Identification of Factors Causing Low Resilience in Post-Stroke Patients: A Systematic Review

Stroke is the leading cause of long-term disability worldwide, significantly affecting patients' physical, cognitive, and psychological abilities. Psychological resilience, as an adaptive capacity, is crucial for post-stroke patients to recover function and quality of life. However, many stroke survivors exhibit low levels of resilience, which implies an increased risk of depression, anxiety, and decreased rehabilitation compliance. Understanding the most consistent determinants of resilience is a crucial step in developing targeted interventions. This study aims to identify and synthesize the main causal factors contributing to low levels of psychological resilience in post-stroke patients, based on the latest empirical evidence from the scientific literature. This systematic review follows the PRISMA guidelines. Literature searches were conducted in electronic databases such as Google Scholar and PubMed using a combination of relevant keywords (MeSH terms), including "Resilience," "Stroke," "Post-Stroke," and "Determinants" or "Factors." The inclusion criteria were quantitative or qualitative research articles published between 2020 and 2025, available in full text in English or Indonesian, and focusing on factors that influence resilience in adult stroke patients. A total of 11 core articles met the inclusion criteria and were analyzed in depth. The determining factors were grouped into internal factors (such as self-efficacy, hope, self-esteem, and coping style) and external factors (such as social support, functional status, and environment). Key findings show that self-efficacy and social support are the most consistent predictors of resilience. Furthermore, resilience was found to be negatively associated with psychological conditions such as post-stroke depression and anxiety. Internal and external factors play an important role in determining post-stroke resilience. Nursing and rehabilitation interventions should focus on increasing self-efficacy and strengthening social support networks to improve patients' adaptive capacity.

Psychological Resilience; Post-Stroke Patients; Self-Efficacy; Social Support

1. Chen, C. P., & Tung, H. H. (2021). Resilience and Daily Activity Among Patients After Stroke. Aging Medicine and Healthcare, 12(4), 152–158. https://doi.org/10.33879/AMH.124.2021.03011 [Google Scholar] [Crossref]

2. Dirren, E., Klug, J., Jarne, C., Vidaurre, D., & Carrera, E. (2025). Determinants of brain network resilience after stroke. Brain Communications, 7(3), 1–16. https://doi.org/10.1093/braincomms/fcaf218 [Google Scholar] [Crossref]

3. Faradisa, E., Kusumawati, M. W., & Budiman, A. A. (2025). Self-Efficacy and Social Support as Determinants of Resilience in Post- Stroke Patients. 4(3). [Google Scholar] [Crossref]

4. Han, Z. T., Zhang, H. M., Wang, Y. M., Zhu, S. S., & Wang, D. Y. (2021). Uncertainty in illness and coping styles: Moderating and mediating effects of resilience in stroke patients. World Journal of Clinical Cases, 9(30), 8999–9010. https://doi.org/10.12998/wjcc.v9.i30.8999 [Google Scholar] [Crossref]

5. Heltty, H., & Zahalim, Z. (2023). Resilience after stroke and its correlation with functional independence. Jurnal Ners, 18(1), 57–63. https://doi.org/10.20473/jn.v18i1.41229 [Google Scholar] [Crossref]

6. Jiang, N., Xv, Y., Sun, X., Feng, L., Wang, Y. B., & Jiang, X. L. (2023). Study on self-management of real-time and individualized support in stroke patients based on resilience: a protocol for a randomized controlled trial. Trials, 24(1), 1–14. https://doi.org/10.1186/s13063-023-07475-x [Google Scholar] [Crossref]

7. Liu, Z., Zhou, X., Zhang, W., & Zhou, L. (2021). Resilience is an independent correlate of the course of quality of life in patients with first-ever ischemic stroke. International Psychogeriatrics, 33(6), 567–575. https://doi.org/10.1017/S1041610220000587 [Google Scholar] [Crossref]

8. Norvang, O. P., Dahl, A. E., Thingstad, P., & Askim, T. (2022). Resilience and Its Association With Activities of Daily Living 3 Months After Stroke. Frontiers in Neurology, 13(June), 1–8. https://doi.org/10.3389/fneur.2022.881621 [Google Scholar] [Crossref]

9. Sun, B., Wang, N., Li, K., Yang, Y., & Zhang, F. (2024). The mediating effects of hope on the relationships of social support and self-esteem with psychological resilience in patients with stroke. BMC Psychiatry, 24(1), 1–12. https://doi.org/10.1186/s12888-024-05744-w [Google Scholar] [Crossref]

10. Takil, M., & Ökten, Ç. (2023). The Relationship of Functional Status with Self-Efficacy and Resilience in Stroke Patients. Archives of Health Science and Research, 10(2), 101–107. https://doi.org/10.5152/ArcHealthSciRes.2023.0137 [Google Scholar] [Crossref]

11. Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., … Straus, S. E. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850 [Google Scholar] [Crossref]

12. Wang, Y., Xie, H., Sun, H., Ren, L., Jiang, H., Chen, M., & Dong, C. (2024). Influencing Factors of Psychological Resilience in Stroke Patients: A Systematic Review and Meta-Analysis. Archives of Clinical Neuropsychology, 39(5), 644–654. https://doi.org/10.1093/arclin/acad107 [Google Scholar] [Crossref]

13. Zhou, X., Liu, Z., Zhang, W., & Zhou, L. (2020). Resilience is associated with post-stoke depression in Chinese stroke survivors: A longitudinal study. Journal of Affective Disorders, 273(September 2018), 402–409. https://doi.org/10.1016/j.jad.2020.04.042 [Google Scholar] [Crossref]

• A Comparative Study of Adjustment Level, Parental Income and Academic Achievement of Adolescent Girls
• Increase in STIs among Adolescents in Masvingo District
• A Correlation between SDG 4 (Quality Education) and Emotional Disposition of Teacher Educators in Hyderabad District
• Ear Piercing Behaviour and Self-Esteem among Male University Students in Nigeria
• A Study of Religiosity and Psychological Well-Being