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PSYCHOSOCIAL PROBLEMS, QUALITY OF LIFE AND CAREGIVER BURDEN

AMONG STROKE CAREGIVERS IN INDIA

Rinu Susan Raju M.A. M.Phil.

Parmdeep Kaur M.Sc B.Ed PGDCA

Jeyaraj D Pandian MD DM FRACP

Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, Punjab 141008,

India

Address for Communication

Dr Jeyaraj D Pandian MD DM FRACP

Professor and Head of Neurology

Head of Research, Betty Cowan Research and Innovation Centre

Christian Medical College, Ludhiana

Punjab, India- 141008

E mail: [email protected]

Phone: 91 9915784750

Fax: 91-161-2220850



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Acknowledgements and Conflict of Interest

We are thankful to Dr Clarence Samuel MD, Assistant Professor, Department of Community and

Preventive Medicine, Christian Medical College, Ludhiana for his statistical advice and Dr

Yashpal Singh, Professor and Head, Department of Neurology for giving us his support to

conduct this project.

There are no conflicts of interest



3

PSYCHOSOCIAL PROBLEMS, QUALITY OF LIFE AND CAREGIVER BURDEN

AMONG STROKE CAREGIVERS IN INDIA

Key words: Psychosocial, stroke, quality of life, care giver stress, developing countries

Cover title: Psychosocial issues among stroke caregivers in India

Abstract: 250

Text: 2374

Number of references: 35

Number of Tables: 4



4

Abstract

Background: Caring for stroke patients is demanding with caregivers experiencing considerable

burden for several years after the initial event. However, scant information is available from

developing countries. Aim: To study the quality of life (QoL), caregiver strain, anxiety and

depression experienced by stroke caregivers and their relationship with stroke characteristics.

Methods: Prospective hospital based study. Patients were interviewed after ≥1 month post-

stroke. WHOQoL-BREF was used to assess QoL. Anxiety and Depression was recorded using

Hospital Anxiety Depression Scale (HADS) and caregiver burden was evaluated using Modified

Caregiver Strain Index (MCSI). Statistical analyses was done using SPSS version 16.0.Results:

152 caregivers participated (women, 104 (68.4%); mean age 40.5±13.8 years [range 17 to 78]).

Mean duration of follow up was 18.9±26.7 months (range 1 to 147). The care givers had high

scores in the all the domains of QoL. Anxiety was seen in 72 (47%) caregivers and 66 (43%) had

depression. Caregiver strain influenced anxiety in the multivariate logistic regression analysis

(OR 0.23, CI 0.09-0.53, p=0.001). Ischemic stroke (OR 0.21, CI 0.08-0.57, p=0.002) and

psychological domain (OR 5.21, CI 1.88-14.45, p=0.001) were the predictors of depression.

Anxiety was the predictor of caregiver strain (OR 0.20, CI 0.08-0.47, p<0.0001). Conclusion:

Despite a good QoL there was a high prevalence of anxiety and depression with very high levels

of caregiver strain in our cohort. Caregivers particularly women need to be educated about

coping strategies regarding anxiety, depression and caregiver strain.



5

Introduction

Stroke is a common disabling disease requiring the involvement of family caregivers’ for

patients’ successful rehabilitation.1

However, caring for stroke patients can be a stressful task

with caregivers reporting a considerable burden for several years after the initial

event.2,3

Enduring the patient's changes in the levels of ability and behavior can be very stressful,

thus exposing the caregiver to the risk of depression and physical vulnerability, especially if they

do not receive support from other family members, friends or society.4-10

Many encounter a

variety of problems including financial difficulties, social isolation, lack of information, and poor

physical and mental health.4-10

While a plethora of studies on caregivers and stroke patients have been done in developed

countries, but scant data is available from developing countries despite stroke being one of the

most common causes of disability and handicap in these nations. In India, family plays an active

role in taking care of a stroke patient. Hence the psychosocial problems among Indian stroke

caregivers could be different from other developed countries.The objective of this study was to

study the quality of life (QoL), caregiver strain, anxiety and depression experienced by stroke

caregivers, and to study the relationship between the above mentioned variables and stroke

characteristics.

Materials and methods

Study site

This study was conducted in the Stroke and Neurology Clinics of Christian Medical College and

Hospital (CMCH), Ludhiana, Punjab, India. CMCH is an 800-bed private sector teaching



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hospital catering not only to the medical needs of the people of Punjab, but also to patients from

neighboring states.11

Study subjects

We interviewed caregivers’ of stroke survivors, who had completed ≥1 month follow-up.

