Compassion imbalance, resilience, and depressive symptoms among older stroke survivors: A moderated–moderated mediation analysis of neuroticism, compassion, and self-compassion

Abstract

Post-stroke depression is a frequent and clinically important complication among stroke survivors, contributing to poorer functional recovery and reduced quality of life. The aim of this study was to examine the interrelationships among neuroticism, resilience, compassion, self-compassion, and depressive symptoms in older stroke survivors. Stroke survivors aged ≥50 years were recruited from outpatient clinics at Chiang Mai University Hospital, Thailand. Participants completed standardized questionnaires assessing neuroticism, resilience, compassion, self-compassion, and depressive symptoms. Pearson correlation, multiple regression, mediation, and moderated–moderated mediation analyses were conducted to examine direct, indirect, and conditional associations among these psychological constructs. A total of 142 patients were included in the final analysis. Neuroticism was positively correlated with depressive symptoms (r=0.412, p<0.01) and negatively correlated with resilience (r=−0.311, p<0.01), whereas resilience was negatively correlated with depressive symptoms (r=−0.400, p<0.01). Mediation analysis showed that resilience partially mediated the association between neuroticism and depressive symptoms (indirect effect of 0.098, 95%CI: 0.029–0.195). This indirect association was conditional on levels of compassion and self-compassion. Compassion significantly moderated the association between resilience and depressive symptoms (B=−0.018, p=0.003), and self-compassion moderated the association between compassion and depressive symptoms (B=−0.072, p=0.019). The moderated–moderated mediation model was significant, as indicated by the index of moderated–moderated mediation (index=−0.0096, 95%CI: −0.0230 to −0.0021). The indirect pathway through resilience was strongest among participants with higher compassion for others but lower self-compassion, suggesting a pattern of compassion imbalance. These findings indicate that resilience functions within a broader emotional context, in which the balance between compassion for others and compassion toward oneself may shape vulnerability to depressive symptoms after stroke. Incorporating self-compassion-based strategies into post-stroke rehabilitation may help strengthen psychological recovery and reduce depressive symptoms among older stroke survivors.