In contrast, cognitive reappraisal significantly reduced the risk of ischemic stroke by moderating the association between ischemic stroke risk and the following independent variables: perceived stress and insomnia. The moderation analysis revealed that expressive suppression had a significant moderating effect on the relationship between depression, anxiety, perceived stress, insomnia, and ischemic stroke risk, resulting in an increased risk of stroke incidence. Data was collected by filling out an anonymous paper-based questionnaire. Methods: This is a case–control survey study involving 113 Lebanese inpatients with a clinical diagnosis of ischemic stroke admitted in hospitals and rehabilitation centers in Beirut and Mount Lebanon, and 451 gender-matched volunteers without clinical signs of stroke as controls recruited from the same hospitals as the cases or attending outpatient clinics for illnesses or treatments unconnected to stroke or transient ischemic attack, as well as visitors or relatives of inpatients (April 2020–April 2021). As a secondary objective, we sought to determine how these pre-existing conditions affect stroke severity levels. To the best of our knowledge, this is the first study in the MENA region to shed light on the relationship between these conditions and stroke risk, aiming to determine whether depression, anxiety, insomnia, stress, and the way of coping with emotions may be risk factors for ischemic stroke occurrence and to further investigate the ability of two specific types of emotion regulation (cognitive reappraisal and expressive suppression) as possible moderators of the relationship between these psychological diseases and ischemic stroke risk. Moreover, no research on the efficacy of emotion regulation, which is critical for various components of healthy affective and social adaptability, is being conducted. There are numerous debates regarding the relationship between depression, anxiety, insomnia, perceived stress, and ischemic stroke. 10Hopital Henri Mondor, APHP, Créteil, Franceīackground: Stroke is a leading cause of disability and death worldwide. 9Faculté de Santé, UPE-C, Université Paris-Est Créteil, Créteil, France.8Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.7Medical School, University of Nicosia, Nicosia, Cyprus.6INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicolo-gie-Liban, Beirut, Lebanon.5School of Medicine, Lebanese American University, Byblos, Lebanon.4Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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