Stage Evolution Analysis of Psychological-Social-Family Fun ction in Young Patients with Ischemic Stroke

Stage Evolution Analysis of Psychological-Social-Family Fun ction in Young Patients with Ischemic Stroke | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Stage Evolution Analysis of Psychological-Social-Family Fun ction in Young Patients with Ischemic Stroke juan bao, hao gao, xian zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9184506/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Objective To analyze the dynamic evolution characteristics of psychological, social, and family functions in young patients with ischemic stroke at different disease stages. Methods A longitudinal cohort design was adopted, enrolling 432 young patients with ischemic stroke. Indicators from the GAD-7, PHQ-9, ADL, FAQ, Zarit Burden Interview (ZBI), and APGAR scales were dynamically monitored during the acute, recovery, and sequelae phases. Results Regarding psychological status, anxiety and depression exhibited a "double-peak" pattern in the acute and recovery phases and were significantly associated with a significant post-stroke income reduction. Regarding social and family aspects, the recovery phase presented a complex situation characterized by the superposition of various functional disorders and the heaviest caregiver burden (particularly prominent in single-parent families). Conclusion The psychological, social, and family functions of young patients with ischemic stroke show specific changes across different disease stages. The recovery phase is the stage where these problems are most concentrated and complex, warranting increased clinical and research attention. Health sciences/Diseases Health sciences/Health care Health sciences/Neurology Biological sciences/Neuroscience Biological sciences/Psychology Social science/Psychology Young ischemic stroke Psychological function Social function Family function INTRODUCTION Young ischemic stroke (YIS) accounts for approximately 10%–15% of all ischemic strokes, and its incidence is increasing annually [1] . Most young people are at a critical stage of career development and family responsibility. Ischemic stroke not only impairs normal physical functions but also leads to psychological disorders, accompanied by declined social function and increased family care pressure [2,3] . Current clinical interventions mostly focus on physical rehabilitation in the acute and recovery phases, with insufficient attention to social dysfunction, family care burden, psychological adaptation, and other disease-related issues [4,5] . This study conducted long-term follow-up to analyze dynamic changes in psychological status, social function, and family function among YIS patients across the acute, recovery, and sequelae phases [6,7] , so as to provide evidence for formulating individualized comprehensive treatment plans [8,9] . SUBJECTS AND METHODS 1.1 Research Subjects A total of 432 patients with ischemic stroke aged 18-44 years admitted to the Second Affiliated Hospital of Kunming Medical University from January 2021 to April 2025 were selected as research subjects in this study. 1.1.1 Inclusion and Exclusion Criteria Inclusion Criteria: 1. Meeting the diagnostic criteria for ischemic stroke, aged 18-44 years; 2. Within 7 days of onset and in stable condition (stable vital signs, no progressive aggravation of neurological deficit symptoms); 3. Conscious, without severe communication disorders, able to understand the assessment content. Exclusion Criteria: 1. Patients with other types of cerebral hemorrhage diseases such as hemorrhagic stroke and subarachnoid hemorrhage; 2. A clear history of mental illness or cognitive impairment in the past; 3. Complicated with severe organ failure of heart, liver, kidney, etc. (such as NYHA grade Ⅳ cardiac function, Child-Pugh grade C liver function) or malignant tumor (expected survival time < 1 year); 4. Severe assessment disorders: complete aphasia, consciousness disorders (lethargy, stupor or coma), etc.; 5. Loss to follow-up or refusal to continue participating in the study during the follow-up period; 1.2 Research Methods 1.2.1 Assessment Tools 1.2.1.1 Psychological State Assessment: Generalized Anxiety Disorder scale (GAD-7): A score ≥ 5 was defined as an "anxiety state".Patient Health Questionnaire (PHQ-9): A score ≥ 5 was defined as a "depressive state".Post-stroke income changes were investigated via questionnaire and categorized into "significant income reduction (income decreased by ≥50%)" and "basically stable income (income decreased by ≤30%)" for analysis (see Table 2). 1.2.1.2 Social Function Assessment: Activity of Daily Living Scale (ADL): A score > 40 was defined as "moderate to severe physical dysfunction" .Functional Activities Questionnaire (FAQ): Cognitive-related functions mainly included "handling affairs" (Item 1: writing checks, paying bills, balancing checkbook; Item 2: assembling tax, business, or family records) and "social interaction and communication" (Item 8: understanding and discussing TV, books, magazine content; Item 9: remembering appointments), reflecting patients' executive function, memory, and social cognition. Complex social participation functions mainly included "using public transportation" (Item 10: traveling alone, driving, or arranging public transport) and "participation in housework" (Item 5: simple meal preparation; Item 6: balanced meal preparation), reflecting patients' capacity for independent living and participation in household tasks within the community. A score ≥ 2 on an item indicated dysfunction in that corresponding function. Multiple social dysfunctions referred to the presence of any two or more of physical dysfunction, cognitive-related dysfunction, and complex social participation dysfunction (see Table 3). 1.2.1.3 Family System Assessment: Zarit Burden Interview (ZBI): A score > 60 was defined as "severe caregiver burden" .Family APGAR Index: It includes five aspects: Adaptation, Partnership, Growth, Affection, and Resolve. A score <7was defined as "moderate to severe family dysfunction" , indicating significant deficiencies in family support, communication, and emotional expression (see Table 4). 1.2.2 Data Collection and Follow-up Clinical data: Demographic and clinical data such as patients' gender, age, disease course, past medical history (hypertension, diabetes, coronary heart disease) and changes in post-illness income were collected. Longitudinal follow-up was conducted at different stages. Acute phase (within 2 weeks post-onset): The first assessment was completed within 1 week of onset. Recovery phase (2 weeks to 6 months post-onset): The second assessment was completed at 3 months post-onset. Sequelae phase (after 6 months post-onset): The third assessment was completed at 9 months post-onset. 1.2.3 Ethical Approval This study was performed in accordance with the principles of the Declaration of Helsinki. All experimental protocols were approved by the Ethics Committee of the Second Affiliated Hospital of Kunming Medical University (Approval No.: 审-PJ-科-2025-325). All methods were carried out in accordance with relevant guidelines and regulations. 1.2.4 Informed Consent This study was a retrospective analysis of clinical data. The requirement for informed consent was waived by the Ethics Committee of the Second Affiliated Hospital of Kunming Medical University (Approval No.: 审-PJ-科-2025-325) due to the retrospective nature of the study and the use of de-identified data. Patient confidentiality was strictly maintained throughout the research process. 