Social functioning has been recognized for many years to play an important role in development of depression associated with stress or negative life events (Brown et al. 1986; Henderson 1990). Furthermore, the effect of social support on psychological distress depends upon the nature of the supportive attachment. Among women in a community sample, for example, inadequate social support from a spouse was found to have a greater emotional impact than lack of support from a non-spousal relationship (Andrews and Brown 1988). Although an acute physical illness, such as stroke, can serve to mobilize social support from friends and family, patients who perceive their support to be inadequate may be more vulnerable to poststroke depression than patients who do not.

We have examined the relationship between poststroke depression and social functioning as measured by the social functioning exam (SFE) (Robinson et al. 1985a) and the social ties checklist (STC) (Robinson et al. 1985a) in several studies. The SFE was developed to quantify patient satisfaction with their social functioning both before and following a stroke. The SFE is shown in Table 16.1. It is a semi-structured interview in which the examiner, after asking one or several probing questions, rates each item on a 3-point scale: 0, indicates no difficulties, 1, indicates moderate difficulties, and 2, indicates severe impairment.