Opposing Associations of Stress and Resilience With Functional Outcomes in Stroke Survivors in the Chronic Phase of Stroke: A Cross-Sectional Study.

Prajwal Gyawali,Coralie English,Michael Nilsson,Lin Kooi Ong,Madeleine Hinwood,Murielle Kluge,Wei Zhen Chow,Frederick Rohan Walker

doi:10.3389/fneur.2020.00230

Abstract

Stroke survivors report significant levels of psychological distress post stroke. To date, most studies conducted have focused on the relationship between psychological stress and functional outcomes in the acute phase of stroke. However, no studies had considered the role of stress over the chronic phase, where stress may continue to exert negative effects on cognitive and psychological processes. Further, the role of potentially modulatory variables, such as psychological resilience, on stroke outcomes has been understudied. The purpose of this study was to consider the relationships between stress and resilience with functional outcomes in long-term survivors of stroke. People (N = 70) who had experienced a stroke between 5 months and 28 years ago were included in the cross-sectional study, along with age-matched controls (N = 70). We measured stress using both the Perceived Stress Scale and biological markers, and resilience using both the Brief Resilience Scale and the Connor-Davidson Resilience Scale. Stroke outcomes were assessed using the Stroke Impact Scale. We found that, compared with age-matched controls, stroke survivors reported greater levels of perceived stress, and lower levels of resilience. In stroke survivors, both perceived stress and resilience were independently associated with stroke outcomes in linear regression models. In particular, these relationships were observed for cognitive outcomes including mood, memory, and communication. The association between stress and stroke outcome did not differ across time post stroke. Given that resilience is a modifiable psychological construct, future research may consider whether strategies directed at enhancing resilience may improve recovery from stroke.Australia and New Zealand Clinical Trials Registry: ACTRN12617000736347.

Highlights

Psychological stress refers to the negative emotional states generated when an individual perceives that they do not have the resources to cope with or respond to a threat, whether that threat is real or imagined [1]
We explore whether the relationship between stress and cognitive or emotional outcomes is affected by time post stroke
We investigated the relationship between resilience and stroke outcome in stroke survivors using two complementary scales, the Brief Resilience Scale (BRS) and the Connor Davidson Resilience Scale (CD-RISC), thought to capture different aspects of resilience

Summary

Introduction

Psychological stress refers to the negative emotional states generated when an individual perceives that they do not have the resources to cope with or respond to a threat, whether that threat is real or imagined [1]. Over a longer time frame, Ostwald et al identified a relationship between self-reported stress, using the ten-item Perceived Stress Scale (PSS-10), and functional outcomes at 3, 6, 9, and 12 months post-stroke [7]. A recent systematic review of 48 studies showed that elevated cortisol, a stress biomarker, is associated with increased dependency, morbidity, and mortality post-stroke [9]. These studies have examined relationships between stress and broad functional stroke outcomes for up to 24 months post-stroke, increasing survival rates mean that stroke survivors may live for several decades following stroke onset. Knowledge around the impact of stress over these longer time frames remains limited

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