1.3 Statistical Methods SPSS 26.0 statistical software was used for data analysis. Measurement data were expressed as mean ± standard deviation (x±s). One-way analysis of variance was used for comparison among multiple groups (acute phase, recovery phase, sequelae phase), and repeated measures analysis of variance was used for comparison at different time points within the group (the same patient at different disease stages). The Greenhouse-Geisser correction coefficient (ε=0.82) was used in the repeated measures analysis of variance to adjust the results. Count data were expressed as frequency (percentage), and the χ² test was used for comparison between groups. RESULTS 2.1 Baseline Characteristics of Research Subjects A total of 432 YIS patients were included in this study, including 278 males (65.4%) with a mean age of (35.8 ± 6.1) years; and 154 females (34.6%) with a mean age of (37.1 ± 5.2) years. There were 132 cases (30.6%) complicated with hypertension, 89 cases (20.6%) with diabetes, and 52 cases (12.0%) with coronary heart disease (see Table 1 ). Table 1 Baseline characteristics of research subjects (n = 432) Male (n, %) Female ( n , %) Mean age of males (years) Mean age of females (years) Hypertension ( n , %) Diabetes ( n , %) Coronary heart disease ( n , %) 278 cases (65.4%) 154 cases (34.6%) 35.8 ± 6.1 37.1 ± 5.2 132 cases (30.6%) 89 cases (20.6%) 52 cases (12.0%) 2.2 Psychological State Changes at Different Disease Stages The incidence of anxiety and depression in the acute phase (30.1%, 25.0%) and recovery phase (28.0%, 22.9%) was significantly higher than in the sequelae phase (15.0%, 12.0%). The comorbidity rate of anxiety + depression decreased with the disease stage ( χ ²=35.19, p < 0.001). In the recovery phase, 48.1% (208/432) of patients experienced a significant post-stroke income reduction, among whom 31.2% had significant emotional problems, significantly higher than the incidence (12.5%) in patients with basically stable income during the same period (see Table 2 ). Table 2 Anxiety and depression status at different disease stages and the incidence of psychological disorders in different income groups Indicators ( n , %) Acute Phase Recovery Phase Sequelae Phase χ ² Value P Value GAD-7 ≥ 5 points (n, %) 130 (30.1%) 121 (28.0%) 65 (15.0%) 42.36 < 0.001 PHQ-9 ≥ 5 points (n, %) 108 (25.0%) 99 (22.9%) 52 (12.0%) 38.72 < 0.001 Comorbidity of GAD-7 ≥ 5 points and PHQ-9 ≥ 5 points (n, %) 86 (19.9%) 78 (18.1%) 38 (8.8%) 35.19 < 0.001 Patients with psychological disorders in the group with income reduction ≥ 50% (n, %) 30/105 (28.6%) 65/208 (31.2%) 24/132 (18.2%) - - Patients with psychological disorders in the group with income reduction ≤ 30% (n, %) 42/327 (12.8%) 28/224 (12.5%) 28/300 (9.3%) - - 2.3 Stage-specific Disorders in Social Function Recovery Social function recovery exhibited stage-specific patterns: the acute phase was mainly characterized by "physical dysfunction" (28.0%), manifested as an ADL score > 40 (moderate to severe dependence); the recovery phase was prominent for "cognitive-related dysfunction" (22.0%), manifested as FAQ scores ≥ 2 on items such as "handling affairs" and "social interaction and communication"; the sequelae phase had the highest proportion of "complex social participation dysfunction" (28.0%), manifested as FAQ scores ≥ 2 on items such as "using public transportation" and "participation in housework". In the recovery phase, 41.2% of patients had two or more types of dysfunction simultaneously, significantly higher than in the acute phase (12.9%) and sequelae phase (21.3%) (see Table 3 ). Table 3 Distribution of social function disorder types at different disease stages Types of Disorders Acute Phase (n, %) Recovery Phase (n, %) Sequelae Phase (n, %) χ ² Value (Intergroup Comparison) P Value ADL score > 40 points (n, %) 121 (28.0%) 86 (19.9%) 74 (17.1%) 12.58 < 0.01 FAQ cognitive-related functional disorders (item score ≥ 2 points) (n, %) 52 (12.0%) 95 (22.0%) 74 (17.1%) 9.72 < 0.01 FAQ complex social participation functional disorders (item score ≥ 2 points) (n, %) 65 (15.0%) 108 (25.0%) 121 (28.0%) 16.38 < 0.001 Multiple social function disorders (≥ 2 types) (n, %) 56 (12.9%) 178 (41.2%) 92 (21.3%) 48.26 < 0.001 2.4 Changes in Family Function-related Indicators at Different Disease Stages In family function, severe caregiver burden and moderate to severe family function disorder both reached their peaks in the recovery phase, accounting for 50.0% and 34.9% respectively, which were significantly higher than those in the acute phase and sequelae phase; among them, the proportion of severe caregiver burden in single-parent families showed an overall trend of first increasing and then decreasing in different periods ( χ ²=12.54, p = 0.002) (see Table 4 ). Table 4 Statistics of caregiver burden and family function-related indicators at different disease stages Indicators Acute Phase (n, %) Recovery Phase (n, %) Sequelae Phase (n, %) χ ² Value P Value Severe caregiver burden (Zarit > 60 points) (n, %) 141 (32.6%) 216 (50.0%) 165 (38.1%) 18.36 < 0.001 Proportion of single-parent families in the group with severe caregiver burden (n, %) 92 (65.3%) 156 (72.2%) 97 (58.7%) 12.54 0.002 APGAR score < 7 points (n, %) 123 (28.5%) 151 (34.9%) 114 (26.3%) 11.27 < 0.01 DISCUSSION Young stroke patients are at a critical stage of career development, family formation, and social role establishment, leading to different needs from other age groups in disease coping, functional reconstruction, and long-term adaptation [2,3,29] . Current clinical management recommendations for stroke are mostly based on data from elderly patients, and no clear consensus or practical individualized guidance has been established for interventions targeting young populations [1,15] . This study focused on the characteristics of young ischemic stroke patients at different disease stages to identify core difficulties and provide a basis for clinical support programs. Emotional disorders in YIS patients are stage-specific, showing a “double-peak” pattern in the acute and recovery phases, with incidence higher than in the sequelae phase, jointly influenced by biomedical, psychosocial, and economic factors. The incidence of post-stroke depression (PSD) in elderly patients is approximately 18%–25%, lower than in YIS patients, with the peak mostly in the recovery phase [10,11,31] . This difference may be related to greater economic pressure and disrupted social roles after stroke in young patients [5,8] . From a pathophysiological perspective, the first peak of anxiety and depression in the acute phase may be related to the direct effects of stroke on neurobiological changes, including limbic system injury and monoamine neurotransmitter dysregulation [23,28] . Among patients with significant income reduction in the recovery phase, 31.2% had emotional problems, higher than 12.5% in the stable income group, indicating that economic pressure is an important driver of the second psychological peak in the recovery phase [13,22] . Decreased working ability and reduced income further aggravate psychological burden. Our results clearly show that regular emotional screening is necessary throughout stroke management, especially during the acute and recovery phases. Furthermore, preventive psychological intervention for high-risk groups such as those with expected income decline may reduce the risk of post-stroke psychological complications [4,20] . Social function recovery in YIS patients shows obvious stage differences with disease progression. The acute phase is dominated by physical dysfunction; in the sequelae phase, complex social participation dysfunction becomes more prominent. The recovery phase is the most concentrated and complex period for social function problems, during which 41.2% of patients have two or more coexisting dysfunctions, significantly higher than in the acute and sequelae phases. Specifically, patients in the recovery phase face challenges in multiple domains: cognitively, 22.0% show significant impairment in FAQ items such as “handling affairs” and “social interaction”, reflecting reduced information processing and executive ability [14,25] . For complex social participation, 25.0% have difficulties in “using public transport” and “housework participation”. Although influenced by physical function, these dysfunctions are more related to psychological status; anxiety, depression, and stigma may reduce willingness and confidence to participate in social activities [7,24] . Physically, 19.9% still have moderate–severe dependence (ADL > 40), indicating incomplete recovery of basic daily abilities. Cognitive, social participation, and physical dysfunctions interact and jointly restrict social function: cognitive dysfunction limits social information processing, social participation dysfunction directly hinders community integration, and incomplete physical recovery further aggravates participation barriers [14,26,32] . These findings are consistent with Xiao et al. [12] that perceived participation in young