Depression and caregiver burden experienced by caregivers of Jordanian patients with stroke

Many stroke survivors will be cared for at home, primarily by their relatives. Providing care to a family member with a chronic disabling disease can be both emotionally and physically distressing for the caregivers. The purpose of this study was to investigate the relationship between patients' characteristics, duration of caregiving, daily caregiving time, caregiver's characteristics, caregiver depression and burden in caregivers of patients with stroke. A cross-sectional design was used with a convenience sample of 116 subjects. The Center of Epidemiologic Studies of Depression and the Caregiver Strain Index were used to identify caregiver depression and burden, respectively. Logistic regression analysis identified the influence of independent variables on caregiver depression and caregiver burden. Caregivers had high scores for depression and burden indices. Caregivers' health, receiving professional home health care and caregivers' burden were related to caregiver depression. Functional disabilities of patients with stroke and depression of caregivers were related to caregiver burden. To decrease caregiver depression and burden, nurses must provide caregivers with instructions for home management of patients with stroke. Development of specialized stroke home health services in Jordan that targets patients with stroke and their caregivers are recommended.     

Comparing Perceived Burden for Korean and American Informal Caregivers of Stroke Survivors

Little is known about the burden of cross‐cultural care for stroke patients. This article compares the perceived burden for caregivers of stroke survivors in Korea and the United States. A brief interview was conducted to determine specific problem areas for caregivers. Caregiver burden (using the Sense of Competence Questionnaire) and social support (using the ENRICHD Social Support Inventory) also were measured. The overall‐sense‐of‐burden‐from‐caregiving score was significantly higher in the Korean cohort than in the American cohort, as was the scale regarding satisfaction with the relationship with the recipient of care. The primary predictors of overall burden for the combined sample were caregiver and patient depression and insufficient social support. Lower perceived social support among Korean caregivers was strongly related to caregiver depression, while it was more strongly related to increased hours of caregiving in the American sample. These findings can help rehabilitation nurses plan supportive interventions that incorporate cultural values for stroke survivors and their caregivers.     

脑卒中后抑郁症的危险因素分析

目的 探讨脑卒中后抑郁症(PSD)的危险因素.方法 对196例脑卒中患者行头颅MRI或头颅CT检查以明确诊断,发病后6周内多次对患者进行汉密尔顿抑郁量表(HAMD)评分,共有65人确诊为PSD,分析PSD的发生与性别、年龄、文化程度、卒中性质、日常生活能力、独立行走和发病部位的关系.结果 日常生活能力明显障碍或不能独立...     

Testing a home-telehealth programme for US veterans recovering from stroke and their family caregivers

Purpose. The study purpose was to implement a stroke-specific, care coordination home telehealth (CCHT) programme for US veterans with stroke and their family caregivers.

Methods. In a non-randomized open trial using a mixed methods design, we tested the utility of a stroke-specific, home telehealth programme with 18 veterans and 14 caregivers for 14 days. Programme questions assessed physical impairment, depressive symptoms, and fall prevalence among veterans, and burden level among family caregivers. Nine veterans and six caregivers completed post-programme interviews exploring their experiences with telehealth.

Results. During the 14-day trial, 55% of the veterans screened positive for depression at least once, 36% of the caregivers had clinically significant burden, half of the veterans and caregivers reported post-stroke concerns, and 90% believed post-stroke contact from a care coordinator would have been helpful. In the interviews, seven veterans indicated they had fallen or almost fallen post-stroke. Themes centred on tailoring CCHT to individual needs, coordinating with support services, identifying safety issues, and providing information about stroke prevention.

Conclusions. Home telehealth offers innovative ways to target post-stroke rehabilitation programmes to the needs and concerns of patients and their caregivers, and should include regular real-time contact between stroke patients and their healthcare providers.     

