Understanding the role of illness perceptions in the relationship between cognitive and emotional difficulties after stroke

Emotional difficulties are common after stroke and up to one third of stroke-survivors develop post-stroke depression. Psychological distress in this population remains poorly understood, despite high prevalence and secondary implications. One established predictor of depressive symptoms after stroke is cognitive impairment, however, the mechanism underlying this relationship is unclear. This research investigated the potential role of stroke-related illness appraisals as a mediating factor to this known association. Seventy-seven participants, aged 45-94, were consecutively recruited from inpatient stroke units in Oxfordshire over 15-months and completed assessments of mood, cognition and illness appraisals, which were analyzed cross-sectionally. As expected, cognitive impairment significantly predicted depressive symptoms. Importantly, this relationship was shown to be mediated by perceptions of threat and control. Higher levels of cognitive impairment were significantly associated with lower perceived control and higher perceived threat, which partially explained the relationship between cognitive impairment and depressive symptoms. Perceptions of illness coherence were predictive of depressive symptoms but not associated with degree of cognitive impairment. This research has implications for the management of cognitive impairment in the early stages after stroke and suggests that illness appraisals may be an important intervention target for reducing depressive symptoms in patients with post-stroke cognitive impairments.