Multiple-adverse health conditions, mental health, and health-related quality of life in stroke survivors: Latent profile analysis and mediation analysis.

Abstract

ObjectiveThis study aimed to identify subgroups of stroke survivors based on multiple-adverse health conditions and determine the potential mediation effects of mental health in their relationship with health-related quality of life.DesignA cross-sectional study.SettingThree tertiary hospitals in Tianjin, China.ParticipantsA total of 558 stroke survivors were recruited between March and June 2023.Main measuresMultiple-adverse health conditions (multimorbidity, frailty and disability) were assessed using the age-corrected Charlson Comorbidity Index, FRAIL Scale, and Barthel Index. Mental health was measured with Patient Health Questionnaire-4, and health-related quality of life was evaluated using the EuroQol 5-dimension 5-level scale. Latent profile analysis identified subgroups, and mediation analysis explored mental health's role.ResultsThree subgroups were identified: Mild (65.4%, n = 365), Moderate (17.4%, n = 97), and Severe (17.2%, n = 96). Mediation analysis showed that, compared with the Mild subgroup, survivors in the Moderate subgroup (β = 0.138, 95% CI: 0.055 to 0.232) and the Severe subgroup (β = 0.217, 95% CI: 0.113 to 0.316) exhibited worse mental health, and poorer mental health was associated with lower health-related quality of life (β = -0.119, 95% CI: -0.170 to -0.075).ConclusionsThis study suggests heterogeneity in multiple-adverse health conditions and indicates that mental health may partially account for the association between these conditions and health-related quality of life in stroke survivors. The findings highlight the need for further research into subgroup-specific interventions-with particular attention to mental health-to determine whether such approaches could improve health-related quality of life.