Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2019

Open Access 01-12-2019 | Stroke | Research article

Associations of psychological distress with positive psychological variables and activities of daily living among stroke patients: a cross-sectional study

Authors: Xiaoxi Wang, Shengjie Shang, Huazhe Yang, Hua Ai, Yin Wang, Shijie Chang, Xianzheng Sha, Lie Wang, Xiran Jiang

Published in: BMC Psychiatry | Issue 1/2019

Login to get access

Abstract

Background

Depression and anxiety result in psychological distress, which can further affect mental status and quality of life in stroke patients. Exploring the associations between positive psychological variables and symptoms of psychological distress following stroke is of great significance for further psychological interventions.

Methods

A total of 710 stroke patients from the five largest cities in Liaoning Province in China were enrolled into the present study in July 2014. All patients independently completed the questionnaires with respect to psychological distress and positive psychological variables. Depressive and anxiety symptoms were evaluated using Center for Epidemiologic Studies Depression Scale (CES-D) and Self-Rating Anxiety Scale, respectively. Positive psychological variables were evaluated using Perceived Social Support Scale, Adult Hope Scale (AHS), General Perceived Self-Efficacy Scale and Resilience Scale-14 (RS-14). Activities of Daily Living (ADL) was measured using Barthel Index. Factors associated with psychological variables and depressive and anxiety symptoms were identified using t-test, ANOVA, correlation and hierarchical linear regression analysis.

Results

Depressive and anxiety symptoms were present in 600 of 710 (84.51%) and 537 of 710 (75.63%) stroke patients enrolled, respectively.
Social support (β = − 0.111, p < 0.001) and hope (β = − 0.120, p < 0.001) were negatively associated with both depressive and anxiety symptoms.
Resilience (β = − 0.179, p < 0.001) was negatively associated with depressive symptoms.
Self-efficacy (β = − 0.135, p < 0.001) was negatively associated with anxiety symptoms. Hierarchical regression analyses indicated that ADL accounted for 10.0 and 6.0% of the variance of depressive and anxiety symptoms, respectively.
Social support, resilience, self-efficacy and hope as a whole accounted for 7.5 and 5.3% of the variance of depressive and anxiety symptoms.

