholar
Krahn, T. (2015). Traumatic brain injury and the use of documentary narrative media to redress social stigma. In Clausen, J. & Levy, N. (Eds.), Handbook of neuroethics (pp. 1501–1524). Dordrecht: Springer. doi: 10.1007/978-94-007-4707-4_126.Google Scholar
Lawrence, M. (2010).Young adults' experience of stroke: A qualitative review of the literature. British Journal of Nursing, 19 (4), 241–248. doi: 10.12968/bjon.2010.19.4.46787 Google Scholar
Linden, M.K., & McClure, J. (2012). The causal attributions of nursing students toward survivors of brain injury. Nursing Research, 61 (1), 58–65. doi: 10.1097/NNR.0b013e31823ca253 Google Scholar
Lingsom, S. (2008). Invisible impairments: Dilemmas of concealment and disclosure. Scandinavian Journal of Disability Research, 10 (1), 2–16. doi: 10.1080/15017410701391567 CrossRefGoogle Scholar
Maaijwee, N.A.M.M., Rutten-Jacobs, L.C.A., Schaapsmeerders, P., van Dijk, E.J., & de Leeuw, F.-E. (2014). Ischaemic stroke in young adults: Risk factors and long-term consequences. Nature Reviews Neurology, 10 (11), 315–325. doi:10.1038/nrneurol.2014.183 Google Scholar
Mackenzie, A., Perry, L., Lockhart, E., Cottee, M., Cloud, G., & Mann, H. (2007). Family carers of stroke survivors: Needs, knowledge, satisfaction and competence in caring. Disability and rehabilitation, 29 (2), 111–121. doi: 10.1080/09638280600731599 Google Scholar
Major, B., & O'Brien, L.T. (2005). The social psychology of stigma. Annual Review of Psychology, 56, 393–421.Google Scholar
Mayo, N.E., Anderson, S., Barclay, R., Cameron, J.I., Desrosiers, J., Eng, J.J., . . . Richards, C.L. (2015). Getting on with the rest of your life following stroke: A randomized trial of a complex intervention aimed at enhancing life participation post stroke. Clinical rehabilitation, 29 (12), 1198–1211. doi: 10.1177/0269215514565396 Google Scholar
McClure, J. (2011). The role of causal attributions in public misconceptions about brain injury. Rehabilitation Psychology, 56 (2), 85–93. doi: 10.1037/a0023354 Google Scholar
McClure, J., & Abbott, J. (2009). How normative information shapes attributions for the actions of persons with traumatic brain injury. Brain Impairment, 10 (2), 180–187. doi: https://doi.org/10.1375/brim.10.2.180 CrossRefGoogle Scholar
McClure, J., Buchanan, S., McDowall, J., & Wade, K. (2008). Attributions for behaviours of persons with brain injury: The role of perceived severity and time since injury. Brain Injury, 22 (9), 639–648. doi: 10.1080/02699050802255585 Google Scholar
McClure, J., Devlin, M.E., McDowall, J., & Wade, K. (2006). Visible markers of brain injury influence attributions for adolescents’ behaviour. Brain Injury, 20 (10), 1029–1035. doi: 10.1080/02699050600909870 Google Scholar
McClure, J., Patel, G.J., & Wade, K. (2011). Attributions and expectations for the behaivour of persons with brain injury: The effect of visibility of injury. The Journal of Head Trauma Rehabilitation, 26 (5), 392–396. doi: 10.1097/HTR.0b013e3181f8fd34 CrossRefGoogle Scholar
Morris, R. (2011). The psychology of stroke in young adults: The roles of service provision and return to work. Stroke Research and Treatment, 2011, 1–10. doi: https://doi.org/10.4061/2011/534812 Google Scholar
Murray, C.D., & Harrison, B. (2004). The meaning and experience of being a stroke survivor: An interpretative phenomenological analysis. Disability and Rehabilitation, 26 (13), 808–816. doi: 10.1080/09638280410001696746 Google Scholar
Paranthaman, R., & Baldwin, R.C. (2006). Treatment of psychiatric syndromes due to cerebrovascular disease. International Review of Psychiatry, 18 (5), 453–470. doi: 10.1080/09540260600935462 Google Scholar
Pontes-Neto, O.M., Silva, G.S., Feitosa, M.R., De Figueiredo, N.L., Fiorot, J.A., Rocha, T.N., . . . Leite, J.P. (2008). Stroke awareness in Brazil alarming results in a community-cased study. Stroke, 39 (2), 292–296. doi: 10.1161/STROKEAHA.107. 493908 Google Scholar
