A Bibliometric Analysis of Research Trends in Psychological Interventions for Stroke Survivors: Focusing on Resilience and Psychological Well-Being (2000-2024)

Introduction

Stroke, as a severe cerebrovascular disorder, has emerged as the second leading cause of mortality and a primary cause of disability worldwide.¹ The Global Burden of Disease study indicates that approximately 15 million individuals suffer from stroke annually, with one-third experiencing permanent functional impairment.¹ Clinical nursing practice demonstrates that stroke survivors, beyond experiencing physical symptoms such as motor deficits and dysphasia, frequently encounter complex psychological health challenges. Recent evidence confirms that approximately 40–60% of patients manifest depressive symptoms,² 30–50% experience anxiety symptoms,³ while a significant proportion develop post-traumatic stress disorder and adjustment disorders.⁴ These psychological health complications significantly impact patients’ rehabilitation adherence and self-care capabilities. This diminishes their quality of life and ultimately resulting in elevated mortality and disability rates.⁵ Consequently, enhancing psychological nursing interventions for stroke survivors has become an indispensable core component of contemporary holistic rehabilitation.⁶

Over the past two decades (2000–2024), psychological interventions for stroke survivors have undergone a significant paradigm shift, transitioning from traditional symptom-oriented nursing models toward a holistic rehabilitation approach based on positive psychology.⁷ This transformation stems from researchers’ profound understanding of patients’ psychological health needs and the successful application of positive psychology in chronic condition management.⁸ This shift emphasizes the importance of integrated multidisciplinary collaboration, combining expertise from nursing science, psychology, rehabilitation medicine, and healthcare management to address the complex psychological challenges faced by stroke survivors. In contrast to conventional models, positive psychology emphasizes the identification and cultivation of patients’ psychological strengths and resources, promoting the development of positive emotions and psychological potential.⁹ This theoretical framework has driven a significant transformation in stroke-related psychological nursing, expanding its scope from basic complication prevention to comprehensive psychological potential development.¹⁰ Notably, since 2015, with the advancement of evidence-based practice and interdisciplinary integration, psychological resilience and psychological well-being have progressively emerged as fundamental theoretical foundations guiding healthcare professionals in implementing psychological interventions.¹¹

Psychological resilience, as a core concept in positive psychology, reflects patients’ capacity to maintain and restore psychological health when confronting illness-related challenges.¹² Nursing research demonstrates that stroke survivors with higher levels of psychological resilience exhibit not only enhanced illness adaptation and self-management capabilities but also more active engagement in rehabilitation exercises and daily care activities.¹³ Similarly, as another key concept in positive psychology, psychological well-being represents patients’ optimal psychological functioning at both cognitive and emotional levels.¹⁴ Large-scale clinical investigations reveal that elevated psychological well-being significantly enhances patients’ rehabilitation adherence and nursing cooperation, facilitates social function restoration, and improves overall quality of life.¹⁵ Cutting-edge nursing intervention studies further confirm a significant positive correlation between psychological resilience and psychological well-being, indicating that systematic nursing interventions targeting these two aspects can markedly improve patients’ rehabilitation outcomes.¹⁶

Despite the rapid growth in relevant research, a systematic analysis of the overall development trends in this field still needs to be improved. While traditional reviews have provided important references for understanding the field’s development, they demonstrate notable limitations in revealing the evolution of research hotspots, nursing practice innovations, and knowledge structures.¹⁷ Bibliometrics, as an objective literature analysis method, can systematically demonstrate the development trajectory, practice patterns, and research frontiers of specific domains through multi-dimensional quantitative analysis of nursing research literature.¹⁸ This methodology not only precisely identifies nursing research hotspots and knowledge foundations but also profoundly reveals nursing scholars’ collaboration networks and interdisciplinary characteristics, providing scientific evidence for future nursing practice and research development.¹⁹ However, no studies have yet employed bibliometric methods to systematically analyze the developmental trends of psychological resilience and psychological well-being in psychological interventions for stroke survivors.²⁰

Therefore, this study aims to conduct a systematic analysis of research related to psychological interventions for stroke survivors published between 2000 and 2024 using bibliometric tools such as CiteSpace and VOSviewer. Specifically, this analysis will focus on the research progress of two core concepts: psychological resilience and psychological well-being. This study will analyze multiple aspects of nursing research in this field, including development trends, knowledge distribution patterns, and geographical characteristics. It will also explore the evolution of nursing intervention themes and emerging research directions, while identifying core research teams and collaboration networks, with particular focus on the knowledge foundations and theoretical frameworks related to psychological resilience and psychological well-being. Through this systematic analysis, we aspire to provide scientific references for enhancing the practice level and research quality of psychological nursing interventions for stroke survivors, promoting in-depth development in this field.

