{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T17:03:38Z","timestamp":1784221418725,"version":"3.55.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the chain mediating effects of resilience and self-efficacy on the association between social support and quality of life (QoL) among patients with severe stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study enrolled 272 inpatients between June 2023 and June 2025. Validated instruments were used to assess social support (SSRS), resilience (CD-RISC), self-efficacy (GSES), and quality of life (QoL) (SS-QOL). PROCESS Model 6 with 5,000 bias-corrected bootstrap samples was used to test sequential mediation while adjusting for key covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean scores indicated moderate levels of social support, resilience, self-efficacy, and QoL. Quality of life scores were significantly higher among patients aged &amp;lt;60 years compared to those aged \u226560 years (54.62\u00a0\u00b1\u00a014.07 vs. 49.34\u00a0\u00b1\u00a013.12), among patients with higher education levels (college or above: 54.73\u00a0\u00b1\u00a014.27 vs. primary school or below: 47.26\u00a0\u00b1\u00a011.38), among patients covered by Employee Health Insurance compared to self-funded patients (53.26\u00a0\u00b1\u00a013.42 vs. 42.36\u00a0\u00b1\u00a011.25), and among patients with lower NIHSS scores (10\u201314 points: 56.38\u00a0\u00b1\u00a013.45 vs. 15\u201324 points: 46.44\u00a0\u00b1\u00a012.41). All comparisons were statistically significant at\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.05. All main variables were positively correlated. The direct association between social support and QoL was significant (adjusted unstandardized \u03b2 = 0.88, 95% CI [0.790, 0.975]), accounting for 53.5% of the total association. The three indirect associations were: (1) SSRS - CD-RISC - SS-QOL: \u03b2 = 0.255, 95% CI [0.192, 0.329]; (2) SSRS - GSES - SS-QOL: \u03b2 = 0.126, 95% CI [0.020, 0.208]; and (3) SSRS - CD-RISC - GSES - SS-QOL: \u03b2 = 0.385, 95% CI [0.289, 0.510],supporting the hypothesized chain mediation model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Social support was strongly associated with QoL, both directly and indirectly through resilience and self-efficacy and their sequential pathways. These findings highlight potential intervention targets, although causal inferences are limited by the study\u2019s cross-sectional design. Strengthening social support and related psychological resources may improve rehabilitation outcomes in patients with severe strokes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1851981","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T16:09:46Z","timestamp":1784218186000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The association between social support and quality of life in patients with severe stroke: a chain mediation analysis of resilience and self-efficacy"],"prefix":"10.3389","volume":"17","author":[{"given":"Yun","family":"Li","sequence":"first","affiliation":[{"name":"Department of Intensive Care Rehabilitation, Shandong Provincial Public Health Clinical Center","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuru","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Rehabilitation, Shandong Provincial Public Health Clinical Center","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Rehabilitation, Shandong Provincial Public Health Clinical Center","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmei","family":"Pang","sequence":"additional","affiliation":[{"name":"Center of Critical Care Medicine, Shandong Provincial Public Health Clinical Center","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongrong","family":"Hao","sequence":"additional","affiliation":[{"name":"Offline Center, Shandong Provincial Public Health Clinical Center","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Du","sequence":"additional","affiliation":[{"name":"Surgical Intensive Care Unit, Shandong Provincial Public Health Clinical Center","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaonan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Shandong Provincial Public Health Clinical Center","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yining","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Rehabilitation, Shandong Provincial Public Health Clinical Center","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0254-1424.2024.03.006","article-title":"Effects of intermittent theta-burst transcranial magnetic stimulation with different intervention sequences combined with rehabilitation training on upper limb function in stroke patients","volume":"46","author":"Wu","year":"2024","journal-title":"Chin J Phys Med Rehabil"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930241308142","article-title":"World stroke organization: global stroke fact sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int J Stroke"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15781","article-title":"Dyadic psycho\u2010social interventions for stroke survivors and family caregivers: A systematic review and meta\u2010analysis of randomized controlled trials","volume":"79","author":"Zhang","year":"2023","journal-title":"J Adv Nurs"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1186\/s12913-022-08473-6","article-title":"Effectiveness of interventions to support the transition home after acute stroke: a systematic review and meta-analysis","volume":"22","author":"O'Callaghan","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"B5","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1037\/hea0001069","article-title":"Multilevel resilience resources and cardiovascular disease in the United States: A systematic review and meta-analysis","volume":"41","author":"Park","year":"2022","journal-title":"Health Psychol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2025.2573148","article-title":"Impact of an asynchronous telerehabilitation program on the self-efficacy and motivation for physical activity in discharged COVID-19 patients: a secondary analysis of a randomized controlled trial","volume":"57","author":"Carpallo-Porcar","year":"2025","journal-title":"Ann Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"100522","DOI":"10.1016\/j.arrct.2025.100522","article-title":"Temporal