Job strain, social support, and changes in disability among workers after stroke: Evidence from a longitudinal study in Thailand

Work-related psychosocial factors can affect cardiovascular health; however, their impact on stroke prognosis among young employed workforce remains understudied. This longitudinal study investigated the relationship of work stress, measured by the Demand-Control-Support model, with changes in disability over a year among 103 Thai workers aged 20 to 59 who had a stroke. The study evaluated job strain (combination of high demand and low control) and social support before discharge at baseline. Disability status, using the Barthel index (BI) and modified Rankin Scale (mRS), was measured at baseline, 6 months, and 12 months after discharge. Generalized estimating equations were used to test the hypothesis that job strain and social support at baseline would have direct effects on disability throughout a year. The results showed that job strain was not significantly associated with disability (both BI and mRS), while low social support was significantly associated with worse disability over a year, particularly mRS (Coefficient 0.10; 95% CI: 0.0063, 0.20). The interaction between job strain and social support was not significant. These findings suggest the potential importance of social support in the recovery process from stroke, particularly in the workplace. Given the rising global burden of stroke in working-age adults, these findings underscore the crucial role of worksite health promotion for stroke management. • Stroke has increased in incidence among younger and working-age populations, even in many low- and middle-income countries. • No study has examined impact of work stress in terms of the Demand-Control-Support model on the prognosis of stroke among workers. • In this one-year longitudinal study among workers who had experienced a stroke in Thailand, social support at work was found to be significantly associated with changes in disability status, indicating the potential importance of workplace social support in the recovery process of stroke. • The findings provide important evidence to identify effective interventions to promote supportive workplace, especially in resource-restrictive settings.