Moderating Role of Self-Regulation Difficulties in the Momentary Associations Between Depressive Symptoms and Participation Poststroke

Importance: Because depressive symptoms are momentarily associated with lower levels of participation poststroke, it is crucial to investigate what moderates such associations to identify a potential intervention target to reduce the momentary links between depressive symptoms and participation poststroke. Self-regulation seems to be a potential moderator of such associations. Objective: To investigate the extent to which difficulties in self-regulation moderate the momentary associations between depressive symptoms and participation poststroke. Design: This study uses a real-time, repeated-measures design using smartphone-based ecological momentary assessment surveys five times a day for 10 days. We performed multilevel modeling to uncover the momentary associations among the study variables. Setting: Community. Participants: 39 people with stroke. Outcomes and Measures: We obtained real-time data for difficulties in self-regulation (total, cognitive, behavioral, and emotion regulation), depressive symptoms, and participation in daily activities (performance in daily activities and satisfaction with performing daily activities). Results: We included 1,612 survey responses in the analysis. Higher depressive symptoms were momentarily associated with lower levels of performance (b 5 −0.05 to −0.07, p < .001) and satisfaction (b 5 −0.04 to −0.06, p < .05), regardless of adjusting for self-regulation variables and other covariates. Difficulties in total self-regulation (b 5 −0.01, p < .001) and emotion regulation (b 5 −0.02, p < .001) magnified the negative associations between depressive symptoms and satisfaction with performing daily activities. Conclusions and Relevance: Using self-regulation and emotion regulation strategies may be a target for just-in-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke.