Institutionen för klinisk vetenskap / Department of Clinical Sciences
Abstract
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