Self-Discrepancy and Affective Distress after Stroke

AIMS: To investigate self-discrepancies in stroke survivors and explore associations between discrepancies and distress, drawing on Higgins’s (1987) Self-Discrepancy Theory. More specifically, investigate if stroke survivors reported a change in their sense of self following stroke, if this change was related to their reported anxiety and depression, and if this relationship was mediated by their perceived self-esteem. Also, to explore if discrepancies between survivors’ post-stroke self and their ideal and ought self, respectively, were associated with depression and anxiety, respectively. METHOD: A retrospective cross-sectional design was employed. The participants were 67 first-time community-living stroke survivors, with a mean age of 61.6 years and a mean time since stroke of 5.6 years. The measures included the Head Injury Semantic Differential for assessing pre-stroke (retrospectively), post-stroke, ideal and ought selves; the Hospital Anxiety and Depression Scale; the Rosenberg Self-Esteem Scale; the Stroke-Specific Quality of Life Questionnaire (adapted); and the Barthel Index. RESULTS: Stroke survivors perceived themselves significantly more negatively than prior to their stroke. The discrepancy between pre and post-stroke selves was positively associated with affective distress and negatively associated with self-esteem and quality of life, respectively. The discrepancy between post-stroke self and ideal self, and the discrepancy between post-stroke self and ought self were also positively associated with affective distress. However, these relationships were undifferentiated, as the former was not only related to depression but also to anxiety, and the latter was not only related to anxiety but also to depression. Survivors’ perceived self-esteem was a mediator in the relationship between the pre and post-stroke selves discrepancy and affective distress. CONCLUSIONS: This was the first study to show a perceived change in identity in a large sample of stroke survivors, and it contributed to our understanding of how psychological factors may be involved in emotional adjustment after stroke. This highlighted the importance of considering such changes in informing neurorehabilitation; the clinical implications were discussed. It was also the first study to provide support, albeit partial for Higgins’ (1987) self-discrepancy theory in a stroke population. The strengths and limitations of the study were considered and ideas for future research were proposed.