Materials and Methods

Search Strategy

This study conducted literature retrieval based on the Web of Science Core Collection (WoSCC). As an internationally recognized high-quality digital literature database, WoSCC is widely considered the optimal resource for bibliometric analysis.²¹ To ensure the completeness and accuracy of retrieved data, we selected the Science Citation Index Expanded (SCI-Expanded, 1900-present) as the citation index.²² Furthermore, we adhered to internationally recognized bibliometric methodologies to ensure methodological rigor.²³ These standards provided a robust theoretical foundation for the bibliometric analysis conducted in this study. Despite the increasing recognition of psychological interventions in stroke survivors, research specifically focusing on resilience and psychological well-being remains limited. To present the trends of this field, we included not only intervention studies but also other types of studies. This method ensures a broader understanding the trends of resilience and psychological well-being in stroke survivors, while also identifying the scientific foundation of intervention strategies.

The retrieval strategy was as follows:

Topic 1(TS) = (“stroke” OR “cerebrovascular accident” OR “brain infarction” OR “ischemic stroke” OR “hemorrhagic stroke”) AND

Topic 2(TS) = (“psychological intervention*” OR “mental health intervention*” OR “psychotherapy” OR “cognitive therapy” OR “behavioral therapy” OR “mindfulness” OR “counseling” OR “psychological support” OR “psychological treatment”) AND

Topic 3(TS) = (“resilience” OR “psychological resilience” OR “emotional resilience” OR “mental resilience” OR “psychological well-being” OR “well-being” OR “quality of life” OR “mental health” OR “emotional health”).

The retrieval timeframe was set from January 1, 2000, to September 30, 2024, to comprehensively reflect the latest advances in psychological intervention research for stroke survivors. The included literature types comprised original research articles and reviews, as they provide complementary perspectives in understanding psychological interventions. Original research articles provide direct empirical evidence, while reviews offer existing evidence, establish theoretical frameworks, and identify research gaps. This comprehensive inclusion enabled thorough analysis of research development trajectories and knowledge structures in this field. Considering English as the predominant language of international scientific communication, we restricted the literature language to English to ensure the readability of included literature and the universality of research findings.

Analysis Tools

This study employed multiple bibliometric analysis tools and visualization software to comprehensively analyze the bibliometric characteristics of psychological intervention research for stroke survivors. Initially, we utilized Microsoft Excel 2019 for data management and preliminary descriptive statistics. Specifically, Excel was used to organize the original literature data by annual publications, calculate the total number of publications, and generate visualizations such as line charts to illustrate publication trends. Subsequently, we employed CiteSpace 6.2.3 R3 and VOSviewer 1.6.17 software for in-depth bibliometric analysis and visualization. Both software packages are Java-based platforms and are widely recognized information visualization tools in bibliometric research.^20,24

Using CiteSpace, we conducted a multi-dimensional analysis of the literature data on psychological interventions for stroke survivors. Initially, we generated an author publication network map to reveal the core authors and their publication volumes in this field. Based on this, we performed a cluster analysis of the author network to explore research teams and collaborative groups in the domain. Additionally, we generated an author co-citation network map to identify scholars with significant influence in the field. Through CiteSpace, we also created country and institution maps, demonstrating the geographical distribution characteristics and institutional collaboration patterns in this field. Furthermore, we conducted a dual map overlay analysis of journals to illustrate the interdisciplinary knowledge exchange and dissemination patterns in this domain. In the dual-map overlay, the left side represents citing literature, while the right side represents cited literature, with curves indicating citation links. The z-value function was used to amplify the more robust flow trajectories, with higher z-values depicted by thicker links.

Using VOSviewer, we focused on Analyzing the knowledge structure and research theme evolution in psychological interventions for stroke survivors. By creating a journal co-citation network map based on publication volumes (Figure 1A), we identified significant journals and their citation patterns in this field. Through keyword co-occurrence analysis (Figure 1B), we constructed a keyword co-occurrence network map, highlighting the structural distribution of research themes and hotspots. Meanwhile, we demonstrated the knowledge density and distribution patterns of various research themes using the keyword density visualization map (Figure 1C). Furthermore, we conducted a visualization analysis of country/region distribution in the literature data, revealing the global research landscape in this field. Finally, by generating a reference co-citation network map, we delineated this domain’s knowledge lineage and theoretical foundations.

Figure 1 (A) Map of co-cited journals with publications. (B) Map of co-occurring keywords with occurrences. (C) Map of keywords density.

Research Ethics

This study was conducted as a bibliometric analysis. All data were sourced from online resources, and no animals or human subjects were involved. Therefore, ethical approval from an ethics committee was not required.

Results

Analysis of Publication Output and Citations

From 1 January 2000 to 30 September 2024, 373 articles meeting the inclusion criteria were retrieved from the Web of Science Core Collection database (Figure 2), comprising 258 original research articles and 115 review articles. Overall, this field yearly literature output demonstrates a steady upward trend (Figure 3A).

Figure 2 The flow chart of screening process.

Figure 3 The quantity of publications and citations. (A) The publication output and its growth trend from 2000 to 2024. (B) The annual citation count from 2000 to 2024.

