Dissertation Defence: Predicting Depression and Anxiety Among Couples After Stroke Based on Survivor Neuropsychological Function and Spousal Caregiver Moral Responses
June 3 at 9:00 am - 1:00 pm
Alanna Coady, supervised by Drs. Harry Miller and Jamie Piercy, will defend their dissertation titled “Predicting Depression and Anxiety Among Couples After Stroke Based on Survivor Neuropsychological Function and Spousal Caregiver Moral Responses” in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Clinical Psychology.
An abstract for Alanna Coady’s dissertation is included below.
Examinations are open to all members of the campus community as well as the general public. Registration is not required for in-person exams.
Abstract
Introduction: Over 12.2 million new strokes occur worldwide each year, and the lifetime risk of stroke for an individual has risen to one in four. In Canada, approximately 80% of stroke survivors are discharged home, where they receive care from an informal family caregiver, most often a spouse. An estimated 30% of survivors develop depression or anxiety within five years, adversely affecting rehabilitation and quality of life. Stroke caregivers likewise experience elevated rates of anxiety and depression relative to non-caregiving populations, which in turn influences survivor recovery. Cognitive impairments have been identified as significant predictors of distress, yet few studies have used formal neuropsychological assessments to determine which domains are most relevant for mental health outcomes of caregivers and stroke survivors, respectively. In addition, caregiver emotional and psychological responses, particularly moral emotions such as guilt, resentment, and anger, may independently contribute to distress but remain underexplored in the context of stroke caregiving.
Methods: This dissertation included two studies with the same participant sample. A total of 40 couples (N = 80) were recruited from a Western Canadian inpatient rehabilitation unit. Stroke survivors completed a neuropsychological assessment during hospitalization, and spouses who planned to provide care were enrolled while their spouse was in hospital. Both partners completed follow-up surveys three months post-discharge, online or in person. Study 1 used a longitudinal design to test whether survivors’ inpatient cognitive function and mood predicted depression and anxiety in both partners three months after discharge using multiple regression analyses. Study 2 employed a cross-sectional design at three months after discharge to examine associations between caregiver moral emotions (guilt, resentment, anger, ambivalence) and dyad symptoms of depression and anxiety, assessed with validated self-report measures using multiple regression.
Results: Survivor cognitive function did not significantly predict either partner’s emotional outcomes. However, stroke survivor baseline depression during inpatient care was significantly associated with survivor depression three months after discharge (B = 0.42, SE = 0.15, β = .44, t = 2.81, p = .009). At the three-month timepoint, greater caregiver resentment was significantly associated with more caregiver depressive symptoms (B = 0.32, SE = 0.11, β = .43, t = 2.90, p = .006) and anxiety (B = 0.37, SE = 0.12, β = .55, t = 3.03, p = .005). Elevated caregiver anger was also associated with greater caregiver depressive symptoms (B = 0.39, SE = 0.13, β = .39, t = 3.02, p = .005) and anxiety (B = 0.30, SE = 0.14, β = .33, t = 2.07, p = .046). Guilt and ambivalence were not significantly related to outcomes.
Conclusions: Findings suggest that emotional concerns are stronger indicators than survivor cognitive deficits of couples’ emotional wellbeing three months after hospitalization for stroke. Early screening and interventions addressing stroke survivor depressive symptoms and caregiver resentment and anger may improve adjustment for both survivors and caregivers.
