Stress wouldn't exist in survivors if you had 100% recovery protocols. They would be too busy counting reps and looking forward to recovery. Solve the primary problem, 100% recovery, and you wouldn't have to solve all these myriad secondary problems.
Contributing Factors and Induced Outcomes of Psychological Stress Response in Stroke Survivors: A Systematic Review
Song Zhang1,2†, 
Yuan Yuan2†, Wenwen Zhuang3, 
Tianqing Xiong3,4, Yijun Xu1,3, Jingwen Zhang2, Chunhua Tao2, Jingyan Liang3,4 and Yingge Wang1*- 1Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- 2School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
- 3Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- 4Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
Background: Remarkable evidence indicates that psychological stress is significantly associated with stroke. However, a uniform recommendation to identify and alleviate poststroke psychological stress responses and improve postmorbid outcomes is not currently available. Thus, this systematic review aimed to summarize the types of poststroke psychological stress, measurement tools, contributing factors, and outcomes.
Methods: This systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search was conducted in PubMed, Web of Science, Embase, CNKI, WanFangData, and CQVIP from database inception to November 2021. Cross-sectional and longitudinal studies were included in this research. Quality assessment was performed based on the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
Results: Eighteen quantitative, peer-reviewed studies were included for analysis. Selected articles mainly investigated perceived stress and posttraumatic stress disorder after stroke. We classified the contributing factors into four categories: sociodemographic factors, clinical disease factors, psychological factors, and behavioral and lifestyle factors. The postmorbid outcomes were divided into three categories: clinical disease outcomes, psychological outcomes, and behavioral and quality of life outcomes.
Conclusions: Compared to common patients, stroke survivors with the following characteristics suffered an increased psychological stress response: younger age, the presence of caregivers, depression, unsuitable coping strategies, etc. Meanwhile, lower quality of life, worse drug compliance, worse functional independence, and more severe mental disorders were significantly associated with increased psychological stress symptoms. Further studies are required to provide more trustworthy and meaningful references for mitigating the damage caused by psychological stress after stroke.
Introduction
Stroke is the third leading cause of death and disability worldwide (1). In recent decades, the numbers of new first-time stroke victims and stroke survivors have separately increased by 68% and 84%, respectively, worldwide (2). Although the mortality from stroke has declined, stroke survivors still suffer from severe physical and psychological sequelae, which become a great burden to society and their families. Numerous studies have identified that stroke survivors experience short- and long-term depression, anxiety, and psychological stress (3). However, most studies were devoted to poststroke depression and anxiety, and studies investigating psychological stress after stroke are still needed.
Psychological stress response refers to the changes in negative emotional and functional states when individuals lack the resources and abilities to deal with threats (4). A major event such as a stroke is a stressor that makes survivors feel stressed. Related studies have shown that more than 33% of stroke survivors suffered from clinically significant psychological stressors (5, 6), and over 23% of them developed posttraumatic stress symptoms 1 year after onset (7). New studies have appeared in recent years as people's focus has gradually turned to poststroke psychological stress. Currently, the poststroke psychological stress response is mainly divided into two categories for research, namely, perceived psychological stress and posttraumatic stress symptoms (PTSS), also known as posttraumatic stress disorder (PTSD). The two categories have no compliance and will appear following the environmental and individual differences of patients at different stages of stroke.
There is no doubt that stroke can be detrimental to a person's life, while the psychological stress response will amplify and aggravate such negative effects (4, 8, 9). Furthermore, the psychological stress response, impacted by social factors and psychological comorbidities, has a similar or even more serious influence on mental health and the quality of life among survivors compared with physical disorders (10, 11). Thus, it is crucial to explore which factors can predict the psychological stress response of patients and its impact on the prognosis of stroke.
In recent years, there have been some cross-sectional and longitudinal studies on poststroke psychological stress symptoms, including analyses of early predictive factors and late prognostic effects. Nevertheless, most current reviews have focused on the prevalence of poststroke psychological stress response or mainly analyzed the predictors or prognostic effects of one type of response (5, 12, 13). Hence, this study attempts to integrate the existing relevant literature to elaborate on the status quo and assessment tools between two types of psychological stress responses after stroke and weigh the conflicting findings in premorbid predicting factors and postmorbid outcomes of psychological stress response to provide a reference for establishing a more effective intervention management strategy.
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