Does Caregiver Well-Being Predict Stroke Survivor Depressive Symptoms? A Mediation Analysis

Abstract Background and Purpose: Studies suggest that family caregiver well-being (ie, depressive symptoms and life satisfaction) may affect stroke survivor depressive symptoms. We used mediation analysis to assess whether caregiver well-being might be a factor explaining stroke survivor depressive symptoms, after controlling for demographic factors and stroke survivor impairments and problems. Methods: Caregiver/stroke participant dyads (N = 146) completed measures of stroke survivor impairments and problems and depressive symptoms and caregiver depressive symptoms and life satisfaction. Mediation analysis was used to examine whether caregiver well-being mediated the relationship between stroke survivor impairments and problems and stroke survivor depressive symptoms. Results: As expected, more stroke survivor problems and impairments were associated with higher levels of stroke survivor depressive symptoms (P < .0001). After controlling for demographic factors, we found that this relationship was partially mediated by caregiver life satisfaction (29.29%) and caregiver depressive symptoms (32.95%). Although these measures combined to account for 40.50% of the relationship between survivor problems and impairments and depressive symptoms, the direct effect remained significant. Conclusions: Findings indicate that stroke survivor impairments and problems may affect family caregivers and stroke survivors and a high level of caregiver distress may result in poorer outcomes for stroke survivors. Results highlight the likely importance of intervening with both stroke survivors and family caregivers to optimize recovery after stroke.

[1]  C. Moy,et al.  Disparities in stroke incidence contributing to disparities in stroke mortality , 2011, Annals of neurology.

[2]  D. Roth,et al.  Race and Gender Differences in 1-Year Outcomes for Community-Dwelling Stroke Survivors With Family Caregivers , 2011, Stroke.

[3]  D. Roth,et al.  Quality of life after stroke: a prospective longitudinal study , 2011, Quality of Life Research.

[4]  Sandra E. Ward,et al.  Testing Mediation in Nursing Research: Beyond Baron and Kenny , 2010, Nursing research.

[5]  Hillary Anger Elfenbein,et al.  The Way You Make Me Feel , 2010, Psychological science.

[6]  B. Wild,et al.  Effects of Interventions Involving the Family in the Treatment of Adult Patients with Chronic Physical Diseases: A Meta-Analysis , 2010, Psychotherapy and Psychosomatics.

[7]  S. Wolf,et al.  Caregiver characteristics predict stroke survivor quality of life at 4 months and 1 year. , 2009, Research in nursing & health.

[8]  F. J. Carod-Artal,et al.  Determinants of quality of life in Brazilian stroke survivors , 2009, Journal of the Neurological Sciences.

[9]  Jeanne Hayes,et al.  The Prevalence of Injury for Stroke Caregivers and Associated Risk Factors , 2009, Topics in stroke rehabilitation.

[10]  D. Roth,et al.  Problems and Benefits Reported by Stroke Family Caregivers: Results From a Prospective Epidemiological Study , 2009, Stroke.

[11]  F. J. Carod-Artal,et al.  Quality of Life after Stroke: The Importance of a Good Recovery , 2009, Cerebrovascular Diseases.

[12]  E. Lindeman,et al.  Psychosocial Functioning of Spouses of Patients With Stroke From Initial Inpatient Rehabilitation to 3 Years Poststroke: Course and Relations With Coping Strategies , 2009, Stroke.

[13]  B. Given,et al.  Stroke Caregiver Outcomes from the Telephone Assessment and Skill-Building Kit (TASK) , 2009, Topics in stroke rehabilitation.

[14]  J. Sims,et al.  Psychosocial Predictors of Quality of Life in a Sample of Community-Dwelling Stroke Survivors: A Longitudinal Study , 2009, Topics in stroke rehabilitation.

[15]  D. Roth,et al.  Changes in social support and their impact on psychosocial outcome over a 5‐year period for African American and White dementia caregivers , 2008, International journal of geriatric psychiatry.

[16]  W. Haley,et al.  Predictors of well-being in bereaved former hospice caregivers: The role of caregiving stressors, appraisals, and social resources , 2008, Palliative and Supportive Care.

[17]  M. Heesacker,et al.  Structural equation modeling of the relationship between caregiver psychosocial variables and functioning of individuals with stroke. , 2008 .

[18]  Tatjana Barskova,et al.  Interdependence of stroke survivors' recovery and their relatives' attitudes and health: A contribution to investigating the causal effects , 2007, Disability and rehabilitation.

[19]  N. Gimpel,et al.  Validation of a telephone-administered geriatric depression scale in a hispanic elderly population , 2001, Journal of General Internal Medicine.

[20]  E. Lindeman,et al.  Spouses’ Quality of Life 1 Year after Stroke: Prediction at the Start of Clinical Rehabilitation , 2005, Cerebrovascular Diseases.

[21]  C. Moy,et al.  The Reasons for Geographic and Racial Differences in Stroke Study: Objectives and Design , 2005, Neuroepidemiology.

[22]  S. Noh,et al.  Caregiver's burden, depression and support as predictors of post-stroke depression: a cross-sectional survey. , 2005, International journal of nursing studies.

[23]  M. Pinquart,et al.  Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: a meta-analytic comparison , 2004, Aging & mental health.

[24]  S. Studenski,et al.  Evaluation of Proxy Responses to the Stroke Impact Scale , 2002, Stroke.

[25]  G. Savić,et al.  Spouses of spinal cord injury survivors: the added impact of caregiving. , 1997, Archives of physical medicine and rehabilitation.

[26]  N. Aaronson,et al.  The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: A review , 1992 .

[27]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[28]  L. Radloff.  The CES-D Scale , 1977 .

[29]  V. Wood,et al.  An analysis of a short self-report measure of life satisfaction: correlation with rater judgments. , 1969, Journal of gerontology.