Top

BMC Psychiatry

Published in:

Open Access 01-12-2024 | Stroke | Research

The mediating effects of hope on the relationships of social support and self-esteem with psychological resilience in patients with stroke

Authors: Boru Sun, Nan Wang, Ke Li, Yan Yang, Fengjiao Zhang

Published in: BMC Psychiatry | Issue 1/2024

Abstract

Purpose

To explore the mediating effect of hope in the relationships between social support and self-esteem with psychological resilience among patients with stroke survivors in early rehabilitation.

Methods

A cross-sectional study design was adopted. Data from a cross-sectional survey of 210 patients undergoing early stroke rehabilitation were analyzed using structural equation modeling. The variables of interest were measured using the Connor Davidson Resilience Scale, the Social Support Rating Scale, the Herth Hope Index, and the Self-Esteem Scale. This article reports according to the STROBE checklist.

Results

A positive relationship was found between social support and psychological resilience (β₁ = 0.548), which was mediated by hope (β₂ = 0.114), and social support had significant direct effect on resilience (β₃ = 0.434). A positive relationship was also found between self-esteem and psychological resilience (β₄ = 0.380), which was mediated by hope (β₅ = 0.200), and self-esteem had significant direct effect on resilience (β₆ = 0.179).

Conclusion

According to the results of this study, some strategies can be incorporated into the rehabilitation process to enhance psychological resilience, such as cultivating individual personality characteristics and improving patients’ social relationships. In the future, we need to explore methods for improving psychological resilience among patients with stroke in combination with their risk factors to improve their quality of life and reduce the incidence of post-stroke depression.

Available only for authorised users

Kao CC, Chiang HT, Chen CY, Hung CT, Chen YC, Su LH, et al. National bundle care program implementation to reduce ventilator-associated pneumonia in intensive care units in Taiwan. Journal of microbiology, immunology, and infection. J Microbiol Immunol Infect. 2019;52(4):592–7. https://doi.org/10.1016/j.jmii.2017.11.001. Epub 2017/12/05.CrossRefPubMed

Zhou M, Wang H, Zeng X, Yin P, Zhu J, Chen W, 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. https://doi.org/10.1016/s0140-6736(19)30427-1.CrossRefPubMedPubMedCentral

Villa RF, Ferrari F, Moretti A. Post-stroke depression: mechanisms and pharmacological treatment. Pharmacol Ther. 2018;184:131–44. https://doi.org/10.1016/j.pharmthera.2017.11.005.CrossRefPubMed

Medeiros GC, Roy D, Kontos N, Beach SR. Post-stroke depression: a 2020 updated review. Gen Hosp Psychiatry 2020 Sep-Oct;66:70–80. https://doi.org/10.1016/j.genhosppsych.2020.06.011. Epub 2020 Jun 27.

Hebert D, Lindsay MP, McIntyre A, Kirton A, Rumney PG, Bagg S, et al. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015. Int J Stroke. 2016;11(4):459–84. https://doi.org/10.1177/1747493016643553.CrossRefPubMed

Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. J Neurol. 2018;265(8):1891–9. https://doi.org/10.1007/s00415-018-8938-0.CrossRefPubMedPubMedCentral

Zhou X, Liu Z, Zhang W, Zhou L. Resilience is associated with post-stoke depression in Chinese stroke survivors: a longitudinal study (273, pg 402, 2020). J Affect Disord. 2020;274:1232. https://doi.org/10.1016/j.jad.2020.06.024.CrossRefPubMed

American Psychological Association. The road to resilience. 2017. Retrieved from https://www.apa.org/helpcenter/road-resilience.

Kim M, Kim K, Kim J-S. Impact of resilience on the health-related quality of life of adolescents with a chronic health problem: a structural equation approach. J Adv Nurs. 2019;75(4):801–11. https://doi.org/10.1111/jan.13888.CrossRefPubMed

10.

Liu ZH, Zhou X, Zhang W, Zhou LZ. Resilience is an independent correlate of the course of quality of life in patients with first-ever ischemic stroke. Int Psychogeriatr. 2021;33(6):567–75. https://doi.org/10.1017/S1041610220000587.CrossRefPubMed

11.

Burton CR. Living with stroke: a phenomenological study. J Adv Nurs. 2000;32(2):301–9. https://doi.org/10.1046/j.1365-2648.2000.01477.x.CrossRefPubMed

12.