and middle-aged stroke survivors after discharge is affected by multiple factors, and confirm Della et al. [14] that restricted social participation results from combined effects of multiple functional impairments and environmental factors. Mussa et al. [2] also noted that young stroke patients face synergistic challenges in social and occupational life. After entering the recovery phase, family pressure reaches the highest level post-stroke. In this stage, the proportion of severe caregiver burden reaches 50.0%, and moderate–severe family dysfunction 34.9%, both higher than in the acute and sequelae phases. Such inter-stage differences are related to multiple factors [16,17,19] . In the acute phase, despite severe neurological deficits, centralized care in professional medical institutions shares the main responsibility. After entering the recovery phase, patients return home for recuperation; daily living abilities are not fully recovered, requiring continuous rehabilitation and complication management, leading to a rapid increase in family care pressure. In the recovery phase, 34.9% of patients have APGAR < 7, suggesting family dysfunction in support, communication, growth, affection, and company. After returning to family life, the original division of labor changes, and family members need to renegotiate responsibilities. Long-term care burden continuously consumes emotional resources, weakens intimate interactions, and impairs family function [18,21,27] . Rannikko et al. [21] proposed from an ethical perspective that families often undergo a process of value and responsibility reconstruction after stroke, and the recovery phase is critical for this adjustment. Notably, single-parent families account for 72.2% of the severe burden group in the recovery phase, higher than in other periods, mainly due to the single support structure in single-parent families, where the main caregiver independently bears financial, care, and emotional responsibilities, leading to more concentrated pressure [16,27] . Existing evidence suggests that establishing clear daily care plans, reasonably distributing family responsibilities, and forming consistent rehabilitation goals during the recovery phase are clinically important for improving family function and relieving caregiver burden [9,19,30] . Rehabilitation of YIS patients goes far beyond physical recovery. It spans the acute, recovery, and sequelae phases and is closely linked to patients’ critical stages of career and family life. Patients need to complete psychological adjustment, reintegrate into social roles, and adapt to family pressure, all of which are challenging [3,6,29] . Based on the stage-specific characteristics of young ischemic stroke patients, clinical interventions should be staged and focus on core needs at each phase. In the acute phase, interventions should prioritize physical recovery, disease education, and prognosis counseling to help patients understand their condition, relieve anxiety, and lay a foundation for subsequent rehabilitation. In the recovery phase, existing interventions should be maintained, while reducing family care pressure and supporting patients to gradually return to society, including assisting with return to work, social activities, and family role resumption [8,15,24] . In the sequelae phase, help patients accept that physical function may not fully recover, learn to use residual abilities in daily life and work, enhance life confidence, and maintain a stable and high-quality rhythm. This staged, individualized intervention matches the core needs of young patients at different stages and helps them achieve rehabilitation and smooth social reintegration [5,20,32] . Declarations Conflicts of Interest: The authors declare no conflicts of interest. Author Contributions: Juan Bao and Xian Zhang contributed to the conception and design of the study. Hao Gao contributed to data collection, analysis, and interpretation. All authors participated in drafting and revising the manuscript. All authors approved the final version for submission. Funding: This study received no specific funding from any funding agency in the public, commercial, or not-for-profit sectors. Data Availability Statement: The datasets generated and analyzed during the current study are not publicly available due to patient privacy and confidentiality restrictions, but are available from the corresponding author on reasonable request and with the approval of the institutional ethics committee. References Rasing A, Hilkens N, Leeuw DEF. Young stroke: An update on epidemiology, emerging risk factors, and future research directions. International Journal of Stroke. 2026;21(1):6-13. doi:10.1177/17474930251400524 Chen R, Zhang J, Qu Y, et al. The trajectory of depression-related symptom clusters following stroke: A network and latent class analysis. Journal of Affective Disorders. 2025;389:119659. doi:10.1016/J.JAD.2025.119659 Kuo YW, Chen LK, Tseng MS, et al. The Care Needs, Preferences, and Coping Strategies of Young Stroke Survivors: A Qualitative Study. The Journal of Cardiovascular Nursing. 2025. doi:10.1097/JCN.0000000000001193 Liu S, Zhou W, Wu X, et al. Post-traumatic growth in young and middle-aged patients with stroke: a qualitative systematic review and meta-synthesis. BMC Psychology. 2025;13(1):967. doi:10.1186/S40359-025-03321-8 Lo SHS, Chau JPC, Butt L, et al. Young stroke survivors' experiences and approaches to community reintegration: a descriptive qualitative study. BMC Public Health. 2025;26(1):269. doi:10.1186/s12889-025-25918-9 Moretta P, Marcuccio L, Cavallo DN, et al. Clinical and Linguistic Correlates of Functional Communication Abilities After Stroke: A Longitudinal Study. Brain Sciences. 2025;15(10):1027. doi:10.3390/BRAINSCI15101027 Mussa R, Ambler G, Ozkan H, et al. Patient-reported outcomes after stroke in young adults: University College London (UCL) Young Stroke Systematic Evaluation Study (ULYSSES). Journal of Neurology, Neurosurgery, and Psychiatry. 2025. doi:10.1136/JNNP-2025-336411 Wu JX, Ke K, Liu H, et al. Social isolation in the young and middle-aged patients with stroke: role of social support, family resilience and hope. Frontiers in Psychiatry. 2025;16:1499186. doi:10.3389/FPSYT.2025.1499186 Åsa Franzén Dahlin, Hoang MT, von Koch L, et al. A cross-sectional study of associations between stroke survivors' disability and caregiver burden dimensions. Journal of Clinical Neuroscience. 2025;141:111599. doi:10.1016/J.JOCN.2025.111599 Bartoníčková D, Gurková E, Zeleníková R, et al. Return to work after ischaemic stroke in young adults: a scoping review. Central European Journal of Public Health. 2024;32(2):108-118. doi:10.21101/CEJPH.A7938 Huang V, Marais O, Mortenson BW, et al. "I just kept asking and asking and there was nothing": re-thinking community resources & supports for young adult stroke survivors. Disability and Rehabilitation. 2024;47(11):2877-2886. doi:10.1080/09638288.2024.2404185 Ignacio KHD, Muir RT, Diestro JDB, et al. Prevalence of depression and anxiety symptoms after stroke in young adults: A systematic review and meta-analysis. Journal of Stroke and Cerebrovascular Diseases. 2024;33(7):107732. doi:10.1016/j.jstrokecerebrovasdis.2024.107732 Ni H, Liu Y, Yang J, et al. The association between caregiver burden, social capital, and family functioning among caregivers of older adults with PSD - A cross-sectional study. Psychology, Health & Medicine. 2024;30(2):11-13. doi:10.1080/13548506.2024.2411064 Wang H, Zhu L, Cao W, et al. Family resilience, patient-reported symptoms in young stroke dyads: The effect of caregiver readiness and social support. Journal of Clinical Nursing. 2024;33(10):3954-3968. doi:10.1111/JOCN.17046 Xu Q, Ma J, Zhang Y, et al. Family resilience and social support as mediators of caregiver burden and capacity in stroke caregivers: a cross-sectional study. Frontiers in Psychology. 2024;15:1435867. doi:10.3389/fpsyg.2024.1435867 Dandan X, ZhenXiang Z, Song G, et al. Physio-psycho-social interaction mechanism in dyadic health of young and middle-aged stroke survivors and their spousal caregivers: a longitudinal observational study protocol. BMJ Open. 2023;13(4):e065767. doi:10.1136/BMJOPEN-2022-065767 Rannikko S, Suhonen R, Pasanen M, et al. The ethical pathway of individuals with stroke-A follow-up study. Scandinavian Journal of Caring Sciences. 