Background/Purpose: Identifying caregivers at risk for negative outcomes is an important part of the discharge process for stroke survivors. Screening caregivers for depressive symptoms may be one method to assess caregivers at risk for difficulty with tasks and negative life changes. The purpose of this study was to test for differences in task difficulty and life changes in caregivers with no depressive symptoms versus those with mild or greater depressive symptoms, screened with the PHQ-9 within 8 weeks after discharge.
Methods: Telephone interviews were conducted with 176 stroke caregivers enrolled in an ongoing caregiver intervention study. Baseline data were analyzed to determine differences in Task Difficulty (OCBS) and Life Changes (BCOS) based on PHQ-9 cutoff scores (PHQ-9 < 5 no depressive symptoms, n = 90; PHQ-9 > 5 mild or greater depressive symptoms, n = 86). Differences in total OCBS and BCOS scores were analyzed using ANOVA. Response differences for individual OCBS and BCOS items were tested using exact-likelihood ratio Chi-square (Bonferroni adjusted for significance at p = .003).
Results: There were significant differences in task difficulty (OCBS) [F(1,174) = 24.46, p < .001] and life changes (BCOS) [F(1,174) = 31.47; p < .001) in caregivers with no depressive symptoms versus those with mild or greater depressive symptoms. One half of the task difficulty and life changes items demonstrated different response patterns between groups. In the caregivers with mild or greater depressive symptoms, the most difficult tasks were performing household tasks (60%) and managing survivor behavior problems (51%). The most negative life changes were financial well-being (61%), level of energy (60%), and emotional well-being (57%).
Conclusions: Findings support the need for assessment and treatment of stroke caregiver depressive symptoms during the early discharge period. The PHQ-9 is a useful screening tool to identify at risk caregivers. For those who score in the mild or greater depressive symptom range, assistance with the behavior problems of the survivor and helping the caregiver to manage household tasks, energy levels, emotions, and finances may be priority areas for further intervention.