Cumulative Association of Sexual, Cognitive, and Depressive Disorders With Quality of Life After Stroke: A Rehabilitation Cohort in Kinshasa

This study assessed the individual and cumulative associations of post-stroke cognitive, depressive, and sexual disorders with quality of life (QoL) among patients undergoing rehabilitation. This cross-sectional study included 169 stroke survivors receiving outpatient rehabilitation. QoL was assessed using the Stroke Impact Scale version 3.0 (SIS 3.0). Cognitive, depressive, sexual, motor, and disability status were assessed using validated instruments. Bivariate analyses and multivariable linear regression were performed. Cumulative association was examined using a 0–3 disorder score and ANOVA with Tukey post-hoc comparisons. Cognitive impairment, depressive symptoms, and sexual dysfunction were identified in 29.6%, 46.7%, and 55.0% of participants, respectively. Lower SIS scores were observed among participants with cognitive impairment, depressive symptoms, and interview-reported sexual difficulties. In multivariable regression, participants without cognitive impairment had higher QoL scores than those with impairment (B = 8.23, 95% CI [4.05, 12.42], p < 0.001). Depressive symptoms (B = −4.80, 95% CI [−9.10, −0.40], p = .031) and interview-reported sexual difficulties (B = −5.30, 95% CI [−10.20, −0.30], p = .037) were independently associated with lower QoL, whereas BISF-W/MSHQ-assessed sexual dysfunction was not. Age and motor function were positively associated with QoL, whereas disability was negatively associated. QoL differed significantly by number of co-occurring disorders (ANOVA F = 5.61, p = .001, η² = 0.093), decreasing from 55.3% with no disorders to 38.6% with three disorders. Co-occurring disorders were cumulatively associated with QoL. Given the cross-sectional design, causality cannot be inferred. The findings support multidimensional rehabilitation addressing motor and non-motor sequelae in this rehabilitation cohort in Kinshasa.