Title:
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Stroke, psychological outcomes and the self-regulatory model
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The present thesis examines psychological outcomes following stroke.
Psychological distress is common following stroke and post-stroke depression has most
frequently been studied. Associations between post-stroke depression and further adverse
outcomes have been evidenced, including impaired physical recovery and even mortality.
A need is highlighted for psychological factors associated with post-stroke distress to be
identified that are modifiable and amenable to intervention.
Associations between illness perceptions, or subjective beliefs regarding illness,
and a range of health outcomes have been demonstrated across multiple chronic
conditions. As such, illness perceptions are proposed as psychological constructs with the
potential to further understanding of the subjective experience of stroke and
psychological outcomes. The self-regulatory model (SRM), which theorises the dynamic
relationship between illness perceptions and coping strategies in determining health
outcomes, is advanced as an integrative framework for research examining post-stroke
psychological adjustment. Research regarding cognitions compatible with the SRM is
limited. However, promising findings are reviewed regarding the relationships between
psychological outcome and perceptions of control, treatment and achieving a sense of
meaning regarding stroke.
On the basis of identified needs in the evidence base, a questionnaire-based study
was undertaken employing the Illness Perception Questionnaire-Revised, a measure
assessing all cognitive domains of the SRM, in a sample of people who had experienced
stroke. Consistent with the SRM, coping strategies were also assessed, as were anxiety,
depression and positive affect. It was hypothesised that illness perceptions and copingvariables would explain additional variance in psychological outcomes over that
explained by previously implicated clinical and psychosocial variables. Illness
perceptions or coping variables contributed significantly to each of the regression models
of measured outcomes and the hypothesis was generally supported. The clinical
implications of the research are discussed and the critical review expands on relevant
issues, including situating illness perceptions in the context of existing psychological
models
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