慢性期脑卒中患者抑郁状态的发生率及相关因素

目的:调查慢性脑卒中患者卒中后抑郁(PSD)情况及其影响因素。方法:对北京望京社区78例首次发病、病程1年以上脑卒中患者采用汉密尔顿抑郁量表(HAMD)进行抑郁状况调查,同时评测运动功能(Fulg-Meyer)、生存质量(SF-36)、日常生活自理能力(Barthel指数),收集患者的年龄、性别、文化程度、家庭收入等人口学特征和脑卒中并发症等疾病相关内容,并进行单因素相关分析。结果:病程1年以上脑卒中患者PSD发生率为57.7%。其中,轻度抑郁35.9%,中度抑郁11.5%,重度抑郁10.3%。单因素分析显示人均月收入、年龄、运动功能、日常生活活动能力水平、SF-36精神健康和SF-36躯体健康6个因素与患者抑郁评测总积分有相关性(P<0.05)。结论:脑卒中慢性阶段患者运动功能、日常生活活动能力、年龄、家庭人均月收入是脑卒中后抑郁主要影响因素。随着病程的延长抑郁发生率无显著性改变。卒中后抑郁降低了脑卒中慢性期患者的生存质量。     

卒中后患者生物学及社会经济因素与抑郁症的相关性研究

目的通过对卒中后患者在年龄、性别、病程、卒中类型、基础疾病、血压、生化指标、神经心理学特点、经济支持等方面与卒中后抑郁发生的相关性研究,进一步发现相关度较高的一些因素,对今后的卒中后抑郁的防治提供依据。方法选取上海养志康复医院自2012年5月至2013年10月住院治疗的卒中后患者,在排除严重言语障碍及认知功能障碍后,根据DSM-Ⅳ的抑郁症诊断标准及MADRS评分,将入组患者分为病例组与对照组。所有患者均接受生化检查及访谈评估。分析比较病例组与对照组在上述各项指标方面的差异及相关性。结果回顾两组患者,在卒中次数(OR=2.862)、TIA发作(OR=2.596)、高血压(OR=2.528)、急性起病(OR=4.678)等方面具有明显的相关性,简易认知功能检查及自理能力、社会活动功能及物体命名能力方面差异有统计学意义(P<0.05)。结论卒中后抑郁的发生更多地取决于血管性疾病,尤其是高血压的治疗与控制,同时既往卒中发生及TIA发作对于卒中后抑郁的发生同样不利,认知能力及社会功能的完整性对于卒中后抑郁的发生具有积极意义。     

脑卒中后抑郁多种相关因素分析

目的 对脑卒中第四周发生脑卒中后抑郁(post stroke depression,PSD)患者进行患病率及多种相关因素的研究,期望对于PSD患者早期诊断和干预治疗提供帮助.方法 采用病例-对照研究方案.选用符合标准的所有脑卒中住院患者,抑郁患者为病例组,其余患者为对照组,对各相关因素进行统计学分析.结果 共调查101例患者,最后能够配合完成所有调查任务的有88例.PSD总发病人数为33例,占37.5%,其中,轻度抑郁14例,占42.42%,中度抑郁16例,占48.48%,重度抑郁3例,占9.09%.结论 神经功能缺损程度为PSD的危险因素,日常生活能力、社会支持为PSD的保护因素.     

Factors predicting the health status of caregivers of stroke survivors: A cross‐sectional study

In this cross‐sectional study, we aimed to determine factors influencing the health status of caregivers of stroke survivors. A total of 126 caregivers of stroke survivors were recruited from three outpatient clinics in Thai Nguyen National General Hospital, Vietnam, from November 2016 to March 2017. Data were collected through six instruments: a demographic questionnaire, the Modified Barthel Index, the Zarit Burden Interview Scale, the Multidimensional Scale of Perceived Social Support, the Family Caregiver Conflict Scale, and the Short Form‐36 Health Survey. Stepwise multiple regression was employed to analyze the data. Caregiver burden, patient's functional status, caregiver's age, and social support together explained 80.3% of the variations in health status of caregivers of stroke survivors. Caregiver burden was the strongest predictor of health status of these caregivers. Based on the findings, nurses should take caregiver's age, functional status of stroke survivors, caregiver burden, and social support into consideration when preparing family caregivers to provide care for stroke survivors. To reduce perceived caregiver burden, family support interventions should be embraced to enhance health status of the caregivers of stroke survivors.     

