Psychosocial Impact of Stroke on Family Caregivers

描述（由申请人提供）：中风是美国成人残疾的主要原因。大约有4，000，000名美国人是中风幸存者，他们患有中风后损伤。绝大多数中风幸存者住在家里，在那里他们通常得到家庭成员的大量照顾和帮助。先前对中风幸存者的家庭照顾者的几项研究表明，照顾者在中风后的急性和慢性阶段都倾向于抑郁水平升高。然而，这些研究通常是基于小方便的样本，往往缺乏足够的比较，非连续性组。事实上，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。这项研究将比较300名中风幸存者的家庭照顾者与300名非照顾者的匹配样本在抑郁、生活满意度、身体健康、医疗保健利用、生活质量和生活压力方面的差异。两组中至少有一半的参与者将是非洲裔美国人。护理者和非护理者将从同一项卒中发病率的全国流行病学研究中招募（N = 30，000）。计算机辅助电话访谈将用于跟踪照顾者和非照顾者随时间推移的心理社会适应，家庭评估将用于评估卒中幸存者损伤和卒中特异性生活质量。该项目的具体目标是：（1）确定脑卒中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色家庭照顾者的抑郁影响;（3）纵向跟踪脑卒中对家庭照顾者的影响;（4）检验社会支持、压力评估和获得护理对照顾者抑郁、身体健康和生活满意度的种族差异的中介作用;（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恢复的影响，（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。以往的研究表明，抑郁和照顾者的不良适应不仅影响照顾者本身，而且还有助于中风幸存者的不良结局。拟议的项目将促进对这些机制的理解，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.