Visser-Meily Anne, Post Marcel, van de Port Ingrid, Maas Cora, Forstberg-Wärleby Gunilla, Lindeman Eline
Department of Rehabilitation Medicine, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht and the Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands.
Stroke. 2009 Apr;40(4):1399-404. doi: 10.1161/STROKEAHA.108.516682. Epub 2008 Dec 18.
Few studies have focused on long-term changes in the caregiving experience after stroke. This study assessed changes in the psychosocial functioning of spouses (burden, depressive symptoms, harmony in the relationship between patient and spouse, and social relations) during the first 3 years after stroke and identified predictors of the course of spouses' psychosocial functioning based on the characteristics of patients and spouses with special emphasis on coping style.
We examined 211 couples shortly after the patient's admission to a rehabilitation center, 197 2 months after discharge, 187 1 year poststroke, and 121 3 years poststroke. Burden was assessed using the Caregiver Strain Index, depressive symptoms with the Goldberg Depression Scale, harmony in the relationship with the Interactional Problem Solving Inventory, and social relations with the Social Support List. Multilevel regression analyses were performed.
A significant effect of time (P<0.01) was found for all 4 aspects of spouses' psychosocial functioning. Although burden decreased, harmony in the relationship and social relations also decreased. The depression score showed a nonlinear pattern with an initial decrease but a long-term increase. All outcomes were significantly related to caregiver coping strategies. A total of 15% to 27% of the variance in psychosocial functioning could be explained.
Follow-up of spouses of patients with stroke requires not only assessment of burden, but also other aspects of psychosocial functioning like harmony in the relationship, depression, and social relations, because our results show negative long-term consequences of stroke for these aspects of caregiver quality of life.
很少有研究关注中风后照料经历的长期变化。本研究评估了中风后前3年配偶心理社会功能的变化（负担、抑郁症状、患者与配偶关系的和谐度以及社会关系），并根据患者和配偶的特征，特别强调应对方式，确定了配偶心理社会功能进程的预测因素。
我们在患者入住康复中心后不久对211对夫妇进行了检查，出院后2个月检查了197对，中风后1年检查了187对，中风后3年检查了121对。使用照料者压力指数评估负担，用戈德堡抑郁量表评估抑郁症状，用互动问题解决量表评估关系和谐度，用社会支持清单评估社会关系。进行了多水平回归分析。
在配偶心理社会功能的所有4个方面均发现了时间的显著影响（P<0.01）。尽管负担减轻了，但关系和谐度和社会关系也下降了。抑郁评分呈非线性模式，最初下降但长期上升。所有结果均与照料者应对策略显著相关。心理社会功能中15%至27%的方差可以得到解释。
对中风患者配偶的随访不仅需要评估负担，还需要评估心理社会功能的其他方面，如关系和谐度、抑郁和社会关系，因为我们的结果显示中风对照料者生活质量的这些方面有负面的长期影响。