Caregivers of advanced cancer patients: feelings of hopelessness and depression

To investigate whether the advanced cancer patients' caregivers' depression and hopelessness are affected by patients' demographic and clinical characteristics and by caregivers' sociodemographic variables. Moreover, the relation between cancer patients' and caregivers' depression and hopelessness was assessed. One hundred five patients with advanced cancer receiving palliative care and 96 caregivers were enrolled in the study. The patients and their caregivers completed the Beck Depression Inventory and the Beck Hopelessness Scale while researchers recorded data on demographic characteristics, disease status, and treatment regimen. The analysis showed that significant associations were found between patient male sex and caregiver's depression (P = .007) and hopelessness (P = .002), between patient family status and caregiver's depression (P = .031) and hopelessness (P = .001), and between patient radiotherapy treatment and caregiver's hopelessness (P = .017). Moreover, statistically significant correlation was found between patient's and caregiver's depression (P = .041). Generalized estimating equations showed that the patients characteristics that predicted caregivers' hopelessness were family status (P = .017), radiotherapy (P = .025), and the caregiver's relation to patient (P = .059). The findings suggest that caregiver's hopelessness is predicted by cancer patient's characteristics and that patient's depression is correlated to that of caregiver. The findings provide a base for future research.     

中风病人照顾者抑郁与其社会支持及病人生活能力的相关性研究

目的了解中风病人主要家庭照顾者的抑郁情况,探讨照顾者抑郁与其所得到的社会支持及所照顾的病人的生活能力的相关性。方法选择51例中风病人的主要家庭照顾者为研究对象,采用CESD量表、BarthelIndex量表和社会支持评定量表对本组照顾者及病人进行调查研究。结果本组主要照顾者有54．90％发生抑郁,社会支持得分属于较低水平;有抑郁的照顾者与其所得到的社会支持和所照顾的病人的生活能力呈负相关。结论社区护理人员、家庭和社会应共同关注中风病人照顾者的抑郁问题,加强社会支持度,提高照顾者的生活质量和照顾质量。     

Emotional and physical health of spouse caregivers of persons with Alzheimer''s disease and stroke

Providing care for a cognitively impaired spouse can adversely affect caregivers' health. It is not known how early in the caregiver's 'career' emotional and physical health deteriorates. The progressive deterioration associated with Alzheimer's disease (AD) may have different effects on caregivers' health when compared with the potential recovery following a stroke. An exploratory study was conducted with 42 couples, equally divided among early phase AD, ischaemic stroke after hospital discharge, and well controls. Couples were evaluated at baseline (time 1), 6 months (time 2) and 1 year (time 3). At time 1, depression was significantly higher in AD and stroke caregivers when compared to controls. Over time, depression increased significantly for AD caregivers with 21% evidencing moderate to severe depression at time 1 and 50% at time 3. For stroke caregivers there was a significant interaction effect with race: white stroke caregivers' depression increased over time while African American stroke caregivers' depression decreased. Physical health was not significantly different for the three groups and remained stable over time. Cognitive and functional impairment levels of care recipients were significantly related to stroke caregivers' but not AD caregivers' depression. Long-term counselling and support to family caregivers is advocated.     

Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences

Purpose. To examine living setting and need for ADL assistance before and one year after a first-ever stroke with special focus on gender differences.

Methods. One-year survivors from a population-based stroke study (n = 377) were studied with regard to place of living, need for ADL assistance and who provided the help. Stroke severity, cognitive impairment, post-stroke depression as well as risk factors were evaluated.

Results. Before the stroke 48 patients (13%) lived in special housing (service flats or nursing homes), and one year after the stroke, 50 of the survivors (20%) lived in such accommodations. Before the stroke, 80 (21%) of the patients needed help with their personal ADL, while 90 (36%) needed help after one year. The increased need was fulfilled by relatives. Female spouses more often helped their male counterparts, and they tended to accept a heavier burden. Age, living alone, stroke severity, cognitive impairment, pre-stroke ADL dependency and depression were predictors for special housing.

Conclusions. In a time when more and more stroke survivors are cared for at home, it is important to pay attention to the situation of the caregivers. Female caregivers seem to be in an especially exposed position by accepting a heavier burden.     

脑卒中后抑郁的相关因素研究

目的探讨脑卒中后抑郁状态(PSD)的发生与相关因素的关系。方法采用Hamilton抑郁量表17版,对53例脑卒中患者进行调查评分,并对各相关因素进行分析。结果 PSD患者18例,总发生率为33.9%。其中轻度8例,占44.5%;中度6例,占33.3%;重度4例,占22.2%。PSD以轻、中度抑郁为主,占77.8%。病前身体健康状况、文化程度与PSD的发生无关。性别、病后身体状况、家庭关系与PSD的发生有关(P<0.05)。结论性别、病后身体状况、家庭和睦情况为PSD的相关因素。教育程度和病前身体状况与PSD无关。     

Acute phase factors associated with the course of depression during the first 18 months after first-ever stroke

