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Byun E, McCurry SM, Kwon S, Tsai CS, Jun J, Bammler TK, Becker KJ, Thompson HJ. Fatigue, Toll-Like Receptor 4, and Pro-Inflammatory Cytokines in Adults With Subarachnoid Hemorrhage: A 6-Month Longitudinal Study. Biol Res Nurs 2024; 26:192-201. [PMID: 37788710 DOI: 10.1177/10998004231203257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Fatigue is prevalent in subarachnoid hemorrhage (SAH) survivors. Biological mechanisms underlying fatigue post-SAH are not clear. Inflammation may contribute to the development of fatigue. This study aimed to examine the associations between inflammatory markers and fatigue during the first 6 months post-SAH. Specific biomarkers examined included both early and concurrent expression of Toll-Like Receptor 4 (TLR4) messenger RNA (mRNA) and plasma concentrations of pro-inflammatory cytokines, Tumor Necrosis Factor-alpha (TNF-α), Interleukin (IL)1β, and IL6. METHODS We conducted a 6-month longitudinal study with a convenience sample of 43 SAH survivors. We collected blood samples on days 2, 3, and 7 and 2, 3, and 6 months post-SAH to assess biomarkers. Fatigue was assessed by the PROMIS Fatigue Scale at 2, 3, and 6 months. Linear mixed models were used to test the associations between early (days 2, 3, and 7) and concurrent (2, 3, and 6 months) TLR4 mRNA expression (TagMan gene expression assays) and TNF-α, IL1β, and IL6 plasma concentrations (multiplex assays) and concurrent fatigue. RESULTS 28% of SAH survivors experienced fatigue during the first 6 months post-SAH. Fatigue levels in SAH survivors were higher than those of the U.S. population and consistent during the 6 months. Experience of fatigue during the 6 months post-SAH was associated with higher IL1β plasma concentrations on day 7 and IL1β, IL6, and TNF-α plasma concentrations during the 6 months post-SAH. CONCLUSION Inflammation appears to underlie the development of fatigue in SAH survivors.
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Affiliation(s)
- Eeeseung Byun
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Susan M McCurry
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Suyoung Kwon
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Chi-Shan Tsai
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Jeehye Jun
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Theo K Bammler
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Kyra J Becker
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Hilaire J Thompson
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
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Alselami S, Butcher HK, Longo J. The Uncertainty in Family Caregivers of Hospitalized Persons With a Stroke in Saudi Arabia: Unitary Caring Perspective. ANS Adv Nurs Sci 2024; 47:104-120. [PMID: 38132430 DOI: 10.1097/ans.0000000000000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Uncertainty is a universal experience of family caregivers caring for persons with a stroke and affects caregivers' readiness to care for their family members with a stroke. Guided by the unitary caring theory and unitary-caring hermeneutic-phenomenological research method, this study was conducted among 15 family caregivers of persons in the hospital who have survived strokes through in-depth semi-structured interviews. Five essences emerged from the analysis: living in a dark reality; yearning for professional support; enduring a life full of tribulations; attempting resolution; and creating new patterns of living. Each of the 5 essences was interpreted from Smith's unitary caring theory perspective.
