Chung Misook L, Bakas Tamilyn, Plue Laura D, Williams Linda S
Misook L. Chung, PhD, RN, FAHA, FAAN Associate Professor, Codirector, RICH Heart Program, College of Nursing, University of Kentucky, Lexington. Tamilyn Bakas, PhD, RN, FAHA, FAAN Professor and Chair, Department of Science of Nursing Care, School of Nursing, Indiana University, Indianapolis. Laura D. Plue, MA Indiana University School of Medicine and Qualitative Research Coordinator, Stroke QUERI Center for Health Information and Communications, Richard L. Roudebusch Veterans Administration Medical Center, Indianapolis. Linda S. Williams, MD, FAHA, FAAN Professor of Neurology, Indiana University School of Medicine and Richard L. Roudebusch Veterans Administration Medical Center, Indianapolis.
J Cardiovasc Nurs. 2016 Mar-Apr;31(2):E8-E16. doi: 10.1097/JCN.0000000000000232.
Depressive symptoms are common in stroke survivors and their family caregivers. Given the interdependent relationship between the members of dyads in poststroke management, improving depressive symptoms in dyads may depend on their partner's characteristics. Self-esteem, optimism, and perceived control, all known to be associated with depressive symptoms in an individual, may also contribute to their partner's depressive symptoms.
The purpose of this study is to examine actor and partner effects of self-esteem, optimism, and perceived control on depression in stroke survivors and their spousal caregivers.
A total of 112 ischemic stroke survivors (78% white, 34% women; mean age, 62.5 ± 12.3 years) and their spouses (mean age, 60.6 ± 12.9 years) completed surveys in which depressive symptoms, self-esteem, optimism, and perceived control were assessed using the Patient Health Questionnaire, the Rosenberg Self-esteem Scale, the Revised Life Orientation Test, and the Sense of Control Scale. Multilevel modeling, actor-partner interdependence model regression was used to determine influences on depressive symptoms within the dyad.
Individuals with lower self-esteem, optimism, and perceived control had higher levels of depressive symptoms. Stroke survivors whose spouses had lower levels of self-esteem (B = -0.338, P < .001) and optimism (B = -0.361, P < .027) tended to have higher levels of depressive symptoms. Spouses whose stroke survivors had lower levels of self-esteem (B = -0.047, P = .036) also had higher levels of depressive symptoms.
We found significant partner effects of self-esteem on depression for both members and partner effect of optimism on patient's depressive symptoms. These findings suggest that further research is needed to determine if dyadic interventions may help to improve self-esteem, optimism, and depressive symptoms in both patients and their caregivers.
抑郁症状在中风幸存者及其家庭照顾者中很常见。鉴于中风后管理中二元组成员之间的相互依存关系，改善二元组中的抑郁症状可能取决于其伴侣的特征。自尊、乐观和感知控制，所有这些都已知与个体的抑郁症状相关，也可能导致其伴侣的抑郁症状。
本研究的目的是检验自尊、乐观和感知控制对中风幸存者及其配偶照顾者抑郁的主效应和伴侣效应。
共有112名缺血性中风幸存者（78%为白人，34%为女性；平均年龄62.5±12.3岁）及其配偶（平均年龄60.6±12.9岁）完成了调查，其中使用患者健康问卷、罗森伯格自尊量表、修订的生活取向测试和控制感量表评估了抑郁症状、自尊、乐观和感知控制。采用多水平建模、主效应-伴侣效应相互依存模型回归来确定二元组内对抑郁症状的影响。
自尊、乐观和感知控制水平较低的个体抑郁症状水平较高。配偶自尊水平较低（B=-0.338，P<.001）和乐观水平较低（B=-0.361，P<.027）的中风幸存者往往抑郁症状水平较高。中风幸存者自尊水平较低的配偶（B=-0.047，P=.036）抑郁症状水平也较高。
我们发现自尊对二元组双方的抑郁有显著的伴侣效应，乐观对患者的抑郁症状有伴侣效应。这些发现表明，需要进一步研究以确定二元干预是否有助于改善患者及其照顾者的自尊、乐观和抑郁症状。