2023. doi:10.1111/SCS.13215 Wei Z, Mingming Y, Wanqiong Z, et al. Trajectory and predictors of family function in caregivers of stroke survivors: A longitudinal study of the first 6 months after stroke. Journal of Advanced Nursing. 2023;80(1):264-274. doi:10.1111/JAN.15749 Della CV, Marie P, Julie H, et al. Factors associated with post-stroke social participation: a quantitative study based on the ICF framework. Annals of Physical and Rehabilitation Medicine. 2022;66(3):101686. doi:10.1016/J.REHAB.2022.101686 Wei Z, Wanqiong Z, Mingming Y, et al. Family resilience of stroke survivors within 6 months after a first-episode stroke: A longitudinal study. Frontiers in Psychiatry. 2022;13:968933. doi:10.3389/FPSYT.2022.968933 Gabrielle WH, Rosa G, Qing Y, et al. Socio-ecological perspective on factors influencing acute recovery of younger stroke survivors: A mixed methods study. Journal of Advanced Nursing. 2021;77(6):2860-2874. doi:10.1111/JAN.14778 Gong SH, Sun C, Yang H, et al. Meta-integration of disease experience in young and middle-aged stroke patients. Chinese Journal of Nursing. 2021;56(6):843-851. [in Chinese] Cheng C, Fan W, Liu C, et al. Reminiscence therapy--based care program relieves post-stroke cognitive impairment, anxiety, and depression in acute ischemic stroke patients: a randomized, controlled study. Irish Journal of Medical Science. 2020;190(1):345-355. doi:10.1007/s11845-020-02273-9 Feng-Hang C, Yen-Nung L, Tsan-Hon L. Recovery After Stroke: Perspectives of Young Stroke Survivors in Taiwan. Archives of Physical Medicine and Rehabilitation. 2020;101(11):e32. doi:10.1016/j.apmr.2020.09.089 Medeiros CG, Roy D, Kontos N, et al. Post-stroke depression: A 2020 updated review. General Hospital Psychiatry. 2020;66:70-80. doi:10.1016/j.genhosppsych.2020.06.011 Rohner A, Gutbrod K, Kühnis B, et al. Health-Related Quality of Life in Young Adults Following Pediatric Arterial Ischemic Stroke. Stroke. 2020;51(3):952-957. doi:10.1161/STROKEAHA.119.027622 Sussana O, Cecilia E, Albert A. Why Me?: A Qualitative Study on the Experiences of Young Stroke Survivors in the Accra Metropolis of Ghana, West Africa. Journal of Patient Experience. 2020;7(6):1788-1796. doi:10.1177/2374373520967505 The Road to Family Resiliency: A Case Report of a Family's Experiences Following Adolescent Stroke. Rehabilitation Nursing. 2020;46(2). doi:10.1097/RNJ.0000000000000293 Zhang S, Xu M, Liu ZJ, et al. Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications. World Journal of Psychiatry. 2020;10(6):125-138. doi:10.5498/wjp.v10.i6.125 Chen X, Yang BB, Guan WJ, et al. Status quo of psychological resilience in young and middle-aged stroke patients and its influencing factors. Nursing Research. 2020;34(11):1882-1887. [in Chinese] Xiao L, Gao Y, Zeng K, et al. Perceived participation and its determinants among young and middle-aged stroke survivors following acute care one month after discharge. Disability and Rehabilitation. 2019;43(5):648-656. doi:10.1080/09638288.2019.1636314 Shi Y, Yang D, Zeng Y, et al. Risk Factors for Post-stroke Depression: A Meta-analysis. Frontiers in Aging Neuroscience. 2017;9:218. doi:10.3389/fnagi.2017.00218 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 17 Apr, 2026 Editor assigned by journal 14 Apr, 2026 Editor invited by journal 13 Apr, 2026 Submission checks completed at journal 27 Mar, 2026 First submitted to journal 27 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9184506","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":625663374,"identity":"7b768e1c-3cc9-4df9-8848-48d7fb904a6c","order_by":0,"name":"juan bao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYBACNvbGxsd/fvxjtm9mPkCcFj6ew4cNeHsOsBuwtyUQp0VOwi1NgIftAL8BzxkDIh0mwWPGIMFzR9pcIufjjTcMdnK6DYS0SPeYPTCweGZsOSN3s+UchmRjswOEtMicMTdI4GFOZriRu02ah+FA4jaCWiRyzCQOsDHXN9zIeUaslrQ0yQa2w8wGZ86wEakFGMjGjD1pzJLtbcaWcwyI8It8OzAqGX7YMPMzMz+88abCTo6gFhQgwUNk1CBrIVXHKBgFo2AUjAgAAEFtP/vZyy2HAAAAAElFTkSuQmCC","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":true,"prefix":"","firstName":"juan","middleName":"","lastName":"bao","suffix":""},{"id":625663375,"identity":"af5ef3e6-9937-4861-b1b8-de26e9e16436","order_by":1,"name":"hao gao","email":"","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":false,"prefix":"","firstName":"hao","middleName":"","lastName":"gao","suffix":""},{"id":625663376,"identity":"22c3cc20-2db2-4a1a-82d2-8f44c4df3bdf","order_by":2,"name":"xian zhang","email":"","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":false,"prefix":"","firstName":"xian","middleName":"","lastName":"zhang","suffix":""}],"badges":[],"createdAt":"2026-03-21 08:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9184506/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9184506/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108006060,"identity":"69853a9c-459b-47a6-8986-5be25b329f84","added_by":"auto","created_at":"2026-04-28 12:52:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":256318,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9184506/v1/ec1f4c7a-14a9-4f82-9915-1d7995e1ca0c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Stage Evolution Analysis of Psychological-Social-Family Fun ction in Young Patients with Ischemic Stroke","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eYoung ischemic stroke (YIS) accounts for approximately 10%\u0026ndash;15% of all ischemic strokes, and its incidence is increasing annually\u003csup\u003e[1]\u003c/sup\u003e. Most young people are at a critical stage of career development and family responsibility. Ischemic stroke not only impairs normal physical functions but also leads to psychological disorders, accompanied by declined social function and increased family care pressure\u003csup\u003e[2,3]\u003c/sup\u003e. Current clinical interventions mostly focus on physical rehabilitation in the acute and recovery phases, with insufficient attention to social dysfunction, family care burden, psychological adaptation, and other disease-related issues\u003csup\u003e[4,5]\u003c/sup\u003e. This study conducted long-term follow-up to analyze dynamic changes in psychological status, social function, and family function among YIS patients across the acute, recovery, and sequelae phases\u003csup\u003e[6,7]\u003c/sup\u003e, so as to provide evidence for formulating individualized comprehensive treatment plans\u003csup\u003e[8,9]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"SUBJECTS AND METHODS","content":"\u003cp\u003e1.1 Research Subjects\u003c/p\u003e\n\u003cp\u003eA total of 432 patients with ischemic stroke aged 18-44 years admitted to the Second Affiliated Hospital of Kunming Medical University from January 2021 to April 2025 were selected as research subjects in this study.\u003c/p\u003e\n\u003cp\u003e1.1.1 Inclusion and Exclusion Criteria\u003c/p\u003e\n\u003cp\u003eInclusion Criteria:\u003c/p\u003e\n\u003cp\u003e1. Meeting the diagnostic criteria for ischemic stroke, aged 18-44 years;\u003c/p\u003e\n\u003cp\u003e2. Within 7 days of onset and in stable condition\u0026nbsp;(stable vital signs, no progressive aggravation of neurological deficit symptoms);\u003c/p\u003e\n\u003cp\u003e3. Conscious, without severe communication disorders, able to understand the assessment content.