The identification of depression, social support, and functional status as predictors of quality of life suggests the need to assist stroke survivors in coping and in maintaining and strengthening their support systems.

S troke is one of the leading causes of severe, long-term disability, 1 with a majority of stroke survivors requiring the assistance of a family caregiver.2 A family caregiver is defined in this context as a relative, partner, personal friend, or neighbor who provides assistance to an adult with a chronic or disabling condition such as stroke.3 Although family members may not consider themselves caregivers, this term is commonly used in the literature to represent family or informal (unpaid) caregivers.Family caregiver stress is commonly associated with longterm institutionalization of stroke survivors, resulting in significant costs to the healthcare system. [4][5][6][7][8] Family caregiver stress can also result in other negative outcomes for both survivors and their caregivers. 7 For example, caregiver stress has been shown to interfere with rehabilitation of the survivor 7 and can result in social isolation, declining health, and increased risk of mortality for the caregivers. 9,10 Depression is especially prevalent in stroke family caregivers, 7,11,12 with some studies reporting higher depression rates in the caregivers than in the survivors for whom they provide care. 11,13 Miller and colleagues 14 made recommendations for family caregiver education and support across inpatient, outpatient, and chronic care settings based on clinical practice guidelines and existing research. These recommendations involved (1) caregivers serving as integral members of interdisciplinary teams, (2) assessment of caregiver needs and concerns, (3) follow-up contacts and referrals, (4) counseling focused on problem solving and social support, (5) provision of strokerelated information, and (6) attention to the emotional and Abstract-Stroke is a leading cause of severe, long-term disability. Most stroke survivors are cared for in the home by a family caregiver. Caregiver stress is a leading cause of stroke survivor institutionalization, which results in significant costs to the healthcare system. Stroke family caregiver and dyad intervention studies have reported a variety of outcomes. A critical analysis of 17 caregiver intervention studies and 15 caregiver/stroke survivor dyad intervention studies was conducted to provide evidence-based recommendations for the implementation and future design of stroke family caregiver and dyad interventions. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on March 26, 2014. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or ...

Treatment participants showed decreased stress over time but were not significantly different from control participants in the amount of change in stress. Control participants showed a significant increase in burden during the study; treatment participants showed a significant increase in competence.

The purposes of this study were to describe the natural history of adaptation to stroke and to identify survivor and caregiver predictors of depressive symptoms. Data were collected for 53 stroke survivors at four times from acute rehabilitation (T1) to 2 years post discharge (T4). Significant improvement occurred in depressive symptoms and perception of health, but change in the rate of depression was not significant. Family functioning became less healthy. Significant predictors of greater levels of depressive symptoms were lower levels of total support, finding meaning, and avoidance coping (T1) and lower levels of family functioning and belonging support (T4). Treatments to promote adaptation can be developed based on these predictors.