Stroke Caregiver Depression: Qualitative Comparison of Treatment Responders and Nonresponders at 1 Year.
Stroke Caregiver Depression: Qualitative Comparison of Treatment Responders and Nonresponders at 1 Year.
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DOI：
10.1097/jcn.0000000000000852
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发表时间：
2022-11-01
期刊：
影响因子：
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通讯作者：
Hartke RJ
中科院分区：
文献类型：
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作者：
King RB;Raad JH;Flaherty J;Hartke RJ
混合方法研究可以揭示干预措施有效减少看护者抑郁症的机制。这项定性研究的目的是了解与无反应者相比，有助于中风护理人员治疗反应者抑郁症状减轻的因素。采用混合方法解释性序贯设计来评估认知行为应对的使用以及对减少实验研究治疗反应者和无反应者抑郁症的帮助。我们在一年的护理中进行有目的抽样，选择了没有抑郁或表现出可能患有抑郁症的反应者，以及分数表明抑郁症恶化或出现新发抑郁症的无反应者。参与者对有关生活变化以及干预应对策略的使用和帮助的半结构化访谈做出回应。主题分析确定了代码和主题。 25 名参与者中有 12 名是响应者。我们确定了两个总体结果主题：“这是关于我的，改变是为了让生活更美好”（受访者）和“感叹我们改变的生活”（非受访者）。确定了与应对相关的五个子主题。回应者积极应对，较少依赖咨询关系，而无回应者则被动应对，更依赖最初的咨询关系。超过四分之一的无反应者和无反应者发现愤怒或之前接受过心理治疗。与 1 名有反应者相比，13 名无反应者中有 9 人的生活发生了负面变化。研究结果支持认知行为应对的帮助。对于许多护理人员来说，参与访谈和更强烈、更长时间的干预（例如分级护理和愤怒管理）可以分别减轻治疗抵抗和抑郁症状。
Mixed method studies can shed light on the mechanisms through which interventions effectively reduce caregiver depression. The objective of this qualitative study was to understand factors contributing to reduced depressive symptoms in stroke caregiver treatment responders compared with non-responders. A mixed methods explanatory sequential design was used to assess cognitive behavioral coping use and helpfulness in reducing depression among experimental study treatment responders and non-responders. Using purposive sampling at one-year caregiving, we selected responders who were not depressed or demonstrated reduction to probable depression, and non-responders whose scores indicated worsened or new depression. Participants responded to semi-structured interviews on life changes and the use and helpfulness of intervention coping strategies. Thematic analysis identified codes and themes. Twelve of 25 participants were responders. We identified two overarching outcome themes: “It was about me, changing to make life better” (responders) and “Lamenting our changed lives” (non-responders). Five subthemes related to coping were identified. Whereas responders coped actively and were less dependent on the counseling relationship, non-responders were passive in coping, and more dependent on the initial counseling relationship. Anger or prior psychologic treatment were found in over a quarter of non-responders and in no responder. Negative life change was found in 9 of 13 non-responders compared with one responder. Findings support the helpfulness of cognitive behavioral coping. For many caregivers engagement Interviews and a more intense, longer intervention, such as stepped-care and anger management is indicated to mitigate treatment resistance and depressive symptoms, respectively.