title: Caregiver stress in stroke survivor: data from a tertiary care hospital -a cross sectional survey.
abstract: BACKGROUND
  A principal caregiver (CG) is directly affected by patient's health problems that lead to CG strain. Pakistan has an estimated 4.8% of the population suffering from strokes. The study objective was to evaluate the caregiver level of stress and the factors which make CGs more prone to stress and also to identify the predictive role of factors such as age, sex, educational, marital status on their burden.
  
  
  METHODS
  This was a cross-sectional survey. 112 Participants were chosen on the basis of being directly involved in the care of patient and able to give consent for the study. Stroke patients had to have a more than 1 month history of stroke and treated in a tertiary care hospital. The severity of stress was rated using the Modified Caregiver Strain Index (MCSI).
  
  
  RESULTS
  Out of a total of 112 stroke patients and their caregivers, 12 were exempted. Most of the CGs were between the ages 30-39 (48%) and male (70%). Out of the males, most were sons (89%). None of the female CGs was employed. The mean MCSI score was 13.8. Gender, age, marital status, and duration of care all did not have a significant effect on the total (P = 0.640, 0.848, 0.839, 0.110 respectively). Female gender (P = 0.0075) was a factor leading to increased emotional adjustments. Single CGs had increased changes in personal plans (P = 0.014), and married CGs found the behaviour of the patients less upsetting (P = 0.0425). There was no significant difference between the total (P = 0.906) or individual components between daughters and daughter-in-laws. Increased duration of care was significantly associated with decrease level of sleep disturbance (P = 0.026), physical strain (P = 0.050) and other demands on time (P = 0.044). Increase age of CG was associated with an increase feeling of being overwhelmed (P = 0.027).
  
  
  CONCLUSIONS
  There is a need to identify the factors responsible for major CG stress by conducting similar studies and to define structured intervention for evaluating and preventing problems of caregivers.
authors.affiliation: Shifa College of Medicine, Shifa Tameer-e-Millat University, Pitras Bukhari Road, H-8/4, Islamabad, Pakistan.
authors.forename: Qurat Ul
authors.initials: QU
authors.lastname: Ain
authors.affiliation: Shifa College of Medicine, Shifa Tameer-e-Millat University, Pitras Bukhari Road, H-8/4, Islamabad, Pakistan.
authors.forename: Nayab Zaheer
authors.initials: NZ
authors.lastname: Dar
authors.affiliation: Associate Professor, Division of Neurology, Shifa College of Medicine and Shifa International Hospital, Shifa Tameer-e-Millat University, Pitras Bukhari Road, H-8/4, Islamabad, Pakistan.
authors.forename: Arsalan
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Division of Neurology, Shifa International Hospital, Shifa Tameer-e-Millat University, Pitras Bukhari Road, H-8/4, Islamabad, Pakistan.
authors.forename: Saad
authors.initials: S
authors.lastname: Munzar
authors.affiliation: Assistant Professor, Department of Psychiatry, Associate Professor, Shifa College of Medicine and Shifa International Hospital, Shifa Tameer-e-Millat University, Pitras Bukhari Road, H-8/4, Islamabad, Pakistan.
authors.forename: Abdul Wahab
authors.initials: AW
authors.lastname: Yousafzai
keywords: Caregiver stress; Pakistan; Stroke