University of Toronto, Department of Occupational Science and Occupational Therapy, Toronto, Ontario, Canada M5G 1V7.
Stroke. 2011 Feb;42(2):302-6. doi: 10.1161/STROKEAHA.110.597963. Epub 2010 Dec 16.
Behavioral and psychological symptoms associated with stroke are gaining increasing attention in a field in which recovery of physical function has dominated. A small body of research has begun to suggest that stroke survivors' (SSs') behavioral and psychological symptoms contribute to family caregivers' experiences of emotional distress. The objective of this research was to determine the unique contribution of SS behavioral and psychological symptoms on caregiver emotional distress during the first 2 years poststroke. Method- A longitudinal cohort study was conducted of individuals who have survived their first stroke and their caregivers. Participants completed standardized measures by telephone interviews at 1, 3, 6, and 12 months poststroke. A subsample completed additional assessments 18 and 24 months poststroke. These longitudinal data were analyzed using mixed effects modeling.
Three hundred ninety-nine SS/caregiver dyads participated. Overall, caregivers reported more emotional distress when caring for SSs exhibiting more depressive symptoms and more cognitive impairment and when caregivers were younger, female, in poorer physical health, experienced more lifestyle interference, and reported less mastery. SSs' physical disability, stroke severity, and comorbidity were not significant. The set of significant predictors remained consistent when examined in the subsample followed for 2 years (except SS cognitive impairment).
Interventions aimed at improving caregiver well-being should focus on enhancing clinical management of SSs' depression and better preparing caregivers to manage behavioral and psychological symptoms. In addition, respite programs that encourage caregivers to maintain participation in valued activities may be beneficial.
在以身体功能恢复为主导的领域中，与中风相关的行为和心理症状正受到越来越多的关注。有少量研究开始表明，中风幸存者（SS）的行为和心理症状会导致其照顾者出现情绪困扰。本研究旨在确定 SS 的行为和心理症状在中风后最初 2 年内对照顾者情绪困扰的独特影响。方法- 对首次中风后存活的个体及其照顾者进行了纵向队列研究。参与者通过电话访谈在中风后 1、3、6 和 12 个月完成了标准化评估。亚组在中风后 18 和 24 个月完成了额外的评估。使用混合效应模型分析这些纵向数据。
结果- 共有 399 对 SS/照顾者参与。总体而言，当照顾者照顾表现出更多抑郁症状和认知障碍的 SS 时，或当照顾者更年轻、女性、身体健康状况较差、生活方式干扰更大、自我掌控感较低时，他们会报告更多的情绪困扰。SS 的身体残疾、中风严重程度和合并症并不显著。当在随访 2 年的亚组中进行检查时，这组显著的预测因素仍然保持一致（除了 SS 的认知障碍）。
结论- 旨在改善照顾者福祉的干预措施应侧重于改善 SS 抑郁的临床管理，并更好地为照顾者管理行为和心理症状做好准备。此外，鼓励照顾者保持参与有价值活动的休息计划可能会有所帮助。