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Affiliation(s)
- Seham Alselami
- Nursing, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia (Dr Alselami); and Nursing, Florida Atlantic University, Boca Raton (Drs Butcher and Longo)
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Liu M, Tang W, Zhang Y, Sun W, Wang Y. Decisional conflict, caregiver mastery, and depression among Chinese parental caregivers of children with leukemia. BMC Psychiatry 2023; 23:625. [PMID: 37641015 PMCID: PMC10463635 DOI: 10.1186/s12888-023-05084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Informal caregivers of children with leukemia can be emotionally and psychiatrically vulnerable when facing difficult treatment decisions (e.g., chemotherapy, targeted therapy, radiation, transplantation). A common behavioral manifestation of decisional conflict is the verbalized expression of uncertainty about which medical treatment plan to take. The study aims to examine the associations between decisional conflict, mastery, and depressive symptoms among parental caregivers of children with leukemia in China. It explored the mediating role of mastery in the relationship. METHODS A cross-sectional survey design was adopted. A total of 386 parental caregivers were recruited, and 325 valid questionnaires remained. The mean age of caregivers was 37.7 years, and 61.5% caregivers were female. We used Question Format Decisional Conflict Scale to assess decisional conflict, Pearlin's Mastery Scale to assess mastery, and Center for Epidemiological Studies Depression 10 to assess depressive symptoms. We used mediation analyses to test the mediating effect of mastery. RESULTS The total score of decisional conflict scale, along with its dimensions of uncertainty, support, and effective decision were found negatively associated with depressive symptoms. In contrast, the dimension of information and value were not significantly associated with depressive symptoms. Mediation analyses demonstrated the direct effects of overall decisional conflict and uncertainly were fully mediated by mastery, while the direct effect of support and effective decision were partially mediated. CONCLUSIONS Efforts should be made to alleviate parental caregivers' decisional conflict and enhance sense of mastery. Particular attention should be paid to the psycho-social support to relieve uncertainties and ineffectiveness in decision making.
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Affiliation(s)
- Mowen Liu
- Department of Social Work and Social Policy, Renmin University of China, Beijing, China
- Beijing Yizhuang Technology Innovation Company Limited, Beijing, China
| | - Weizhou Tang
- Charles R. Drew University of Medicine and Science, Los Angeles, United States
| | - Ye Zhang
- the High School Affiliated to Renmin University of China, Beijing, China
| | - Wenjun Sun
- Tianjin Di Ai Zhi Jia Hard-pressed Families Service Center, Tianjin, China
| | - Yang Wang
- Department of Social Work and Social Policy, Renmin University of China, Beijing, China.
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Uncertainty among families of patients with cerebrovascular diseases in Japan: association with quality of life and background characteristics. Aging Clin Exp Res 2022; 34:3097-3105. [PMID: 36181638 PMCID: PMC9526199 DOI: 10.1007/s40520-022-02254-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022]
Abstract
Purpose To determine the relationship between family uncertainty and family quality of life (QOL) during the recovery period of patients with cerebrovascular disease in Japan, and the factors that influence family uncertainty. Methods Data were collected from copies of patient medical files and interviews with family members of 85 patients admitted to two rehabilitation wards in Japan. Family uncertainty was measured using the Japanese version of the Managing Uncertainty in Illness Scale–Family Member form (MUIS-FM) and family QOL using the World Health Organization Five Well-Being Index (WHO-5). Multiple linear regression analysis was applied to investigate associated factors. Results WHO-5 score was significantly negatively associated with MUIS-FM score (β = − 0.236, p = 0.03); other factors associated with MUIS-FM score were the Care Shared Decision-Making Questionnaire for care providers score (β = − 0.384, p < 0.001), Short Intolerance of Uncertainty Scale score (β = 0.296, p = 0.001), and history of surgical treatment (β = 0.199, p = 0.032). Conclusions Family QOL could be improved by reducing family uncertainty. It is also suggested that promoting shared decision-making between healthcare providers and patients’ families may help reduce family uncertainty. It is necessary to take into account not only family intolerance of uncertainty but also uncertainty that varies by type of acute care provided. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02254-1.
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Shedding Light onto the City Blues Myth—The Potential of Stimulating and Activating Effects of Urban Public Spaces and the Role of City Relatedness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137606. [PMID: 35805264 PMCID: PMC9266095 DOI: 10.3390/ijerph19137606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023]
Abstract
The present study aims to investigate whether a sense of relatedness to a city helps to broaden understanding of the restorative potential of urban public spaces. Findings based on a sample of German adults (n = 249) confirm that people experience relatedness to a city. The study’s 3 × 3 (built, mixed, natural environment) × (average, livability environment, bird’s-eye view) design revealed disordinal interactions for being away, fascination, preference, mental fatigue, and stimulating and activating effects associated with cities. This implies that humans’ place perceptions are more complex than previously assumed. Both city and nature relatedness were relevant covariates of these findings. Surprisingly, the construct ‘activating effects’, was found to be mostly perceived as more positive for mixed and built environments compared to natural environments. Thus, complementing restorative environments research by introducing a measure for city relatedness significantly enhances understanding of the potential of urban public spaces for promoting human health and well-being.
