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Chulalongkorn Medical Journal

Abstract

Background: Caregivers of stroke survivors often face significant psychological challenges, yet limited research in Thailand has explored how patient and caregiver characteristics jointly influence caregiver mental health outcomes.

Objective: To identify characteristics of ischemic stroke patients and their caregivers that may predict distress, sadness, and anxiety symptoms in the caregivers.

Method: To measure caregivers' burden, stress, depression, and anxiety symptoms, the Hospital Anxiety and Depression Scale (HADS), Zarit Burden Interview (22-item ZBI), and Perceived Stress Scale (PSS-10) were utilized. To define a multi-step mediation model, we used partial least squares structural equation modelling (PLS-SEM).

Result: 97 stroke patients and their caregivers were involved in this research. The regression on ZBI-personal strain and stroke of other identified etiology explained 15 percent of the variation in the HADS depression score (p=0.001). We observed that the caregiver's underlying condition and the patients' National Institute Stroke Score (NIHSS) explained 13.6 percent of the variation in the caregivers' overall ZBI score (p=0.001). The total ZBI score, the existence of lacunar circulatory infarction in the patients, and the underlying condition of the caregiver explained 40.9 percent of the variation in the caregivers' overall PSS score (p 0.001). Furthermore, PLS analysis revealed that the NIHSS and the underlying medical condition of the caregiver had substantial indirect impacts on the HADS score, which were mediated by the ZBI score.

Conclusions: The patient's disability, reliance, cognition, and stroke phenotypes, as well as the caregiver's health condition and burden, account for a considerable portion of the variation in stress and depression ratings in caregivers of ischemic stroke patients. Screening ischemic stroke caregivers for the aforementioned risk factors is crucial.

DOI

10.56808/2673-060X.5763

First Page

1.Introduction Healthcare professionals need more vigilance regarding diseases and their potential consequences as the rise of aging population in Thailand and the global community. (1) One of these age-related illnesses is ischemic stroke, which is anticipated to double in prevalence by 2050 compared to 2010. Increased prevalence leads to an increase in disability-adjusted life years as a consequence of better acute ischemic stroke treatment. (1, 2) Stroke has a broad variety of consequences that impact both survivors and their families. (3-5) Half of stroke survivors remain handicapped and need medical treatment a year after the stroke. (6) The majority of family members who stepped up to become unskilled and unpaid informal caregivers are mainly female spouses and the patients' daughters. (7) Among the most often reported pressures on stroke patients' caregivers are family changes, confinement, changes in personal goals, loss of autonomy, and anxiety about the future. (4) The response to the stresses is governed not only by the degree of strain but also by the caregivers' coping mechanisms. (5) Negative outcomes relate to passive and palliative coping techniques more than positive coping styles. (4,5) Although caring activities may be rewarding, positive elements of caregiving have been noted, particularly among elder caregivers. (5) Caregivers may experience emotional anguish because of the difficulties they confront. However, although this discomfort tends to lessen with time, many caregivers may not seek therapy while experiencing stress, depression, and anxiety symptoms that can lead to anxiety and drug misuse disorders, as well as suicide. (6-9) Female sex, being a spouse, Caucasian race, degree of handicap, level of reliance, care duration of 13 hours a day, self-funded financial source, care load, task complexity, and presence of patient's depressive symptoms are factors that predispose caregivers to depression and anxiety. Although there are certain differences, such as having a husband. (10-14) Despite the central role caregivers play in stroke recovery, their psychological distress is frequently overlooked by healthcare professionals. Routine follow-up care often emphasizes secondary prevention and physical rehabilitation, while neglecting the emotional and psychosocial consequences experienced by caregivers. (15) This oversight can result in caregivers becoming “the next patient,” as chronic stress, anxiety, and depression accumulate without intervention (16) Studies have shown that caregivers face severe burden due to lack of respite care, minimal institutional support, and the hidden nature of emotional strain. Interventions such as psychoeducation, counseling, and community-based support have demonstrated potential to reduce caregiver distress and improve outcomes. Therefore, integrating caregiver-focused psychosocial screening and support into stroke aftercare is not only necessary but urgent.

Last Page

Conclusions The patients' disabilities, dependency, cognition, and stroke phenotypes; caregivers' health status and burden; and patients' disability, dependency, cognition, and stroke phenotypes all contribute significantly to the variation in stress and depression scores in caregivers of ischemic stroke patients. Screening ischemic stroke caregivers for the aforementioned variables is crucial. Declaration Ethical approval This study was reviewed and approved by the Institutional Review Board (IRB) of the Faculty of Medicine, Chulalongkorn University (IRB No 532/63). Consent to participate Informed consent was obtained from all individual participants included in the study, including both patients and caregivers, in accordance with the Declaration of Helsinki and institutional guidelines. Consent to publish This manuscript does not contain any individual person’s data in any form and therefore consent to publish is not applicable. Availability of Data The datasets used and analyzed during the current study are available from the corresponding author on request. Author Contribution CT was responsible for data curation, statistical support, and drafting the initial manuscript. SW assisted with data presentation and visualization. CT also contributed to statistical analysis and interpretation. AC assisted with data curation. MM provided conceptual supervision and performed statistical calculations. TS secured funding and APC, supervised the research process, and edited the final manuscript. All authors have reviewed the final version of the manuscript and consent to its publication. Funding source Ratchadapiseksompoch Fund, Faculty of Medicine, Chulalongkorn University, RA66/007

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