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

Abstract

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.