Problem-Solving A Stroke Caregiver Early Intervention

描述（由申请人提供）：中风幸存者的照顾者（CGs）突然承担起他们的角色，几乎没有准备。负面情绪很常见，会持续一段时间，并与其他负面结果（生存能力差，家庭功能下降）有关。早期干预以预防慢性痛苦并不常见。这个随机、混合、治疗-控制的试验，在应对模式的指导下，将测试照顾者解决问题干预（CPSI）。本研究的目的是：1)检验CPSI在照顾第一年对CG抑郁症状、焦虑、准备、生活变化感知、家庭功能和幸存者功能的影响；2)检验照顾评价和问题解决的中介作用；3)描述积极和消极抑郁症状反应的CPSI参与者的经历。卒中幸存者-照护者二组（N = 260）将被随机分配到CPSI组或等候名单对照组（WLC）。CPSI包括急性康复期间的2次会议和出院后3个月内的8次电话会议，根据CG的优先事项解决问题，并培训应对技能。为了测试其有效性，将收集幸存者和CG相关因素以及基线、干预后、出院后6个月和1年的中介和结果变量的数据。出院后6个月，将对WLC CGs进行干预。CPSI护理人员将根据抑郁症状的变化在出院后1年进行有目的的抽样，并对他们的经历和对干预的反应进行访谈。将收集关于CG健康行为、幸存者抑郁症状、住院、机构和死亡率的探索性数据。多变量方差分析、混合模型程序和回归技术将用于评估CPSI对CG结果、幸存者功能和介质的影响。定性数据将使用内容分析和不断比较来分析。描述性和单变量统计将用于评估探索性数据。

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.