The relationship between stroke survivors' perceived identity and mood, self-esteem and quality of life.

OBJECTIVES: To examine change in identity after stroke and to elucidate its relationship with mood and quality of life. To test Higgins' theory of the impact of identity (self-discrepancy) on anxiety and depression. To examine the role of self-esteem in mediating the relationship between identity and outcomes.

METHOD: Sixty-five community-living first-time stroke survivors, mean age 61.58 and time since stroke 5.60 years, were recruited from stroke charities. A cross-sectional study used the Head Injury Semantic Differential Scale, the Hospital Anxiety and Depression Scale, the Rosenberg Self-Esteem Scale, the Stroke-Specific Quality of Life Questionnaire (adapted) and the Barthel Index.

RESULTS: Identity was rated more negatively after stroke than before (t(64) = 6.46, p < .00). Greater discrepancy in identity was associated with anxiety (r = .38, p < .00), depression (r = .59, p < .00), self-esteem (r = -.48, p < .00) and quality of life (r = -.54, p < .00). Overall positivity of identity after stroke predicted outcomes even better than discrepancy. The association between discrepancy and mood and quality of life was mediated by self-esteem (β = .30, p < .01; β = -.24, p < .01, respectively). Specific types of discrepancy defined by Higgins did not show differential relationships with anxiety and depression as predicted.

CONCLUSIONS: Identity changes after stroke and identity and self-esteem are associated with important outcomes for stroke survivors.