Abstract
BACKGROUND: Family resilience theory posits that families can cultivate adaptive capacities to thrive amid adversity. However, evidence on family resilience mechanisms among Chinese stroke survivors and their caregivers remains limited. OBJECTIVES: To investigate the direct and indirect pathways linking perceived social support, caregiver capacity, and family resilience in stroke-affected families and to identify socioeconomic determinants shaping resilience outcomes. DESIGN: This is a cross-sectional study. METHODS: A convenience sample of 513 stroke survivor-caregiver dyads was recruited from two hospitals in Ningbo, China: a large public hospital and a private rehabilitation hospital. Quantitative data were collected using a structured questionnaire with respondent-stratified data sources. Primary family caregivers self-reported their general demographics, as well as their responses to the Perceived Social Support Scale (PSSS), Family Caregiver Task Inventory (FCTI), and Family Resilience Assessment Scale (FRAS-C). Concurrently, the demographics, clinical characteristics, and Activities of Daily Living (ADLs) of stroke survivors were assessed. Statistical analyses encompassed descriptive statistics, Pearson correlation coefficients, multivariate regression models, and mediation analysis to examine relationships between variables. RESULTS: Family resilience scores (mean = 86.70 ± 19.00) showed significant positive correlations with perceived social support (PSS) (r = 0.523, p < 0.01) and positive correlations with caregiver capacity (FCTI, r = 0.522, p < 0.01). Mediation analysis revealed that caregiver capacity partially mediated the relationship between PSS and family resilience (indirect effect: 26.68%). Socioeconomic determinants played a critical role: higher education (β = 8.50, p = 0.008), medical insurance coverage (β = -6.47, p = 0.009), and mild stroke survivors dependence (ADL;β = 9.40, p < 0.001) enhanced resilience, while higher pre-illness income of stroke survivors (β = -8.31, p = 0.002) and poor caregiver sleep quality (β = -6.20, p < 0.05) reduced it. CONCLUSION: This study provides novel evidence on the psychosocial mechanisms underlying family resilience in Chinese stroke populations. First, we identify caregiver capacity as a critical mediator between social support and resilience, elucidating a previously underexplored pathway. Second, we reveal the paradoxical association between higher pre-stroke income and reduced resilience, challenging conventional socioeconomic assumptions in resilience research. Third, we establish caregiver sleep quality as a modifiable determinant of family resilience. The study suggests that interventions should simultaneously strengthen social support networks and caregiver skills, while addressing issues related to sleep quality and financial concerns. CLINICAL TRIAL NUMBER: Not applicable.