Caregivers were defined as “the person most closely involved in maintaining a person's ability to

live independently at home” [as defined by Oxford Handicap Scale].12

They were also living

with the patients and responsible for their daily care. Patients were asked to identify their

principal informal caregiver. However, in the absence of a primary caregiver, alternate informal

caregivers were considered. Caregivers’ with a history of psychiatric co-morbidity were

excluded.

Demographic details like age, gender, marital status, educational qualification, occupation, and

nature of relationship with patient, type of family and medical history were collected. The stroke

details like type of stroke, severity of stroke (National Institute of Health Stroke Scale-NIHSS),13

Oxfordshire stroke classification14

and functional outcome (modified Rankin scale, mRs)15

were

also compiled from stroke survivors by RR who was not involved in the management of patients.

Both JDP and RR were certified for NIHSS and mRs administration. Outcome was classified as

good (mRs 0-2) and bad (mRs 3-6). Joint family was defined as (extended family/ complex

family) multiple generations in a family living in a single house.16

Instruments

The following tools were used to interview the patients:



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WHO QOL – BREF17,18

The WHOQoL BREF is a 26 itemed self administered questionnaire in which the items

are rated on a 5 point scale. The domains which the QoL assesses are the physical,

psychological, social relationships, and environment domains. Translated version of the

questionnaire in the local language (Hindi) was used .19

The WHO QoL Hindi version is

a valid and reliable tool with a Cronbach alpha coefficient of 0.81. 19 Translation and

back translation of the questionnaire in Punjabi was also done. The four domain scores

are scaled in a positive direction, with a score range of 0-100, and with higher scores

denoting higher QoL. Raw domain scores need to be transformed to a 0-100 scale for

ease of comparison with other data sets. This transformation converts the lowest

possible score to 0 and the highest possible score to 100. Scores between these values

represent the percentage of the total possible score achieved.9, 10

Hospital Anxiety and Depression Scale 20

The Hospital Anxiety and Depression Scale (HAD Scale) includes two subscales, one for

depression and the other for anxiety, each comprising seven items relating to symptoms. Each

item is scored (0 to 3) according to severity, with a maximum possible score of 21 on each

subscale. The original validation study suggested that a score of 0-7 would indicate no case (no

anxiety or depression), 8-10 as borderline case and 11+ as case (presence of anxiety and/or

depression). Translated version of the questionnaire in the local language (Hindi) was used.

Permission was obtained to use the Punjabi version of the questionnaire.21 The Punjabi version is



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reliable and a valid measure of anxiety and depression. The Cronbach alpha coefficients revealed

high levels of internal consistency for the Punjabi version (0.86 for anxiety and 0.85 for

depression).21

Modified Caregiver Strain Index22

The Modified Caregiver Strain Index (MCSI) is a tool that can be used to screen for caregiver

strain with long term caregivers. It is a 13-question tool that measures strain related to care

provision. There is at least one item for each of the following major domains: employment,

financial, Physical, Social, and Time. This instrument can be used to assess individuals of any

age who have assumed the role of caregiver for an older adult. The Modified Caregiver Strain

Index is a version of the Caregiver Strain Index developed in 1983. The tool was modified and

developed in 2003. Scoring is 2 points for each ‘yes’, and 1 point for each ‘sometimes’ response.

The higher the score, the higher the level of caregiver strain. Translation and back translation of

the questionnaire in the local languages was done.

The study protocol was approved by the institutional ethics committee. All participants provided

informed consent. The questions were read to the illiterate caregivers by RR and the responses

were noted down. The questions were self administered for all the other caregivers.

Statistics

Statistical analyses were performed using SPSS Statistics version 16.0 (SPSS Inc.,

Chicago, III). The statistical measures used were frequencies, descriptive statistics,



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Pearson correlation and logistic regression analysis. Univariate analysis was done by

using Pearson correlation coefficient. Multivariate logistic regression analysis was done

using stepwise forward method to find out the predictors of WHOQoL, HADS and

MCSI. The variables of interest were WHOQoL (physical, psychological, social and

environmental domains), HADS (anxiety and depression), and MCSI. The variables that

were controlled include age, gender, type of family, income, duration of follow-up, type

of stroke and outcome (mRs). For the logistic regression analysis we used the median

values of continuous variables to divide into 2 groups in WHOQoL (physical,

psychological, social and environmental domains) and MCSI. For HADS, no case (no

anxiety or depression) was considered as one group and borderline cases and cases

(presence of anxiety and/or depression) were considered as another. In the WHOQoL

psychological domain, variables of interests like anxiety and depression were not

included in the model. A p value of <0.005 was taken for statistical significance after

using Bonferroni method for multiple comparisons.

