Date of Award

2013

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Lois K. Evans

Second Advisor

Barbara J. Riegel

Abstract

Caregiver status is a known risk factor for morbidity and mortality. In the time period immediately after a stroke, high levels of uncertainty about the family member's recovery and the sudden assumption of a new caregiver role may be acutely stressful. Little is known, however, about caregivers' experiences in the very early period of caregiving or how caregiver stress may contribute subsequently to health. The purpose of this study was to examine the effect of uncertainty on caregiver perceived and physiological stress and psychological outcomes (burden, health-related quality of life [HRQOL] and depressive symptoms) within 2 weeks poststroke (baseline) and at 6 weeks poststroke. In addition, the mediator effect of stress on the relationship between uncertainty and psychological outcomes was explored. A prospective, longitudinal observational study was conducted using a convenience sample of 63 caregivers and their stroke-survivor relatives recruited from acute-care settings in two academic health-science centers. Multivariate stepwise regression was used to achieve the overall aim of this study. Additionally, multivariate regression was used to explore the mediator effect of stress on the relationship between uncertainty and psychological outcomes. Level of uncertainty at baseline was higher than reported in several other caregiver populations and it remained so at 6 weeks poststroke. Greater level of uncertainty was associated with higher perceived stress at baseline (p < 0.001) and at 6 weeks poststroke (p < 0.001). Uncertainty, however, was not a significant predictor of physiological stress at either time point. Overall, greater uncertainty was associated with greater burden (p < 0.001 at baseline and p = 0.031 at 6 weeks poststroke), poorer HRQOL (p < 0.001 at baseline and p = 0.023 only in univariate analysis at 6 weeks poststroke) and greater depressive symptoms (p = 0.002 at both observations). By 6 weeks poststroke, perceived stress fully mediated the relationship between uncertainty and depressive symptoms. Healthcare providers in neuroscience must become sensitized to caregiver uncertainty in the early period of caregiving. Using uncertainty as a predictor may help identify caregivers at risk for stress, burden, poor HRQOL or depressive symptoms, that is, those in need of additional support. Further research exploring uncertainty and the development and testing of target interventions for it may reduce the early uncertainty and stress of caregivers of stroke survivors and prevent negative longer term health outcomes.

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