Abstract
Although there has been considerable investigation of the physical and cognitive effects of stroke, there has been very little study of the psychological impact on the person in terms of their self-image. This study is an attempt to apply the Repertory Grid Technique derived from Kelly (1955) to patients who have had a cerebrovascular accident. From an original cohort of 52 patients, 26 people without substantial receptive language impairment (Mini-Mental State Score >26) were recruited to complete the Grid. They also completed the Hospital Anxiety and Depression Scale and the Barthel Index was administered, which gives some indication of functional disability. Analysis of variance demonstrated that the patients viewed their current self more negatively than their prestroke self, with similar negative shifts in three constructs provided to all participants (independence, happiness and frustration). They did not expect this view of the self to improve over the next year. Regression analysis revealed that the presence of more (sizable) factors in the grid predicted a less dramatic change in self-image, but failed to demonstrate effects of age or anxiety scores. Where the data was not normally distributed, a significant rank correlation between the degree of change in self-image and depression scores was observed, and there was also a negative correlation between depression scores and the time elapsed since the stroke, but this was not observed between depression scores and the change in self-image. The level of functional disability was not related to change in self-image. The study suggests that stroke has strong negative effects on self-image, which are related to scores on an established depression measure. Although depression might lift somewhat as time passes, there is no indication from the data that any future improvement in self-image is expected by patients. This may indicate the need for psychological interventions with an educational component for patients early in the course of rehabilitation.