Psychological resilience and self-control in individuals at high risk of stroke: A mental health-focused study

doi:10.5498/wjp.119378

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Sep 19, 2026; 16(9): 119378
Published online Sep 19, 2026. doi: 10.5498/wjp.119378

Psychological resilience and self-control in individuals at high risk of stroke: A mental health-focused study

Cheng-Jian Zhang, Shuang Liu, Wen-Hong An, Jing Liu, Li-Xiang Deng, Ping Liu, Ling-Mei Ruan

Cheng-Jian Zhang, Wen-Hong An, Li-Xiang Deng, Ping Liu, Nursing Teaching and Research Office, School of Health and Wellness, Panzhihua University, Panzhihua 617000, Sichuan Province, China

Shuang Liu, Jing Liu, Department of Basic Medicine, School of Basic Medical Sciences, Panzhihua University, Panzhihua 617000, Sichuan Province, China

Ling-Mei Ruan, Department of Neurology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China

Author contributions: Zhang CJ designed the study, performed data collection, conducted the statistical analysis, and drafted the initial manuscript; Liu S conceived and supervised the study, provided critical intellectual input, and served as the corresponding author; An WH and Deng LX participated in participant recruitment and data acquisition; Liu J assisted with data interpretation and methodological support; Liu P contributed to questionnaire administration and data management; Zhang CJ, Liu S, An WH, Liu J, Deng LX, Liu P, and Ruan LM contributed to manuscript revision, approved the final version of the manuscript, and agree to be accountable for all aspects of the work.

AI contribution statement: We confirm that this manuscript and all the related documents for responding to the reviewers were all written, revised and approved by us personally, without using any artificial intelligence assistance tools. All the authors are fully responsible for the integrity, accuracy, originality and scientific rigor of this manuscript.

Supported by 2024 Open Fund Project of Sichuan Provincial Key Laboratory of Philosophy and Social Sciences for Intelligent Medical Care and Elderly Health Management, No. ZHYYZKYB2424.

Institutional review board statement: This study has been reviewed and approved by the Ethics Committee of Panzhihua Central Hospital (approval No. 2025-096).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: No data available.

Corresponding author: Shuang Liu, MS, MD, Department of Basic Medicine, School of Basic Medical Sciences, Panzhihua University, No. 10 North Section of Third Avenue, Panzhihua 617000, Sichuan Province, China. shuangliu1130055462@protonmail.com

Received: March 17, 2026
Revised: April 14, 2026
Accepted: May 29, 2026
Published online: September 19, 2026
Processing time: 159 Days and 21.8 Hours

Abstract

BACKGROUND

For individuals at a high risk of stroke, cardiovascular risk comprises both biomedical and psychological factors. The relationship between health risk and sustained health risk can be driven by behavior and self risk.

AIM

To investigate whether psychological resilience mediates relationships between active health behaviors and self-control in individuals at high risk of stroke.

METHODS

A cross-sectional study was conducted from January 2024 to December 2025 involving 1000 individuals at a high risk of stroke recruited from several area institutions. Participants completed the Scale for Proactive Health Behavior in Chronic Diseases, 10-point Connor-Davidson Resilience Scale, Stroke Self-monitoring Scale, and 7-point Generalized Anxiety Disorder Scale to assess proactive health behavior, psychological stability, self-control, and anxiety symptoms, respectively. Mediation analysis was performed using the PROCESS Model 4 macro, considering demographic variables.

RESULTS

The average age of the participants was 58.34 ± 9.76 years (54.2%). Proactive health behaviors were positively correlated with both psychological resilience (r = 0.562, P < 0.001) and self-control (r = 0.647, P < 0.001). A total of 34.6% of the participants showed mild anxiety (7-point Generalized Anxiety Disorder Scale score 5-9), and psychological distress was inversely correlated with resilience (r = -0.412, P < 0.001) and self-control (r = -0.389, P < 0.001). Furthermore, psychological resilience significantly mediated the association between proactive health behaviors and self-control (indirect effect = 0.198, 95% confidence interval: 0.165-0.234), accounting for 28.2% of the overall effect. The direct effect of an active health approach on self-control remained significant (β = 0.374, P < 0.001).

CONCLUSION

Psychological resilience functions as a pathway to mental health, proactive health behaviors, and risk-based self-control. Resilience-building, routine mental health screening, and development of stress tolerance are important for at-risk populations.

Keywords: Psychological stability; Subclinical psychological stress; Results of mental functioning; Stroke prevention; Self-management/control; Executive functions; Anxiety; Psychological resilience

Core Tip: This study measured psychological resilience, proactive health behaviors, self-control abilities, and the presence of anxiety in participants at a high risk of stroke. The results showed positive correlations between proactive health behaviors and resilience and between proactive health behaviors and self-control. Minimal-mild anxiety was common among the participants. Mediation analysis showed that resilience partially explained this relationship. These results suggest that stroke prevention strategies should go beyond traditional health education and incorporate evidence-based resilience-enhancing interventions for individuals at a high risk of stroke.