Figure 3B illustrates the annual citation frequencies of published literature between 2000 and 2024. The total citation frequency of 373 articles showed a significant growth trend. Annual citation frequencies increased progressively from 813 in 2020 to 978 in 2021, rising to 1203 in 2022 and reaching a peak of 1285 in 2023. The citation frequency for the first nine months of 2024 was 1138, indicating sustained academic attention to research outcomes in this field. Specifically, citation frequencies for original research articles increased from 424 in 2020 to 665 in 2023, while citation frequencies for review articles rose from 389 in 2020 to 620 in 2023, reflecting the significant roles both original research articles and review articles played in advancing disciplinary development.

Analysis of Authors and Co-Cited Authors

Figure 4A and Table 1 list the top five authors by publication volume, with Vranceanu, Ana-Maria publishing the most (8 articles), followed by Rosand, Jonathan and Lin, Ann (7 articles each), then Gates, Melissa (6 articles) and Wong, Dana (5 articles). Through keyword cluster analysis of the author collaboration network, we identified 14 significant clusters (Figure 4B), encompassing research themes such as hormone replacement therapy, mindfulness intervention, depression treatment, and physician-advised patient action.

Table 1 Top Five Active Authors and Co-Cited Authors

Figure 4 (A) Map of authors with publications. (B) Map of clustering of authors. (C) Map of co-cited authors with publications.

Figure 4C presents the co-cited author network map. Among all co-cited authors, Hackett ML received the highest citation frequency (75 times), followed by Ayerbe L (39 times), Zigmond AS (33 times), Lincoln NB (31 times), and Beck AT (26 times) (Table 1). The research outputs of these highly cited authors constitute the core knowledge foundation for psychological intervention research in stroke survivors. Among co-cited authors, Hackett ML demonstrated the highest centrality (0.16), followed by Beck AT (0.14), Ayerbe L (0.12), American Psychiatric Association (0.11), and Bakas T (0.1). These researchers have exerted significant influence in the field, playing important roles in connecting different research groups and facilitating knowledge integration and dissemination.

Analysis of Countries and Institutions

Figure 5A illustrates the global distribution and collaborative relationships of participating countries or regions in this research field. The country network map generated by CiteSpace (Figure 5B) demonstrates that multiple countries and regions have contributed to publications on psychological interventions for stroke survivors. The United States leads with 98 publications, followed by the United Kingdom (56) and China (50) in second and third positions, with Australia (42) and Canada (20) following (Table 2). Apart from China, the top five countries by publication volume are developed nations, highlighting their dominant position in this research domain. Purple circles in the figure indicate centrality, with values above 0.1 representing significant nodes. Regarding centrality, the United States ranks first with 0.32, followed by Canada (0.27), Australia (0.26), the United Kingdom (0.22), and China (0.10). These countries have played a significant role in global research collaboration (Table 2).

Table 2 Top Five Countries in Terms of Count and Centrality

Figure 5 (A) The distribution of countries/regions. (B) Map of countries. (C) Map of institutions.

Figure 5C presents the institutional distribution network map. Among the top five institutions by publication volume, three are from the United States, one from the United Kingdom, and one from Australia. Harvard University leads with 24 publications, followed by Harvard Medical School and the University of Nottingham (14), La Trobe University (13), and Massachusetts General Hospital (12) ranking fourth and fifth respectively (Table 3). Analysis of institutional centrality through CiteSpace reveals that Harvard University has the highest centrality (0.29), followed by Brigham and Women’s Hospital (0.13), Complutense University of Madrid (0.10), Monash University (0.09), and Pennsylvania Commonwealth System of Higher Education (0.07). Apart from Harvard University, Brigham and Women’s Hospital, and Complutense University of Madrid with centrality values exceeding 0.1, other institutions show relatively low centrality, indicating that inter-institutional collaboration requires further strengthening (Table 3).

Table 3 Top Five Institutions in Terms of Count and Centrality

Analysis of Journals and Co-Cited Journals

In psychological interventions for stroke survivors, Figure 6 presents the results of a dual-map analysis of journals containing relevant literature. Research findings indicate that literature in psychology, education, and health domains (represented by blue trajectories) is primarily influenced by literature from psychology, education, and sociology fields (z=4.21, f=3942), as well as health, nursing, and medicine domains (z=2.73, f=2685).

Figure 6 The dual-map overlay illustrating journals and respective publications.

Additionally, literature in pharmacy and medicine fields (represented by green trajectories) is significantly influenced by literature from nursing, pharmacy, and health domains (z=1.76, f=1869). Meanwhile, literature from psychology, education, and social domains (pink trajectories) has also substantially influenced literature in rehabilitation exercise and sports fields (z=3.38, f=3237). These interdisciplinary citation relationships comprehensively reflect the multidisciplinary characteristics of psychological intervention research for stroke survivors.

Table 4 lists the top 10 journals ranked by publication volume. “Disability and Rehabilitation” has 12 articles that play a significant role in this field. “Cochrane Database of Systematic Reviews” ranks second with 11 articles and the highest impact factor (IF 2023=8.8), while “Topics in Stroke Rehabilitation” ranks third with 10 articles. Notably, six of the top 10 journals originate from the United Kingdom, demonstrating the UK’s dominant position in this research domain. The average citations per article vary considerably among these journals, ranging from 8.50 for “Brain Impairment” to 60.91 for “Cochrane Database of Systematic Reviews”, reflecting the varying influence of different journals in this field.

