Family risk factors, dyadic coping, and family resilience in young stroke dyads: an actor-partner interdependence...

Stroke in young individuals constitutes a significant familial stressor, with ensuing family risk factors critically influencing recovery. While couples' collaborative coping strategies play a vital role in enhancing family resilience, the mechanisms underlying this process remain largely unexplored. This study aims to elucidate the impact of familial risk factors and dyadic coping on the family resilience of young stroke.

This cross-sectional study integrates evidence-based research with clinical data. We developed a structured questionnaire grounded in identified familial risk factors. A cohort of 243 dyads, comprising young stroke patients and their spouses, was recruited from the neurology departments of four tertiary hospitals. The Actor-Partner Interdependence Mediation Model (APIMeM) framework was utilized, in which patients were treated as actors (influencing their own outcomes) and spouses as partners (influencing each other's outcomes), to determine both direct and indirect effects among variables, with significance evaluated using bootstrap procedures (5,000 resamples, 95% confidence intervals). Model simplification was guided by chi-square difference testing.

The analysis indicated that family resilience could be strengthened in young stroke survivors and their spouses. APIMeM analyses showed that patients' and spouses' anxiety (β = -0.479, P = 0.002) and depression (β = -0.718, P < 0.001) had significant negative actor effects on their own family resilience, while patients' activities of daily living (ADL) had significant positive actor (β = 0.175, P < 0.001) and partner effects (β = 0.198, P < 0.001) on family resilience. Crucially, dyadic coping partially mediated these relationships, with significant actor-actor indirect effects for anxiety (β =-0.139, 95% CI [-0.261, -0.029]), depression (β = -0.190, 95% CI [-0.321, -0.084]), and ADL (β = 0.062, 95% CI [0.009, 0.131]) on family resilience. Significant actor-partner mediation effects were also observed for depression (β = -0.072, 95% CI [-0.170, -0.017]) and ADL (β = 0.028, 95% CI [0.002, 0.079]).

Using a dyadic APIMeM approach, this study demonstrates that dyadic coping serves as a key mediator linking familial risk factors to family resilience in young stroke dyads. Resilience emerges as a shared, co-constructed process rather than an individual attribute, underscoring the need for interventions targeting the couple as a unit to mitigate intervention bias.