Factors associated with strain in informal caregivers of stroke patients

Background: Stroke is one of the most prevalent causes of adult disability and handicap.Informal caregivers play an important role in poststroke care.However, informal caregivers may experience strain, which threatens the recovery of stroke subjects.This study aimed to describe changes in strain experienced by informal caregivers from 3 to 6 months after the stroke, and identify the predicting factors. Methods:We recruited pairs of inpatients with ischemic stroke and informal caregivers from a tertiary referral hospital and interviewed them at 3 and 6 months after the stroke.Caregiver strain was evaluated using the Caregiver Strain Index (CSI), with a CSI 7 indicating considerable caregiver strain.Various factors associated with caregiver strain were analyzed using generalized estimating equations. Results:Eighty-nine stroke patients and caregivers completed the study.Considerable strain was reported in 46% and 43% of the caregivers at the 3 rd and 6 th month, respectively.Patient factors such as severe disabilities (Barthel Index 60), poor cognition (Mini-Mental State Examination 23), depression (Beck Depression Inventory [BDI] 10), and recurrent stroke were predictors for caregiver strain.Caregiver factors, such as changed employment status, help from formal caregivers, and depression (BDI 10) were also associated with considerable caregiver strain.Conclusions: Nearly 50% of caregivers experienced considerable strain.Interventions aimed at reducing the caregivers' strain should focus on enhancing the functional and emotional status of stroke subjects, prevention of recurrent stroke, and efficient management of depression symptoms in caregivers.(Chang Gung Med J 2012;35:392-401) Key words: stroke, informal caregivers, strain S troke is one of the most prevalent causes of adult disability and handicap.(1)(2)(3)(4) A substantial proportion of stroke survivors rely on instrumental and emotional support from informal caregivers after acute hospitalization.(5,6) These caregivers are recognized as "informal caregivers" because they are not paid or trained by statutory bodies.The informal caregiver is usually a spouse, child, child-in-law or