Results

152 patients were interviewed over a period of 14 months from November 1st 2008 to February

1st

2010. We had approached 192 patients for the study. Forty patients were excluded (refused

consent). There were no significant differences between patients (n=152) studied and who were

excluded (n=40). Mean age (study cohort 59.1±13 years vs. excluded patients 60.8±19 years,

p=0.47) and gender (study cohort; men 100 (65.8%) vs. excluded patients 30 (75%), p=0.23).

The stroke outcome was also similar in both the groups (study cohort mRs 0-2, n=72 (47.4%) vs.

excluded patients mRs 0-2 n=21 (52.5%), p=0.56).



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Demography

The demographic details of the stroke survivors and their caregivers are given in Table 1. The

mean age for survivors was 59.1 ± 13.0 years (range 19 to 88 years) and 100 (65.8%) survivors

were men. The mean age for caregivers was 40.5 ± 13.8 (range 17 to 78) with 104 (68.4%)

caregivers being women. Caregivers were mostly wives (n= 54, 35.5%), followed by sons (n=

37, 24.3%), daughters in law (n=28, 18.4%), daughter (n=15, 9.9%), husband (n=7, 4.6%), sister

in law (n=4, 2.6%), brother (n=2, 1.3%), sister (n=1, 0.7%) , son in law (n=1, 0.7%), disciple

(n=1, 0.7%), grandson (n=1, 0.7%) and nephew (n=1, 0.7%). Majority of the patients lived in a

joint family (n=100, 65.8%).

Stroke characteristics

The stroke characteristics are given in Table 2. One hundred and thirteen patients (74.3%) had an

ischemic stroke. The mean duration of follow up was 18.9±26.7 months (range 1 to 147).

Coronary artery disease 36 (23.7%), hypertension 17 (11.2%), alcohol (current use) 14 (9.2%)

and diabetes mellitus 8 (5.3%) were the common risk factors among the caregivers. Seventy two

patients (47.4%) had good outcome.

WHO QoL

The mean transformed scores for the domains were: physical 57.6±13.5 (median-57, range 18 to

89), psychological 62.9±14.7 (median- 63, range 29 to 100), social 72.6±19.4 (median-75, range

0 to 100) and environmental 62.8±17.9 (median-63, range 19 to 100). Table 3 shows various

significant factors associated with WHOQoL. In the univariate analysis, presence of depression



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and caregiver burden was negatively associated with QoL in all the domains (physical,

psychological, social and environmental) i.e. patients with depression and caregiver burden were

more likely to have impaired QoL. Anxiety correlated negatively with social and environmental

domains of WHOQoL (Table 3). Other factors such as age, gender, education, occupation,

family type and type of stroke were not significant in the univariate analysis.

Hospital Anxiety and Depression Scale

Of the 152 patients, 72 (47%) had anxiety and 66 (43%) had depression. Thirty one (20%)

patients had mild anxiety, 29 (19%) moderate and 12 (8%) severe anxiety and 80 (53%) had no

anxiety. On the other hand, 34 (22%) had mild depression, 26 (17%) moderate depression, 6

(4%) had severe depression and 86 (57%) had no depression. Table 3 shows various significant

factors associated with HADS. Patient’s occupation and social domain of WHOQoL were

inversely associated with anxiety, whereas depression and caregiver strain positively correlated

with anxiety (Table 3). All domains of WHOQoL and caregiver gender were negatively

associated with depression. Presence of anxiety and caregiver burden positively correlated with

depression.

MCSI

Over 129 (85%) had caregiver strain in the present study. The mean score for MCSI was

12.6±6.77. Table 3 shows various significant factors associated with MCSI. Social domain

negatively correlated with caregiver strain. Anxiety and depression were found to be positively

associated with caregiver burden.



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Predictors of QoL, HADS and MCSI – Multivariate Logistic Regression Analysis

Multivariate logistic regression analysis (Table 4) showed depression as the predictor of QoL in

physical, social and environmental domains. Other demographic factors and stroke

characteristics were not significant.

Caregiver strain was found to be the predictor for anxiety (Table 4) in multivariate logistic

regression. Ischemic stroke and psychological domain were the predictors for depression. The

other variables were not significant.

