Factors Associated With Depression Among Family Caregivers of Patients With Stroke in Indonesia: A Cross-Sectional Study

10.1097/jnr.0000000000000515

Wahyuni FAUZIAH；Mayumi KATO；Miho SHOGENJI；Hiromasa TSUJIGUCHI；Yoshimi TANIGUCHI

caregivers ； depression ； family ； self-efficacy ； stroke

The Journal of Nursing Research

30卷5期（2022 / 10 / 01）

1 - 13

英文

Background: Strokes may lead to increased dependency, which may impact the daily lives of patients with stroke and their family caregivers. Caring for a poststroke family member in Indonesia may differ from other countries in terms of extending beyond the provision of hands-on care. Contradictions and gaps in the factors affecting caregiver depression have been highlighted in a review of the relevant literature. Few studies have examined comprehensively the contradictory factors, uncovered factors, and cultural and spiritual values affecting this phenomenon. Purpose: This study was designed to identify the factors associated with depression in family caregivers of patients with stroke in Indonesia. We examined the following factors related to caregiver depression: demographic characteristics of the caregiver and care recipient, functional ability of the patient, caregiver self-efficacy, knowledge regarding stroke care, and spiritual values. Methods: In this cross-sectional study, 157 primary caregivers completed questionnaires involving depression factors during face-to-face interviews. The data were analyzed using multiple logistic regression. Results: The prevalence of depression among the participants was 56.7%. The overall mean ages of the participants and their care recipients were 43.6 and 57.1 years, respectively. In this study, 65.6% of the participants were female, and 70.1% lacked knowledge regarding stroke care. In the early caregiving phase, caregiver depression was more likely to occur in female caregivers with back pain and long care hours. Self-efficacy in achieving respite time was found to be associated with a lower risk of depression. Conclusions/Implications for Practice: Caregivers' gender, presence of back pain, sufficient respite time, and time since stroke occurrence should be considered when providing knowledge, skills, and coping strategies to caregivers to help them adapt to their caregiving role, maintain their quality of life, and prevent the onset of depression. Understanding the factors influencing caregiver depression may help nursing professionals identify individuals at a higher risk of depression early on and provide critical follow-up and early access to supportive counseling.