Conclusions

The high frequency of depressive and anxiety symptoms among Chinese stroke survivors should receive attentions from all stakeholders. Findings suggested that intervention strategies on ADL, social support, hope, resilience and self-efficacy could be developed to improve psychosocial outcomes for stroke survivors.
Appendix
Available only for authorised users
Literature
1.
Zhou MG, Wang HD, Zeng XY, Yin P, Zhu J, Chen WQ, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;394(10204):1145–58.CrossRefPubMedPubMedCentral
2.
Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation. 2017;135(8):759–71.CrossRefPubMed
3.
Wang YL, Li ZX, Zhao XQ, Wang D, Li H, Xian Y, et al. Stroke care quality in China: substantial improvement, and a huge challenge and opportunity. Int J Stroke. 2017;0(0):1–7.
4.
Li Z, Wang C, Zhao X, Liu L, Wang C, Li H, et al. Substantial progress yet significant opportunity for improvement in stroke care in China. Stroke. 2016;47:2843–9.CrossRefPubMed
5.
Liu LP, Wand D, Lawrence Wong KS, Wang YJ. Stroke and stroke care in China huge burden, significant workload, and a national priority. Stroke. 2011;42(12):3651–4.CrossRefPubMed
6.
Bakken LN, Kim HS, Finset A, Lerdal A. Stroke patients’ functions in personal activities of daily living in relation to sleep and socio-demographic and clinical variables in the acute phase after first-time stroke and at six months of follow-up. J Clin Nurs. 2012;21(13–14):1886–95.CrossRefPubMed
7.
Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke. 2014;9(8):1017–25.CrossRefPubMed
8.
Jones F, Partridge C, Reid F. The stroke self-efficacy questionnaire: measuring individual confidence in functional performance after stroke. J Clin Nurs. 2008;17(7B):244–52.CrossRefPubMed
9.
Carod-Artal FJ, Egido JA. Quality of life after stroke: the importance of a good recovery. Cerebrovasc Dis. 2009;27:204–14.CrossRefPubMed
10.
Bonita R, Mendis S, Truelsen T, Bogousslavsky J, Toole J, Yatsy F. The global stroke initiative. Lancet Neurol. 2004;3(7):391–3.CrossRefPubMed
11.
Braamse AM, Van Meijel B, Visser O, Van Oppen P, Boenink AD, Eeltink C, et al. Distress and quality of life after autologous stem cell transplantation: a randomized clinical trial to evaluate the outcome of a web-based stepped care intervention. BMC Cancer. 2010;10:361–9.CrossRefPubMedPubMedCentral
12.
Van Mierlo ML, Schröder C, Van Heugten CM, Post MW, De Kort PL, Visser-Meily JM. The influence of psychological factors on health-related quality of life after stroke: a systematic review. Int J Stroke. 2014;9(3):341–8.CrossRefPubMed
13.
Prieto JM, Atala J, Blanch J, Carreras E, Rovira M, Cirera E, et al. Role of depression as a predictor of mortality among cancer patients after stem-cell transplantation. J Clin Oncol. 2005;23(25):6063–71.CrossRefPubMed
14.
Yang YL, Sui GY, Liu GC, Huang DS, Wang SM, Wang L. The effects of psychological interventions on depression and anxiety among Chinese adults with cancer: a meta-analysis of randomized controlled studies. BMC Cancer. 2014;14:956.CrossRefPubMedPubMedCentral
15.
Ryan H, Schofield P, Cockburn J, Butow P, Tattersall M, Turner J, et al. How to recognize and manage psychological distress in cancer patients. Eur J Cancer Care. 2005;14(1):7–15.CrossRef
16.
Wang ZY, Liu L, Shi M, Wang L. Exploring correlations between positive psychological resources and symptoms of psychological distress among hematological cancer patients: a cross-sectional study. Psychol Health Med. 2016;21(5):571–82.CrossRefPubMed
17.
Sun W, Wu M, Qu P, Lu C, Wang L. Psychological well-being of people living with HIV/AIDS under the new epidemic characteristics in China and the risk factors: a population-based study. Int J Infect Dis. 2014;28:147–52.CrossRefPubMed
18.
Sui GY, Hu S, Sun W, Wang Y, Liu L, Yang XS, et al. Prevalence and associated factors of depressive symptoms among Chinese male correctional officers. Int Arch Occup Environ Health. 2014;87(4):387–95.CrossRefPubMed
19.
Wallston BS, Alagna SW, DeVellis BM, DeVellis RF. Social support and physical health. Health Psychol. 1983;2:367–91.CrossRef
20.
Ikeda A, Kawachi I, Iso H, Iwasaki M, Inoue M, Tsugane S. Social support and cancer incidence and mortality: the JPHC study cohort II. Cancer Causes Control. 2013;24(5):847–60.CrossRefPubMed
21.
Dreyer J, Schwartz-Attias I. Nursing care for adolescents and young adults with cancer: literature review. Acta Haematol. 2014;132(3–4):363–74.CrossRefPubMed
22.
Liu L, Xu NL, Wang L. Moderating role of self-efficacy on the associations of social support with depressive and anxiety symptoms in Chinese patients with rheumatoid arthritis. Neuropsychiatr Dis Treat. 2017;13:2141–50.CrossRefPubMedPubMedCentral
23.
Zhang H, Qian HZ, Meng SQ, Shu M, Gao YZ, Xu Y, et al. Psychological distress, social support and medication adherence in patients with ischemic stroke in the mainland of China. J Huazhong Univ Sci Technol. 2015;35(3):405–10.CrossRef
24.
