Psychosocial predictors of quality of life in a sample of community-dwelling stroke survivors: a longitudinal study.

BACKGROUND: Stroke research and rehabilitation has traditionally focussed on the physical impact of a stroke, with less attention given to associated psychosocial factors. This study aimed to identify psychosocial predictors of health-related quality of life (HRQoL) in chronic stroke survivors and examine differences between nondepressed and depressed participants.
METHOD: Participants were recruited primarily from six major metropolitan hospital databases. A total of 135 first-ever stroke survivors aged 25-96 years who were 6 to 24 months post stroke and community-dwelling were studied longitudinally over 6 months. HRQoL and psychosocial factors (optimism, self-esteem, perceived control, depressive status, and social support) were measured at baseline, 10 weeks, and 6 months.
RESULTS: Psychosocial factors were significantly associated with HRQoL at every time point, accounting for 33% to 53% of the variance after controlling for demographic and clinical characteristics. At least 26% of all participants reported clinically significant depressive symptoms throughout the study. Compared to nondepressed participants, depressed participants had significantly poorer scores for HRQoL, social support, optimism, self-esteem, perceived control, and physical functioning. There were improvements in participants' physical health, social participation, depressive status, and optimism over the course of the study.
CONCLUSION: These findings highlight the important role that psychosocial factors play in chronic stroke survivors' HRQoL and have implications for stroke rehabilitation programs: rehabilitation that targets poststroke depression and psychosocial adjustment to stroke has the potential to improve HRQoL for chronic stroke survivors, independent of functional impairment.