Psychosocial Impact of Stroke on Family Caregivers

描述(由申请人提供)：中风是美国成年人残疾的主要原因。大约有400万美国人是中风幸存者，他们生活在中风后的损害中。绝大多数中风幸存者住在家里，他们通常会从家人那里得到实质性的照顾和帮助。之前对中风幸存者的家庭照顾者进行的几项研究表明，在中风后的急性期和慢性期，照顾者的抑郁水平往往都会升高。然而，这些研究通常是基于小的便利样本，而且往往缺乏与非护理群体的充分比较。几乎没有关于中风幸存者的家庭照顾者之间潜在的种族或种族差异的信息。这项拟议的调查将比较300名中风幸存者的家庭照顾者和300名非照顾者的匹配样本，这些衡量标准包括抑郁、生活满意度、身体健康、医疗利用、生活质量和护理压力。两组中至少有一半的参与者将是非裔美国人。照顾者和非照顾者都将从同一项关于中风发病率的全国性流行病学研究中招募(N=30,000)。计算机辅助电话访谈将被用来跟踪照顾者和非照顾者随着时间的推移而进行的心理社会适应，家庭评估将被用来获得对中风幸存者损害和中风特定生活质量的评估。该项目的具体目标是(1)确定中风对主要家庭照顾者的抑郁、生活满意度、身体健康、卫生保健利用和生活质量的影响；(2)比较非裔美国人和白人家庭照顾者的照护效果；(3)纵向跟踪中风对家庭照顾者的影响；(4)测试社会支持、压力评估和获得护理的效果，以调节照顾者抑郁、身体健康和生活满意度的种族差异；(5)评估照顾者抑郁、生活质量和压力评估对中风幸存者身体和情绪康复的影响，以及(6)建立家庭照顾者不良结局的多变量预测模型，用于规划未来的干预措施。以前的研究表明，照顾者中的抑郁和不良适应不仅会影响照顾者本身，还会导致中风幸存者的不良结局。拟议的项目将促进对这些机制的了解，并为未来的干预工作提供有益的影响。

DESCRIPTION (provided by applicant): Stroke is the leading cause of adult disability in the United States. Approximately 4,000,000 Americans are stroke survivors who are living with post-stroke impairments. A large majority of stroke survivors live at home, where they typically receive substantial care and assistance from family members. Several previous studies of the family caregivers of stroke survivors have shown that caregivers tend to have elevated levels of depression during both the acute and chronic phases after the stroke. However, these studies have usually been based on small convenience samples and often lack adequate comparisons to noncaregiving groups. Virtually no information is available on potential ethnic or racial differences among family caregivers of stroke survivors. The proposed investigation will compare 300 family caregivers of stroke survivors to a matched sample of 300 noncaregivers on measures of depression, life satisfaction, physical health, health care utilization, quality of life, and caregiving stress. At least half of the participants in both groups will be African Americans. Both caregivers and noncaregivers will be recruited from the same national, epidemiological study of stroke incidence (N = 30,000). Computer-assisted telephone interviewing will be used to track psychosocial adjustment over time in caregivers and noncaregivers, and in-home evaluations will be used to obtain assessments of stroke survivor impairments and stroke-specific quality of life. The specific aims of the project are (1) to identify the effects of stroke on the depression, life satisfaction, physical health, health care utilization, and quality of life of primary family caregivers; (2) to compare the effects of caregiving between African American and White family caregivers; (3) to track the effects of stroke on family caregivers longitudinally; (4) to test the effects of social support, stressfulness appraisals, and access to care for mediating racial differences in caregiver depression, physical health, and life satisfaction; (5) to assess the impact of caregiver depression, quality of life, and stressfulness appraisals on the physical and emotional recovery of the stroke survivor, and (6) to develop a multivariate predictive model of poor outcome in family caregivers for use in planning future intervention efforts. Previous studies have suggested that depression and poor adjustment among caregivers not only affect the caregivers themselves, but also contribute to poor outcomes among the stroke survivors. The proposed project will advance the understanding of these mechanisms, and provide useful implications for future intervention efforts.