Associations of ADL Impairment and Insomnia with Post-Stroke Depression: An Exploratory Mediation Analysis of Neuroticism and Social Support

Background Post-stroke depression (PSD) is a common complication after stroke, yet the biopsychosocial mechanisms underlying PSD remain poorly understood. Using the stress–diathesis model, we examined the relationships of activities of daily living (ADL) independence and insomnia with depressive symptoms in stroke patients, particularly focused on the potential mediating roles of neuroticism and social support. Methods This cross-sectional study included 207 stroke patients. Descriptive analyses were conducted using SPSS, and structural equation modeling with the R package 'lavaan' was used to test whether neuroticism and social support mediated the associations of ADL independence and insomnia with PSD. Results The total effect of higher ADL independence on lower PSD symptoms was significant (β = −0.198, 95% CI: [− 0.303, − 0.092]), as was the total effect of insomnia on higher PSD (β = 0.550, 95% CI: [0.453, 0.647]). The association between lower ADL independence and PSD was largely explained by parallel indirect effects via neuroticism (β = −0.034, 95% CI [− 0.064, − 0.004]) and social support (β = −0.046, 95% CI [− 0.089, − 0.003]). For insomnia, significant indirect effects were observed via neuroticism (β = 0.072, 95% CI [0.029, 0.156]) and social support (β = 0.067, 95% CI [0.018, 0.116]), along with a significant serial pathway from neuroticism to social support (β = 0.019, 95% CI [0.001, 0.037]) . Conclusions Lower ADL independence and insomnia appear to be associated with depressive symptoms through distinct psychosocial pathways involving neuroticism and social support. These findings support the development of targeted interventions addressing neuroticism and social support in stroke survivors. Trial registration: Not applicable