Opposing associations of stress and resilience with functional outcomes in stroke survivors in the chronic phase of stroke: A cross-sectional study

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

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28 Citations (Scopus)


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.

Original languageEnglish
Article number230
Number of pages12
JournalFrontiers in Neurology
Publication statusPublished - 22 Apr 2020


  • cognition
  • emotion
  • mood
  • resilience
  • stress
  • stroke recovery

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