Table 4 Top 10 Academic Journals Based on Publications

We used VOSviewer software to conduct cluster analysis on 187 journals with co-citation frequencies exceeding 20 times for further study of journal co-citations. As shown in Figure 1A, the journal co-citation network formed clusters of different colors. The red cluster primarily encompasses mental health and aging research, epidemiology and public health, behavioral medicine and psychological therapy, and health services. These journals collectively focus on improving chronic patients’ health status through psychological and behavioral interventions, with particular emphasis on psychological health management for patients with conditions such as stroke. The central green cluster covers research in neurology and brain science, psychiatry, geriatric mental health, mental health in public health, and psychological intervention approaches for depression and anxiety. These studies jointly focus on the application and impact of mental health in neurological diseases and elderly populations. The blue cluster primarily includes rehabilitation medicine, speech-language pathology and therapy, occupational therapy, brain injury and neurorehabilitation, and frontier research in neuroscience. These studies collectively emphasize various rehabilitation approaches to enhance functional recovery and quality of life for post-stroke patients. The yellow cluster mainly involves geriatric medicine and aging research, physical rehabilitation and stroke recovery, alternative and complementary medicine, neurology, and evidence-based medicine. These studies focus on the unique needs of elderly populations during stroke rehabilitation while exploring the effectiveness and evidence base of various rehabilitation methods. The clustering distribution of these journals reflects the multidisciplinary characteristics of psychological intervention research for stroke survivors. Analyzing articles published in these journals provides theoretical and empirical foundations for this study.

As shown in Table 5 and Figure 1A, “Stroke” has the highest journal co-citation frequency (241 times), followed by “Archives of Physical Medicine and Rehabilitation” (173 times) and “Disability and Rehabilitation” (165 times). These journals have high publication volumes and play central roles in knowledge dissemination within this field. Calculation of journal centrality through CiteSpace reveals that the “American Journal of Epidemiology” has the highest centrality (0.17), followed by the “American Journal of Psychiatry” (0.13) and “Archives of Physical Medicine and Rehabilitation” (0.10) (Table 5). These journals are important hubs in connecting different disciplines and facilitating knowledge integration. Notably, while some specialized rehabilitation medicine journals, such as “Clinical Rehabilitation” and “Topics in Stroke Rehabilitation”, have relatively lower centrality values, they hold significant value in guiding the clinical practice of psychological interventions for stroke survivors.

Table 5 Top Five Co-Cited Journals in Terms of Counts and Centrality

Analysis of Co-Cited References

To examine reference co-citations, we constructed a reference co-citation network map using VOSviewer (Figure 7). From 18,158 references, we selected those with co-citation frequencies of no fewer than 9 times for analysis, ultimately identifying 68 core references. These analyses enabled us to construct a knowledge network in the field of psychological interventions for stroke survivors.

Figure 7 Map of co-cited references with citations.

Table 6 lists the top 10 most-cited references, comprising four original research articles and six reviews. These highly cited publications were primarily published between 1983 and 2014. The article “The hospital anxiety and depression scale” by Zigmond et al, published in 1983, received the highest number of citations (40 times), introducing a measurement tool for assessing anxiety and depression in hospital patients. The review article by Ayerbe et al, published in 2013, ranked second (33 times), systematically reviewing the natural history, predictive factors, and prognosis of post-stroke depression. The article by Hackett et al from 2014 ranked third (27 times), updating the frequency of post-stroke depression through Meta-analysis. Hackett ML authored four of the top 10 articles as first author, reflecting this scholar’s significant contribution to psychological intervention research in stroke survivors.

Table 6 Top 10 Co-Cited References in Terms of Citations

The reference co-citation network displays five distinct clusters (Figure 7). The red cluster primarily encompasses psychiatry and mental health diagnostics, rehabilitation research, and psychological and physical rehabilitation of post-stroke survivors. The green cluster mainly covers post-stroke depression and mental health, geriatric care and rehabilitation, psychopathology and behavioral interventions. The blue cluster focuses on mindfulness therapy and psychological interventions, psychological support in stroke rehabilitation, utilization of psychological assessment tools, and systematic review methodologies. The yellow cluster primarily encompasses treatment and psychological interventions for post-stroke depression, applications of clinical psychology in rehabilitation, systematic reviews and evidence-based practice, and psychopathology research. The purple cluster mainly involves the development and application of psychometric instruments, the implementation of systematic reviews and evidence-based medicine in interventions, functional assessment of stroke patients, and health-related quality of life evaluation.

