title: Comparison of caregiver strain in Parkinson's disease between Yamagata, Japan, and Maryland, The United States.
abstract: BACKGROUND
  Japan and the United States (US) have different cultures of caregiving including differences in family structure and social programs that may influence caregiver strain. Differences in caregiver strain between regions in Japan and in the US have not been investigated in patient-spouse dyads in PD.
  
  
  OBJECTIVE
  To compare caregiver strain in spouses of PD patients between Yamagata, Japan and Maryland, US. Correlations between caregiver strain and patient/spousal variables are also examined.
  
  
  METHODS
  In Yamagata and Maryland, spouses of patients with PD completed questionnaires assessing caregiver strain. Patients and spouses completed scales assessing mental health, and medical co-morbidity. PD severity and disability were assessed with the Unified Parkinson's Disease Rating Scale and the Schwab and England Activities of Daily Living Scale. Results in the two regions were compared with Chi-square and Student's t-tests. Relationships between caregiver strain and patient/spousal variables were analyzed with univariate correlations and multivariate regression.
  
  
  RESULTS
  178 Spouse-patient pairs were assessed. The level of caregiver strain in PD did not differ between Yamagata, Japan and Maryland, US despite differences in demographics and social support programs in the two regions. Yamagata spouses reported physical, time and financial constraints, while Maryland spouses reported more emotional distress. In both regions, spousal depression was a significant contributor to caregiver strain.
  
  
  CONCLUSIONS
  Different approaches to reduce caregiver strain will likely be necessary in Yamagata and Maryland since the contributing factors to caregiver strain are influenced by differences in culture and social supports in each country.
authors.affiliation: Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, Japan. t.haruko@med.id.yamagata-u.ac.jp
authors.forename: Haruko
authors.initials: H
authors.lastname: Tanji
authors.forename: Shingo
authors.initials: S
authors.lastname: Koyama
authors.forename: Manabu
authors.initials: M
authors.lastname: Wada
authors.forename: Toru
authors.initials: T
authors.lastname: Kawanami
authors.forename: Keiji
authors.initials: K
authors.lastname: Kurita
authors.forename: Gen
authors.initials: G
authors.lastname: Tamiya
authors.forename: Naohiro
authors.initials: N
authors.lastname: Saito
authors.forename: Kyoko
authors.initials: K
authors.lastname: Suzuki
authors.forename: Takeo
authors.initials: T
authors.lastname: Kato
authors.forename: Karen E
authors.initials: KE
authors.lastname: Anderson
authors.forename: Ann L
authors.initials: AL
authors.lastname: Gruber-Baldini
authors.forename: Paul S
authors.initials: PS
authors.lastname: Fishman
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Reich
authors.forename: William J
authors.initials: WJ
authors.lastname: Weiner
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Shulman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D016009:Chi-Square Distribution; D003431:Cross-Cultural Comparison; D003469:Culture; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010300:Parkinson Disease / Q000451:nursing* / Q000523:psychology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States