Problem-Solving A Stroke Caregiver Early Intervention

描述（由申请人提供）：中风幸存者的照顾者（CG）突然承担起他们的角色，几乎没有准备。 消极情绪是常见的，随着时间的推移而持续存在，并与其他负面结果（生存功能差，家庭功能下降）有关。 早期干预，以防止慢性困扰是罕见的。 这项随机、混合方法、治疗对照试验，以应对模式为指导，将测试照顾者问题解决干预（CPSI）。 其目的是：1）测试CPSI对CG抑郁症状，焦虑，准备，生活变化的感知，家庭功能和幸存者功能的影响，在第一年的康复期间，2）检查评估康复和解决问题的中介作用;和3）描述CPSI参与者对抑郁症状的积极和消极反应者的经历。 卒中幸存者-护理人员二人组（N = 260）将被随机分配至CPSI或等待列表对照条件（WLC）。 CPSI包括急性康复期间的2次会议和出院后3个月的8次电话会议，根据CG的优先事项和应对技能培训量身定制问题解决方案。 为了测试其有效性，将在基线、干预后、出院后6个月和1年收集幸存者和CG背景因素以及中介和结局变量的数据。 WLC CG将在出院后6个月接受干预。 CPSI照顾者将在出院后1年根据抑郁症状的变化进行有目的的抽样，并就他们的经验和对干预的反应进行访谈。 探索性数据将收集CG的健康行为，和幸存者抑郁症状，住院，机构，和死亡率。 将使用多变量方差分析、混合模型程序和回归技术评估CPSI对CG结局、存活者功能和介质的影响。 定性数据将使用内容分析进行分析，并进行持续比较。 将使用描述性和单变量统计量评估探索性数据。

DESCRIPTION (provided by applicant): Caregivers (CGs) of stroke survivors assume their role suddenly and with little preparation. Negative emotions are common, persist over time, and are related to other negative outcomes (poor survivor function, decreased family functioning). Early intervention to prevent chronic distress is uncommon. This randomized, mixed-method, treatment-control trial, guiding by a coping model, will test a caregiver problem-solving intervention (CPSI). The aims are to: 1) test the effect of CPSI on CG depressive symptoms, anxiety, preparedness, perceptions of life changes, family functioning, and survivor function during the first year of caregiving, 2) examine the mediation effects of appraisal of caregiving and problem-solving; and 3) describe the experiences of CPSI participants who are positive and negative responders on depressive symptoms. Stroke survivor-caregiver dyads (N = 260) will be randomly assigned to the CPSI or a waitlist control condition (WLC). The CPSI includes 2 sessions during acute rehabilitation and 8 telephone sessions through 3 months post-discharge with problem solving tailored to the CG's priorities and training in coping skills. To test its effectiveness data will be collected on survivor and CG contextual factors, and mediating and outcome variables at baseline, post-intervention, and 6 months and 1 year post-discharge. The WLC CGs will be offered an intervention 6 months post-discharge. CPSI caregivers will be purposively sampled 1 year post-discharge based on changes in depressive symptoms, and interviewed about their experiences and responses to the intervention. Exploratory data will be collected on CG health behaviors, and survivor depressive symptoms, hospitalization, institutionalization, and mortality. Multivariate analysis of variance, Mixed-Models procedures, and regression techniques will be used to assess CPSI effects on CG outcomes, survivor function, and mediators. Qualitative data will be analyzed using content analysis with constant comparison. Descriptive and univariate statistics will be used to assess the exploratory data.