Analysis of Co-Occurring Keywords

Analyzing keyword co-occurring may reveal core themes and research priorities in psychological interventions for stroke survivors. As of September 2024, 1844 keywords have been identified in this research domain. Using VOSviewer software, we set a minimum co-occurrence frequency of 5, ultimately including 176 keywords for analysis (Figure 1B). We utilized the Pajek software package for keyword clustering, where nodes represent keywords, node size reflects keyword co-occurrence frequency, and connecting lines indicate association strength. Figure 1C presents the density visualization of keywords, facilitating rapid assessment of the knowledge framework and research hotspot distribution in this field.

We identified five keyword clusters in the network (Figure 1B and Table 7). The red cluster primarily addresses chronic disease management, nursing burden, caregiver support, intervention effects on health outcomes, quality of life research. It includes keywords such as “interventions” and “quality of life”. The green cluster mainly involves psychological and cognitive therapy for neurological disorders, intervention efficacy studies, and systematic review methodologies. Representative keywords include “cognitive behavioral therapy”, “double-blind”. The blue cluster focuses on research linking cardiovascular diseases with depression, improving overall patient health through psychological support and behavioral interventions. Keywords include “mental health”, “behavioral therapy”. The yellow cluster primarily addresses mental health issues (such as “anxiety”, “depression”), behavioral treatment and community support, family caregiver roles, and rehabilitation needs of post-stroke patients, including keywords like “depression”, “anxiety”. The purple cluster involves the development and validation of psychometric instruments and symptom management during rehabilitation, with keywords like “mindfulness”, “symptoms”.

Table 7 Top 10 Keywords

Table 7 lists high-frequency keywords with co-occurrence frequencies exceeding 30 times. The core terminology in this field comprises “quality of life” (135 times), “stroke” (82 times), “depression” (59 times), “anxiety” (41 times), and “cognitive behavioral therapy” (41 times). Additionally, frequently occurring keywords include “mental health” (35 times), “randomised controlled trial” (34 times), “poststroke depression” (32 times), “health” (31 times), and “people” (30 times), reflecting key research concerns and methodologies in this field.

Discussion

Using bibliometric analysis, this study systematically analyzed the developmental trends in psychological intervention research focusing on resilience and psychological well-being among stroke survivors. Through VOSviewer and CiteSpace, we identified the major contributors and high-impact literature in this field. The findings revealed the knowledge structure of this research field, providing scientific evidence for advancing psychological interventions targeting resilience and psychological well-being among stroke survivors. Additionally, this study laid the foundation for clinical practice utilizing multidisciplinary integration and complementary resources. These findings contribute to promoting and improving the psychological health of stroke survivors and enhancing their quality of life.

Development Trends of Psychological Intervention Among Stroke Survivors

Scholarly publication volume serve as a crucial indicator for measuring the developmental trajectory of a research field.³⁵ Figure 3A shows the publications on psychological interventions focusing on resilience and psychological well-being among stroke survivors from 2000 to 2024 (Figure 3A). The publication volume increased substantially after 2018, reaching 55 articles in 2023. In the first nine months of 2024, 43 articles were published, reflecting the growing research interest in this field (Figure 3A). The citation analysis reveals a growth in scholarly impact, with annual citations increasing from 369 in 2018 to 1285 in 2023 (Figure 3B). The findings indicate that this field has emerged as a prominent research hotspot, drawing increasing scholarly attention. In recent years, the growing emphasis on stroke survivors’ psychological health and the documented benefits of resilience and psychological well-being in rehabilitation outcomes have contributed to this research expansion.^36,37 Given the increasing global burden of stroke and the recognized need for psychological support, this field is likely to maintain its growth trajectory.³⁸

Overall Characteristics of Psychological Intervention Among Stroke Survivors

The bibliometric analysis revealed distinct geographical patterns in psychological intervention research for stroke survivors. Developed countries, led by the United States, dominated the field, reflected both in publication volume (the United States leading with 98 articles) and centrality in international collaboration networks (Table 2). This geographic distribution pattern may be attributed to multiple factors: firstly, these countries have well-developed healthcare systems and substantial research resources;³⁹ secondly, their long-standing expertise in neurorehabilitation and mental health has established a solid foundation for research on resilience and psychological well-being;⁴⁰ furthermore, their strong emphasis on geriatric mental health has facilitated the advancement of related research.⁴¹ The institutional analysis revealed the distribution of research productivity, with Harvard University leading in publication output (24 articles), followed by significant contributions from Harvard Medical School (14 articles) and the University of Nottingham (14 articles) (Table 3). These institutions demonstrate not only strong research capabilities but also distinctive advantages in interdisciplinary integration and innovation, providing essential research infrastructure and support for studies on resilience and psychological well-being.⁴⁰ Within this research landscape, analysis of author publication networks and author co-citation networks revealed a notable pattern: while Vranceanu Ana-Maria was the most productive author (8 articles), Hackett ML received the highest number of citations (75 citations) and centrality (0.16) (Table 1). This citation pattern suggests an evolution in the research focus: studies on post-stroke depression, a predominant mental health concern, provided the foundation for research on resilience and psychological well-being.⁴² The bibliometric analysis indicates a transition from symptom-oriented research to comprehensive psychological health promotion approaches.⁴³ The works of other frequently cited researchers, including Ayerbe L (39 citations) and Zigmond AS (33 citations), have contributed to this shift in research emphasis.