Ravaud, J.F., Madiot, B., & Ville, I. (1992). Discrimination towards disabled people seeking employment. Social Science and Medicine, 35 (8), 951–958. doi: 10.1016/0277-9536(92)90234-h Google Scholar
Rodgers, H., Atkinson, C., Bond, S., Suddes, M., Dobson, R., & Curless, R. (1999). Randomized controlled trial of a comprehensive stroke education program for patients and caregivers. Stroke, 30 (12), 2585–2591. doi:10.1161/01.STR.30.12.2585 Google Scholar
Röding, J., Linderström, B., Malm, J., & Öhman, A. (2003). Frustrated and invisible - younger stroke patients' experiences of the rehabilitation process. Disability and rehabilitation, 25 (15), 867–874. doi: 10.1080/0963828031000122276 Google Scholar
Rutten-Jacobs, L.C.A., Maaijwee, N.A.M., Arntz, R.M., van Alebeek, M.E., Schaapsmeerders, P., Schoonderwaldt, H.C., . . . de Leeuw, F.-E. (2011). Risk factors and prognosis of young stroke. The FUTURE study: A prospective cohort study. Study rationale and protocol. BMC Neurology, 11 (1), 109–117. doi: 10.1186/1471-2377-11-109 CrossRefGoogle ScholarPubMed
Smith, G.C., Egbert, N., Dellman-Jenkins, M., Nanna, K., & Palmieri, P.A. (2012). Reducing depression in stroke survivors and their informal caregivers: A randomized clinical trial of a web-based intervention. Rehabilitation Psychology, 57 (3), 196–206. doi: 10.1037/a0029587 Google Scholar
Snyder, M.L., Kleck, R.E., Strenta, A., & Mentzer, S.J. (1979). Avoidance of the handicapped: An attributional ambiguity analysis. Journal of Personality and Social Psychology, 37 (12), 2297.Google Scholar
Staub, F., & Bogousslavsky, J. (2001). Fatigue after stroke: A major but neglected issue. Cerebrovascular Diseases, 12 (2), 75–81.Google Scholar
Stone, S.D. (2005). Reactions to invisible disability: The experience of young women survivors of hemorrhagic stroke. Disability and Rehabilitation, 27 (6), 293–304. doi: 10.1080/09638280400008990 CrossRefGoogle ScholarPubMed
Sullivan, K., & Waugh, D. (2005). Stroke knowledge and misconceptions among survivors of stroke and a non-stroke survivor sample. Topics in Stroke Rehabilitation, 12 (2), 72–81. doi: 10.1310/TJK4-V5W9-R5T7-GLEH Google Scholar
Swift, T.L., & Wilson, S.L. (2001). Misconceptions about brain injury among the general public and non-expert health professionals: An exploratory study. Brain Injury, 15 (2), 149–165. doi: 10.1080/02699050117322 Google Scholar
Teasell, R.W., McRae, M.P., & Finestone, H.M. (2000). Social issues in the rehabilitation of younger stroke patients. Archives of Physical Medicine and Rehabilitation, 81 (2), 205–209. doi: 10.1016/S0003-9993(00)90142-4 Google Scholar
The Dominion Post . Rugby star's shock diagnosis Stroke knocks Weepu” Post, p. A1). https://www.nzherald.co.nz/sport/news/article.cfm?c_id=4&objectid=11227764 (accessed March 25, 2014).Google Scholar
Turner-Stokes, L., & Hassan, N. (2002). Depression after stroke: A review of the evidence base to inform the development of an integrated care pathway. Part 1: Diagnosis, frequency and impact. Clinical Rehabilitation, 16 (3), 231–247. doi: 10.1191/0269215502cr487oa Google Scholar
Tversky, A., & Kahneman, D. (1974). Judgement under uncertainty: Heuristics and bias. Science, 185, 1124–1131. doi: 10.1126/science.185.4157.1124 Google Scholar
Tyrrell, P.J., & Smithard, D.G. (2005). Fatigue after stroke. Therapy, 2 (6), 865–869. doi: 10.2217/14750708.2.6.865 Google Scholar
Wellwood, I., Dennis, M.S., & Warlow, C.P. (1994). Perceptions and knowledge of stroke among surviving patients with stroke and their carers. Age and Ageing, 23 (4), 293–298. doi: 10.1093/ageing/23.4.293 Google Scholar
Wolfenden, B., & Grace, M. (2012). Identity continuity in the face of biographical disruption: ‘It's the same me’. Brain Impairment, 13 (2), 203–211. doi:10.1017/BrImp.2012.16 CrossRefGoogle Scholar
Wu, S., Mead, G., Macleod, M., & Chalder, T. (2015). Model of understanding fatigue after stroke. Stroke, 46 (3), 893–898. doi: 10.1161/STROKEAHA.114.006647 Google Scholar