Supporting Care Partner Mental Health: Feasibility of a Behavioral Intervention Tailored for Stroke Survivor-Care Partner Dyads

Abstract

This dissertation begins with an introduction to the current state of the science in patient-caregiver dyad research. Current studies have largely focused on cancer and dementia, and additional research is needed in other chronic conditions. Evidence suggests that various factors may impact caregiver outcomes such as caregiver burden, depression, and quality of life (QOL), and these outcomes may improve with intervention. Three manuscripts are presented, the first presenting a review of the literature related to characteristics of stroke survivors that are associated with depressive symptoms in their caregivers. The findings offer support for dyad-focused interventions to manage depressive symptoms in stroke survivor-caregiver dyads. This led to development of a two-arm randomized feasibility study exploring the use of problem-solving therapy (PST) compared to stroke-related health education for depressive symptoms and QOL in stroke survivor-caregiver dyads. Dyad-focused PST is a novel approach. The second manuscript describes challenges and lessons learned tailoring PST to dyads. These include: personalizing the intervention, balancing participation, maintaining focus, managing conflict, and addressing ethical concerns. Considerations for future research involving dyad-focused interventions are presented. The third manuscript illustrates the design, methods and results of the study. Recruitment required substantial efforts, yielding a recruitment rate of 14.4%. Overall attrition was 25%. Dyads completing the study showed excellent protocol adherence and provided positive experiential feedback, especially for PST, supporting intervention acceptability. No significant changes in outcome measures were seen over time for care partners or stroke survivors. Finally, the work is synthesized, highlighting key takeaways and implications for research and practice.