ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Mental Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1682528
This article is part of the Research TopicThe Role of Psychological Constructs in Chronic Disease Prevention and Management: A Public Health PerspectiveView all articles
The mediating effect of serum cortisol between stigma and post-stroke depression in stroke patients
Provisionally accepted
- 1Xuzhou Medical University, Xuzhou, China
- 2Xuzhou Central Hospital, Xuzhou, China
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Objective: This study aimed to explore the mediating effect of serum cortisol on the relationship between stigma and post-stroke depression (PSD) in patients with acute ischemic stroke. To enhance early screening for post-stroke depression and prevent its development. Methods: A total of 367 patients admitted to the Department of Neurology and Neurosurgery at Xuzhou Central Hospital between January and December 2024 were selected using a convenience sampling method. Participants completed a general information questionnaire and the 8-item Stigma Scale for Chronic Illness, and their serum cortisol levels were measured at 8:00 a.m. the day after admission. Spearman correlation was used to analyze the correlation between serum cortisol, stigma level and depression degree in patients with acute ischemic stroke. The mediating effect Model was tested by Model 4 model in the PROCESS plug-in. Results: Among the participants, 182 were in the PSD group and 185 in the non-PSD group, with significant differences in income, education, serum cortisol, and stigma levels between the groups (P<0.05). Spearman correlation analysis showed a significant positive correlation between stigma and depression severity (r=0.715, P<0.001), stigma and serum cortisol (r=0.193, P<0.001), and serum cortisol and depression severity (r=0.261, P<0.001). Mediation analysis using Model 4 of the PROCESS macro indicated that serum cortisol partially mediated the relationship between stigma and depression, with a mediating effect size of 0.019 (95%CI:0.004–0.046), accounting for 2.5% of the total effect. Conclusion: These findings suggest that serum cortisol plays a partial mediating role between stigma and PSD in patients with acute ischemic stroke, highlighting a potential biological mechanism linking psychosocial stress to mental health outcomes in this population.
Keywords: post-stroke depression, stigma, Serum cortisol, Mediating effect, Stroke
Received: 09 Aug 2025; Accepted: 22 Sep 2025.
Copyright: © 2025 Shitong, Shiyan, Jiangbo, Yiming and Yihao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wu Yihao, 18112207567@163.com
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