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

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.

Similar cognitive deficits in mice and humans in the chronic phase post-stroke identified using the touchscreen-based paired-associate learning task

“…Dyslipidaemia was reported in 54.3% (n = 38) of the stroke cohort compared to 22.9% (n = 16) in the control cohort ( p < 0.001). It should be noted that the details of stroke were self-reported by the study participants, and the primary measure for this cohort was to investigate the relationships between stress and resilience with functional outcomes in long-term survivors of stroke, as reported in our recent publication 22 , 23 .…”

“…Exclusion criteria included a history of pituitary and adrenal gland diseases. The participants were part of a cross-sectional study that was designed to examine the association of stress and resiliency with functional outcome among stroke survivors 22 , 23 .…”

Corticosterone Administration Alters White Matter Tract Structure and Reduces Gliosis in the Sub-Acute Phase of Experimental Stroke

“…Stress is a major and persistent aspect of stroke recovery [16][17][18]. A number of clinical studies have identified that greater levels of perceived stress in the acute phase poststroke (14 days post-stroke) were associated with worse outcomes [19,20].…”

Exploring the relationship between fatigue and circulating levels of the pro-inflammatory biomarkers interleukin-6 and C-reactive protein in the chronic stage of stroke recovery: A cross-sectional study

“…We have little information on whether fatigue present in the later stages of the recovery process is also associated with enhanced peripheral pro-inflammatory activity ( Wu et al., 2015 ; Becker, 2016 ). In the present study, we undertook an exploratory study in a previously described cohort ( Gyawali et al., 2020 ), to consider if there may be a relationship between self-reported fatigue and the inflammatory biomarkers high sensitivity C-reactive protein (hsCRP) and cytokine interleukin-6 (IL-6) during the chronic phase of stroke recovery. Several large-scale prospective epidemiological studies have identified high sensitivity hsCRP and IL-6 as reliable markers of low-grade chronic systemic inflammation ( Ridker et al., 1997 ; Koenig et al., 1999 ; Bruunsgaard et al., 2003 ).…”