Multiple-adverse health conditions, mental health, and health-related quality of life in stroke survivors: Latent profile analysis and mediation analysis

Objective This study aimed to identify subgroups of stroke survivors based on multiple-adverse health conditions and determine the potential mediation effects of mental health in their relationship with health-related quality of life. Design A cross-sectional study. Setting Three tertiary hospitals in Tianjin, China. Participants A total of 558 stroke survivors were recruited between March and June 2023. Main measures Multiple-adverse health conditions (multimorbidity, frailty and disability) were assessed using the age-corrected Charlson Comorbidity Index, FRAIL Scale, and Barthel Index. Mental health was measured with Patient Health Questionnaire-4, and health-related quality of life was evaluated using the EuroQol 5-dimension 5-level scale. Latent profile analysis identified subgroups, and mediation analysis explored mental health's role. Results Three subgroups were identified: Mild (65.4%, n = 365), Moderate (17.4%, n = 97), and Severe (17.2%, n = 96). Mediation analysis showed that, compared with the Mild subgroup, survivors in the Moderate subgroup ( β = 0.138, 95% CI: 0.055 to 0.232) and the Severe subgroup ( β = 0.217, 95% CI: 0.113 to 0.316) exhibited worse mental health, and poorer mental health was associated with lower health-related quality of life ( β = −0.119, 95% CI: −0.170 to −0.075). Conclusions This study suggests heterogeneity in multiple-adverse health conditions and indicates that mental health may partially account for the association between these conditions and health-related quality of life in stroke survivors. The findings highlight the need for further research into subgroup-specific interventions—with particular attention to mental health—to determine whether such approaches could improve health-related quality of life.