The associations between caregivers' psychosocial characteristics and caregivers' depressive symptoms in stroke settings: a cohort study.

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Studies have found that caregivers can influence stroke survivors' outcomes, such as mortality. It is thus pertinent to identify significant factors associated with caregivers' outcomes. The study objective was to examine the associations between caregivers' psychosocial characteristics and caregivers' depressive symptoms.


The analysis obtained three-month and one-year post-stroke data from the Singapore Stroke Study, which was collected from hospital settings. Caregivers' depressive symptoms were assessed via the Center for Epidemiologic Studies Depression instrument. Psychosocial characteristics of caregivers included subjective burden (Zarit Burden Interview), quality of care-relationship (a modified 3-item scale from the University of Southern California Longitudinal Study of Three-Generation Families) and expressive social support (an 8-item scale from Pearlin et al.). Mixed effect Tobit regressions were used to examine the associations between these study variables.


A total of 214 caregivers of stroke patients hospitalized were included in the final analysis. Most caregivers were Chinese women with secondary school education, unemployed and married to the patients. Caregivers' subjective burden was positively associated with their depressive symptoms (Partial regression coefficient: 0.18, 95% CI 0.11-0.24). Quality of care-relationship (Partial regression coefficient: - 0.35, 95% CI - 0.63 to - 0.06) and expressive social support (partial regression coefficient: - 0.28, 95% CI - 0.37 to - 0.19) were negatively associated with caregivers' depressive symptoms. Caregivers' depressive symptoms were higher at three-month post-stroke than one-year post-stroke (Partial regression coefficient: - 1.00, 95% CI - 1.80 to - 0.20).


The study identified subjective burden, quality of care-relationship and expressive social support as significantly associated with caregivers' depressive symptoms. Caregivers' communication skills may also play a role in reducing caregivers' depressive symptoms.





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Koh, Yen Sin, Mythily Subramaniam, David Bruce Matchar, Song-Iee Hong and Gerald Choon-Huat Koh (2022). The associations between caregivers' psychosocial characteristics and caregivers' depressive symptoms in stroke settings: a cohort study. BMC psychology, 10(1). p. 121. 10.1186/s40359-022-00828-2 Retrieved from

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David Bruce Matchar

Professor of Medicine

My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention.
Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analysis and cost-effectiveness analysis; (2) a balancing of methodological rigor the needs of medical professionals; and (3) dependence on interdisciplinary groups of experts.
This approach is best illustrated by the Stroke Prevention Patient Outcome Research Team (PORT), for which I served as principal investigator. Funded by the AHCPR, the PORT involved 35 investigators at 13 institutions. The Stroke PORT has been highly productive and has led to a stroke prevention project funded as a public/private partnership by the AHCPR and DuPont Pharma, the Managing Anticoagulation Services Trial (MAST). MAST is a practice improvement trial in 6 managed care organizations, focussing on optimizing anticoagulation for individuals with atrial fibrillation.
I serve as consultant in the general area of analytic strategies for clinical policy development, as well as for specific projects related to stroke (e.g., acute stroke treatment, management of atrial fibrillation, and use of carotid endarterectomy.) I have worked with AHCPR (now AHRQ), ACP, AHA, AAN, Robert Wood Johnson Foundation, NSA, WHO, and several pharmaceutical companies.
Key Words: clinical policy, disease management, stroke, decision analysis, clinical guidelines

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