Longitudinal interaction between emotional regulation difficulties and psychological distress in stroke patients and their spouses during rehabilitation and nursing implications

Objective This longitudinal study examined the dynamic interaction between emotion regulation difficulties and psychological distress in stroke rehabilitation patients and their spouses using the Actor-Partner Interdependence Model (APIM). Methods Between June 2023 and June 2025, 394 patient-spouse dyads were recruited from the Department of Rehabilitation Medicine at Shaoxing People’s Hospital using cluster sampling. A six-month longitudinal investigation was conducted across three phases: pre-rehabilitation (T1), early rehabilitation (T2), and rehabilitation maintenance (T3). The Difficulties in Emotion Regulation Scale and Distress Thermometer were administered at each timepoint. Statistical analyses included measurement invariance testing and cross-lagged APIM analysis. Results Of 394 eligible couples, 386 completed all three surveys. Measurement invariance was established across timepoints (ΔCFI ≤ 0.01). Significant actor effects revealed bidirectional within-individual relationships: patients’ and spouses’ emotion dysregulation positively predicted their subsequent psychological distress (T1→T2: β = 0.19–0.21; T2→T3: β = 0.17–0.18; all p < 0.01). Conversely, psychological distress in both partners predicted later emotion dysregulation (T1→T2: β = 0.21–0.24, p < 0.001; T2→T3: β = 0.19–0.20, p < 0.01). Significant partner effects indicated inter-dyad transmission of psychological distress over time. Conclusion These findings demonstrate reciprocal longitudinal associations between emotion dysregulation and psychological distress within individuals and between partners. Healthcare providers should prioritize simultaneous dyadic screening, and future studies should test whether family-centered interventions can interrupt these reciprocal patterns and reduce distress in both patients and caregivers.