doi:10.4061/2011/534812 Review Article The Psychology of Stroke in Young Adults: The Roles of Service Provision and Return to Work

permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Literature about the psychological consequences of stroke in those under 65 is reviewed focussing on services and work. Despite similarities, young and old survivors have different experiences and needs. These are attributable to the effects of stroke on age-normative roles and activities, self-image, and the young person’s stage in the life-cycle, especially family and work. “Hidden” cognitive impairments, a disrupted sense of self, and the incongruity of suffering an “older person’s ” disease are salient. Young survivors benefit from services, but experience lack of congruence between their needs and service philosophy, methods, and aims, and consequently have unmet needs. Employment is psychologically salient, and the evidence about return rates, factors that affect return, and the adequacy of employment-related service provision is reviewed. Specific and general recommendations are made for increasing congruence between young survivors ’ needs and service provision and also for facilitating their return to work. 1. Definitions and Scope In this paper a “young ” stroke survivor will be considered to be someone aged 18 to 65 years. The lower boundary ties in with the current dividing line between childhood and adulthood, and the upper boundary with the division between working age and old age health services in many countries. This paper is based upon literature searches of several data bases (ASSIA, AMED, British Nursing Index, Cochrane database of systematic reviews, MEDLINE, Psych