Abstract:

Objective To identify potential subtypes of demoralization syndrome among stroke patients undergoing neuroendovascular procedures using latent profile analysis， and to examine differences in death anxiety among these subtypes. Method This cross-sectional study used convenience sampling to recruit 202 stroke patients undergoing neuroendovascular procedures at a hospital from November 2024 to March 2025. Participants completed the General Information Questionnaire， Despair Scale （DS）， and the Chinese version of the Templer's Death Anxiety Scale （CT-DAS）. Using R software， we estimated a series of latent profile models （ranging from 2 to 6 profiles） based on four manifestations of demoralization syndrome： loss of meaning and purpose， dysphoria， helplessness and hopelessness， and sense of failure. Starting from the 2-profile model， we incrementally increased the number of profiles and compared model fit indices to identify the optimal solution. Subsequently， logistic regression analysis was conducted to identify the factors influencing DS scores according to the latent profile classifications. We compared DS scores across subgroups and performed bivariate correlation analysis between DS and CT-DAS subdimensions （Affective， Stress & Pain， Time Awareness， and Cognitive）. Results The DS scores classified stroke patients into two distinct subtypes of demoralization syndrome： A Meaninglessness-Dysphoria Group （51.00%， 103/202） and a Helplessness-Hopelessness Group （49.00%， 99/202）. The HHG demonstrated significantly higher proportions （P < 0.05） of female patients， those hospitalized for 6 ~ 10 days， recipients of arterial stenosis/occlusion surgery， individuals with junior high school or higher education， employed subjects， and rural residents compared to the MDG. Binary logistic regression analysis revealed： Lower probability of HHG membership for urban （OR= 0.159， P < 0.001） and city （OR = 0.224， P = 0.007） residents versus rural counterparts； Higher HHG probability in patients hospitalized 6-10 days versus 1 ~ 5 days （OR = 2.311， P = 0.017）； Elevated HHG risk among junior high school （OR = 4.956， P < 0.001） and high school or above graduates （OR = 5.102， P = 0.001） relative to those with primary education or less； Increased HHG probability in aneurysm embolization （OR = 2.419， P = 0.040） and arterial stenosis/occlusion surgery （OR = 2.733， P = 0.014） recipients compared to cerebrovascular angiography patients. The HHG scored significantly lower on the cognitive dimension of death anxiety than the MDG （t = 2.421， P = 0.016）， while showing no differences in affective， stress & pain， or time awareness dimensions （P > 0.05）. Bivariate Pearson correlations indicated dysphoria （DS） positively correlated with Affective （r = 0.192， P = 0.006）， Time Awareness （r = 0.172， P = 0.015）， and Cognitive （r = 0.139， P = 0.049） of death anxiety. Conclusions Stroke patients undergoing neuroendovascular procedures exhibit elevated levels of death anxiety， with significant variations observed across different subtypes of demoralization syndrome. Residential location， hospitalization duration， anxiety severity， and surgical type constitute significant determinants of demoralization syndrome. Targeted clinical interventions should be implemented to alleviate demoralization severity and mitigate death anxiety.

Key words: acute ischemic stroke, demoralization syndrome, neuroendovascular procedures, death anxiety, latent profile model