Through analysis of author and institutional productivity identified key research contributors in this field. The bibliometric analysis of journal and the journal dual-map further delineated the evolution of knowledge structure in psychological intervention research on resilience and psychological well-being among stroke survivors. Analysis of journal showed that Disability and Rehabilitation had the highest publication output (12 articles), while the Cochrane Database of Systematic Reviews demonstrated the highest citations (Average Citations/Publications=60.91) (Table 4). Journal analysis revealed three interconnected research clusters: rehabilitation journals, represented by Disability and Rehabilitation, focusing on clinical assessment and intervention strategies for post-stroke psychological health;⁴⁴ evidence-based medicine journals, with the Cochrane Database of Systematic Reviews emerging as a highly influential journal, emphasizing systematic reviews of psychological intervention effectiveness;⁴⁵ and specialized journals, with Topics in Stroke Rehabilitation as a representative, exploring comprehensive rehabilitation strategies, particularly the integration of psychological health and functional recovery.⁴⁶ This disciplinary structure reflects significant transitions in stroke survivor psychological intervention research: evolving from single rehabilitation approaches to evidence-based comprehensive intervention, shifting from general psychological issues to resilience and psychological well-being enhancement, while demonstrating increasing methodological standardization in the field.⁴⁷ Analysis of the journal dual-map further supported this evolution in intervention approaches. The journal dual-map analysis identified systematic knowledge flow patterns, specifically, scholarly output in psychology, education, and health (blue trajectory) was predominantly influenced by research contributions from psychology, education, and sociology (z=4.21, f=3942). Meanwhile, publications from psychology, education, and sociology fields (pink trajectory) exhibited significant citation relationships with literature in rehabilitation, exercise, and sports (z=3.38, f=3237) (Figure 6). These knowledge flow patterns indicate that this field is transcending traditional single-disciplinary boundaries, reconstructing psychological intervention systems through multidisciplinary knowledge integration.⁴⁸ This trend of multidisciplinary convergence is directing psychological intervention research for stroke survivors toward more scientific and systematic development pathways, further establishing a solid theoretical foundation for research on resilience and psychological well-being.⁴⁸

Knowledge flow analysis revealed the multidisciplinary characteristics of this field, while co-cited references analysis further reflected the deepening process of research focus. The co-cited references analysis identified three main clusters (Table 6): research on assessment tools, represented by the Hospital Anxiety and Depression Scale developed by Zigmond et al (40 citations); systematic reviews of post-stroke depression, represented by Ayerbe et al (33 citations) and Hackett et al (27 citations); and cognitive behavioral therapy research, represented by Lincoln et al (23 citations). This co-cited references analysis demonstrates researchers’ systematic efforts in developing a complete research framework, from assessment tool to intervention strategy, indicating the field’s progression toward more rigorous and comprehensive research approaches.

Research Focus Changes in Stroke Survivor Psychological Interventions

Keyword co-occurrence analysis reflects the evolution of research themes in psychological interventions for stroke survivors (Table 7). “Quality of life” (135 occurrences) emerged as the most frequent keyword, indicating that research focus has expanded from symptom management to quality of life enhancement. Detailed analysis revealed that the high frequency of keywords “depression” (59 occurrences), “anxiety” (41 occurrences), and “poststroke depression” (32 occurrences) indicates research concentration on psychological symptom identification and intervention (Table 7). While this symptom-focused research direction has provided significant insights into the mental health issues of stroke survivors, it reveals a limitation in the attention to patients’ overall mental health.⁴⁹ With the deepening of research, keywords representing comprehensive health, such as “mental health” (35 occurrences) and “health” (31 occurrences), began to appear frequently, indicating a shift in research focus. In particular, the high frequency of “cognitive behavioral therapy” (41 occurrences) not only demonstrates the standardization of intervention methods, but more importantly reflects the research attention to patients’ cognitive reconstruction and behavioral adaptation capabilities, establishing a foundation for resilience research.⁵⁰ Meanwhile, the occurrences of “randomized controlled trial” (34 occurrences) in the keyword network indicates the field’s development toward evidence-based practice, providing scientific evidence for the effectiveness of resilience and psychological well-being interventions. Notably, the keyword “people” (30 occurrences) reflects the person-centered research orientation, indicating that research increasingly emphasizes patients’ subjective experiences and individual needs, highlighting their active role in the rehabilitation process.⁵¹ This shift in research focus from “symptom management” to “capability enhancement” demonstrates not only the enrichment of research content but also the innovation in intervention concepts. Under this new conceptual framework, research aims to help stroke survivors establish positive life attitudes and improve rehabilitation outcomes through strengthening resilience and enhancing psychological well-being, indicating that this field has entered a more scientific and humanistic phase.⁵²

