The association of social support on self-perceived burden in stroke patients: A serial mediation analysis of psychological resilience and self-esteem.

OBJECTIVE: To examine the mediating roles of psychological resilience (PR) and self-esteem (SE) in the relationship between social support (PSS) and self-perceived burden (SPB) in stroke patients. METHODS: A convenience sampling method was used to recruit stroke patients admitted to a tertiary hospital in Wuhu from November 2024 to April 2025. A total of 370 patients were enrolled. Participants completed questionnaires assessing general demographics, perceived social support (PSS), self-perceived burden (SPB), self-esteem (SE), and psychological resilience (PR). Pearson correlation analysis was conducted to examine the relationships among social support, psychological resilience, self-esteem, and self-perceived burden. The PROCESS macro (Model 6) in SPSS was employed to analyze the serial mediating effects of psychological resilience and self-esteem between social support and self-perceived burden. RESULTS: The mean scores for perceived social support, psychological resilience, self-esteem, and self-perceived burden were 52.25 ± 9.70, 18.48 ± 8.66, 26.69 ± 7.49, and 33.85 ± 7.85, respectively. Self-perceived burden was negatively correlated with social support, psychological resilience, and self-esteem (r = -0.415, -0.497, -0.508, all P < 0.01). The mediation model revealed that psychological resilience and self-esteem played a fully mediating role (effect size = -0.338) in the relationship between social support and self-perceived burden, with no significant direct effect. CONCLUSION: Stroke patients exhibited moderate levels of self-perceived burden. The serial mediation of psychological resilience and self-esteem in the association between social support and self-perceived burden was statistically significant. Future stroke care should extend beyond traditional social support models. We recommend that healthcare institutions collaborate with communities to establish a "social support-psychological service" integrated system, enhancing patients' psychological resilience and self-esteem to alleviate self-perceived burden and improve quality of life.