Purpose: The aim of this study was to describe the course of post-stroke depression (PSD) during the first 18 months after first-ever stroke and to examine differences in the course of depressive symptoms in relation to patient demographic and clinical characteristics in the acute phase. Methods: As part of a longitudinal cohort study, data were collected from medical records and in face-to-face interviews using standardized questionnaires within 15 days after stroke and 6, 12 and 18 months later. The sample consisted of 94 patients with first-ever stroke. PSD was measured with the Beck Depression Inventory II. Repeated measures analysis of variance was used to evaluate the course of depressive symptoms over time and in relation to demographic and clinical variables. Results: Depression levels were stable during the 18 months after first-ever stroke. However, depression scores were significantly higher among patients who had lower physical functioning in the acute phase, were living alone or were not employed at the time of stroke. Conclusions: Several demographic and acute phase factors were associated with a more severe PSD course following stroke. Psychosocial support that begins in the acute phase and continues throughout the rehabilitation process may be helpful in improving both physical and psychological outcomes following stroke.

• Implications for Rehabilitation

• Depression levels are stable during the first 18 months after first-ever stroke.

• The course of post-stroke depression is related to the level of physical functioning in the acute phase, whether the stroke survivors live alone and their employment status at the time of stroke.

• Psychological support that begins in the acute phase and continues throughout the rehabilitation process may be helpful in improving both physical and psychological outcomes following stroke.

     

Caregiver empowerment program based on the adaptation model increase stroke family caregiver outcome

Objective: Post-stroke disability and psychosocial disorders cause burdens for the families of stroke patients, including physical and financial burdens. The physical and psychological health of family caregivers determines the quality of care they provide to patients.The purpose of this study was to identify the effectiveness of the Caregiver Empowerment Program Based on the Adaptation Model (CEP-BAM) in increasing the family caregiver's coping ability against various problems and reducing their burden while caring for the stroke patient.Methods: This research was a quasi-experimental study with pre- and post-test control group design. The intervention group received CEP-BAM, while the control group received a conventional intervention in the form of a discharge planning program for family caregivers in the hospital. The samples were caregivers who care for and facilitate the recovery of stroke patients during their convalescence at home. We selected the samples from the population using the stratified random sampling method. The number of samples completed in the study was 40 in the intervention group and 40 in the control group. Measurement of outcome variables (coping and caregiver burden) was carried out 4 times including pre-test before the intervention, post-test 1 at 4 months after the intervention, post-test 2 at 5 months after the intervention, and post-test 3 at 6 months after the intervention.Results: There were significant differences in caregiver's coping (P = 0.016) and caregiver's burden (P = 0.009) in measurements between the two groups.Conclusions: The CEP-BAM interventions were effective in increasing adaptive coping strategies and reducing the burden of caregivers 4 months and continuing 6 months after the intervention.     

Stroke: coping strategies and depression among Chinese caregivers of survivors during hospitalisation

Aims and objectives. The main aim of this study was to identify the coping strategies of stroke caregivers, to identify the factors associated with caregivers’ depression and to identify predictors of caregivers’ depression. Background. Stroke has a high incidence in China. Most stroke survivors are accompanied by family caregivers during hospitalisation. However, little is known about these informal caregivers’ coping strategies to the consequences brought on by stroke and their depressive symptoms. Method. A correlation and cross‐sectional design was used and a purposive sample of 92 stroke survivors and their caregivers completed the questionnaires, which were used to describe the demographic of both the caregiver and stroke survivor, coping strategies (the Brief COPE Inventory) and depression of caregivers (the Center for Epidemiologic Studies Depression Scale). Spearman's correlation and multiple stepwise regression analysis were used in data analyses. Results. Several coping strategies (planning, positive reframing, acceptance, active coping, use of instrumental support and humour) were most commonly used by stroke caregivers. The length of hospital stay, stroke survivor's cognitive status and functional status, family income and coping strategies such as (i) denial, (ii) self‐blame, (iii) planning and (iv) religion had significant correlations with caregiver's depression. The best predictors of caregiver's depression were denial, planning and stroke survivor's functional status. Conclusions. This study contributes to our knowledge about the coping strategies and depression level of stroke caregivers on the Chinese mainland. The depression rate is very high during hospitalisation, although these caregivers often had positive coping responses to the stroke event. Many factors were associated with caregivers’ depression. Relevance to clinical practice. Nurses should not only pay attention to stroke survivors but also to their caregivers. To help them adjust well from the stroke consequences and avoid depression, nurses should implement effective interventions.     

