Preventing Chronic Emotional Distress in Stroke Survivors and Their Informal Caregivers
Open accessAbstract
Background/objective Chronic emotional distress (e.g., depression, anxiety, post-traumatic stress) is common after stroke and interdependent between patients and their informal caregivers. We measured stroke survivors', caregivers', and neurocritical care nurses' views of primary drivers of distress during the stroke experience, and needs and preferences for the structure, topics, mode of delivery, and timing of an intervention to promote emotional recovery.Methods We conducted semi-structured interviews with 24 patient-caregiver dyads within the Neuroscience Intensive Care Unit (Neuro-ICU). Additionally, we conducted two focus groups with 15 nurses. Interviews and focus groups were audio-recorded, transcribed, and coded using NVivo 11 (QSR International) software.Results and conclusions The challenges and impacts of stroke most commonly reported by dyads were: uncertainty about future health, fear of recurrent strokes, negative emotions, and role changes post-stroke. Dyads and nurses agreed that resiliency skills such as mindfulness/focusing on the present, problem solving, gratitude/optimism, self-care, interpersonal communication and developing a supportive team of family, friends, and medical staff are beneficial to optimize recovery. The potential barrier to intervention delivery was accessibility, due to challenges of time and travel to appointments. Participants agreed that starting the intervention at hospitalization and continuing via live video after discharge is an ideal delivery modality. Stroke survivors, caregivers, and Neuro-ICU nurses believe that a resiliency skills-based intervention to prevent chronic emotional distress is necessary and urgent. This qualitative study provides valuable information on the challenges faced by dyads, intervention topics to prioritize, and strategies to maximize feasibility, acceptability, and effect.
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In a study of 24 stroke survivor-informal caregiver dyads in neurocritical care, dyads were interested in learning MBSR techniques in the acute setting but identified challenges to continuing postdischarge, including stress of intensive care days.
“Results suggest that the dyads were interested in learning MSBR techniques in the acute setting, but identified multiple challenges associated with continuing such practices postdischarge including the stress of intensive care days with adding in MSBR techniques.”
From Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families. (2022) · cites this paper as [64]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredPresent research studies are focused on either the informal caregiver or the stroke survivor.
“Present research studies are focused on either the informal caregiver or the stroke survivor; however, given the symbiotic nature of this relationship, it is suggested that the stroke survivor and informal caregiver be addressed as a dyad.4,9,64,65”
From Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families. (2022) · cites this paper as [64]
The Introduction (page unavailable) says current psychosocial interventions primarily focus on the patient or caregiver individually, supporting the claim's general point. But the claim broadens that observation to present research studies as a whole; the Discussion (page unavailable) explicitly describes existing studies of dyadic interventions. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn a study using neuroscience ICU nurse focus groups, nurses recognized that patients need MBIs to help catalyze recovery but did not feel adequately trained to facilitate this in the acute setting.
“In a study that utilized neuroscience intensive care unit nurse focus groups as an adjunct to studying patient-caregiver dyads, nurses recognized that patients need MBIs to help catalyze their recovery, yet they did not feel they had adequate training to facilitate this process in the acute setting.64”
From Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families. (2022) · cites this paper as [64]
The Methods report Neuro-ICU nurse focus groups alongside patient-caregiver interviews. The Results (Barriers to Effective Implementation) say nurses supported a resiliency-skills program and wanted training to help with recruitment, referral, and communication. The program included mindfulness, but the paper does not say nurses felt inadequately trained to facilitate mindfulness-based interventions for patients in the acute setting. Page numbers were not provided. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNurses suggested that an admission screening tool to identify patients who could benefit most from MBI techniques would be useful.
“Nurses also suggested that an admission screening tool to help identify patients who could benefit most from MBI techniques would be useful.64”
From Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families. (2022) · cites this paper as [64]
The Results section, under “Barriers to Effective Implementation,” says nurses suggested an intake screening tool to identify patients who may benefit from a psychosocial skills intervention. The Discussion lists mindfulness among several proposed skills, but the paper does not describe the screening tool as specifically identifying patients for MBI techniques. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThere is compelling evidence for the interdependence of psychological health poststroke in both informal caregivers and stroke survivors.
“There is compelling evidence for the interdependence of psychological health poststroke in both informal caregivers and stroke survivors.4,9,64”
From Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families. (2022) · cites this paper as [64]
Early symptoms of emotional distress in the acute period in both stroke survivors and informal caregivers may evolve into chronic negative outcomes, including increased morbidity and mortality, for both groups.
“Early symptoms of emotional distress in the acute period in both the stroke survivor and informal caregiver may evolve into chronic negative outcomes, including an increase in morbidity and mortality, for both groups.64”
From Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families. (2022) · cites this paper as [64]
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- Authors
- McCurley, J. L., Funes, C. J., Zale, E. L., Lin, A., Jacobo, M., Jacobs, J. M., Salgueiro, D., Tehan, T., Rosand, J., & Vranceanu, A.-M.
- Affiliations
- Harvard University (US)
- Corresponding author
- Vranceanu, Ana-Maria
- ORCID
- Venue
- Neurocritical Care
- Published
- 2018-11-12
- Volume
- 30
- Issue
- 3
- Pages
- 581-589
- ISSN
- 1541-6933 (ISSN-L)
- 1556-0961
- PMC
- PMC6958510
- OpenAlex
- W2901775239
- Cited by
- 171
- References
- 37
- Citations by year
- 2026: 22 · 2025: 42 · 2024: 24 · 2023: 27 · 2022: 29 · 2021: 12 · 2020: 11 · 2019: 4
- FWCI
- 5.77
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Neurocritical Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Heart Association (228671)
- Brain Aneurysm Foundation (229663)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Keywords
- stroke, depression, anxiety, post-traumatic stress, informal caregivers, patient-caregiver dyads, resilience skills, mindfulness, self-care, emotional recovery
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Depression, Female, Humans, Intensive Care Units, Male, Middle Aged, Nursing Staff, Hospital, Stress Disorders, Post-Traumatic, Stress, Psychological, Caregivers, Focus Groups, Survivors, Stroke, Qualitative Research, Young Adult
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