In multivariate logistic regression analysis, (Table 4) only anxiety was the predictor of caregiver

strain. Caregiver age, gender, educational qualification, family and type of stroke were not found

to be significant.

Discussion

We explored the QoL, caregiver strain, anxiety and depression experienced by caregivers of

stroke survivors in Northwest India. Despite the overall good QoL, anxiety (47%) and depression

(43%) were quite prevalent among the caregivers. Majority of our cohort (85%) had caregiver

strain. Caregiver strain predicted anxiety, whereas ischemic stroke and psychological domain of

WHOQoL were the predictors of depression in the multivariate logistic regression analysis. Only

presence of anxiety was associated with caregiver strain in the multivariate logistic regression

analysis.



13

Caregivers’ in our study were found to have high scores on all four domains of WHOQoL,

particularly the social domain. This is in contrast with studies from Nigeria, 23 Netherlands, 24 and

Sweden,25

where low scores were observed in caregivers’ for all the domains of QoL. The better

QoL among our caregivers’ could be attributed to the joint family system observed here in India.

Most of our caregivers belonged to joint family (66%). This helped them in sharing

responsibilities of caregiving by taking turns in looking after the needs of the patient, thereby

getting some time to spend on their own and in doing so relieving the amount of stress

experienced by them.

The presence of anxiety and depression among our caregivers were high as compared to other

studies from Newcastle2, London

26and Germany

27where anxiety and emotional distress were

prevalent, affecting about one-third at 3 to 5 years. A plausible explanation for this could be that

the majority of caregivers were spouses and women, belonging to a younger age group. Prior

studies from Netherlands28

and Germany29

found that female caregivers reported more anxiety

and depressive symptoms than did their men counterparts or caregivers belonging to any other

group.30, 31

The frequency of anxiety (47%) and depression (43%) was lower in our cohort as

compared to the Kolkata study from India (anxiety and depression 76%). 32 There were more

number of people who were working (42.4%) and who lived in a joint family (65.8%) in our

cohort as compared to the Kolkata study.32

The greater family support received by the caregivers

in our study would have influenced the difference in the prevalence of anxiety and depression.

We found that the caregivers in our study experienced high caregiver strain, a finding that is

supported by observations from Scotland 9 and United States of America. 33 As per studies from



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Scotland,9

Australia,34

and Norway,35

caring for disabled people is associated with a high risk of

disrupting caregivers’ work and leisure, family life and QoL. The Kolkata study showed a

significant financial and psychological stress among the caregivers.32

They had used a different

tool- Burden Assessment Schedule [BAS] to evaluate the care giver burden.

There are limitations in this study. Caregiver anxiety, depression and strain were assessed at

different periods after stroke for each caregiver. As a result, the longitudinal differences in the

same person could not be assessed. Secondly, this was not a community based study and the

findings of this study could be generalized to an urban North Indian population. Despite the

limitations this study offers new information regarding the psychosocial problems, QoL, and care

giver strain using standardized tools from Asia.

Conclusions

Our caregivers’ experienced better QoL. The QoL was less impaired because of the joint family

system since women share responsibilities of caring within the family. Despite a better QoL

there was a high prevalence of anxiety and depression with very high levels of caregiver strain in

our cohort. Caregivers particularly women need to be educated about coping strategies regarding

anxiety, depression and caregiver strain.



15

References

1. Low JTS, Payne S, Roderick P. The impact of stroke on informal caregivers: a literature

review. Soc Sci Med. 1999; 49: 711-25.

2. Greveson GC, Gray CS, French JM, James OF. Long term outcomes for patients and

carers following hospital admission for stroke. Age Ageing. 1991; 20: 337-44.

3. Bugge C, Alexander H, Hagen S. Stroke patients’ informal caregivers: patient, caregiver,

service factors that affect caregiver strain. Stroke. 1999; 30: 1517-23.

4. Han B, Haley WE. Family caregiving for patients with stroke: review and analysis.

Stroke. 1999; 30: 1478-85.

5. Hanger HC, Mulley GP. Questions people ask about stroke. Stroke. 1993; 24: 536-8.

6. Forster A, Smith J, Young J, Knapp P, House A, Wright J. Information provision for

stroke patients and their caregivers. Cochrane Database Syst Rev. 2001;3:CD001919.

7. van Veenedaal H, Grinspun DR, Adriaanse HP. Educational needs of stroke survivors

and their family members, as perceived by themselves and by health professionals.

Patient Educ Couns. 1996; 28: 265-76.

