The Moderating Role of Perceived Stress in the Relationship Between Resilience and Quality of Life among Burn Survivors

Burn injuries leave survivors with lasting physical, psychological, and social burdens, yet quality of life (QoL) after burns varies widely, and little is known about the conditions under which psychological resources matter most. Guided by conservation of resources theory, this cross-sectional study examined whether perceived stress moderates the relationship between resilience and QoL among burn survivors in Pakistan and whether these variables differ by gender. Burn survivors (N = 300; 169 men, 131 women) who had been injured at least 6 months earlier were recruited from three hospitals in Islamabad and Rawalpindi and completed the Nicholson McBride Resilience Questionnaire, the Perceived Stress Scale, and the WHOQOL-BREF. Resilience was positively correlated with QoL (r = .50), whereas perceived stress was negatively correlated with QoL (r = −.38) and with resilience (r = −.38). Moderation analysis revealed a significant Resilience × Perceived Stress interaction, R² = .32, F(3, 296) = 48.12, p < .001: the positive association between resilience and QoL grew stronger as perceived stress increased (conditional effects = .44, .78, and 1.12 at 1 SD below the mean, at the mean, and 1 SD above the mean of perceived stress). Men reported higher perceived stress and lower resilience than women, whereas QoL did not differ significantly by gender. Resilience was associated with better Quality of Life (QoL) at every level of stress and most strongly among survivors under high stress, supporting rehabilitation that combines resilience-building with stress management. Longitudinal, multi-site research is needed.