Mental Health Symptoms Mediate the Association of Subjective Cognitive Ability with Community Participation after Stroke

Research Objectives: To investigate if mental health (MH) symptoms - depression, apathy, and anxiety - mediate the association of subjective (SCF) and objective (OCF) measures of cognitive function with participation after stroke.

Design: A prospective cross-sectional study. We performed a regression-based mediation analysis using Hayes’s PROCESS macro. 12 Models were built for three MH mediators in the association of SCF and OCF measures with two participation measures, respectively.

Setting: Community

Participants: 74 persons with stroke.

Interventions: Not applicable

Main Outcome Measures: We used Patient Health Questionnaire-9 for depression, Apathy Evaluation Scale, and State-Trait Anxiety Inventory-Trait Anxiety Scale as MH mediators. The dependent variables were participation measured using Reintegration to Normal Living (RNL) and Activity Card Sort (ACS). Independent variables were SCF, measured using Stroke Impact Scale Memory and Thinking, and OCF, measured using Delis-Kaplan Executive Function System Trail-Making Test (Number-letter switching).

Results: In the model of RNL, depression (b=0.093, 95% CI=0.038~0.157), apathy (b=0.134, 95% CI=0.071~0.202), and anxiety (b=0.116, 95% CI=0.049~0.194), were full mediators of the association between the SCF measure and RNL total score. For the ACS, apathy was the only mediator between the SCF measure and ACS total activity retention (b=0.144, 95% CI=0.032~0.293). In both models, none of the MH measures were significant mediators of the association between the OCF measure and RNL or ACS after stroke (p>0.05)

Conclusions: These findings indicate that depression, apathy, and anxiety may be stronger mediators of the association between SCF with participation than for OCF with participation after stroke. Rehabilitation professionals should pay attention to measures of both SCF and OCF as they have different dynamics with MH symptoms and participation after stroke.

Author(s) Disclosures: None