8. Dennis M, O’Rourke S, Slattery J, Staniforth T, Warlow C. Evaluation of a stroke family

care worker: results of a randomized controlled trial. BMJ. 1997; 314: 1071-76.

9. Dennis M, O’Rourke S, Lewis S, Sharpe M, Warlow C. A quantitative study of the

emotional outcome of people caring for stroke survivors. Stroke. 1998; 29: 1867-72.

10. Kotila M, Numminen H, Waltimo O, Kaste M. Depression after stroke: result of the

FINNSTROKE study. Stroke. 1998; 29: 368-72.



16

11. Pandian, J D, Kalra G, Jaison A, Deepak S S, Shamsher S, Padala S, et al. Factors

delaying admission to a hospital based stroke unit in India. J Stroke and Cerebrovascular

diseases. 2006; 15: 81-87.

12. Bamford JM, Sandercock PA, Warlow CP, Slattery J. Interobserver agreement for the

assessment of handicap in stroke patients. Stroke. 1989; 20: 828. 13. Granger CV, Gresham GE. Functional assessment in rehabilitation medicine. Baltimore:

Williams & Wilkins, 1984.

14. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural

history of clinically identifiable subtypes of cerebral infarction. Lancet 1991; 22;

337:1521-6.

15. Rankin J. Cerebral vascular accidents in patients over the age of 60.

Scott Med J.1957;2:200-15.

16. Niranjan S, Sureender S, Rama Rao G. Family structure in India-Evidence from NFHS.

Demogr India 1998; 27:287-300.

17. WHOQOL GROUP. The World Health Organization Quality of Life Assessment

(WHOQOL): position paper from the World Health Organization. Soc Sci Med 1995;

41:1403-9.

18. The WHOQoL Group Development of the World Health Organization WHOQOL- BREF

quality of life assessment. Psychol Med 1998b; 28:551-58.

19. Saxena S, Chandiramani K, Bhargava R. WHOQOL-Hindi: a questionnaire for assessing

quality of life in health care settings in India. World Health Organization Quality of Life.

Natl med J India. 1998;11: 155-7.



17

20. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr

Scand 1983; 67:361-370.

21. Lane DA, Jagoo J, Taylor RS, Lip GYH, Jolly K. Cross cultural adaptation into Punjabi

of the English version of the Hospital Anxiety and Depression Scale. BMC Psychiatry.

2007; 26: 7:5.

22. Thornton M, Travis SS. Analysis of the reliability of the modified caregiver strain index.

J Gerontol B Psychol Sci Soc Sci. 2003;58:S127-32.

23. Fatoye FO, Komolafe MA, Adewuya AO, Fatoye GK. Emotional distress and self-

reported quality of life among primary caregivers of stroke survivors in Nigeria. East Afr

Med J. 2006; 83:271-9.

24. Visser-Meily A, Post M, Schepers V, Lindeman E. Spouses' quality of life 1 year after

stroke: prediction at the start of clinical rehabilitation. Cerebrovasc Dis. 2005; 20:443-8.

25. Jönsson AC, Lindgren I, Hallström B, Norrving B, Lindgren A. Determinants of quality

of life in stroke survivors and their informal caregivers. Stroke. 2005; 36:803-808.

26. Wilkinson PR, Wolfe CD, Warburton FG, Rudd AG, Howard RS, Ross-Russell RW, et

al. A long-term follow-up of stroke patients. Stroke 1997; 28: 507-12.

27. Wilz G, Kalytta T. Anxiety symptoms in spouses of stroke patients. Cerebrovasc Dis.

2008; 25:311-5.

28. Scholte op ReimerWJ, de Haan RJ, Rijnders PT, Limburg M, van den Bos GA. The

burden of caregiving in partners of long-tem stroke survivors. Stroke 1998; 29:1605- 11.

29. Alexander T, Wilz G. Family caregivers: Gender differences in adjustment to stroke

survivors' mental changes. Rehabil Psychol. 2010;55:159-69.



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30. Jeng-Ru L, Hills GA, Kaplan S, Johnson PM. Burden among caregivers of stroke patients

in Taiwan. Top Geriatr Rehabil 1998; 14: 74-83.

31. Cantor MH. Strain among caregivers: A study of experience in the United States.

Gerontologist 1983; 23: 597-604.

32. Das S, Hazra A, Ray BK, Ghosal M, Banerjee TK, Roy T, et al. Burden among stroke

caregivers. Results of a community- based study from Kolkata. Stroke. 2010; 41:2965-

68.

