Psychological Resilience In the first year of surviving a Stroke among Africans

Abstract

Introduction: Resilience may be central to poststroke recovery. There is a knowledge gap on the predictors of resilience and its impact on mental health of Africans who survive a stroke. We describe the trajectory of psychological resilience and its association with depression and quality of life across the first poststroke year in Nigeria. Methods: Prospective observational study. Resilience was ascertained at 3 time-points prospectively over 12 months using the resilience scale. Depression and quality of life were also assessed at baseline and follow-up, respectively using centre for epidemiologic studies depression scale (CES-D 10) and health related quality of life in stroke patients (HRQOLISP-26). Trajectory was examined using the Greenhouse-Gaiser and Bonferoni corrected Analyses of variance. Associations were investigated using regression models and presented as adjusted odds ratios (aOR) and wald test coefficients within 95% confidence intervals (CI). Results: Of 150 consenting stroke survivors, 132 (88%) could be assessed for resilience. Resilience scores improved across time points of measurement (F-test=23.516, p<0.001). In multivariate logistic regression analyses adjusted for the effect of age, education, and alcohol use, resilience was associated with male sex (aO.R=5.3, 95% C.I= 1.7,17.2), younger age (aO.R=4.8, 95% C.I=1.5,15.7), and baseline hypertension (aO.R= 0.2, 95% C.I= <0.1,0.8). In mixed effect linear regression analyses adjusting for the effect of age, education, alcohol use and hypertension, resilience was associated with improvement in depression (baseline=-2.5, 95% C.I= -4.9, -0.1; three months= -4.6, 95% C.I= -5.9, -3.2; twelve months = -4.2, 95% C.I=-5.6, -2.8) and quality of life (baseline total=9.5, 95% C.I= 5.5,13.5; three months= 3.9, 95% C.I= 1.0, 6.7; twelve months=5.2, 95% C.I=2.2, 8.2) overtime Discussion: Resilience was associated with improvement in the mental health and wellbeing of stroke survivors in this population. Findings suggest important role for resilience building as part of intervention strategies to promote recovery of health and wellbeing after stroke.