1. Ramazanu, S.,Leung, D.,Chiang, V. C. L.(2020).The experiences of couples affected by stroke and nurses managing patient rehabilitation: A descriptive study in Singapore.The Journal of Nursing Research,28(5),Article e113.
   連結：
2. Wang, Y. N.,Hsu, W. C.,Shyu, Y. I. L.(2020).Job demands and the effects on quality of life of employed family caregivers of older adults with dementia: A cross-sectional study.The Journal of Nursing Research,28(4),Article e99.
   連結：
3. Yang, F. Y.,Lai, C. Y.,Yen, C. F.,Hsu, Y. Y.,Zauszniewski, J. A.(2017).The depressive symptoms, resourcefulness, and selfharm behaviors of adolescents.The Journal of Nursing Research,25(1),41-50.
   連結：
4. Albert, P. R.(2015).Why is depression more prevalent in women?.Journal of Psychiatry and Neuroscience,40(4),219-221.
5. Almborg, A.-H.,Ulander, K.,Thulin, A.,Berg, S.(2009).Discharge planning of stroke patients: The relatives' perceptions of participation.Journal of Clinical Nursing,18,857-865.
6. Amiri, S.,Behnezhad, S.,Azad, E.(2020).Back pain and depressive symptoms: A systematic review and meta-analysis.The International Journal of Psychiatry in Medicine,Article, 91217420913001.
7. Andresen, E. M.,Malmgren, J. A.,Carter, W. B.,Patrick, D. L.(1994).Screening for depression in well older adults: Evaluation of a short form of the CES-D.American Journal of Preventive Medicine,10(2),77-84.
8. Bandura, A.(2002).Self-efficacy in changing societies.Cambridge University Press.
9. Björgvinsson, T.,Kertz, S. J.,Bigda-Peyton, J. S.,McCoy, K. L.,Aderka, I. M.(2013).Psychometric properties of the CES-D-10 in a psychiatric sample.Assessment,20(4),429-436.
10. Byun, E.,Evans, L.,Sommers, M.,Tkacs, N.,Riegel, B.(2019).Depressive symptoms in caregivers immediately after stroke.Topics in Stroke Rehabilitation,26(3),187-194.
11. Chafjiri, R. T.,Navabi, N.,Shamsalinia, A.,Ghaffari, F.(2017).The relationship between the spiritual attitude of the family caregivers of older patients with stroke and their burden.Clinical Interventions in Aging,12,453-458.
12. Chen, K.,Lou, V. W. Q.,Cheng, C. Y. M.,Lum, T. Y. S.,Tang, J. Y. M.(2022).Family caregiver's positive, negative, and ambivalent feelings towards stroke survivors: Association with psychological well-being.Applied Research Quality Life,17,169-183.
13. Faul, F.,Erdfelder, E.,Lang, A.-G.,Buchner, A.(2007).G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behavior Research Methods,39(2),175-191.
14. Fauziah, W.,Kato, M.,Irwan, A. M.(2019).Contradiction, similarity, and uncovered factors of depression among post-stroke patients family-caregivers.International Journal of Caring Sciences,12(3),1380-1401.
15. Freytes, I. M.,Sullivan, M.,Schmitzberger, M.,LeLaurin, J.,Orozco, T.,Eliazar-Macke, N.,Uphold, C.(2020).Types of stroke-related deficits and their impact on family caregiver's depressive symptoms, burden, and quality of life.Disability and Health Journal,14(2),Article 101019.
16. Giannelli, F. R.(2020).Major depressive disorder.Journal of the American Academy of Physician Assistants,33(4),19-20.
17. Gilliam, C. M.,Steffen, A. M.(2006).The relationship between caregiving self-efficacy and depressive symptoms in dementia family caregivers.Aging and Mental Health,10(2),79-86.
18. Grano, C.,Lucidi, F.,Violani, C.(2017).The relationship between caregiving self-efficacy and depressive symptoms in family caregivers of patients with Alzheimer disease: A longitudinal study.International Psychogeriatrics,29(7),1095-1103.
19. Hu, P.,Yang, Q.,Kong, L.,Hu, L.,Zeng, L.(2018).Relationship between the anxiety/depression and care burden of the major caregiver of stroke patients.Medicine,97(40),Article e12638.
20. James, C.,Powell, M.,Seixas, A.,Bateman, A.,Pengpid, S.,Peltzer, K.(2020).Exploring the psychometric properties of the CES-D-10 and its practicality in detecting depressive symptomatology in 27 low- and middle-income countries.International Journal of Psychology,55(3),435-445.
21. Jennings, L. A.,Reuben, D. B.,Evertson, L. C.,Serrano, K. S.,Ercoli, L.,Grill, J.,Chodosh, J.,Tan, Z.,Wenger, N. S.(2015).Unmet needs of caregivers of individuals referred to a dementia care program.Journal of the American Geriatrics Society,63(2),282-289.
22. Kable, A.,Pond, D.,Baker, A.,Turner, A.,Levi, C.(2018).Evaluation of discharge documentation after hospitalization for stroke patients discharged home in Australia: A cross-sectional, pilot study.Nursing & Health Sciences,20(1),24-30.
23. Kristanti, M. S.,Effendy, C.,Utarini, A.,Vernooij-Dassen, M.,Engels, Y.(2019).The experience of family caregivers of patients with cancer in an Asian country: A grounded theory approach.Palliative Medicine,33(6),676-684.