relationships between depression, self-efficacy, and physical activity in individuals with stroke","volume":"7","author":"Bellinger","year":"2025","journal-title":"Arch Rehabil Res Clin Transl"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.70020","article-title":"The relationships between quality of life with health literacy, social support and resilience in older stroke survivors: a structural equation model","volume":"11","author":"Chen","year":"2024","journal-title":"Nurs Open"},{"key":"B9","doi-asserted-by":"publisher","first-page":"698","DOI":"10.3760\/cma.j.cn113694-20231024-00261","article-title":"Guidelines for the management of severe stroke in China 2024","volume":"57","year":"2024","journal-title":"Chin J Neurol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.20.7.864","article-title":"Measurements of acute cerebral infarction: a clinical examination scale","volume":"20","author":"Brott","year":"1989","journal-title":"Stroke"},{"key":"B11","doi-asserted-by":"publisher","first-page":"98","DOI":"10.4324\/9781003188261-2","article-title":"Theoretical basis and research application of the Social Support Rating Scale","volume":"4","author":"Xiao","year":"1994","journal-title":"J Clin Psychiatry"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-96-8504-2_11","article-title":"Correlation of social support, psychological resilience and self-esteem with post-traumatic stress disorder in intensive care unit nurses","volume":"100","author":"Zhang","year":"2020","journal-title":"Natl Med J China"},{"key":"B13","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12889-022-13729-1","article-title":"Reliability and validity of the general self-efficacy scale","author":"Wang","year":"2001","journal-title":"Chin J Appl Psychol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.12114\/j.issn.1007-9572.2021.02.041","article-title":"Factors influencing quality of life in patients at different stages after ischemic stroke","volume":"24","author":"Yao","year":"2021","journal-title":"Chin Gen Pract"},{"key":"B15","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1038\/s41598-024-84454-5","article-title":"Changes of health-related quality of life within 6 months after stroke by clinical and sociodemographic factors","volume":"15","author":"Butsing","year":"2025","journal-title":"Sci Rep"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1161\/circ.129.suppl_1.mp48","article-title":"Social network, social support, and risk of incident stroke: Atherosclerosis Risk in Communities study","volume":"45","author":"Nagayoshi","year":"2014","journal-title":"Stroke"},{"key":"B17","doi-asserted-by":"publisher","first-page":"4988","DOI":"10.1080\/09638288.2023.2292270","article-title":"Self-efficacy and resilience in severe aphasia\u2013an exploratory cross-sectional study of two psychosocial factors and their relation to functional communication","volume":"46","author":"Olsson","year":"2024","journal-title":"Disabil Rehabil"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000207219","article-title":"Association of brain age, lesion volume, and functional outcome in patients with stroke","volume":"100","author":"Liew","year":"2023","journal-title":"Neurology"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1080\/10749357.2023.2178133","article-title":"Health literacy is associated with less depression symptoms, higher perceived recovery, higher perceived participation, and walking ability one year after stroke\u2013a cross-sectional study","volume":"30","author":"Flink","year":"2023","journal-title":"Top Stroke Rehabil"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000206747","article-title":"Disentangling the association between neurologic deficits, patient-reported impairments, and quality of life after ischemic stroke","volume":"100","author":"van der Ende","year":"2023","journal-title":"Neurology"},{"key":"B21","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1080\/10749357.2024.2318087","article-title":"Mediation effect of self-efficacy on the relationship between perceived social support and resilience in caregivers of patients with first-stroke in China: a cross-sectional survey","volume":"31","author":"Wang","year":"2024","journal-title":"Top Stroke Rehabil"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/13548506.2025.2576215","article-title":"Psychological resilience buffers the effects of care burden on depression and quality of life: a moderated mediation model in stroke caregivers","volume":"7","author":"Yu","year":"2025","journal-title":"Psychol Health Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s12955-025-02337-3","article-title":"Relationship between social support, functional outcomes and health-related quality of life in working-aged adults at three months after ischemic stroke: results from the FRAILTY study","volume":"23","author":"Gurkov\u00e1","year":"2025","journal-title":"Health Qual Life Outcomes"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2025.2500060","article-title":"Exploring the homecoming: a qualitative multimethod approach to understanding stroke survivors and their caregivers\u2019 experience","volume":"47","author":"Veronese","year":"2025","journal-title":"Disabil Rehabil"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2024.104892","article-title":"Effects of a nurse-led peer support intervention on psychosocial outcomes of stroke survivors: a randomised controlled trial","volume":"160","author":"Wan","year":"2024","journal-title":"Int J Nurs Stud"},{"key":"B26","doi-asserted-by":"publisher","first-page":"576275","DOI":"10.2147\/jmdh.s576275","article-title":"The mediating roles of self-efficacy, resilience, and social support in the relationship between clinical factors and adaptation to chronic disease","volume":"2026","author":"Laza","year":"2026","journal-title":"J Multidiscip Healthc"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1851981\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T16:09:51Z","timestamp":1784218191000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1851981\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":26,"alternative-id":["10.3389\/fpsyt.2026.1851981"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1851981","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"article-number":"1851981"}}