Cross A, Schneider M. A preliminary qualitative analysis of the impact of hope on stroke recovery in women. Top Stroke Rehabil. 2010 Nov-Dec;17(6):484–95. https://doi.org/10.1310/tsr1706-484.

13.

Nilsson I, Jansson L, Norberg A. To meet with a stroke: patients’ experiences and aspects seen through a screen of crises. J Adv Nurs. 1997;25(5):953–63. https://doi.org/10.1046/j.1365-2648.1997.1997025953.x.CrossRefPubMed

14.

Popovich JM, Fox PG, Burns KR. Hope in the recovery from stroke in the U.S. Int J Psychiatr Nurs Res. 2003;8(2):905–20.PubMed

15.

Zhang W, Liu Z, Zhou X, Zhou L. Resilience among stroke survivors: a cohort study of the first 6 months. J Adv Nurs. 2020;76(2):504–13. https://doi.org/10.1111/jan.14247.CrossRefPubMed

16.

Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson Resilience scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82. https://doi.org/10.1002/da.10113.CrossRefPubMed

17.

Lim ML, Lim D, Gwee X, Nyunt MSZ, Kumar R, Ng TP. Resilience, stressful life events, and depressive symptomatology among older Chinese adults. Aging Ment Health. 2015;19(11):1005–14. https://doi.org/10.1080/13607863.2014.995591.CrossRefPubMed

18.

Michael K. Call to Action Enhancing Poststroke Resilience. Top Geriatr Rehabil. 2014;30(3):195–8. https://doi.org/10.1097/tgr.0000000000000018.CrossRef

19.

Wild K, Wiles JL, Allen RES. Resilience: thoughts on the value of the concept for critical gerontology. Ageing Soc. 2013;33:137–58. https://doi.org/10.1017/s0144686x11001073.CrossRef

20.

Herrman H, Stewart DE, Diaz-Granados N, Berger EL, Jackson B, Yuen T. What is resilience? Can J Psychiatry. 2011;56(5):258–65. https://doi.org/10.1177/070674371105600504.CrossRefPubMed

21.

Krueger EA, Upchurch DM. Sexual orientation, social support, and mental health resilience in a U.S. national sample of adults. Behav Med (Washington DC). 2020;1–9. https://doi.org/10.1080/08964289.2020.1825922. Epub 2020/10/15.

22.

Lok N, Bademli K. The Relationship between the Perceived Social Support and Psychological Resilience in caregivers of patients with Schizophrenia. Community Ment Health J. 2021;57(2):387–91. https://doi.org/10.1007/s10597-020-00665-w.CrossRefPubMed

23.

Price P, Kinghorn J, Patrick R, Cardell B. Still there is beauty: one man’s resilient adaptation to stroke. Scand J Occup Ther. 2012;19(2):111–7. https://doi.org/10.3109/11038128.2010.519402.CrossRefPubMed

24.

Sadler E, Sarre S, Tinker A, Bhalla A, McKevitt C. Developing a novel peer support intervention to promote resilience after stroke. Health Soc Care Community. 2017;25(5):1590–600. https://doi.org/10.1111/hsc.12336.CrossRefPubMed

25.

Fukuya Y, Fujiwara T, Isumi A, Doi S, Ochi M. Association of Birth Order with Mental Health Problems, Self-Esteem, Resilience, and happiness among children: results from A-CHILD study. Front Psychiatry. 2021;12. https://doi.org/10.3389/fpsyt.2021.638088.

26.

Chen S, Lewthwaite R, Schweighofer N, Winstein CJ. Discriminant validity of a new measure of self-efficacy for reaching movements after stroke-induced hemiparesis. J Hand Ther. 2013 Apr-Jun;26(2):116– 22; quiz 123. https://doi.org/10.1016/j.jht.2012.09.002.

27.

Vickery CD, Sepehri A, Evans CC. Self-esteem in an acute stroke rehabilitation sample: a control group comparison. Clin Rehabil. 2008;22(2):179–87. https://doi.org/10.1177/0269215507080142.

28.

Vickery CD, Sepehri A, Evans CC, Lee JE. The association of level and stability of self-esteem and depressive symptoms in the acute inpatient stroke rehabilitation setting. Rehabil Psychol. 2008;53:171–9. https://doi.org/10.1037/0090-5550.53.2.171.

29.