24. Long, N. X.,Pinyopasakul, W.,Pongthavornkamol, K.,Panitrat, R.(2019).Factors predicting the health status of caregivers of stroke survivors: A cross-sectional study.Nursing & Health Sciences,21(2),262-268.
25. Lutz, B. J.,Young, M. E.,Creasy, K. R.,Martz, C.,Eisenbrandt, L.,Brunny, J. N.,Cook, C.(2017).Improving stroke caregiver readiness for transition from inpatient rehabilitation to home.The Gerontologist,57(5),880-889.
26. Malhi, G. S.,Mann, J. J.(2018).Depression.The Lancet,392(10161),2299-2312.
27. Márquez-González, M.,Losada, A.,López, J.,Peñacoba, C.(2009).Reliability and validity of the Spanish version of the revised scale for caregiving self-efficacy.Clinical Gerontologist,32(4),347-357.
28. Masuku, K. P.,Khoza-Shangase, K.(2018).Spirituality as a coping mechanism for family caregivers of persons with aphasia.Journal of Psychology in Africa,28(3),245-248.
29. Mboi, N.,Murty Surbakti, I.,Trihandini, I.,Elyazar, I.,Houston Smith, K.,Bahjuri Ali, P.,Kosen, S.,Flemons, K.,Ray, S. E.,Cao, J.,Glenn, S. D.,Miller-Petrie, M. K.,Mooney, M. D.,Ried, J. L.,Anggraini Ningrum, D. N.,Idris, F.,Siregar, K. N.,Harimurti, P.,Bernstein, R. S.,Hay, S. I.(2018).On the road to universal health care in Indonesia, 1990-2016: A systematic analysis for the global burden of disease study 2016.The Lancet,392(10147),581-591.
30. Nursiswati, N.,Halfens, R. J. G.,Lohrmann, C.(2020).Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian hospitals.International Journal of Nursing Sciences,7(3),330-336.
31. Nursiswati, N.,Halfens, R. J. G.,Lohrmann, C.(2017).Change in care dependency of stroke patients: A longitudinal and multicenter study.Asian Nursing Research,11(2),113-118.
32. Rössler, W.(2016).The stigma of mental disorders: A millennialong history of social exclusion and prejudices.EMBO Reports,17(9),1250-1253.
33. Roth, D. L.,Haley, W. E.,Sheehan, O. C.,Liu, C.,Clay, O. J.,Rhodes, J. D.,Judd, S. E.,Dhamoon, M.(2020).Depressive symptoms after ischemic stroke: Population-based comparisons of patients and caregivers with matched controls.Stroke,51(1),54-60.
34. Shah, S.,Vanclay, F.,Cooper, B.(1989).Improving the sensitivity of the Barthel index for stroke rehabilitation.Journal of Clinical Epidemiology,42(8),703-709.
35. Soósová, M. S.,Mauer, B.(2021).Psychometrics properties of the daily spiritual experience scale in Slovak elderly.Journal of Religion & Health,60,563-575.
36. Steffen, A. M.,Gallagher-Thompson, D.,Arenella, K. M.,Au, A.,Cheng, S.-T.,Crespo, M.,Cristancho-Lacroix, V.,López, J.,Losada-Baltar, A.,Márquez-González, M.,Nogales-Gonzáles, C.,Romero-Moreno, R.(2019).Validating the Revised Scale for Caregiving Self-Efficacy: A cross-national review.Gerontologist,59(4),e325-e342.
37. Steffen, A. M.,McKibbin, C.,Zeiss, A. M.,Gallagher-Thompson, D.,Bandura, A.(2002).The Revised Scale for Caregiving Self-Efficacy: Reliability and validity studies.The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences,57(1),74-86.
38. Torregosa, M. B.,Sada, R.,Perez, I.(2018).Dealing with stroke: Perspectives from stroke survivors and stroke caregivers from an underserved Hispanic community.Nursing & Health Sciences,20(3),361-369.
39. Tsuji, T.,Matsudaira, K.,Sato, H.,Vietri, J.(2016).The impact of depression among chronic low back pain patients in Japan.BMC Musculoskeletal Disorders,17(1),Article No. 447.
40. Underwood, L. G.,Teresi, J. A.(2002).The daily spiritual experience scale: Development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data.Annals of Behavioral Medicine,24(1),22-33.
41. Wharton, W.,Gleason, C. E.,Olson, S.,Carlsson, C. M.,Asthana, S.(2012).Neurobiological underpinnings of the estrogen-Mood relationship.Current Psychiatry Reviews,8(3),247-256.
42. Yu, F.,Li, H.,Tai, C.,Guo, T.,Pang, D.(2019).Effect of family education program on cognitive impairment, anxiety, and depression in persons who have had a stroke: A randomized, controlled study.Nursing and Health Sciences,21(1),44-53.
43. Zhang, J.,Xu, L.,Li, J.,Sun, L.,Qin, W.,Ding, G.,Wang, Q.,Zhu, J.,Yu, Z.,Xie, S.,Zhou, C.(2019).Gender differences in the association between body mass index and health-related quality of life among adults: A cross-sectional study in Shandong, China.BMC Public Health,19(1),Article No. 1021.
44. Zhao, J.,Zeng, Z.,Yu, J.,Xu, J.,Chen, P.,Chen, Y.,Li, J.,Ma, Y.(2021).Effect of main family caregiver's anxiety and depression on mortality of patients with moderate-severe stroke.Scientific Reports,11(1),Article No. 2747.