Resilience And Its Predictors Of First-ever Ischemic Stroke Patients:a Longitudinal Study

ObjectiveTo investigate resilience level and its predictors,as well as to explore the effect of resilience on depression and quality of life,using a multilevel model.Participants were first-ever ischemic stroke survivors during hospitalization and at 1,3,and 6 months after discharge.MethodsA longitudinal study of 228 stroke survivors was conducted from the neurology departments of two tertiary hospitals in Shanghai between February 2017 and January 2018 using a convenient sampling method.Psychological functioning,physical functioning,and quality of life at each point was measured using the Connor-Davidson Resilience Scale(CD-RISC),the Hospital Anxiety and Depression Scale,the modified Rankin Scale,Functional Independence Measure,and the Stroke Scale Quality of Life.Covariates were also explored,including coping modes,self-efficacy,and sociodemographic data.ResultsA total of 217 patients participated at least twice;their assessments were involved in the final analysis.The mean CD-RISC score of the full sample was 62.19(14.03),and the level of resilience for all participants declined over time,with an average decrease of 3.0783 points per month.Four latent growth trajectories(or classes)for resilience were identified using a Growth Mixed Model,and nearly 40 percent of participants experienced a reduction of resilience during the first six months after the stroke.Unique influencing resilience factors were found,including religious beliefs,working and living conditions,swallowing function,days of hospitalization,type of care,self-efficacy,and coping modes.When compared to the lower-resilience survivors,individuals with higher resilience were more likely to be religious,had no job,lived alone before the stroke,had no dysphagia on admission,had a longer hospital stay,were cared for by their relatives,had higher self-efficacy,and adopted less acceptance-resignation.A higher level of resilience at hospitalization is an independent predictor for less depression occurrence at 1,3,and 6 months after discharge after controlling for depression at hospitalization and other factors.In general,the depression trajectories in the four resilience latent classes are in accordance with prototypical outcome trajectories of depression after a stressful event obtained by using the measures of depression from previous research.Resilience could play a positive role in quality of life both directly and indirectly by buffering the effects of depressive emotions.ConclusionResilience plays a positive role in the quality of life in stroke patients,which may be a new intervention target for prevention and reduction of post-stroke depression.Interventions to increase patients' levels of resilience may be beneficial to the psychological adjustment of stroke survivors.