老年人脑卒中后抑郁的临床研究

目的探讨老年人脑卒中后抑郁的患病率、相关因素及治疗。方法对136例脑卒中后老年患者采用汉密尔顿抑郁量表进行评定,其中抑郁55例,分析脑卒中后抑郁的相关因素和服用?罗西汀的治疗效果。结果老年人脑卒中后抑郁的患病率为40%,以轻中度抑郁为主;脑卒中后抑郁与患者文化程度、神经功能缺损程度和日常生活能力之间存在显著相关性;?罗西汀治疗24周后,有效率达89%。结论老年人脑卒中后抑郁患病率较高,严重影响神经功能缺损和日常生活能力的恢复,抗抑郁治疗能明显改善患者抑郁症状,促进神经功能康复。     

以增强应对资源为重点的护理干预对减轻脑卒中居家照顾者负荷的影响

目的 检测以增强照顾者应对资源为重点的综合性护理干预对减轻脑卒中患者主要居家照顾者负荷的效果.方法 从上海市某5社区中选择脑卒中患者主要居家照顾者60例,随机分为干预组（30例）和对照组（30例）.对照组接受常规社区护理,干预组在接受常规社区护理的同时,给予增强照顾者应对资源为重点的综合性护理干预,为期3个月.以BCOS量表、照顾知识问卷、一般自我效能量表、社会支持量表作为主要评价工具,于干预后、干预后3个月分别进行干预效果的评价.结果 干预后干预组照顾者总体负荷明显降低,尤以身体负荷和社会负荷的降低明显.重复测量方差分析,干预组BCOS总分及身体负荷和社会负荷2个维度的得分均高于对照组（P＜0.01;＜0.05,P＜0.01）.多元方差分析,干预后、干预后3个月2个时间点,干预组照顾者负荷总分,身体负荷得分、社会负荷得分均高于对照组（P＜0.05）;干预组心理负荷得分于干预后3个月高于对照组（P＜0.01）.照顾者应对资源增强.重复测量方差分析和多元方差分析结果显示,干预组照顾知识总分以及疾病知识、护理知识和康复知识3个维度的得分均高于对照组（P＜0.01;P＜0.01;P＜0.05;P＜0.01）;干预组社会支持水平高于对照组（P＜0.01）.结论 以增强照顾者应对资源为重点的综合性护理干预方案,明显地减轻了脑卒中患者主要居家照顾者的负荷,适用于在减轻脑卒中患者主要居家照顾者负荷的干预中推行.     

Community reintegration in stroke survivors: Relationship with motor function and depression

Stroke survivors show a variety of physical and psychosocial problems, which can affect their reintegration into the community. This study explored the association of community reintegration with motor function and post-stroke depression (PSD). Ninety community-dwelling stroke survivors with mean age of 58.3 ± 7.8 years participated in this study. Participants were 56 men and 34 women attending the physiotherapy clinics of selected hospitals in southwestern Nigeria. Motor function was assessed using the Motor Assessment Scale (MAS), PSD by the Hamilton Depression Scale, and community reintegration by the Reintegration to Normal Living Index (RNLI). The mean RNLI, MAS, and PSD scores were 57.3 ± 23.5, 34.9 ± 10.9, and 9.4 ± 4.8, respectively. RNLI scores were significantly associated with MAS (r = 0.584, p = 0.001) and PSD (r = ?0.373, p = 0.006) scores. Multiple regression analysis showed that age, depression, and motor function were associated with RNLI scores, which accounted for 41% of the variance. This study concluded that the higher the community reintegration, the higher the motor function, and the lower the PSD. Motor function and depression are factors that influence community reintegration and should be properly assessed and adequately treated before stroke survivors return to the community.     

家属支持辅导对脑卒中后抑郁患者生活质量的影响

目的探讨家属支持辅导对脑卒中后抑郁患者生活质量的影响。方法将68例脑卒中后抑郁患者分为观察组和对照组,各34例。两组患者均接受常规诊疗和护理,同时对观察组患者家属实施同步健康教育,比较两组患者的康复效果。结果观察组患者治疗后的汉密尔顿抑郁量表(HAMD)评分明显低于对照组(P<0.01)。结论家属支持辅导能提高患者的生活质量。