Psychological health and life situation in spouses of stroke patients

Sammanfattning: About 30,000 people in Sweden are affected by stroke each year. The effect on physical functioning, and also consequences such as depression and aphasia, are likely to affect not only the life of the patient, but also the life of the spouse and family. The aims of the thesis were to identify factors of importance for the life situation of spouses of stroke patients and to evaluate the effect of a support- and education programme on the spouses psychological health. The participants in this thesis were gathered from three different populations. Participants in Paper I were significant others of depressed stroke patients. The aim of this study was to describe the life situation among significant others to patients with post stroke depression (PSD) and to identify associations between the life situation of the significant other in relation to patient characteristics. In Paper II the participants were significant others of depressed or aphasic stroke patients. The aim was to describe and compare predictors of the life situation of significant others of depressed or aphasic stroke patients. In Papers III and IV the participants were spouses of stroke patients consecutively approached and invited to participate in a randomised controlled trial (RCT) intervention programme. The aim of Paper III was to explore if a nurse-led support- and education programme for spouses of persons affected by stroke improved the psychological health in the spouses, and the aim of Paper IV was to identify predictors of psychological health and to examine if these predictors change over time in spouses of stroke patients during the first year after stroke. A second aim was to identify gender differences in psychological health among the spouses. Perceived need of assistance was the only common predictor of the life situation of the significant other of both significant others of depressed and aphasic stroke patients. Amongst the aphasic patients, perceived personality change and living with the patient were factors that had a negative effect on the life situation of the significant other. General well-being and presence of illness in the spouse were the most prominent predictors of psychological health, throughout the first year. Significant others of stroke patients participating in a support- and education programme had significantly more knowledge about stroke after 12 months compared to the controls. No difference in psychological health was found. However, the 5 participants appreciated the group sessions and the attention from the health professionals. Significant others of male stroke patients reported a more negative impact on their life situation, than did significant others of female stroke patients. There was a significant relation between the patient s level of depression and physical function (ADL); those with less impaired ADL had more major depression than those with more impaired ADL. This thesis highlights the importance of assessing the situation of spouses of stroke patients. The perception of the patient s need of assistance is an important factor affecting the life situation of spouses of both depressed and aphasic stroke patients. An intervention programme increases the spouses knowledge about stroke, but a combination of group meetings and individualised support may be necessary in order to gain effect also on the psychological health. Assessments of the spouses perception as well as of the patients factual situation may identify spouses at risk. Enhancing the psychological health and supporting those in need may enable the patient to continue to live at home without risking the health of the spouse.