\u003c/p\u003e\n\u003cp\u003eExclusion Criteria:\u003c/p\u003e\n\u003cp\u003e1. Patients with other types of cerebral hemorrhage diseases such as hemorrhagic stroke and subarachnoid hemorrhage;\u003c/p\u003e\n\u003cp\u003e2. A clear history of mental illness or cognitive impairment in the past;\u003c/p\u003e\n\u003cp\u003e3. Complicated with severe organ failure of heart, liver, kidney, etc. (such as NYHA grade Ⅳ cardiac function, Child-Pugh grade C liver function) or malignant tumor (expected survival time \u0026lt; 1 year);\u003c/p\u003e\n\u003cp\u003e4. Severe assessment disorders: complete aphasia, consciousness disorders (lethargy, stupor or coma), etc.;\u003c/p\u003e\n\u003cp\u003e5. Loss to follow-up or refusal to continue participating in the study during the follow-up period;\u003c/p\u003e\n\u003cp\u003e1.2 Research Methods\u003c/p\u003e\n\u003cp\u003e1.2.1 Assessment Tools\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1.1 Psychological State Assessment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGeneralized Anxiety Disorder scale (GAD-7): A score \u0026ge; 5 was defined as an \u0026quot;anxiety state\u0026quot;.Patient Health Questionnaire (PHQ-9): A score \u0026ge; 5 was defined as a \u0026quot;depressive state\u0026quot;.Post-stroke income changes were investigated via questionnaire and categorized into \u0026quot;significant income reduction (income decreased by \u0026ge;50%)\u0026quot; and \u0026quot;basically stable income (income decreased by \u0026le;30%)\u0026quot; for analysis (see Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1.2 Social Function Assessment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eActivity of Daily Living Scale (ADL): A score \u0026gt; 40 was defined as \u0026quot;moderate to severe physical dysfunction\u0026quot; .Functional Activities Questionnaire (FAQ): Cognitive-related functions mainly included \u0026quot;handling affairs\u0026quot; (Item 1: writing checks, paying bills, balancing checkbook; Item 2: assembling tax, business, or family records) and \u0026quot;social interaction and communication\u0026quot; (Item 8: understanding and discussing TV, books, magazine content; Item 9: remembering appointments), reflecting patients\u0026apos; executive function, memory, and social cognition. Complex social participation functions mainly included \u0026quot;using public transportation\u0026quot; (Item 10: traveling alone, driving, or arranging public transport) and \u0026quot;participation in housework\u0026quot; (Item 5: simple meal preparation; Item 6: balanced meal preparation), reflecting patients\u0026apos; capacity for independent living and participation in household tasks within the community. A score\u0026nbsp;\u0026ge;\u0026nbsp;2 on an item indicated dysfunction in that corresponding function. Multiple social dysfunctions referred to the presence of any two or more of physical dysfunction, cognitive-related dysfunction, and complex social participation dysfunction (see Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1.3 Family System Assessment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZarit Burden Interview (ZBI): A score \u0026gt; 60 was defined as \u0026quot;severe caregiver burden\u0026quot; .Family APGAR Index: It includes five aspects: Adaptation, Partnership, Growth, Affection, and Resolve. A score \u0026lt;7was defined as \u0026quot;moderate to severe family dysfunction\u0026quot; , indicating significant deficiencies in family support, communication, and emotional expression (see Table 4).\u003c/p\u003e\n\u003cp\u003e1.2.2 Data Collection and Follow-up\u003c/p\u003e\n\u003cp\u003eClinical data: Demographic and clinical data such as patients\u0026apos; gender, age, disease course, past medical history (hypertension, diabetes, coronary heart disease) and changes in post-illness income were collected.\u003c/p\u003e\n\u003cp\u003eLongitudinal follow-up was conducted at different stages. Acute phase (within 2 weeks post-onset): The first assessment was completed within 1 week of onset. Recovery phase (2 weeks to 6 months post-onset): The second assessment was completed at 3 months post-onset. Sequelae phase (after 6 months post-onset): The third assessment was completed at 9 months post-onset.\u003c/p\u003e\n\u003cp\u003e1.2.3 Ethical Approval\u003c/p\u003e\n\u003cp\u003eThis study was performed in accordance with the principles of the Declaration of Helsinki. All experimental protocols were approved by the Ethics Committee of the Second Affiliated Hospital of Kunming Medical University (Approval No.:\u0026nbsp;审-PJ-科-2025-325). All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e1.2.4 Informed Consent\u003c/p\u003e\n\u003cp\u003eThis study was a retrospective analysis of clinical data. The requirement for informed consent was waived by the Ethics Committee of the Second Affiliated Hospital of Kunming Medical University (Approval No.:\u0026nbsp;审-PJ-科-2025-325) due to the retrospective nature of the study and the use of de-identified data. Patient confidentiality was strictly maintained throughout the research process.\u003c/p\u003e\n\u003cp\u003e1.3 Statistical Methods\u003c/p\u003e\n\u003cp\u003eSPSS 26.0 statistical software was used for data analysis. Measurement data were expressed as mean \u0026plusmn; standard deviation (x\u0026plusmn;s). One-way analysis of variance was used for comparison among multiple groups (acute phase, recovery phase, sequelae phase), and repeated measures analysis of variance was used for comparison at different time points within the group (the same patient at different disease stages). The Greenhouse-Geisser correction coefficient (\u0026epsilon;=0.82) was used in the repeated measures analysis of variance to adjust the results. Count data were expressed as frequency (percentage), and the \u0026chi;\u0026sup2; test was used for comparison between groups.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Baseline Characteristics of Research Subjects\u003c/h2\u003e \u003cp\u003eA total of 432 YIS patients were included in this study, including 278 males (65.4%) with a mean age of (35.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1) years; and 154 females (34.6%) with a mean age of (37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2) years. There were 132 cases (30.6%) complicated with hypertension, 89 cases (20.6%) with diabetes, and 52 cases (12.0%) with coronary heart disease (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of research subjects (n\u0026thinsp;=\u0026thinsp;432)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale (\u003cem\u003en\u003c/em\u003e, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean age of males (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean age of females (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHypertension (\u003cem\u003en\u003c/em\u003e, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDiabetes (\u003cem\u003en\u003c/em\u003e, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCoronary heart disease (\u003cem\u003en\u003c/em\u003e, %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e278 cases (65.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 cases (34.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e132 cases (30.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89 cases (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e52 cases (12.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Psychological State Changes at Different Disease Stages\u003c/h2\u003e \u003cp\u003eThe incidence of anxiety and depression in the acute phase (30.1%, 25.0%) and recovery phase (28.0%, 22.9%) was significantly higher than in the sequelae phase (15.0%, 12.0%). The comorbidity rate of anxiety\u0026thinsp;+\u0026thinsp;depression decreased with the disease stage (\u003cem\u003eχ\u003c/em\u003e\u0026sup2;=35.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the recovery phase, 48.1% (208/432) of patients experienced a significant post-stroke income reduction, among whom 31.2% had significant emotional problems, significantly higher than the incidence (12.5%) in patients with basically stable income during the same period (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnxiety and depression status at different disease stages and the incidence of psychological disorders in different income groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicators (\u003cem\u003en\u003c/em\u003e, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute Phase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRecovery Phase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSequelae Phase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u0026sup2; Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGAD-7\u0026thinsp;\u0026ge;\u0026thinsp;5 points (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e130 (30.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePHQ-9\u0026thinsp;\u0026ge;\u0026thinsp;5 points (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52 (12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity of GAD-7\u0026thinsp;\u0026ge;\u0026thinsp;5 points and PHQ-9\u0026thinsp;\u0026ge;\u0026thinsp;5 points (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78 (18.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients with psychological disorders in the group with income reduction\u0026thinsp;\u0026ge;\u0026thinsp;50% (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30/105 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65/208 (31.