Date of Award

January 2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Dawn Denny

Second Advisor

Tracy Evanson

Abstract

Background: Poststroke depression (PSD) is a frequently occurring complication of stroke that affects up to 30% of all stroke survivors in the first 24 months after stroke. PSD has been correlated with increases in hospital length of stay and hospital costs, increased physical morbidity and mortality, the risk for recurrent stroke at one year, decreased functional outcome, decreased cognitive function, and decreased quality of life post stroke. Estimates are >50% stroke survivors with depressive symptoms are left untreated due to lack of recognition. Moreover, depression in family caregivers of stroke survivors may negatively influence stroke recovery and stroke survivor quality of life.

Design and Purpose: This explanatory sequential mixed-method study sought to examine the relationship between stroke disability as measured by the Modified Rankin Scale (mRS) (Van Sweiten et al., 1988), caregiver burden as measured by Zarit Burden Interview-12 (ZBI-12)(Bedard et al., 2001), rurality, prior history of depression and depressive symptoms after stroke as measured by the Beck Depression Inventory-Fast Screen (BDI©-FS) (Beck et al, 2000) and to also identify specific symptoms of depressive symptoms after stroke from the perspectives of stroke survivors and their caregivers in rural and urban communities.

Methods: A sample of thirty-two stroke survivor-caregiver dyads were enrolled. Stroke survivors completed the Beck Depression Inventory-Fast Screen (BDI©-FS) (Beck et al., 2000) and the Modified Rankin Scale (mRS) (van Sweiten, 1988). Caregivers completed the ZBI-12 (Bedard et al., 2001) and the (BDI©-FS) (Beck et al., 2000). Multiple linear regression was used to determine the relationships between stroke disability, caregiver burden, rurality, and depressive symptoms after stroke in populations of non-rural stroke survivors and their caregivers. Once the quantitative arm was completed, subjects from the quantitative arm who could share details regarding the most frequently occurring depressive symptoms after stroke, the experience of living with depressive symptoms after stroke and details of stroke caregiver burden were invited to participate in the qualitative arm of this study. A total of nine (9) stroke survivors and seven (7) caregivers completed 1:1 semi-structured individual recorded telephone interview guided by researcher-generated interview guides. The qualitative arm sample size met informational redundancy. Content and thematic analysis was used to analyze qualitative data.

Study Implication: Quantitative study findings were significant for RQ3: Among stroke caregivers, are there any significant relationships between depression score and the independent variables of interest? A three-way ANOVA was run to this question. The dependent variable was depression score as measured by the (BDI©-FS) score. Independent variables were included for relationship to stroke survivor, history of depression, and gender. Relationship to stroke survivor was re-coded into two categories, significant other/spouse, or family member (child, sibling, parent). Based on a p-value of 0.0397, there is compelling evidence to suggest there is a significant mean difference in (BDI©-FS) score between stroke caregivers who are a spouse/significant other and stroke caregivers who are a family member. There is also robust evidence to suggest there is a significant mean difference in (BDI©-FS) score between stroke caregivers who have a prior history of depression and stroke caregivers who do not (p-value = 0.025).

Qualitative study findings corroborated these results with spouses and significant other caregivers and those caregivers with prior history of depression noting experiencing increased depressive symptoms upon taking on stroke caregiver role.

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