33. Periard ME, Ames DB. Lifestyle changes and coping patterns among caregivers of stroke

survivors. Public Health Nurs 1993; 10: 252-56.

34. Anderson CS, Linto J, Stewart-Wynne EG. A population based assessment of the impact

and burden of caregiving for long-term stroke survivors. Stroke 1995;26: 843-49.

35. Thommessen B, Wyller TB, Bautz-Holter E, Laake K. Acute phase predictors of

subsequent psychosocial burden in carers of elderly stroke patients. Cerebrovasc Dis

2001; 11:201-6.



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Table shows demographic characteristics of stroke patients and care givers

†Lower <10 000 Indian Rupees (Rs) per

month; Upper, > Rs. 10 000 per month.

Variables Stroke Patients

n(%)

Caregiver

n (%)

Age

≤ 60 years

> 60 years

83 (54.6)

69 (45.4)

139 (91.4)

13 (8.6)

Gender

Male

Female

100 (65.8)

52 (34.2)

48 (31.6)

104 (68.4)

Education

No schooling

Schooling

22 (14.5)

130 (85.5)

11 (7.2)

141 (92.8)

OccupationEmployed

Unemployed

61 (40.7)

89 (59.3)

64 (42.4)

87 (57.6)†IncomeLower

Upper

75 (49.3)

77 (50.7)

75 (49.3)

77 (50.7)



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Table 2 shows stroke characteristics of the patients (n=152)

n %Type of Stroke

Ischemic

Hemorrhage

113

39

74.3

25.7*Oxfordshire classification

TACS

PACSLACS

POCS

23

7234

23

15.1

47.422.4

15.1

¶mRs

Good outcome 72 47.4Poor outcome 80 52.6

*TACS, total anterior circulation stroke; PACS, partial anterior circulation stroke;

LACS, lacunar syndrome; POCS, posterior circulation syndrome. ¶

– modified Rankin scale.



21

Table 3 shows factors predicting WHOQoL, HADS and MCSI in univariate analysis

Variable r¶p value

WHOQOL

Physical domain AnxietyDepression

MCSI

-0.19-0.46

-0.27

0.02

<0.0001

0.001

Psychological domain Anxiety

Depression

MCSI

-0.20

-0.55

-0.31

0.01

<0.0001

<0.0001

Social domain Anxiety

Depression

MCSI

-0.29

-0.47

-0.34

<0.0001

<0.0001

<0.0001

Environmental domain Anxiety

Depression

MCSI

-0.32

-0.51

-0.40

<0.0001

<0.0001

<0.0001

HADS

Anxiety Patient age

Patient occupation

Caregiver gender

Caregiver occupation

Physical domainPsychologicaldomain

Social domain

Depression

MCSI

-0.19

-0.22

-0.16

0.16

-0.19-0.20

-0.29

0.56

0.42

0.02

0.0050.05

0.05

0.020.01

<0.0001

<0.0001<0.0001

Depression Caregiver gender

Type of stroke

Physical domain

Psychological domain

Social domain

Environmental domain

Anxiety

MCSI

-0.23

0.22

-0.46

-0.56

-0.47

-0.51

0.56

0.43

0.0050.006

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001 MCSI Type of stroke

Social domain

Anxiety

Depression

0.22

-0.34

0.42

0.43

0.006

<0.0001

<0.0001

<0.0001

r-Pearson’s correlation coefficient. ¶

p<0.005 significant.



22

Table 4 shows factors predicting WHOQoL, HADS and MCSI in multivariate logistic

regression analysis

Variables§Adjusted Odd’s

Ratio

95% CI*p value

WHOQOL

Physical domain Depression 3.11 1.42-6.84 0.005

¶Psychological

domain

MCSI 2.22 1.08-4.54 0.03

Social Domain Depression 4.29 1.90-9.68 <0.0001Environmental domain Depression 5.26 2.21-12.49 <0.0001

HADS

Anxiety Caregiver age

MCSI

10.50

0.23

1.47-74.88

0.09-0.53

0.02

0.001

Depression Caregiver

gender

Type of stroke

Psychological

domain

2.59

0.21

5.21

0.98-6.86

0.08-0.57

1.88-14.45

0.05

0.002

0.001

MCSI Social domainAnxiety

0.290.20

0.11-0.810.08-0.47

0.02<0.0001

¶Anxiety and depression were not included in the model.

§Variables adjusted include, age, gender, income,

education, family type, stroke type, duration of follow-up and outcome (mRs).*p<0.005 significant.

cg paperjune172011

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