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24/132 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients with psychological disorders in the group with income reduction\u0026thinsp;\u0026le;\u0026thinsp;30% (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42/327 (12.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28/224 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28/300 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Stage-specific Disorders in Social Function Recovery\u003c/h2\u003e \u003cp\u003eSocial function recovery exhibited stage-specific patterns: the acute phase was mainly characterized by \"physical dysfunction\" (28.0%), manifested as an ADL score\u0026thinsp;\u0026gt;\u0026thinsp;40 (moderate to severe dependence); the recovery phase was prominent for \"cognitive-related dysfunction\" (22.0%), manifested as FAQ scores\u0026thinsp;\u0026ge;\u0026thinsp;2 on items such as \"handling affairs\" and \"social interaction and communication\"; the sequelae phase had the highest proportion of \"complex social participation dysfunction\" (28.0%), manifested as FAQ scores\u0026thinsp;\u0026ge;\u0026thinsp;2 on items such as \"using public transportation\" and \"participation in housework\". In the recovery phase, 41.2% of patients had two or more types of dysfunction simultaneously, significantly higher than in the acute phase (12.9%) and sequelae phase (21.3%) (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of social function disorder types at different disease stages\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTypes of Disorders\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute Phase (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRecovery Phase (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSequelae Phase (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u0026sup2; Value (Intergroup Comparison)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADL score\u0026thinsp;\u0026gt;\u0026thinsp;40 points (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74 (17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAQ cognitive-related functional disorders (item score\u0026thinsp;\u0026ge;\u0026thinsp;2 points) (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95 (22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74 (17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAQ complex social participation functional disorders (item score\u0026thinsp;\u0026ge;\u0026thinsp;2 points) (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e121 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple social function disorders (\u0026ge;\u0026thinsp;2 types) (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92 (21.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Changes in Family Function-related Indicators at Different Disease Stages\u003c/h2\u003e \u003cp\u003eIn family function, severe caregiver burden and moderate to severe family function disorder both reached their peaks in the recovery phase, accounting for 50.0% and 34.9% respectively, which were significantly higher than those in the acute phase and sequelae phase; among them, the proportion of severe caregiver burden in single-parent families showed an overall trend of first increasing and then decreasing in different periods (\u003cem\u003eχ\u003c/em\u003e\u0026sup2;=12.54, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStatistics of caregiver burden and family function-related indicators at different disease stages\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute Phase\u003c/p\u003e \u003cp\u003e(n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRecovery Phase\u003c/p\u003e \u003cp\u003e(n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSequelae Phase\u003c/p\u003e \u003cp\u003e(n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u0026sup2; Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere caregiver burden (Zarit\u0026thinsp;\u0026gt;\u0026thinsp;60 points) (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e216 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e165 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of single-parent families in the group with severe caregiver burden (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92 (65.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e156 (72.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97 (58.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPGAR score\u0026thinsp;\u0026lt;\u0026thinsp;7 points (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123 (28.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151 (34.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e114 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eYoung stroke patients are at a critical stage of career development, family formation, and social role establishment, leading to different needs from other age groups in disease coping, functional reconstruction, and long-term adaptation\u003csup\u003e[2,3,29]\u003c/sup\u003e. Current clinical management recommendations for stroke are mostly based on data from elderly patients, and no clear consensus or practical individualized guidance has been established for interventions targeting young populations\u003csup\u003e[1,15]\u003c/sup\u003e. This study focused on the characteristics of young ischemic stroke patients at different disease stages to identify core difficulties and provide a basis for clinical support programs.\u003c/p\u003e \u003cp\u003eEmotional disorders in YIS patients are stage-specific, showing a \u0026ldquo;double-peak\u0026rdquo; pattern in the acute and recovery phases, with incidence higher than in the sequelae phase, jointly influenced by biomedical, psychosocial, and economic factors. The incidence of post-stroke depression (PSD) in elderly patients is approximately 18%\u0026ndash;25%, lower than in YIS patients, with the peak mostly in the recovery phase \u003csup\u003e[10,11,31]\u003c/sup\u003e. This difference may be related to greater economic pressure and disrupted social roles after stroke in young patients\u003csup\u003e[5,8]\u003c/sup\u003e. From a pathophysiological perspective, the first peak of anxiety and depression in the acute phase may be related to the direct effects of stroke on neurobiological changes, including limbic system injury and monoamine neurotransmitter dysregulation\u003csup\u003e[23,28]\u003c/sup\u003e. Among patients with significant income reduction in the recovery phase, 31.2% had emotional problems, higher than 12.5% in the stable income group, indicating that economic pressure is an important driver of the second psychological peak in the recovery phase\u003csup\u003e[13,22]\u003c/sup\u003e. Decreased working ability and reduced income further aggravate psychological burden. Our results clearly show that regular emotional screening is necessary throughout stroke management, especially during the acute and recovery phases. Furthermore, preventive psychological intervention for high-risk groups such as those with expected income decline may reduce the risk of post-stroke psychological complications\u003csup\u003e[4,20]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSocial function recovery in YIS patients shows obvious stage differences with disease progression. The acute phase is dominated by physical dysfunction; in the sequelae phase, complex social participation dysfunction becomes more prominent. The recovery phase is the most concentrated and complex period for social function problems, during which 41.2% of patients have two or more coexisting dysfunctions, significantly higher than in the acute and sequelae phases. Specifically, patients in the recovery phase face challenges in multiple domains: cognitively, 22.0% show significant impairment in FAQ items such as \u0026ldquo;handling affairs\u0026rdquo; and \u0026ldquo;social interaction\u0026rdquo;, reflecting reduced information processing and executive ability\u003csup\u003e[14,25]\u003c/sup\u003e. For complex social participation, 25.0% have difficulties in \u0026ldquo;using public transport\u0026rdquo; and \u0026ldquo;housework participation\u0026rdquo;. Although influenced by physical function, these dysfunctions are more related to psychological status; anxiety, depression, and stigma may reduce willingness and confidence to participate in social activities\u003csup\u003e[7,24]\u003c/sup\u003e. Physically, 19.9% still have moderate\u0026ndash;severe dependence (ADL\u0026thinsp;\u0026gt;\u0026thinsp;40), indicating incomplete recovery of basic daily abilities. Cognitive, social participation, and physical dysfunctions interact and jointly restrict social function: cognitive dysfunction limits social information processing, social participation dysfunction directly hinders community integration, and incomplete physical recovery further aggravates participation barriers\u003csup\u003e[14,26,32]\u003c/sup\u003e. These findings are consistent with Xiao et al.