Background: A third of carers of people who have had a stroke experience poor psychological health. Early prediction of carers' later well-being would allow interventions to be targeted at carers most at risk of a poor outcome.
Aim: To develop a predictive model for the identification of stroke carers at risk of developing poor psychological well-being in the first year post stroke.
Method: Fifty consecutive one-year survivors of a stroke and their carers were assessed on a range of demographic, environmental and psychosocial variables at three months post stroke. The carers' psychological well-being at 12 months post stroke was assessed using the General Well-Being Index (GWBI). Multiple regression analysis was performed to identify the best early predictors of carers' later well-being.
Results: The regression analysis identified three significant predictors of carers' well-being: carers' appraisal of caregiving stress; carers' physical health; and carers' satisfaction with service provision (r2 = 0.53). Using this model, 72% of carers' predicted well-being scores fell within nine points of their actual 12-month GWBI score.
Conclusion: Findings from this preliminary study indicate that it may be possible to identify carers most likely to experience poor psychological well- being. In order to develop a clinically usable 'carer risk prediction instrument' further research to test this model is essential.
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References
1.
Green H.General Household Survey 1985: Informal carers. London : HMSO, 1988.
2.
Henwood M.Through a glass darkly: community care and elderly people. London: King's Fund Institute, Research Report No. 14, 1992.
3.
Parker G.With due care and attention: a review of research on informal care. London: Family Policy Studies Unit, HMSO, 1990.
4.
Twigg J., Atkin K., Perring C.Carers and services: a review of research. London: HMSO, 1990.
5.
Lamb B., Layzell S.Disabled in Britain: behind closed doors - the carers' experience. London: Campaigns and Parliamentary Affairs Dept, Scope, 1995.
6.
British Medical Association.Taking care of the carers: The need to recognise and support the role of the unpaid carers in the U.KLondon: BMA, February 1995.
7.
Harris AIHandicapped and impaired in Great Britain, Part 1. London : Office of Population, Censuses and Surveys, HMSO, 1971.
8.
Carnwath Tmc , Johnson Daw.Psychiatric morbidity among spouses of patients with stroke. BMJ1987; 294: 409-11.
9.
Coughlan A., Humphrey M.Presenile Stroke: Longterm outcome for patients and their families. Rheumatol Rehabil1982; 21: 115-22.
10.
Greeveson CS , Gray CS, French JM et al. Longterm outcome for patients and carers following hospital admission for stroke. Age Ageing1991; 20: 337-44.
11.
Kinsella GJ , Duffy FDPsychological readjustment in the spouses of aphasic patients. Scand J Rehabil Med1979 ; 11: 129-32.
12.
Stein PN, Gordon WA, Hibbard MRAn Examination of depression in the spouses of stroke patients. Rehabil Psychol1992; 37(2): 121-30.
13.
Montgomery Rjv.Investigating caregiver burden. In: Markides KS, Cooper CL eds. Aging stress and health. Chichester: John Wiley, 1989.
14.
Ravies VH, Siegel K., Sudit M.Psychological impact of caregiving on the careprovider: a critical review of extant research. J Appl SocSci1988/89; 13(1): 40-79.
15.
Barer B., Johnson LJA critique of the caregiving literature. Gerontology1990; 30(1): 26-29.
16.
Malonebeach EE, Zarit SHCurrent research issues in caregiving to the elderly. Int J Aging Hum Dev1991; 32(2): 103-14.
17.
Schulz R., Tompkins CA, Rau MTA longitudinal study of the psychosocial impact of stroke on primary support persons. Psychol Aging1988; 3(2): 131-41.
18.
Enderby PM, Wood VA, Wade DTThe Frenchay Aphasia Screening Test: A short, simple test for aphasia appropriate for non-specialists. Int J Rehabil Med1987 ; 8: 166-70.
19.
Mahoney FI, Barthel DWFunctional evaluation: the Barthel Index. Md State Med J1965; 14: 61-65.
20.
Collin C., Wade DT, Davis S.The Barthel ADL Index: a reliability study. Int Disabil Stud1988; 10: 61-63.
21.
Katzman R., Brown T., Fuld P. et al. Validation of a short orientation-memory-concentration test of cognitive impairment. Am J Psychiatry1983 ; 140(6): 734-39.
22.
Wade DT, Legh-Smith, Langton-Hewer R.Social Activities after stroke: measurement and natural history using the Frenchay Activities Index. Int Rehabil Med1985; 7: 176-81.
23.
Snaith RP, Ahmed SN, Mehta S. et al. Assessment of the severity of primary depressive illness: Wakefield self-assessment depression inventory. Psychol Med1971; 1: 143-49.
24.
Stokes JPPredicting satisfaction with social support from social network structure . Am J Community Psychol1983; 11(2): 141-52.
25.
Venters M.Familial coping with chronic and severe childhood illness: the case of cystic fibrosis. Soc Sci Med1981; 15A: 289-97.
26.
Anderson R.The aftermath of stroke. Cambridge: Cambridge University Press, 1992.
27.
Pearlin LI, Mullan JT, Semple SJ et al. Caregiving and the stress process: An overview of concepts and their measures. Gerontologist1990; 30(5): 583-91.
28.
Hunt SM, McKenna SP. A British adaptation of the General Well-Being Index: a new tool for clinical research. Br J Med Econ1992; 2: 49-60.
29.
Dupuy HJThe Psychological General Well-Being (PGWB) Index. In: Wenger NK, Mattson M, Furberg C, Elinson J eds. Assessment of quality of life in clinical trials of cardiovascular therapies. New York: le Jacq, 1984; 170-83.
30.
Altman DGPractical statistics for medical research. London: Chapman & Hall, 1991.
31.
Taylor SEAdjustment to threatening events: a theory of cognitive adaptation. Am Psychol1983; 38: 1161-73.
32.
Zarit SH, Todd PA, Zarit JMSubjective burden of husbands and wives as caregivers. Gerontologist1986; 26(3): 260-66.
33.
Chwalisz K.Perceived stress and caregiver burden after brain injury: a theoretical integration. Rehabil Psychol1992; 37(3): 189-203.
34.
Bowling A., Browne PDSocial networks, health, and emotional well-being among the oldest old in London. J Gerontol Soc Sci1991; 46(1): 520-32.
35.
Levin E., Moriaty J., Gorbach P.Better for the break. London: National Institute for Social Work Research Unit, HMSO, 1994.
36.
Field D., Cordle CJ, Bowman GSCoping with a stroke at home. Int Rehabil1983; 5: 96-100.
37.
Harper DJ, Manasse PR, James O. et al. Intervening to reduce distress in caregivers of impaired elderly people: a preliminary evaluation. Int J GerontolPsychiatry1993; 8: 139-45.
38.
Warburton RWImplementing caring for people: home and away. London: Department of Health, HMSO, 1994.
