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. 2025 Jul 22:16:105-115.
doi: 10.2147/PROM.S528307. eCollection 2025.

The Impact of Self-Perceived Burden on Loneliness in Stroke Patients: The Mediating Role of Rumination

Xinxin Zhou  1 , Lina Guo  2 , Yuanli Guo  2 , Genoosha Namassevayam  3 , Peng Zhao  1 , Mengyu Zhang  1 , Yuying Xie  1 , Yanjin Liu  4
Affiliations

The Impact of Self-Perceived Burden on Loneliness in Stroke Patients: The Mediating Role of Rumination

Xinxin Zhou et al. Patient Relat Outcome Meas. .

Abstract

Background: Stroke outcomes are often measured through objective scales, which may neglect subtle cognitive changes and fail to capture patients' subjective experiences of recovery and quality of life. This study aimed to examine the interrelations among self-perceived burden, loneliness, and rumination in stroke survivors through the patient-reported outcomes and to provide theoretical insights and intervention strategies for improving psychological well-being and quality of life in stroke patients.

Methodology: Data from 1024 stroke patients who aged 18 years and above were prospectively collected in September 2022 in Zhengzhou, China. PROs included Self-Perceived Burden Scale, UCLA-Loneliness Scale, and Event-Related Rumination Inventory. Statistical methods employed included correlation analysis and mediation effect analysis.

Results: A total of 1024 participants completed this survey (90.9%), with 56.2% males and a mean age of 62.22 (SD = 13.60) years. Approximately 84.28% of stroke patients felt moderate loneliness. Self-perceived burden was positively correlated with rumination (r = 0.516, 95% CI [0.460, 0.574]) and loneliness (r = 0.370, 95% CI [0.307, 0.431]). Rumination was also positively associated with loneliness (r = 0.493, 95% CI [0.443, 0.541]). Both intrusive and deliberate rumination served as mediators in the relationship between SPB and loneliness (b = 0.119, 55.09%, b = 0.031, 14.35%, respectively).

Conclusion: Intrusive and deliberate rumination mediated the relationship between self-perceived burden and loneliness in stroke patients. Rumination in stroke patients should be emphasized as a modifiable factor to reduce loneliness and improve quality of life.

Keywords: loneliness; mediating effect; rumination; self-perceived burden; stroke.

Plain language summary

Understanding how stroke patients’ self-perceived burden (SPB) contributes to loneliness and the influencing of rumination between them could help improve their well-being and reduce negative outcomes. The focus was on exploring whether two types of rumination—intrusive and deliberate rumination—connect self-perceived burden to loneliness. Key findings showed that both intrusive and deliberate rumination played a role in connecting self-perceived burden with loneliness. Meanwhile, intrusive rumination has a stronger effect. This suggested that reducing repetitive negative thoughts, especially intrusive ones, and addressing more mental patterns in care plans might help lessen loneliness in stroke patients and improve their quality of life after stroke.

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Conflict of interest statement

The authors stated that they have no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Hypothesis theoretical model of mediation.
Figure 2
Figure 2
Results of the final path model (N = 1024).
See this image and copyright information in PMC

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