The association between social support and quality of life in patients with severe stroke: a chain mediation analysis of resilience and self-efficacy

ObjectiveTo explore the chain mediating effects of resilience and self-efficacy on the association between social support and quality of life (QoL) among patients with severe stroke.MethodsThis cross-sectional study enrolled 272 inpatients between June 2023 and June 2025. Validated instruments were used to assess social support (SSRS), resilience (CD-RISC), self-efficacy (GSES), and quality of life (QoL) (SS-QOL). PROCESS Model 6 with 5,000 bias-corrected bootstrap samples was used to test sequential mediation while adjusting for key covariates.ResultsMean scores indicated moderate levels of social support, resilience, self-efficacy, and QoL. Quality of life scores were significantly higher among patients aged <60 years compared to those aged ≥60 years (54.62 ± 14.07 vs. 49.34 ± 13.12), among patients with higher education levels (college or above: 54.73 ± 14.27 vs. primary school or below: 47.26 ± 11.38), among patients covered by Employee Health Insurance compared to self-funded patients (53.26 ± 13.42 vs. 42.36 ± 11.25), and among patients with lower NIHSS scores (10–14 points: 56.38 ± 13.45 vs. 15–24 points: 46.44 ± 12.41). All comparisons were statistically significant at P < 0.05. All main variables were positively correlated. The direct association between social support and QoL was significant (adjusted unstandardized β = 0.88, 95% CI [0.790, 0.975]), accounting for 53.5% of the total association. The three indirect associations were: (1) SSRS – CD-RISC – SS-QOL: β = 0.255, 95% CI [0.192, 0.329]; (2) SSRS – GSES – SS-QOL: β = 0.126, 95% CI [0.020, 0.208]; and (3) SSRS – CD-RISC – GSES – SS-QOL: β = 0.385, 95% CI [0.289, 0.510],supporting the hypothesized chain mediation model.ConclusionSocial support was strongly associated with QoL, both directly and indirectly through resilience and self-efficacy and their sequential pathways. These findings highlight potential intervention targets, although causal inferences are limited by the study’s cross-sectional design. Strengthening social support and related psychological resources may improve rehabilitation outcomes in patients with severe strokes.