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Predictors of Positive Aspects of Caregiving and Depression Among Informal Caregivers of Stroke Survivors

Uphold CR, Van Puymbroeck AM, Sberna M, Rittman MR, Williams LS. Predictors of Positive Aspects of Caregiving and Depression Among Informal Caregivers of Stroke Survivors. Paper presented at: American Geriatrics Society Annual Meeting; 2007 May 4; Seattle, WA.

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Stroke is the leading cause of serious disability in the U.S. Presence of a competent informal caregiver is a critical determinant of whether a stroke survivor receives quality care and lives in the community. Although caregiving has traditionally been viewed as burdensome, the stress-health model, which characterizes caregiving as having both positive and negative dimensions, was used to guide this study. Stroke survivor characteristics (health, abilities to complete activities of daily living) and caregiver characteristics (health, being a spousal caregiver, age, social support, and health promoting behaviors) were hypothesized to be positively associated with positive aspects of caregiving and negatively related to depressive symptoms. The sample consisted of the first 100 patient/caregiver dyads who were randomly selected from the Veterans Affairs (VA) Functional Status and Outcomes and who were interviewed as part of an on-going two-year funded VA study that uses a telephone survey methodology. All variables were measured with instruments that had established reliability and validity. The majority of the caregivers were female (n = 94) and lived in the same household as the survivors (n = 93). Twenty-two percent of the caregivers strongly agreed with all items on the positive aspects of caregiving instrument. The logistic regression analysis found that spouse vs. nonspouse caregiving ( = 2.97, p = 0.006) and social support (( = 0.07, p = 0.03) were significant predictors of positive aspects of caregiving. Controlling for all other variables, the odds of having perceptions of high positive aspects of caregiving were 10.4 times greater for spouses as compared to non-spouse caregivers and were 1.07 greater for those persons with higher levels of social support. Forty-five percent of the caregivers were at risk for clinical depression. The multiple regression analysis found that older age ( = -0.02, p = 0.002), higher social support ( = -0.01, p = 0.006), and more frequent health promoting behaviors ( = -0.14, p = 0.004) were significant negative predictors of depressive symptoms. The model explained 40% of the variance in depressive symptoms (p < 0.0001). Our findings indicate that even though a large number of caregivers are at risk for clinical depression, they can simultaneously hold positive beliefs about caregiving. Factors which professionals can modify, such as social support and health promoting behaviors, may improve caregiving outcomes. Nonspousal, younger caregivers may require targeted interventions to improve their perceptions of caregiving and reduce their risk of depression.

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