Post-stroke depression in primary support persons: Predicting those at risk.

Abstract

This research assessed the psychosocial impact of a first stroke on the primary support person of the patient. Three waves of data were gathered at 6-month intervals, beginning on average 7 weeks poststroke (Time 1). A discriminant function approach was used to identify two groups of support persons from Time 1 data: those at risk for significant long-term depression and those whose depressive symptoms did not exceed age expectations. For 6-month and 1 -year follow-ups, group membership was predicted and validated with at least 74% accuracy. Support persons at risk for depression at the 6-month follow-up had higher Time 1 depression scores, were less optimistic, were more concerned about future care for the patient, had lower household incomes, and were more likely to be married to the patient. Additionally, they named fewer people in their social networks but had more face-toface contacts with those people prior to the stroke and were less satisfied with their social contacts after the stroke. Those at risk i year after the first interview again had higher initial depression scores, were less optimistic, were more likely to be married to the patient, and named fewer network members for the period preceding the stroke. In addition, their stroke-patient partners were younger and more impaired in the physical activities of daily living at Time 1.Stroke is the third leading cause of death and disability in the United States. Its sequelae may be physical, cognitive, or emotional, and its effects are often long-lasting. Because of its unpredictable, uncontrollable nature, stroke may leave its survivors particularly vulnerable to emotional adjustment difficulties. Clinicians and researchers concerned with recovery from stroke have frequently stressed the importance of a supportive family or network of friends.Recently, it has been recognized that people providing support to stroke survivors may face their own adjustment problems. For example, Duffy (1978, 1979) noted a high prevalence of depressive symptoms in a study of strokepatient spouses. Coughlan and Humphrey (1982) reported decreased life satisfaction in spouses of stroke patients more than 3 years after the event. Similarly, Holbrook (1982) found that one third of the family members in her study had not yet adjusted 2-5 years after the stroke.Literature in this area has also characterized specific psychosocial problems reported by significant others in the aftermath of stroke.

Disagreement in Patient and Carer Assessment of Functional Abilities After Stroke

“…14 Measurement error is a possible explanation of differences in assessment, but the Barthel Index is reliable, 15,16 and measurement error cannot explain the systematic differences in patient and carer assessments.…”

Caregiver strain in spouses of stroke patients

“…Studies of stroke caregivers usmg measures of physical symptoms demonstrated that carers with more phyiscal symptoms were more likely to be depressed (Camwath and Johnson, 1987;SchuLz et al, 1988;Tompkms et al, 1988). However, studies that UtiUsed a self-rated global health scale evaluating health from poor to excellent faUed to find a significant relationship between carers' self-rated health and depression (Draper et al, 1992;Schulz et al, 1988;SUUman et al, 1986;Tompkins et al, 1988).…”

“…The most usefiil model was the Caregiver Sttess-Coping Model, which included a wide range of variables as stressors, conditioning variables or enduring outcomes. This model has been used in early studies of stroke caregivers Tompkins et al, 1988). The present study draws heavily on the Caregiver Stress-Coping Model (House, 1974;George, 1980) yet includes additional aspects which may be relevant to sttoke spouses.…”

“…This model (see figure 5) has been adapted in studies of caregivers of elderly spinal cord injured patients (Schulz et al, 1987), stroke patients Tompkins et al, 1988) and Alzheimer's patients (Schulz et al, 1989). ).…”

The Burden of Caregiving in Partners of Long-Term Stroke Survivors

“…7 Characteristics of caregivers themselves are also important, 8,12 and include physical and psychosocial health problems. [15][16][17] Furthermore, partners' perception of support from professional care services will likely influence the level of their burden of caregiving. To the best of our knowledge, the relative contributions of both patients' and caregivers' characteristics to the burden of caregiving have not been described.…”