Stroke recurrence, uncertainty in illness, and self-efficacy as predictors of post-stroke depression in Korean survivors: a cross-sectional study

BACKGROUND: Post-stroke depression (PSD) is a common neuropsychological complication that significantly impacts recovery and quality of life in stroke survivors. Understanding psychological factors such as uncertainty in illness and self-efficacy is crucial for developing targeted interventions and improving post-stroke outcomes. This study aimed to identify factors affecting PSD in stroke survivors, with particular focus on uncertainty in illness and self-efficacy. METHODS: A cross-sectional study was conducted with 190 stroke survivors. PSD was assessed using the Korean version of the Geriatric Depression Scale Short Form (GDSSF-K), with scores > 5 indicating depression. Demographic and stroke-related characteristics, uncertainty in illness, and self-efficacy were evaluated. Chi-square tests, Fisher’s exact tests, independent t-test, and multiple logistic regression analysis controlling for demographic and clinical covariates were conducted to identify independent predictors. RESULTS: The prevalence of PSD was 41.1% (n = 78). Significant associations were found between depressed and non-depressed groups in age (≥ 75 years), education level (elementary school or below), living arrangement (living alone), stroke recurrence, presence of hemiparesis, presence of dysphasia, and presence of pain. Participants with PSD demonstrated significantly higher uncertainty in illness (66.99 ± 9.88 vs. 57.87 ± 8.87) and lower self-efficacy (83.97 ± 19.12 vs. 98.03 ± 5.05). Multiple logistic regression analysis controlling for demographic and clinical covariates identified educational level (high school vs. ≥ bachelor: OR = 0.26, 95% CI: 0.07–0.94), stroke recurrence (OR = 6.91, 95% CI: 2.42–19.68), uncertainty in illness (OR = 1.08, 95% CI: 1.02–1.13), and self-efficacy (OR = 0.91, 95% CI: 0.85–0.97) as significant independent predictors of PSD, with the model explaining 54% of variance (Nagelkerke R²=0.536). CONCLUSIONS: PSD is prevalent among stroke survivors and associated with modifiable psychological factors. Educational level, stroke recurrence, uncertainty in illness, and self-efficacy were identified as significant predictors. These findings underscore the necessity for routine depression screening and comprehensive nursing care addressing both physical and psychological aspects of stroke recovery.