Cumming TB, Cadilhac DA, Rubin G, Crafti N, Pearce DC. Psychological distress and social support in informal caregivers of stroke survivors. Brain Impair. 2008;9(2):152–60.CrossRef
25.
Barry L, Guo Z, Kerns RD, Duong BD, Reid CM. Functional self-efficacy and pain-related disability among older veterans with chronic pain in the primary care setting. Pain. 2003;104(1–2):131–7.CrossRefPubMed
26.
Robinson-Smith G, Johnston MV, Allen J. Self-care self-efficacy, quality of life, and depression after stroke. Arch Phys Med Rehabil. 2000;81(4):460–5.CrossRefPubMed
27.
Snyder CR. Hope theory: rainbows in the mind. Psychol Inq. 2002;13(4):249–75.CrossRef
28.
Ebright PR, Lyon B. Understanding hope and factors that enhance hope in women with breast cancer. Oncol Nurs Forum. 2002;29(3):561–8.CrossRefPubMed
29.
30.
Hellstrom K, Lindmark B, Wahlberg B, Fugl-Meyer AR. Self-efficacy in relation to impairments and activities of daily living in elderly patients with stroke: a prospective investigation. J Rehabil Med. 2003;35(5):202–7.CrossRefPubMed
31.
Li MY, Yang YL, Wang L. Effects of social support, hope and resilience on quality of life among Chinese bladder cancer patients: a cross-sectional study. Health Qual Life Outcomes. 2016;14:73–81.CrossRefPubMedPubMedCentral
32.
Wang Y, Bao Y, Liu L, Ramos A, Wang Y, Wang L. The mediating effect of self-efficacy in the relationship between social support and post-traumatic stress disorder symptoms among patients with central system tumors in China: a cross-sectional study. Psycho-oncol. 2015;24(12):1701–7.CrossRef
33.
Zhang L, Lou P, Zhu Y, Chen P, Zhang P, Yu J, et al. Impact of risk factors, activities and psychological disorders on the health of patients with chronic obstructive pulmonary disease in China: a cross-sectional study. BMC Public Health. 2013;13:627–34.CrossRefPubMedPubMedCentral
34.
Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Md State Med J. 1965;14(4):61–5.PubMed
35.
Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52:30–41.CrossRef
36.
Wang Y, Zhu X, Yang Y, Yi J, Tang L, He J, et al. What factors are predictive of benefit finding in women treated for non-metastatic breast cancer? A prospective study. Psycho-oncol. 2015;24:533–9.CrossRef
37.
Snyder CR, Harris C, Anderson JR, Holleran SA, Irving LM, Sigmon ST, et al. The will and the ways: development and validation of an individual-differences measure of hope. J Pers Soc Psychol. 1991;60(4):570–85.CrossRefPubMed
38.
Chen LL, Peng L, Tang T, Li M. Correlation between mental health and coping style in gynecological cancer patients (in Chinese). J Third Mil Med Univ. 2012;34:1097–9.
39.
Wagnild GM. The resilience scale user’s guide for the US English version of the resilience scale and the 14-item resilience scale (RS-14). The Resilience Center; 2009.
40.
Tian J, Hong JS. Validation of the Chinese version of the resilience scale and its cutoff score for detecting low resilience in Chinese cancer patients. Support Care Cancer. 2013;21(5):1497–502.CrossRefPubMed
41.
Schwarzer R, Jerusalem M, Weinman J, Wright S, Johnston M. Generalized Self-Efficacy scale. In: Weinman J, Wright S, Johnston M, editors. Measures in health psychology: A user’s portfolio. Causal and control beliefs. Windsor: NFER-NELSON; 1995. p. 35–7.
42.
Chiu FP, Tsang HW. Validation of the Chinese general self-efficacy scale among individuals with schizophrenia in Hong Kong. Int J Rehabil Res. 2004;27(2):159–61.CrossRefPubMed
43.
Hann D, Winter K, Jacobsen P. Measurement of depressive symptoms in cancer patients: evaluation of the center for epidemiological studies depression scale (CES-D). J Psychosom Res. 1999;46(5):437–43.CrossRefPubMed
44.
Zhang J, Lester D, Zhao S, Zhou C. Suicidal ideation and its correlates: testing the interpersonal theory of suicide in Chinese students. Arch Suicide Res. 2013;17(3):236–41.CrossRefPubMed
45.
Song Y, Huang Y, Liu D, Kwan JS, Zhang F, Sham PC, et al. Depression in college: depressive symptoms and personality factors in Beijing and Hong Kong college freshmen. Compr Psychiatry. 2008;49(5):496–502.CrossRefPubMed
46.
Wang JN, Sun W, Chi TS, Wu H, Wang L. Prevalence and associated factors of depressive symptoms among Chinese doctors: a cross-sectional survey. Int Arch Occup Environ Health. 2010;83:905–11.CrossRefPubMed
47.
Wang Y, Yao LT, Liu L, Yang XS, Wu H, Wang J, et al. The mediating role of self-efficacy in the relationship between big five personality and depressive symptoms among Chinese unemployed population: a cross-sectional study. BMC Psychiatry. 2014;14:61.CrossRefPubMedPubMedCentral
48.
49.
Li M, Wang L. The associations of psychological stress with depressive and anxiety symptoms among Chinese bladder and renal cancer patients: the mediating role of resilience. PLoS One. 2016;11(4):e0154729.CrossRefPubMedPubMedCentral
50.
Ayerbe L, Ayis S, Crichton S, Wolfe CD, Rudd AR. The long-term outcomes of depression up to 10 years after stroke; the South London stroke register. J Neurol Neurosur Ps. 2014;85(5):514–21.CrossRef
51.