Vickery CD, Sherer M, Evans CC, Gontkovsky ST, Lee JE. The relationship between self-esteem and functional outcome in the acute stroke-rehabilitation setting. Rehabil Psychol. 2008;53:101–9. https://doi.org/10.1037/0090-5550.53.1.101.

30.

Ellis-Hill CS, Horn S. Change in identity and self-concept: a new theoretical approach to recovery following a stroke. Clin Rehabil. 2000;14(3):279–87. https://doi.org/10.1191/026921500671231410.

31.

Penninx BW, van Tilburg T, Boeke AJ, Deeg DJ, Kriegsman DM, van Eijk JT. Effects of social support and personal coping resources on depressive symptoms: different for various chronic diseases? Health Psychol. 1998;17(6):551–8. https://doi.org/10.1037//0278-6133.17.6.551.

32.

Park EY, Kim JH. An analysis of self-esteem in stroke survivors: the interaction between gender, income, and the presence of a spouse. J Ment Health. 2016;25(2):159–64. https://doi.org/10.3109/09638237.2015.1101430.

33.

Shida J, Sugawara K, Goto J, Sekito Y. Relationship between self-esteem and living conditions among stroke survivors at home. Jpn J Nurs Sci. 2014;11(4):229–40. https://doi.org/10.1111/jjns.12024. Epub 2013 Jul 16.

34.

Muhlenkamp AF, Sayles JA. Self-esteem, social support, and positive health practices. Nurs Res. 1986 Nov-Dec;35(6):334–8.

35.

Kendall E, Terry DJ. Psychosocial adjustment following closed head injury: a model for understanding individual differences and predicting outcome. Neuropsychological Rehabilitation. 1996;6:101–32. https://doi.org/10.1080/713755502.

36.

Zeigler-Hill V. The connections between self-esteem and psychopathology. J Contemp Psychother. 2011;41(3):157–64. https://doi.org/10.1007/s10879-010-9167-8.

37.

Bright FA, Kayes NM, McCann CM, McPherson KM. Understanding hope after stroke: a systematic review of the literature using concept analysis. Top Stroke Rehabil. 2011 Sep-Oct;18(5):490–508. https://doi.org/10.1310/tsr1805-490.

38.

Cross A, Schneider M. A preliminary qualitative analysis of the impact of hope on stroke recovery in women. Top Stroke Rehabil. 2010;17(6):484–95. https://doi.org/10.1310/tsr1706-484.CrossRefPubMed

39.

Snyder CR. Hope theory: rainbows in the mind. Psychol Inq. 2002;13(4):249–75. https://doi.org/10.1207/s15327965pli1304_01.CrossRef

40.

Setliff AE, Marmurek HHC. The mood regulatory function of autobiographical recall is moderated by self-esteem. Pers Individ Dif. 2002;32(4):761–71. https://doi.org/10.1016/s0191-8869(01)00078-2.CrossRef

41.

Soundy A, Stubbs B, Freeman P, Coffee P, Roskell C. Factors influencing patients’ hope in stroke and spinal cord injury: a narrative review. Int J Therapy Rehabilitation. 2014;21(5):210–8. https://doi.org/10.12968/ijtr.2014.21.5.210.CrossRef

42.

Zhou X, Wu X, Zhen R. Self-esteem and hope mediate the relations between social support and post-traumatic stress disorder and growth in adolescents following the Ya’an earthquake. Anxiety Stress Coping. 2018;31(1):32–45. https://doi.org/10.1080/10615806.2017.1374376.CrossRefPubMed

43.

Snyder CR, Michael ST, Cheavens JS. Hope as a psychotherapeutic foundation of common factors, placebos, and expectancies. The heart and soul of change: what works in therapy. Washington, DC, US: American Psychological Association; 1999. pp. 179–200.CrossRef

44.

Yadav S. Perceived social support, hope, and quality of life of persons living with HIV/AIDS: a case study from Nepal. Qual Life Res. 2010;19(2):157–66. https://doi.org/10.1007/s11136-009-9574-z. Epub 2010/01/05.CrossRefPubMed

45.

Lambert LSJORM. Beyond significance testing: Reforming Data Analysis methods in behavioral research. Am J Psychiatry. 2007;10(4):713–6. https://doi.org/10.1176/appi.ajp.162.3.643-a.CrossRef

46.