\u003csup\u003e[12]\u003c/sup\u003e that perceived participation in young and middle-aged stroke survivors after discharge is affected by multiple factors, and confirm Della et al.\u003csup\u003e[14]\u003c/sup\u003e that restricted social participation results from combined effects of multiple functional impairments and environmental factors. Mussa et al.\u003csup\u003e[2]\u003c/sup\u003e also noted that young stroke patients face synergistic challenges in social and occupational life.\u003c/p\u003e \u003cp\u003eAfter entering the recovery phase, family pressure reaches the highest level post-stroke. In this stage, the proportion of severe caregiver burden reaches 50.0%, and moderate\u0026ndash;severe family dysfunction 34.9%, both higher than in the acute and sequelae phases. Such inter-stage differences are related to multiple factors\u003csup\u003e[16,17,19]\u003c/sup\u003e. In the acute phase, despite severe neurological deficits, centralized care in professional medical institutions shares the main responsibility. After entering the recovery phase, patients return home for recuperation; daily living abilities are not fully recovered, requiring continuous rehabilitation and complication management, leading to a rapid increase in family care pressure. In the recovery phase, 34.9% of patients have APGAR\u0026thinsp;\u0026lt;\u0026thinsp;7, suggesting family dysfunction in support, communication, growth, affection, and company. After returning to family life, the original division of labor changes, and family members need to renegotiate responsibilities. Long-term care burden continuously consumes emotional resources, weakens intimate interactions, and impairs family function\u003csup\u003e[18,21,27]\u003c/sup\u003e. Rannikko et al.\u003csup\u003e[21]\u003c/sup\u003e proposed from an ethical perspective that families often undergo a process of value and responsibility reconstruction after stroke, and the recovery phase is critical for this adjustment. Notably, single-parent families account for 72.2% of the severe burden group in the recovery phase, higher than in other periods, mainly due to the single support structure in single-parent families, where the main caregiver independently bears financial, care, and emotional responsibilities, leading to more concentrated pressure\u003csup\u003e[16,27]\u003c/sup\u003e. Existing evidence suggests that establishing clear daily care plans, reasonably distributing family responsibilities, and forming consistent rehabilitation goals during the recovery phase are clinically important for improving family function and relieving caregiver burden \u003csup\u003e[9,19,30]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRehabilitation of YIS patients goes far beyond physical recovery. It spans the acute, recovery, and sequelae phases and is closely linked to patients\u0026rsquo; critical stages of career and family life. Patients need to complete psychological adjustment, reintegrate into social roles, and adapt to family pressure, all of which are challenging\u003csup\u003e[3,6,29]\u003c/sup\u003e. Based on the stage-specific characteristics of young ischemic stroke patients, clinical interventions should be staged and focus on core needs at each phase. In the acute phase, interventions should prioritize physical recovery, disease education, and prognosis counseling to help patients understand their condition, relieve anxiety, and lay a foundation for subsequent rehabilitation. In the recovery phase, existing interventions should be maintained, while reducing family care pressure and supporting patients to gradually return to society, including assisting with return to work, social activities, and family role resumption\u003csup\u003e[8,15,24]\u003c/sup\u003e. In the sequelae phase, help patients accept that physical function may not fully recover, learn to use residual abilities in daily life and work, enhance life confidence, and maintain a stable and high-quality rhythm. This staged, individualized intervention matches the core needs of young patients at different stages and helps them achieve rehabilitation and smooth social reintegration\u003csup\u003e[5,20,32]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJuan Bao and Xian Zhang contributed to the conception and design of the study. Hao Gao contributed to data collection, analysis, and interpretation. All authors participated in drafting and revising the manuscript. All authors approved the final version for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no specific funding from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to patient privacy and confidentiality restrictions, but are available from the corresponding author on reasonable request and with the approval of the institutional ethics committee.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRasing A, Hilkens N, Leeuw DEF. Young stroke: An update on epidemiology, emerging risk factors, and future research directions. International Journal of Stroke. 2026;21(1):6-13. doi:10.1177/17474930251400524\u003c/li\u003e\n\u003cli\u003eChen R, Zhang J, Qu Y, et al. The trajectory of depression-related symptom clusters following stroke: A network and latent class analysis. Journal of Affective Disorders. 2025;389:119659. doi:10.1016/J.JAD.2025.119659\u003c/li\u003e\n\u003cli\u003eKuo YW, Chen LK, Tseng MS, et al. The Care Needs, Preferences, and Coping Strategies of Young Stroke Survivors: A Qualitative Study. The Journal of Cardiovascular Nursing. 2025. doi:10.1097/JCN.0000000000001193\u003c/li\u003e\n\u003cli\u003eLiu S, Zhou W, Wu X, et al. Post-traumatic growth in young and middle-aged patients with stroke: a qualitative systematic review and meta-synthesis. BMC Psychology. 2025;13(1):967. doi:10.1186/S40359-025-03321-8\u003c/li\u003e\n\u003cli\u003eLo SHS, Chau JPC, Butt L, et al. Young stroke survivors\u0026apos; experiences and approaches to community reintegration: a descriptive qualitative study. BMC Public Health. 2025;26(1):269. doi:10.1186/s12889-025-25918-9\u003c/li\u003e\n\u003cli\u003eMoretta P, Marcuccio L, Cavallo DN, et al. Clinical and Linguistic Correlates of Functional Communication Abilities After Stroke: A Longitudinal Study. Brain Sciences. 2025;15(10):1027. doi:10.3390/BRAINSCI15101027\u003c/li\u003e\n\u003cli\u003eMussa R, Ambler G, Ozkan H, et al. Patient-reported outcomes after stroke in young adults: University College London (UCL) Young Stroke Systematic Evaluation Study (ULYSSES). Journal of Neurology, Neurosurgery, and Psychiatry. 2025. doi:10.1136/JNNP-2025-336411\u003c/li\u003e\n\u003cli\u003eWu JX, Ke K, Liu H, et al. Social isolation in the young and middle-aged patients with stroke: role of social support, family resilience and hope. Frontiers in Psychiatry. 2025;16:1499186. doi:10.3389/FPSYT.2025.1499186\u003c/li\u003e\n\u003cli\u003e\u0026Aring;sa Franz\u0026eacute;n Dahlin, Hoang MT, von Koch L, et al. A cross-sectional study of associations between stroke survivors\u0026apos; disability and caregiver burden dimensions. Journal of Clinical Neuroscience. 2025;141:111599. doi:10.1016/J.JOCN.2025.111599\u003c/li\u003e\n\u003cli\u003eBarton\u0026iacute;čkov\u0026aacute; D, Gurkov\u0026aacute; E, Zelen\u0026iacute;kov\u0026aacute; R, et al. Return to work after ischaemic stroke in young adults: a scoping review. Central European Journal of Public Health. 2024;32(2):108-118. doi:10.21101/CEJPH.A7938\u003c/li\u003e\n\u003cli\u003eHuang V, Marais O, Mortenson BW, et al. \u0026quot;I just kept asking and asking and there was nothing\u0026quot;: re-thinking community resources \u0026amp; supports for young adult stroke survivors. Disability and Rehabilitation. 