Analysis of references with the strongest citation bursts revealed the evolution of research hotspots in psychological interventions for stroke survivors (Table 8). In early studies, systematic reviews and meta-analyses by Burton et al (strength=3.07) and Ayerbe et al (strength=5.29), which highlighted both the complex mental health challenges of stroke survivors and the importance of enhancing positive psychological attributes, laying the groundwork for resilience and mental well-being oriented interventions.^26,53 In subsequent research, Hackett et al (Strength=4.26), through an updated systematic review of post-stroke depression prevalence, emphasized the necessity of psychological interventions while highlighting the importance of developing positive psychological intervention strategies.²⁷ Sekhon et al’s study (Strength=2.82) deepened the concept of psychological interventions by integrating patients’ subjective experiences and individual needs.⁵⁴ Citation burst analysis revealed Wang et al’s meta-analysis (strength=5.05), which demonstrated that cognitive behavioral therapy significantly improved mental health in patients with post-stroke depression, including depressive symptoms, anxiety, and activities of daily living.⁵⁵ This systematic evaluation of intervention effectiveness provided significant references for exploring effective intervention strategies to enhance resilience and psychological well-being in stroke survivors. Majumdar et al’s research (strength=4.79) conducted group-based acceptance and commitment therapy, demonstrating that this intervention helped stroke survivors accept reality and reconstruct meaning in life, thereby improving their mental health levels.⁵⁶ This intervention approach integrating acceptance and behavioral change provided new theoretical and practical evidence for developing intervention strategies. Notably, McCurley et al’s qualitative research (strength=2.77) explored in depth the challenges faced by patients and caregivers, identifying intervention needs based on psychological resilience.⁵⁷ The above analysis of references with the strongest citation bursts provided comprehensive insights into psychological interventions for stroke survivors. Overall, the citation burst analysis revealed a systematic development from symptom management to individualized needs and further to diversified interventions in psychological intervention research for stroke survivors. This process not only reflects the standardization of research methods and innovation in intervention strategies, but also indicates the development of interventions based on resilience and psychological well-being. These findings provide significant implications for optimizing psychological interventions for stroke survivors.⁵⁸

Table 8 Top 20 References With The Strongest Citation Bursts

In addition to the analysis of references with citation bursts, keyword burst analysis revealed the developmental trajectory of psychological intervention research (Table 9). Keywords “frequency” (strength=2.94) and “predictors” (strength=2.55) reflected the initial research focus on identifying and predicting mental health issues. Subsequently, keyword “poststroke depression” (strength=3.52) indicated attention to specific psychological symptoms in stroke survivors. Keywords “social support” (strength=3.25) and “family caregivers” (strength=3.49) indicated increasing research attention to social support in mental health, providing theoretical foundations for developing interventions focusing on resilience and psychological well-being.⁷¹ The burst of “metaanalysis” (strength=3.6) indicated increased attention to evidence-based practice, supporting the optimization of psychological interventions through systematic evaluation of intervention effectiveness and contributing to research on interventions focusing on resilience and well-being.⁷²

Table 9 Top 20 Keywords With The Strongest Citation Bursts

Clinical Implications of Psychological Resilience and Well-Being for Stroke Survivors

The analysis of references and keywords with citation bursts demonstrated the increasing clinical applications of resilience and well-being in psychological interventions for stroke survivors. Specifically, enhancing psychological resilience can improve patients’ capacity to cope with challenges related to health,⁷³ while increasing mental well-being contributes to maintaining positive emotional experiences and life satisfaction.⁷⁴ These findings contribute to the theoretical framework of psychological interventions for stroke survivors and provided scientific evidence for optimizing clinical practice.

In the acute phase, patients face both physiological and psychological impacts from sudden illness,⁷⁵ where rebuilding a sense of control and confidence is crucial for developing psychological resilience and enhancing psychological well-being.⁷⁶ The citation burst of “stress reduction” (strength=3.01) indicated that early stress management interventions help patients establish positive attitudes toward illness, enhance resilience, and improve treatment adherence and rehabilitation participation.⁷⁷ Studies demonstrated that relaxation training and mindfulness effectively improves patients’ coping abilities and emotional regulation.^78,79 Healthcare providers should help patients understand their condition, manage anxiety and stress, and establish initial confidence in rehabilitation through active communication and emotional support.⁸⁰ Subsequently, individualized psychological assessment and interventions should be implemented based on patients’ functional status and psychological need.⁸⁰ Additionally, the implementation of individualized recreational activities, including music therapy and occupational activities, supports positive psychological adaptation in stroke survivors with functional impairments.^81,82

During rehabilitation progression, patients experience psychological exhaustion and discouragement in prolonged training.⁸³ The maintenance of rehabilitation engagement is essential, requiring enhanced resilience and psychological well-being for improved rehabilitation outcomes.⁸⁴ Research by Majumdar et al (burst strength=4.79) confirmed that group-based acceptance and commitment therapy significantly improved patients’ resilience and psychological well-being.⁵⁶ Specifically, this therapy improved patients’ resilience and psychological well-being through acceptance of current health status, value identification, and structured goal setting in rehabilitation.⁵⁶ Wang et al’s research (strength=3.2) showed that individualized mindfulness and relaxation techniques improved stress management capacity and adaptive functioning in daily activities.⁶⁶ These studies indicated that combining group and individualized intervention promotes comprehensive mental health.⁸⁵ These findings suggest that healthcare providers should implement a comprehensive intervention. During group sessions, they can use acceptance and commitment therapy to help patients accept their current status, identify personal values, and set achievable rehabilitation goals, while building peer support networks.⁸⁶ In individual interventions, they can guide patients in practicing mindfulness and relaxation techniques to strengthen their psychological well-being.⁸⁷ Through integrating these psychological approaches with rehabilitation training, healthcare providers can help patients achieve progressive improvements and optimize rehabilitation outcomes.

