Objective: To explore the impacts of social participation and the environment on depression among people with stroke.
Design: Cross-sectional survey.
Setting: Structured interviews in the participants' homes.
Subjects: Community-dwelling persons with stroke in the rural areas of China ( N = 639).
Interventions: Not applicable.
Main measures: Depression (Hamilton Rating Scale for Depression-6), activity and social participation (Chinese version of the World Health Organization's Disability Assessment Schedule 2.0), environmental barriers (Craig Hospital Inventory of Environmental Factors), neurological function (Canadian Neurological Scale).
Results: A total of 42% of the variance in depression was explained by the environmental barriers, neurological function, activity, and social participation factors studied. Social participation, services/assistance, and attitudes/support were directly related to depression; their standardized regression coefficients were 0.530, 0.162, and 0.092, respectively ( p ⩽ 0.01). The physical environment, policies, and neurological function indirectly impacted depression. Depression influences social participation in turn, with a standardized regression coefficient of 0.29 ( p ⩽ 0.01).
Conclusions: Depression and social participation are inversely related. The physical environment, services/assistance, attitudes/support, and policies all impact post-stroke depression.
Keywords: China; Stroke; depression; environment; rehabilitation; social participation; structural equation modelling.