Nonlinear association between perceived social support and fear of disease progression in stroke patients: a cross-sectional study

Abstract

Objectives To explore the nonlinear association between perceived social support and fear of disease progression in stroke patients. Methods In this cross-sectional study, 300 patients with stroke completed a general information questionnaire, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Modified Barthel Index (MBI). Independent-samples t tests, one-way analysis of variance, hierarchical linear regression, and restricted cubic spline (RCS) analysis were used. Results The mean FoP score was 30.34 ± 8.56. In the hierarchical regression model, higher PSS was associated with lower FoP (B = −0.223, P < 0.001). Compared with employed participants, unemployed participants had lower FoP scores (B = −3.188, P = 0.008), and severe ADL dependence was associated with higher FoP compared with independence (B = 4.921, P = 0.035). The restricted cubic spline analysis indicated evidence of nonlinearity (Pforoverall < 0.001; Pfor nonlinear = 0.023). Exploratory piecewise linear regression identified an estimated change point at a PSS score of 67 (P = 0.011). Below 67, each one-point increase in PSS was associated with a 0.319-point lower FoP score (B = −0.319, 95% CI −0.396 to −0.241; P < 0.001). At PSS scores ≥ 67, the slope was not statistically significant and was imprecisely estimated (B = 0.304, 95% CI −0.142 to 0.751; P = 0.182). Conclusions This study suggested a nonlinear association between perceived social support and fear of disease progression, with a change point at a perceived social support score of 67. However, this change point requires validation in larger multicenter and prospective studies. In addition, unemployed and severely dependent were independently associated with fear of disease progression. These findings may help guide more comprehensive psychosocial assessment for stroke patients at risk of fear of disease progression.