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Haji Assa A, Umberger RA. A concept analysis of family caregivers' uncertainty of patient's illness. Nurs Forum 2022; 57:121-126. [PMID: 34463349 DOI: 10.1111/nuf.12645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
AIM To analyze and examine the concept of uncertainty of the patient's illness among family caregivers. BACKGROUND Promoting family caregivers' health is significant in nursing. Family caregivers may experience uncertainty related to their loved ones' illness. A lack of clarity exists regarding the uncertainty concept among family caregivers and its implications in nursing. DATA SOURCE A review of the literature that focused on family caregivers of adult patients using PubMed, CINAHL, and Scopus databases was completed. METHODS The Walker and Avant framework was applied to identify the attributes, antecedents, and consequences of family caregivers' uncertainty. RESULTS Eight articles were analyzed. Attributes of family caregivers' uncertainty included the patient's illness probability and family caregivers' perception of the illness. Antecedents included the characteristics of the patient's illness, factors associated with the family caregivers' perception of the illness, and family responsibilities of caregiving. The consequences included family caregivers' emotional, psychological, and financial outcomes. Family caregivers' uncertainty is defined as the perception of the inability to process information regarding the patient's illness trajectory when caring for significant others' illness. CONCLUSIONS Individuals can perceive uncertainty differently as a patient-facing uncertainty in illness versus a family caregiver facing uncertainty of their loved ones' illness.
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Affiliation(s)
- Amal Haji Assa
- Nursing Science PhD Program, College of Graduate Health Sciences, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Reba A Umberger
- Department of Acute and Tertiary Care, The University of Tennessee Health Science Cente, Memphis, Tennessee, USA
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Kum C, Miller EL, Jones H, Kean EB, Kreitzer N, Bakas T. Theoretically Based Factors Affecting Stroke Family Caregiver Health: An Integrative Review. West J Nurs Res 2021; 44:338-351. [PMID: 34636275 DOI: 10.1177/01939459211050955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke family caregivers often neglect their own health while providing care. Rigorous reviews have focused on stroke caregiver needs and outcomes; however, a comprehensive review of stroke caregiver health is lacking. The purpose of this integrative review was to determine factors associated with stroke family caregiver health. Using a PRISMA flow diagram and Rayyan software, 41 studies were identified published from January 2000 to December 2020. Databases included Cochrane Reviews, Cochrane Trials, PsycINFO, Ovid MEDLINE, PubMed, EBSCOhost MEDLINE, Embase, and CINAHL. Rigorous guidelines were used to critique the 41 articles. Health measures were global in nature, lacking details regarding health promotion activities important to stroke family caregiver health. Common factors associated with caregiver health were depressive symptoms and burden. Further research is needed to design more situation-specific instruments to measure stroke family caregiver health, as well as interventions to reduce depressive symptoms and burden while promoting caregiver health.
