title: Implications of stroke for caregiver outcomes: findings from the ASPIRE-S study.
abstract: BACKGROUND
  Informal caregivers are vital to the long-term care and rehabilitation of stroke survivors worldwide. However, caregiving has been associated with negative psychological outcomes such as anxiety and depression, which leads to concerns about caregiver as well as stroke survivor well-being. Furthermore, caregivers may not receive the support and service provision they require from the hospitals and community.
  
  
  OBJECTIVE
  This study examines caregiver psychological well-being and satisfaction with service provision in the context of stroke.
  
  
  METHODS
  Caregiver data were collected as part of the ASPIRE-S study, a prospective study of secondary prevention and rehabilitation which assessed stroke patients and their carers at six-months post stroke. Carer assessment included measurement of demographics, satisfaction with care (UK Healthcare Commission National Patient Survey of Stroke Care), psychological distress (Hospital Anxiety and Depression Scale), and vulnerability (Vulnerable Elders Scale). Logistic regression analyses and chi-squared tests were performed using stata version 12.
  
  
  RESULTS
  Analyses from 162 carers showed substantial levels of dissatisfaction (37·9%) with community and hospital services, as well as notable levels of anxiety (31·3%) and depressive symptoms (18·8%) among caregivers. Caregiver anxiety was predicted by stroke survivor anxiety (OR = 3·47, 95% CI 1·35-8·93), depression (OR = 5·17, 95% CI 1·83-14·58), and stroke survivor cognitive impairment (OR 2·35, 95% CI 1·00-5·31). Caregiver depression was predicted by stroke survivor anxiety (OR = 4·41, 95% CI 1·53-12·72) and stroke survivor depression (OR = 6·91, 95% CI 2·26-21·17).
  
  
  CONCLUSIONS
  Findings indicate that caregiver and stroke survivor well-being are interdependent. Thus, early interventions, including increased training and support programs that include caregivers, are likely to reduce the risk of negative emotional outcomes.
authors.affiliation: Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Samar
authors.initials: S
authors.lastname: Atteih
authors.affiliation: Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mellon
authors.affiliation: Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hall
authors.affiliation: Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Linda
authors.initials: L
authors.lastname: Brewer
authors.affiliation: School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Frances
authors.initials: F
authors.lastname: Horgan
authors.affiliation: Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Anne
authors.initials: A
authors.lastname: Hickey
mesh_terms: D000368:Aged; D001007:Anxiety / Q000150:complications; D017028:Caregivers / Q000523:psychology; D003072:Cognition Disorders / Q000209:etiology; D003863:Depression / Q000150:complications; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: caregivers; informal caregivers; satisfaction with care; secondary prevention; stroke outcomes; well-being