Temporal dynamics and bidirectional coupling of self-discrepancy and depressive symptoms after stroke

Adjustment after stroke involves not only functional recovery but also changes in self-concept, which may contribute to depression. Self-discrepancy has been linked to depressive symptoms, yet its temporal development and directionality remain unclear. Participants were recruited from a stroke unit and assessed at baseline (N = 488; M = 5.71 days post-stroke, SD = 3.56) and at 3, 6, and 12 months (n = 188) post-stroke. Self-discrepancy was measured using a visual single-item measure, the adapted Inclusion of the Other in the Self Scale (IOSS), and depressive symptoms using the Patient Health Questionnaire-2 (PHQ-2). Continuous time structural equation modeling was applied to examine temporal stability and cross-process effects. Both self-discrepancy and depressive symptoms showed substantial temporal persistence across the first year post-stroke. Model comparisons favored a bidirectional coupling model (ΔAIC = 7.41) with cross-process associations in opposite directions. Higher self-discrepancy was associated with subsequent increases in depressive symptoms (1.66, 95% CI [0.56, 2.83]), whereas higher depressive symptoms were associated with subsequent decreases in self-discrepancy (-1.25, 95% CI [-2.13, -0.34]). Findings indicate reciprocal temporal associations between self-discrepancy and depressive symptoms during the first year after stroke. The observed pattern highlights the complexity of their relationship and suggests that changes in self-discrepancy may reflect distinct underlying processes.