Application of structural equation modeling to determine factors influencing cognitive impairment, depression, and fatigue among stroke survivors

Abstract

This study explored the causal relationships between independent factors (individual factors, stroke characteristics) and post-stroke mental health issues through physiological and behavioral mediating factors. The study design is cross-sectional with a total of 162 stroke survivors treated at Vietnam's National Geriatric Hospital between June and December, 2021. We performed structural equation modeling analysis to calculate the standardization coefficient and correlation coefficient for our hypothesis. The structural model and standardized path coefficients had a goodness-of-fit indexes of Root-MeanSquare Error of Approximation (RMSEA) of 0.089, a comparative fit index (CFI) of 0.997, a Tucker-Lewis Index (TLI) of 0.954, and a standardized root mean-square residual (SRMR) of 0.019. Sleep disorder was positively associated with increasing post-stroke depression (Coef: 4.723; p<0.001) and fatigue status (Coef: 3.846; p<0.001). By contrast, alcohol use disorder was found as a factor that decreased fatigue status (Coef:-4.460; p = 0.005). Furthermore, post-stroke disability severity was significantly related to cognitive impairment (Coef: -3.229; p<0.001), depression (Coef: 1.559; p<0.001), and fatigue (Coef: 1.701; p = 0.002). The severity of post-stroke disability was associated with increasing cognition and mental health problems. Alcohol consumption and sleeplessness were found to be mediating effects between gender and age of stroke patients with changes in post-stroke depression and fatigue.