2024;47(11):2877-2886. doi:10.1080/09638288.2024.2404185\u003c/li\u003e\n\u003cli\u003eIgnacio KHD, Muir RT, Diestro JDB, et al. Prevalence of depression and anxiety symptoms after stroke in young adults: A systematic review and meta-analysis. Journal of Stroke and Cerebrovascular Diseases. 2024;33(7):107732. doi:10.1016/j.jstrokecerebrovasdis.2024.107732\u003c/li\u003e\n\u003cli\u003eNi H, Liu Y, Yang J, et al. The association between caregiver burden, social capital, and family functioning among caregivers of older adults with PSD - A cross-sectional study. Psychology, Health \u0026amp; Medicine. 2024;30(2):11-13. doi:10.1080/13548506.2024.2411064\u003c/li\u003e\n\u003cli\u003eWang H, Zhu L, Cao W, et al. Family resilience, patient-reported symptoms in young stroke dyads: The effect of caregiver readiness and social support. Journal of Clinical Nursing. 2024;33(10):3954-3968. doi:10.1111/JOCN.17046\u003c/li\u003e\n\u003cli\u003eXu Q, Ma J, Zhang Y, et al. Family resilience and social support as mediators of caregiver burden and capacity in stroke caregivers: a cross-sectional study. Frontiers in Psychology. 2024;15:1435867. doi:10.3389/fpsyg.2024.1435867\u003c/li\u003e\n\u003cli\u003eDandan X, ZhenXiang Z, Song G, et al. Physio-psycho-social interaction mechanism in dyadic health of young and middle-aged stroke survivors and their spousal caregivers: a longitudinal observational study protocol. BMJ Open. 2023;13(4):e065767. doi:10.1136/BMJOPEN-2022-065767\u003c/li\u003e\n\u003cli\u003eRannikko S, Suhonen R, Pasanen M, et al. The ethical pathway of individuals with stroke-A follow-up study. Scandinavian Journal of Caring Sciences. 2023. doi:10.1111/SCS.13215\u003c/li\u003e\n\u003cli\u003eWei Z, Mingming Y, Wanqiong Z, et al. Trajectory and predictors of family function in caregivers of stroke survivors: A longitudinal study of the first 6 months after stroke. Journal of Advanced Nursing. 2023;80(1):264-274. doi:10.1111/JAN.15749\u003c/li\u003e\n\u003cli\u003eDella CV, Marie P, Julie H, et al. Factors associated with post-stroke social participation: a quantitative study based on the ICF framework. Annals of Physical and Rehabilitation Medicine. 2022;66(3):101686. doi:10.1016/J.REHAB.2022.101686\u003c/li\u003e\n\u003cli\u003eWei Z, Wanqiong Z, Mingming Y, et al. Family resilience of stroke survivors within 6 months after a first-episode stroke: A longitudinal study. Frontiers in Psychiatry. 2022;13:968933. doi:10.3389/FPSYT.2022.968933\u003c/li\u003e\n\u003cli\u003eGabrielle WH, Rosa G, Qing Y, et al. Socio-ecological perspective on factors influencing acute recovery of younger stroke survivors: A mixed methods study. Journal of Advanced Nursing. 2021;77(6):2860-2874. doi:10.1111/JAN.14778\u003c/li\u003e\n\u003cli\u003eGong SH, Sun C, Yang H, et al. Meta-integration of disease experience in young and middle-aged stroke patients. Chinese Journal of Nursing. 2021;56(6):843-851. [in Chinese]\u003c/li\u003e\n\u003cli\u003eCheng C, Fan W, Liu C, et al. Reminiscence therapy--based care program relieves post-stroke cognitive impairment, anxiety, and depression in acute ischemic stroke patients: a randomized, controlled study. Irish Journal of Medical Science. 2020;190(1):345-355. doi:10.1007/s11845-020-02273-9\u003c/li\u003e\n\u003cli\u003eFeng-Hang C, Yen-Nung L, Tsan-Hon L. Recovery After Stroke: Perspectives of Young Stroke Survivors in Taiwan. Archives of Physical Medicine and Rehabilitation. 2020;101(11):e32. doi:10.1016/j.apmr.2020.09.089\u003c/li\u003e\n\u003cli\u003eMedeiros CG, Roy D, Kontos N, et al. Post-stroke depression: A 2020 updated review. General Hospital Psychiatry. 2020;66:70-80. doi:10.1016/j.genhosppsych.2020.06.011\u003c/li\u003e\n\u003cli\u003eRohner A, Gutbrod K, K\u0026uuml;hnis B, et al. Health-Related Quality of Life in Young Adults Following Pediatric Arterial Ischemic Stroke. Stroke. 2020;51(3):952-957. doi:10.1161/STROKEAHA.119.027622\u003c/li\u003e\n\u003cli\u003eSussana O, Cecilia E, Albert A. Why Me?: A Qualitative Study on the Experiences of Young Stroke Survivors in the Accra Metropolis of Ghana, West Africa. Journal of Patient Experience. 2020;7(6):1788-1796. doi:10.1177/2374373520967505\u003c/li\u003e\n\u003cli\u003eThe Road to Family Resiliency: A Case Report of a Family\u0026apos;s Experiences Following Adolescent Stroke. Rehabilitation Nursing. 2020;46(2). doi:10.1097/RNJ.0000000000000293\u003c/li\u003e\n\u003cli\u003eZhang S, Xu M, Liu ZJ, et al. Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications. World Journal of Psychiatry. 2020;10(6):125-138. doi:10.5498/wjp.v10.i6.125\u003c/li\u003e\n\u003cli\u003eChen X, Yang BB, Guan WJ, et al. Status quo of psychological resilience in young and middle-aged stroke patients and its influencing factors. Nursing Research. 2020;34(11):1882-1887. [in Chinese]\u003c/li\u003e\n\u003cli\u003eXiao L, Gao Y, Zeng K, et al. Perceived participation and its determinants among young and middle-aged stroke survivors following acute care one month after discharge. Disability and Rehabilitation. 2019;43(5):648-656. doi:10.1080/09638288.2019.1636314\u003c/li\u003e\n\u003cli\u003eShi Y, Yang D, Zeng Y, et al. Risk Factors for Post-stroke Depression: A Meta-analysis. Frontiers in Aging Neuroscience. 2017;9:218. doi:10.3389/fnagi.2017.00218\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Young ischemic stroke, Psychological function, Social function, Family function","lastPublishedDoi":"10.21203/rs.3.rs-9184506/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9184506/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e To analyze the dynamic evolution characteristics of psychological, social, and family functions in young patients with ischemic stroke at different disease stages.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e A longitudinal cohort design was adopted, enrolling 432 young patients with ischemic stroke. Indicators from the GAD-7, PHQ-9, ADL, FAQ, Zarit Burden Interview (ZBI), and APGAR scales were dynamically monitored during the acute, recovery, and sequelae phases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Regarding psychological status, anxiety and depression exhibited a \"double-peak\" pattern in the acute and recovery phases and were significantly associated with a significant post-stroke income reduction. Regarding social and family aspects, the recovery phase presented a complex situation characterized by the superposition of various functional disorders and the heaviest caregiver burden (particularly prominent in single-parent families).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e The psychological, social, and family functions of young patients with ischemic stroke show specific changes across different disease stages. The recovery phase is the stage where these problems are most concentrated and complex, warranting increased clinical and research attention.\u003c/p\u003e","manuscriptTitle":"Stage Evolution Analysis of Psychological-Social-Family Fun ction in Young Patients with Ischemic Stroke","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-24 16:19:33","doi":"10.21203/rs.3.rs-9184506/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-17T09:31:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-14T16:35:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-13T14:48:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-27T14:52:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-03-27T14:47:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"da94ead4-06b2-483e-8589-03d4980f0255","owner":[],"postedDate":"April 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":66593290,"name":"Health sciences/Diseases"},{"id":66593291,"name":"Health sciences/Health care"},{"id":66593292,"name":"Health sciences/Neurology"},{"id":66593293,"name":"Biological sciences/Neuroscience"},{"id":66593294,"name":"Biological sciences/Psychology"},{"id":66593295,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-04-24T16:19:33+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-24 16:19:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9184506","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9184506","identity":"rs-9184506","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}