Post-traumatic growth in young and middle-aged patients with stroke: a qualitative systematic review and meta-synthesis

Abstract Background With the increasing incidence of stroke among young and middle-aged individuals, addressing their psychological well-being has become a critical concern. Negative emotional states such as depression, anxiety, and conditions like post-traumatic stress disorder (PTSD) can hinder recovery and increase the risk of recurrence. Therefore, this study aims to conduct a meta-synthesis of qualitative research on post-traumatic growth (PTG) in this population, examining the factors that contribute to PTG, its developmental trajectory, and the coping mechanisms involved. Methods A systematic search of 14 databases was conducted, with reference tracking, to ensure comprehensive literature retrieval. A total of 1,753 articles were initially identified. After removing duplicates and excluding articles that did not meet the criteria, 11 studies were included, involving 156 participants in total, with 5 studies conducted in China and the remaining from other regions. The review followed the Joanna Briggs Institute (JBI) approach: systematic search with predefined criteria, critical appraisal of study quality using the JBI Checklist (assessing rigor in data collection/analysis), and meta-synthesis via iterative theme development (coding, categorizing findings) and validation (cross-checking by reviewers) to derive integrated results. Results A total of 42 research findings were synthesized into 9 new categories, further grouped into 3 integrated results: (1) trauma and stress period, which includes physical, psychological, and social stress; (2) adjustment and reconstruction period, involving seeking support, cognitive processing, self-mobilization, and life reorganization; and (3) growth period, characterized by new possibilities and self-actualization. Limitations The limited time frame of the studies and the predominance of research from China (5 out of 11 included studies) may restrict the generalizability of the findings. Excluding non-English and non-Chinese studies introduces a potential language bias. Furthermore, as the review only included qualitative studies with generally small sample sizes (total 156 participants), the findings should be interpreted with caution. Conclusion This meta-synthesis is the first to systematically synthesize qualitative evidence on PTG in young and middle-aged stroke patients, offering a novel three-stage framework (trauma and stress, adjustment and reconstruction, growth) that integrates physical, psychological, and social dimensions of recovery. By clarifying distinct emotional, cognitive, and behavioral features at each stage, this study advances existing research—previously fragmented in exploring PTG elements—by providing a holistic developmental trajectory. In clinical practice, this framework informs targeted interventions (e.g., stage-specific emotional support, cognitive guidance, and social reintegration strategies) to facilitate PTG and enhance patients’ reintegration into society.