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Background: Depression and anxiety result in psychological distress, which can further affect mental status and quality of life in stroke patients. Exploring the associations between positive psychological variables and symptoms of psychological distress following stroke is of great significance for further psychological interventions. Methods: A total of 710 stroke patients from the five largest cities in Liaoning Province in China were enrolled into the present study in July 2014. All patients independently completed the questionnaires with respect to psychological distress and positive psychological variables. Depressive and anxiety symptoms were evaluated using Center for Epidemiologic Studies Depression Scale (CES-D) and Self-Rating Anxiety Scale, respectively. Positive psychological variables were evaluated using Perceived Social Support Scale, Adult Hope Scale (AHS), General Perceived Self-Efficacy Scale and Resilience Scale-14 (RS-14). Activities of Daily Living (ADL) was measured using Barthel Index. Factors associated with psychological variables and depressive and anxiety symptoms were identified using t-test, ANOVA, correlation and hierarchical linear regression analysis. Results: Depressive and anxiety symptoms were present in 600 of 710 (84.51%) and 537 of 710 (75.63%) stroke patients enrolled, respectively. Social support (β = − 0.111, p < 0.001) and hope (β = − 0.120, p < 0.001) were negatively associated with both depressive and anxiety symptoms. Resilience (β = − 0.179, p < 0.001) was negatively associated with depressive symptoms. Self-efficacy (β = − 0.135, p < 0.001) was negatively associated with anxiety symptoms. Hierarchical regression analyses indicated that ADL accounted for 10.0 and 6.0% of the variance of depressive and anxiety symptoms, respectively. Social support, resilience, self-efficacy and hope as a whole accounted for 7.5 and 5.3% of the variance of depressive and anxiety symptoms. Conclusions: The high frequency of depressive and anxiety symptoms among Chinese stroke survivors should receive attentions from all stakeholders. Findings suggested that intervention strategies on ADL, social support, hope, resilience and self-efficacy could be developed to improve psychosocial outcomes for stroke survivors. [ABSTRACT FROM AUTHOR]