Fear of Recurrence Linked to Lower Quality of Life in Stroke Survivors

Fear that a stroke will strike again may quietly erode survivors’ quality of life, and a new cross-sectional study from China suggests the effect travels largely through two psychological and behavioral channels: reduced self-efficacy and diminished health behaviors. The research, published in BMC Neurology, surveyed 120 stroke patients treated in the neurosurgery and neurology departments of a tertiary hospital between March 2024 and March 2025.

Stroke recurrence is a major concern for survivors, affecting both psychological well-being and day-to-day functioning. Fear of recurrence, or FoR, is common in this population, yet the mechanisms by which it shapes quality of life have remained insufficiently explored. The study team set out to quantify the direct association between fear of recurrence and quality of life and to test whether self-efficacy and health behaviors act as chain mediators in that relationship.

Participants completed four validated instruments: the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Stroke-Specific Quality of Life Scale (SS-QOL), the General Self-Efficacy Scale (GSES), and the Health-Promoting Lifestyle Profile II Revised (HPLP-IIR). The researchers analyzed the data with Pearson correlation analysis and a chain mediation model (PROCESS macro Model 6 for SPSS) using bootstrap methods to estimate indirect effects and their confidence intervals.

The correlations were consistent in direction. Fear of recurrence was negatively associated with quality of life (r = -0.487, p < 0.01), self-efficacy (r = -0.396, p < 0.01), and health behaviors (r = -0.312, p < 0.01). Self-efficacy, in turn, was positively correlated with health behaviors (r = 0.524, p < 0.01) and quality of life (r = 0.461, p < 0.01), and health behaviors were positively correlated with quality of life (r = 0.438, p < 0.01).

The mediation analysis identified three indirect pathways linking fear of recurrence to quality of life. The first ran through self-efficacy alone (indirect effect = -0.098, 95% CI [-0.179, -0.031]); the second through health behaviors alone (indirect effect = -0.052, 95% CI [-0.114, -0.008]); and the third through the sequential chain in which fear of recurrence was associated with lower self-efficacy, which in turn related to fewer health behaviors and, ultimately, lower quality of life (indirect effect = -0.037, 95% CI [-0.076, -0.011]). The total indirect effect was -0.187, accounting for 38.4% of the total effect.

In practical terms, the chain pathway implies that fear of recurrence may not only weigh directly on how patients feel and function, but may also undermine their confidence in managing their own health, which then reduces engagement in health-promoting behaviors such as lifestyle management, with consequences for quality of life. Because the confidence intervals for all three indirect effects excluded zero, the authors describe these mediating roles as statistically significant.

The authors conclude that interventions aimed at enhancing self-efficacy and promoting health behaviors may buffer the negative association between fear of recurrence and quality of life in stroke patients.

Important limitations temper the findings. The data are cross-sectional, collected at a single point in time from 120 patients at one tertiary hospital in China, so the analysis demonstrates associations rather than causal effects, and the direction of the pathways cannot be confirmed. The hypothesized mediation model is a statistical decomposition of associations, not proof that fear of recurrence causes changes in self-efficacy, behavior, or quality of life. Generalizability beyond the sampled hospital population is also uncertain, and the article was shared early as a peer-reviewed, accepted version subject to further edits before the final Version of Record.

Even with those caveats, the study adds a measurable structure to a well-recognized clinical problem: quantifying how much of the fear-of-recurrence burden on quality of life flows through confidence and behavior.

Subject of Research: Chain mediation of self-efficacy and health behaviors in the relationship between fear of recurrence and quality of life among stroke patients

Article Title: The relationship between fear of recurrence and quality of life in stroke patients: the chain mediating role of self-efficacy and health behaviors

Article References: Hu, Y., Wu, Y., Wu, Y., & Wang, P. (2026). The relationship between fear of recurrence and quality of life in stroke patients: the chain mediating role of self-efficacy and health behaviors. BMC Neurology. https://doi.org/10.1186/s12883-026-05585-y

Image Credits: AI Generated

DOI: 10.1186/s12883-026-05585-y

Keywords: stroke, fear of recurrence, quality of life, self-efficacy, health behaviors, chain mediation, cross-sectional study, BMC Neurology, stroke survivors, psychological well-being, bootstrap mediation, tertiary hospital