During the maintenance phase, patients confront social reintegration and lifestyle adaptation challenges, with psychological needs focusing on social adjustment and reconstruction of life values.⁸⁸ Research by McCurley et al (strength=2.77) indicated that establishing social support systems improved resilience and psychological well-being.⁵⁷ The findings indicated that multilevel social support networks improved coping abilities and mental health outcomes through increased social participation.⁵⁷ Baker et al (burst strength=2.64) further demonstrated that family-centered comprehensive psychological support improved patients’ ability to manage life transitions while enhancing life satisfaction.⁴⁴ Specifically, systematic training of family members in communication skills and psychological support methods, enabling the application of positive communication, emotional support, and behavioral reinforcement strategies in daily life, helping patients rebuild confidence and sense of value.⁴⁴ Based on these findings, healthcare providers should establish systematic intervention protocols during the maintenance phase. This involves developing patient-centered multidimensional support networks that integrate family, peer, and professional support.⁸⁹ Family members are guided to participate in psychological rehabilitation processes, reinforcing patients’ resilience and psychological well-being through daily interactions.⁹⁰ Concurrently, facilitating patient participation in community activities expands social networks and increases social support.⁹¹ Healthcare providers need to conduct regular evaluations of support system effectiveness, adjust intervention strategies as needed, and assist patients in role transition, facilitating the progression from rehabilitation to social reintegration.⁹¹

Resilience and psychological well-being interventions at different rehabilitation stages demonstrate systematic and dynamic intervention properties. The intervention includes establishing basic psychological resilience through stress reduction techniques and individualized activities in the acute phase, enhancing resilience and well-being through acceptance and commitment therapy and mindfulness in the rehabilitation phase, and achieving role transition and life reconstruction through social support systems in the maintenance phase. This staged intervention not only develops and enhances resilience and psychological well-being, but also provides continuous psychological support throughout rehabilitation. The synergistic enhancement of resilience and psychological well-being at each stage promotes mutual reinforcement, jointly improving rehabilitation outcomes. This intervention provides new perspectives for enhancing mental health among stroke survivors and indicates directions for future research and practice.

Strengths and Limitations

This study employed bibliometric analysis to systematically analyze 373 publications on psychological interventions for stroke survivors from 2000 to 2024, providing comprehensive insights into current research status and trends in this field. The application of visualization tools including VOSviewer and CiteSpace enabled multidimensional analysis of authors, countries, institutions, journals, citations, and keywords, clearly presenting research hotspots and frontier dynamics. This study not only constructed the knowledge map of this field but also focused on the clinical application value of resilience and psychological well-being, providing evidence-based support for optimizing clinical intervention strategies. The systematic bibliometric analysis also offers important references for future research directions.

However, this study has several limitations. Firstly, due to the constraints of CiteSpace and VOSviewer software and techniques, we only included English-language publications from the WoSCC database, potentially excluding important research findings, particularly high-quality studies published in other languages. Second, while bibliometric analysis reveals research trends, it cannot provide detailed analysis of research content. Additionally, to reflect recent research hotpots, the search period was extended to September 2024, which may affect the analysis of overall research trends in 2024.

Based on the findings and limitations, future research should expand literature search scope to include multilingual publications from multiple databases for comprehensive understanding of this field. High quality empirical studies should be strengthened, particularly randomized controlled trials examining intervention effectiveness of resilience and psychological well-being. Considering cultural influences on psychological interventions, future research needs to examine intervention applicability across different cultural contexts and develop culturally adapted assessment tools and intervention protocols. Additionally, qualitative research would provide insights into key factors during intervention processes, offering comprehensive theoretical support for intervention optimization.

Conclusion

This bibliometric analysis examined 373 publications on psychological interventions for stroke survivors from 2000 to 2024, focusing on research trends in resilience and psychological well-being. Analysis indicated that the most productive authors included Vranceanu Ana-Maria, Rosand Jonathan, and Lin Ann. The United States, United Kingdom, and China emerged as major contributing countries, with Harvard University as the most productive institution. Journal analysis showed that Disability and Rehabilitation and Cochrane Database of Systematic Reviews played significant roles in this field. Analysis of knowledge structure revealed a shift in research focus from disease-related factors to systematic psychological interventions. This transition reflects not only the advancement of psychological intervention research but also provides important evidence for improving rehabilitation outcomes and quality of life among stroke survivors in clinical practice.