Riley RD, Ensor J, Snell K, Harrell FE, Martin GP, Reitsma JB, et al. Calculating the sample size required for developing a clinical prediction model. BMJ. 2020;368m441. https://doi.org/10.1136/bmj.m441.

47.

Mahoney FI. DW Barthel 1965 FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Maryland State Med J 14 61–5.

48.

Yu X, Zhang J. Factor analysis and psychometric evaluation of the Connor-Davidson Resilience Scale (CD-RISC) with Chinese people. Social Behav Personality: Int J. 2007;35(1):19–30. https://doi.org/10.2224/sbp.2007.35.1.19.CrossRef

49.

Xiao SY. Theoretical basis and application of social support rating scale. J Clin Psychol Med. 1994; (2):98–100.

50.

GuoYu Y, ZhengZhi F, BenLi XIA. The reliability, validity and National Norm of Social Support Scale in Servicemen. Chin Mental Health J. 2006;20(5):309–12.

51.

Herth K. Abbreviated instrument to measure hope-development and psychometric evaluation. J Adv Nurs. 1992;17(10):1251–9. https://doi.org/10.1111/j.1365-2648.1992.tb01843.x.CrossRefPubMed

52.

Rosenberg M. Society and the adolescent self-image. Princeton: Princeton University Press; 1965.CrossRef

53.

Vispoel WP, Boo J, Bleiler T. Computerized and paper-and-pencil versions of the Rosenberg Self-Esteem Scale: a comparison of psychometric features and respondent preferences. Educ Psychol Meas. 2001;61(3):461–74. https://doi.org/10.1177/00131640121971329.CrossRef

54.

Diana S. The Basics of Structural Equation Modeling. University of Northern Colorado. https://www.lexjansen.com/wuss/2006/tutorials/TUT-Suhr.pdf.

55.

Fradelos EC, Latsou D, Mitsi D, Tsaras K, Lekka D, Lavdaniti M, et al. Assessment of the relation between religiosity, mental health, and psychological resilience in breast cancer patients. Contemp Oncol (Pozn). 2018;22(3):172–7. https://doi.org/10.5114/wo.2018.78947.CrossRefPubMed

56.

Chen YY, Koenig HG. Traumatic stress and religion: is there a relationship? A review of empirical findings. J Relig Health. 2006;45(3):371–81. https://doi.org/10.1007/s10943-006-9040-y.CrossRef

57.

Liu X. The Resilience Affecting Factors of Chronic Patients and Medical Social Worker’s Strategy [Master’s degree]. Chongqing University, China; 2019.

58.

Fawzy FI, Fawzy NW, Arndt LA, Pasnau RO. Critical-review of psychological interventions in cancer care. Arch Gen Psychiatry. 1995;52(2):100–13. https://doi.org/10.1001/archpsyc.1995.03950140018003.CrossRefPubMed

59.

Mahendran N, Kuys SS, Brauer SG. Recovery of ambulation activity across the first six months post-stroke. Gait Posture. 2016;49:271–76. https://doi.org/10.1016/j.gaitpost.2016.06.038.CrossRefPubMed

60.

Mahendran N, Kuys SS, Brauer SG. Recovery of ambulation activity across the first six months post-stroke. Gait Posture. 2016;49:271–6. https://doi.org/10.1016/j.gaitpost.2016.06.038. Epub 2016/07/31.CrossRefPubMed

61.

de Lemos CM, Moraes DW, Pellanda LC. Resilience in patients with ischemic heart disease. Arq Bras Cardiol. 2016;106(2):130–5. https://doi.org/10.5935/abc.20160012. Epub 2016/01/28.CrossRefPubMedPubMedCentral

62.

Hsu H-T, Juan C-H, Chen J-L, Hsieh H-F. Mediator roles of Social Support and Hope in the relationship between body image distress and resilience in breast Cancer patients undergoing treatment: a modeling analysis. Front Psychol. 2021;12. https://doi.org/10.3389/fpsyg.2021.695682.

63.

Zhao X, Sun M, Yang Y. Effects of social support, hope and resilience on depressive symptoms within 18 months after diagnosis of prostate cancer. Health Qual Life Outcomes. 2021;19(1). https://doi.org/10.1186/s12955-020-01660-1.

64.

Xiang G, Teng Z, Li Q, Chen H, Guo C. The influence of perceived social support on hope: a longitudinal study of older-aged adolescents in China. Child Youth Serv Rev. 2020;119(c):105616. https://doi.org/10.1016/j.childyouth.2020.105616.CrossRef

65.