Shi M, Liu L, Wang ZY, Wang L. Prevalence of depressive symptoms and its correlations with positive psychological variables among Chinese medical students: an exploratory cross-sectional study. BMC Psychiatry. 2016;16:3.CrossRefPubMedPubMedCentral
52.
Aina Y, Susman JL. Understanding comorbidity with depression and anxiety disorders. J Am Osteopath Assoc. 2006;106(2):9–14.
53.
Bozo O, Guarnaccia CA. Activities of daily living, social support, and future health of older americans. Aust J Psychol. 2010;144(1):1–14.
54.
Li Y, Yang Y, Zhang R, Yao K, Liu Z. The mediating role of mental adjustment in the relationship between perceived stress and depressive symptoms in hematological cancer patients: a cross-sectional study. PLoS One. 2015;10(11):e0142913.CrossRefPubMedPubMedCentral
55.
Lu L, Pan B, Sun W, Cheng L, Chi T, Wang L. Quality of life and related factors among cancer caregivers in China. Psychiatry Clin Neurosci. 2010;64(5):505–13.CrossRefPubMed
56.
Knapp P, Hewison J. The protective effects of social support against mood disorder after stroke. Psychol Health Med. 1998;3(3):275–83.CrossRef
57.
Kruithof WJ, Van Mierlo ML, Visser-Meily JM, Van Heugten CM, Post MW. Associations between social support and stroke survivors’ health-related quality of life-a systematic review. Patient Educ Couns. 2013;93(2):169–76.CrossRefPubMed
58.
Glass TA, Matchar BD, Belyea M, Feussner JR. Impact of social support on outcome in first stroke. Stroke. 1993;24(1):64–70.CrossRefPubMed
59.
Wilcox VL, Kasl SV, Berkman LF. Social support and physical disability in older people after hospitalization: a prospective study. Health Psychol. 1994;13(2):170–9.CrossRefPubMed
60.
Tugade MM, Fredrickson BL. Resilient individuals use positive emotions to bounce back from negative emotional experiences. J Pers Soc Psychol. 2004;86(2):320–33.CrossRefPubMedPubMedCentral
61.
He F, Cao R, Feng Z, Guan H, Peng J. The impacts of dispositional optimism and psychological resilience on the subjective well-being of burn patients: a structural equation modelling analysis. PLoS One. 2013;8(12):e82939.CrossRefPubMedPubMedCentral
62.
King G, Cathers T, Brown E, Specht JA, Willoughby C, Polgar JM, et al. Turning points and protective processes in the lives of people with chronic disabilities. Qual Health Res. 2003;13(2):184–206.CrossRefPubMed
63.
Harris PB. Another wrinkle in the debate about successful aging: the undervalued concept of resilience and the lived experience of dementia. Int J Aging Hum Dev. 2008;67(1):43–61.CrossRefPubMed
64.
65.
Hardy SE, Concato J, Gill TM. Resilience of community-dwelling older persons. J Am Geriatr Soc. 2004;52(2):257–62.CrossRefPubMed
66.
Jones F, Riazi A. Self-efficacy and self-management after stroke: a systematic review. Disabil Rehabil. 2011;33(10):797–810.CrossRefPubMed
67.
Karademas EC. Self-efficacy, social support and well-being: the mediating role of optimism. Personal Individ Differ. 2006;40:1281–90.CrossRef
68.
Kortte KB, Stevenson JE, Hosey MM, Castillo R, Wegener ST. Hope predicts positive functional role outcomes in acute rehabilitation populations. Rehabil Psychol. 2012;57(3):248–55.CrossRefPubMed
69.
Weis R, Speridakos EC. A meta-analysis of hope enhancement strategies in clinical and community settings. Psychology of Well-Being. 2011;1:5–20.CrossRef
70.
Carlson LE, Waller A, Mitchell AJ. Screening for distress and unmet needs in patients with cancer: review and recommendations. J Clin Oncol. 2012;30(11):1160–77.CrossRefPubMed
71.
Nir Z, Zolotogorsky Z, Sugarman H. Structured nursing intervention versus routine rehabilitation after stroke. Am J Phys Med Rehabil. 2004;83(7):522–9.CrossRefPubMed
72.
Li J, Wang L, Chao B, Liu Y. Prevalence of stroke in China: an epidemiological study based on the National Stroke Screening Survey. Lancet. 2015;386:S49.CrossRef
Metadata
Title
Associations of psychological distress with positive psychological variables and activities of daily living among stroke patients: a cross-sectional study
Authors
Xiaoxi Wang
Shengjie Shang
Huazhe Yang
Hua Ai
Yin Wang
Shijie Chang
Xianzheng Sha
Lie Wang
Xiran Jiang
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2019
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-019-2368-0

Other articles of this Issue 1/2019

BMC Psychiatry 1/2019 Go to the issue

Research article

Feasibility of peer support services among people with severe mental illness in China

Research article

Khat use and psychotic symptoms in a rural Khat growing population in Kenya: a household survey

Research article

The effect of perceived social support during early pregnancy on depressive symptoms at 6 weeks postpartum: a prospective study

Research article

Retrieval practice improves memory in patients with schizophrenia: new perspectives for cognitive remediation

Research article

Associations of mood symptoms with NYHA functional classes in angina pectoris patients: a cross-sectional study

Study protocol

The ReThink study: a 3-arm parallel randomized trial of cognitive bias modification, with and without adherence promotion, for adolescent anxiety disorder: trial design and protocol