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。负面情绪是常见的，随着时间的推移持续存在，并与其他负面结果相关(幸存者功能不佳，家庭功能下降)。预防慢性痛苦的早期干预并不常见。这项随机、混合方法、治疗对照试验，由应对模式指导，将测试照顾者问题解决干预(CPSI)。本研究的目的是：1)测试CPSI对护理第一年期间的CG抑郁症状、焦虑、准备、对生活变化的感知、家庭功能和幸存者功能的影响；2)检验护理评价和问题解决的中介效应；3)描述CPSI参与者对抑郁症状的积极和消极反应。中风幸存者-照顾者二元组(N=260)将被随机分配到CPSI或等待名单控制条件(WLC)。CPSI包括在急性康复期间的2次会议和出院后3个月期间的8次电话会议，根据CG的优先事项和应对技能培训来解决问题。为了测试其有效性，将收集关于存活者和CG背景因素的数据，以及基线、干预后以及出院后6个月和1年的中介变量和结果变量。WLC CGs将在出院后6个月接受干预。CPSI照顾者将根据抑郁症状的变化在出院后1年有目的地抽样，并就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、住院和死亡率的探索性数据。将使用多变量方差分析、混合模型程序和回归技术来评估CPSI对CG结局、生存功能和介体的影响。定性数据将使用内容分析和常量比较进行分析。将使用描述性和单变量统计来评估探索性数据。

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.