Kemer G, Atik G. Hope and social support in high school students from urban and rural areas of Ankara, Turkey. J Happiness Stud. 2012;13(5):901–11. https://doi.org/10.1007/s10902-011-9297-z.CrossRef

66.

Morley CA, Kohrt BA. Impact of peer support on PTSD, hope, and functional impairment: a mixed-methods study of child soldiers in Nepal. J Aggress Maltreatment Trauma. 2013;22(7):714–34. https://doi.org/10.1080/10926771.2013.813882.CrossRef

67.

Simmons BL, Gooty J, Nelson DL, Little LM. Secure attachment: implications for hope, trust, burnout, and performance. J Organizational Behavior: Int J Industrial Occup Organizational Psychol Behav. 2009;30(2):233–47. https://doi.org/10.1002/job.585.CrossRef

68.

Li Z, Yin X. How social support influences hope in college students: the mediating roles of self-esteem and self-efficacy. Psychol Dev Educ. 2015;31(5):610–7. https://doi.org/10.16187/j.cnki.issn1001-4918.2015.05.13.CrossRef

69.

Ong AD, Edwards LM, Bergeman CS. Hope as a source of resilience in later adulthood. Pers Indiv Differ. 2006;41(7):1263–73. https://doi.org/10.1016/j.paid.2006.03.028.CrossRef

70.

Kirmani MN, Sharma P, Anas M, Sanam R. Hope, resilience and subjective well-being among college going adolescent girls. Int J Humanit Social Sci Stud. 2015;2(1):262–70.

71.

Mullin A. Children’s hope, resilience and autonomy. Ethics Social Welf. 2019;13(3):230–43. https://doi.org/10.1080/17496535.2019.1588907.CrossRef

72.

Satici SA. Psychological vulnerability, resilience, and subjective well-being: the mediating role of hope. Pers Indiv Differ. 2016;102:68–73. https://doi.org/10.1016/j.paid.2016.06.057.CrossRef

73.

Granek L, Barrera M, Shaheed J, Nicholas D, Beaune L, D’agostino N, Antle B. Trajectory of parental hope when a child has difficult-to-treat cancer: a prospective qualitative study. Psycho-oncology. 2013;22(11):2436–44. https://doi.org/10.1002/pon.3305.CrossRefPubMed

74.

Condly SJ. Resilience in children: a review of literature with implications for education. Urban Educ. 2006;41(3):211–36. https://doi.org/10.1177/0042085906287902.CrossRef

75.

Mashiach-Eizenberg M, Hasson-Ohayon I, Yanos PT, Lysaker PH, Roe D. Internalized stigma and quality of life among persons with severe mental illness: the mediating roles of self-esteem and hope. Psychiatry Res. 2013;208(1):15–20. https://doi.org/10.1016/j.psychres.2013.03.013.CrossRefPubMedPubMedCentral

76.

Cotter VT, Gonzalez EW, Fisher K, Richards KC. Influence of hope, social support, and self-esteem in early-stage dementia. Dement (London). 2018;17(2):214–24. https://doi.org/10.1177/1471301217741744.CrossRef

77.

Liu JJW, Reed M, Fung KP. Advancements to the Multi-system Model of Resilience: updates from empirical evidence. Heliyon. 2020;6(9). https://doi.org/10.1016/j.heliyon.2020.e04831.

Title: The mediating effects of hope on the relationships of social support and self-esteem with psychological resilience in patients with stroke
Authors: Boru Sun
Nan Wang
Ke Li
Yan Yang
Fengjiao Zhang
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Stroke
Published in: BMC Psychiatry / Issue 1/2024
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-024-05744-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The mediating effects of hope on the relationships of social support and self-esteem with psychological resilience in patients with stroke

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

The Bergen 4-day treatment for social anxiety disorder: a pilot study

Analysis of depression incidence and influence factors among middle-aged and elderly diabetic patients in China: based on CHARLS data

The association between anxiety and internet addiction among left-behind secondary school students: the moderating effect of social support and family types

Challenges of living with veterans with post-traumatic stress disorder from the perspective of spouses: a qualitative content analysis study

ØCD: protocol for the development and evaluation of a cognitive-behavioral prevention program for obsessive-compulsive disorder

Exploring adverse events of Vilazodone: evidence from the FAERS database