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Affiliation(s)
- Cleopatra Kum
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Elaine L Miller
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Holly Jones
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Emily B Kean
- University of Cincinnati, Health Sciences Library, Cincinnati, OH, USA
| | - Natalie Kreitzer
- University of Cincinnati, Department of Emergency Medicine, Cincinnati, OH, USA
| | - Tamilyn Bakas
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
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Liu J, Liu Q, Huang Y, Wang W, He G, Zeng Y. Effects of personal characteristics, disease uncertainty and knowledge on family caregivers' preparedness of stroke survivors: a cross-sectional study. Nurs Health Sci 2020; 22:892-902. [PMID: 32449839 DOI: 10.1111/nhs.12743] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
Family caregivers play an important role in the rehabilitation of stroke survivors. The aims of this study were to describe preparedness, uncertainty, and knowledge regarding stroke in family caregivers of people who have undergone strokes and to investigate factors influencing preparedness. A total of 306 caregivers completed the questionnaires, including the Caregiver Preparedness Scale, the Mishel Uncertainty in Illness Scale, and Knowledge of Stroke. The result showed that the mean score of the family caregivers' preparedness was 14.42, the mean score of disease uncertainty was 75.62, and the mean score of stroke knowledge was 10.41. Caregiver preparedness was negatively correlated with disease uncertainty and positively correlated with knowledge. Multivariate stepwise regression analysis showed that educational background, profession, caregiving experience and uncertainty degree of the family caregivers, gender, and age of stroke survivor could predict 45.90% of the total variation in preparedness. The findings suggest that demographic characteristics of stroke survivor and family caregiver, as well as caregivers' disease uncertainty, enable predict the level of caregiver preparedness. Medical professionals should pay attention to providing personalized and targeted approaches to maximize caregivers' preparedness.
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Affiliation(s)
- Juanjuan Liu
- School of Nursing, University of South China, Hengyang, China.,School of Rehabilitation Medicine and Health, Hunan University of Medicine, Huaihua, China
| | - Qi Liu
- School of Nursing, University of South China, Hengyang, China
| | - Yanjin Huang
- School of Nursing, University of South China, Hengyang, China
| | - Wen Wang
- School of Nursing, University of South China, Hengyang, China
| | - Guoping He
- School of Nursing, University of South China, Hengyang, China
| | - Ying Zeng
- School of Nursing, University of South China, Hengyang, China
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Liu Y, Wheaton AG, Edwards VJ, Xu F, Greenlund KJ, Croft JB. Short self-reported sleep duration among caregivers and non-caregivers in 2016. Sleep Health 2020; 6:651-656. [PMID: 32331864 DOI: 10.1016/j.sleh.2020.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Caregiving, providing regular care or assistance to family members or friends with health problems or disabilities, may affect caregivers' sleep. This study examined self-reported short sleep duration by caregiving status among US adults. METHODS Data of 114,496 respondents aged ≥18 years in 19 states, the District of Columbia, and Puerto Rico from the 2016 Behavioral Risk Factor Surveillance System were analyzed. Prevalence of short sleep duration (<7 hours per 24-hour period) by caregiving status was calculated, and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were derived from a multivariable logistic regression model with adjustment for potential covariates. RESULTS Nearly 1 of 5 adults reported caregiving within the past month. A higher prevalence of short sleep duration was reported among caregivers (39.5%) than among non-caregivers (34.2%, adjusted PR [95% CI] = 1.12 [1.06-1.19]). Caregivers who reported prolonged caregiving (≥5 years) reported a higher prevalence of short sleep duration than those with <2 years of caregiving. Similarly, caregivers who provided 20-39 hours of caregiving per week reported a higher prevalence of short sleep duration than those with <20 hours caregiving per week. CONCLUSIONS Caregivers had a higher prevalence of short sleep duration than noncaregivers. Providing information and community-based resources and supports for caregiving may minimize caregiver stress and improve sleep particularly for those with prolonged or more intense caregiving.
