Stroke is the leading cause of adult disability in the United States. Approximately 4,000,000 Americans are stroke survivors who are living with post-stroke impairments. A large majority of stroke survivors live at home, where they typically receive substantial care and assistance from family members. Several previous studies of the family caregivers of stroke survivors have shown that caregivers tend to have elevated levels of depression during both the acute and chronic phases after the stroke. However, these studies have usually been based on small convenience samples and often lack adequate comparisons to noncaregiving groups. Virtually no information is available on potential ethnic or racial differences among family caregivers of stroke survivors. The proposed investigation will compare 300 family caregivers of stroke survivors to a matched sample of 300 noncaregivers on measures of depression, life satisfaction, physical health, health care utilization, quality of life, and caregiving stress. At least half of the participants in both groups will be African Americans. Both caregivers and noncaregivers will be recruited from the same national, epidemiological study of stroke incidence (N = 30,000). Computer-assisted telephone interviewing will be used to track psychosocial adjustment over time in caregivers and noncaregivers, and in-home evaluations will be used to obtain assessments of stroke survivor impairments and stroke-specific quality of life.
The specific aims of the project are (1) to identify the effects of stroke on the depression, life satisfaction, physical health, health care utilization, and quality of life of primary family caregivers; (2) to compare the effects of caregiving between African American and White family caregivers; (3) to track the effects of stroke on family caregivers longitudinally; (4) to test the effects of social support, stressfulness appraisals, and access to care for mediating racial differences in caregiver depression, physical health, and life satisfaction; (5) to assess the impact of caregiver depression, quality of life, and stressfulness appraisals on the physical and emotional recovery of the stroke survivor, and (6) to develop a multivariate predictive model of poor outcome in family caregivers for use in planning future intervention efforts. Previous studies have suggested that depression and poor adjustment among caregivers not only affect the caregivers themselves, but also contribute to poor outcomes among the stroke survivors. The proposed project will advance the understanding of these mechanisms, and provide useful implications for future intervention efforts.
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