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Affiliation(s)
- Yong Liu
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Anne G Wheaton
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie J Edwards
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fang Xu
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kurt J Greenlund
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet B Croft
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Arias-Rojas M, Carreño-Moreno S, Posada-López C. Uncertainty in illness in family caregivers of palliative care patients and associated factors. Rev Lat Am Enfermagem 2019; 27:e3200. [PMID: 31618393 PMCID: PMC6792341 DOI: 10.1590/1518-8345.3185.3200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE to describe the level of uncertainty in illness in family caregivers of palliative care patients and detect associations between the profile of the caregiver and the levels of uncertainty. METHOD descriptive correlational study conducted with 300 family caregivers of hospitalized patients. The sociodemographic characterization of caregiver and patient was used to assess the caregiver profile, as well as the Uncertainty in Illness scale for family caregivers. Spearman's Rho correlation test was applied to detect associations. RESULTS the average score of illness uncertainty was 91.7 points. The analysis showed significant correlations between the level of uncertainty and patient dependence (r=0.18, p=0.001), symptom assessment (r=0.312, p<0.001), length of service as a caregiver (r=0.131, p=0.023), perception of support from health professionals (r=-0.16, p=0.048), family (r=-0.145, p=0.012) and religious support (r=-0.131, p=0.050). CONCLUSIONS there were high levels of uncertainty in caregivers about their patient's illness. These levels are associated with the health condition and symptoms of the patient who is cared for, the length of service as a caregiver and the perceived support from health professionals, family and religion.
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Affiliation(s)
- Mauricio Arias-Rojas
- Universidad Nacional de Colombia, Facultad de Enfermería, Bogotá, Cund, Colômbia.,Universidad de Antioquia, Facultad de Enfermería, Medellín, Ant, Colômbia
| | - Sonia Carreño-Moreno
- Universidad Nacional de Colombia, Facultad de Enfermería, Bogotá, Cund, Colômbia
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Byun E, Evans L, Sommers M, Tkacs N, Riegel B. Depressive symptoms in caregivers immediately after stroke. Top Stroke Rehabil 2019; 26:187-194. [PMID: 30929619 PMCID: PMC6675402 DOI: 10.1080/10749357.2019.1590950] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/03/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Caregivers of stroke survivors often suffer depressive symptoms that interfere with their own health. Early recognition may lead to attenuation of symptoms and better health and well-being for caregivers. OBJECTIVE We examined characteristics of caregivers and stroke survivors associated with caregivers' depressive symptoms in the early poststroke period. METHODS We conducted a prospective, longitudinal exploratory observational study with a convenience sample of 63 caregivers of older adult (≥ 65 years) stroke survivors recruited from urban acute-care settings. We enrolled caregivers by 2 weeks poststroke (T1) and revisited them 4 weeks later (T2). Depressive symptoms were measured using the Patient Health Questionnaire-9. A separate unadjusted linear mixed model was computed to explore significant associations between each caregiver or stroke-survivor characteristic and depressive symptoms. RESULTS Caregivers, on average, reported mild depressive symptoms at T1 and T2. Each of the following characteristics was independently associated with caregiver depressive symptoms over the first 6 weeks poststroke: caregiver uncertainty (p < 0.001), perceived stress (p < 0.001) but not cortisol levels (p = 0.858 on waking, p = 0.231 evening), coping (p < 0.001), social support (p = 0.006), race (p = 0.022), income (p = 0.001), time spent on care (p = 0.039), and stroke-survivor race (p = 0.033) and functional status (p = 0.003). At T2, caregiver depressive symptoms were correlated with evening cortisol level (p = 0.001). CONCLUSIONS Caregiver and stroke-survivor characteristics may help identify caregivers at highest risk for early depressive symptoms and guide interventions aimed at their resolution.
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Affiliation(s)
- Eeeseung Byun
- a Department of Biobehavioral Nursing and Health Informatics, School of Nursing , University of Washington , Seattle , WA , USA
| | - Lois Evans
- b School of Nursing , University of Pennsylvania , Philadelphia , PA , USA
| | - Marilyn Sommers
- b School of Nursing , University of Pennsylvania , Philadelphia , PA , USA
| | - Nancy Tkacs
- b School of Nursing , University of Pennsylvania , Philadelphia , PA , USA
| | - Barbara Riegel
- b School of Nursing , University of Pennsylvania , Philadelphia , PA , USA
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