Validation of a Caregiver Strain Index
Abstract
This paper outlines the development of a Caregiver Strain Index (CSI) with a sample of spouses, family, friends, and neighbors, aged 22 to 83, who provided varying degrees of care to recently hospitalized hip surgery and heart patients aged 65 and over. Internal consistency (Cronbach's alpha) for the 13-item CSI on 81 cases was .86. Evidence of construct validity was obtained in three areas: ex-patient characteristics; subjective perceptions of the care-taking relationship by caregivers; and emotional health of caregivers. These results indicate that the CSI is a brief, easily administered instrument which identified strain within our sample of informal care providers. Further development of the CSI is being undertaken for predicting specific caregiver populations at risk. This simple index might be usefully included in any interview or assessment package that examines intergenerational relations involving dependency and care.
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The CSI has shown good psychometric properties.
“The CSI has shown good psychometric properties [32].”
From A web-based self-help intervention for partners of cancer patients based on Acceptance and Commitment Therapy: a protocol of a randomized controlled trial. (2015) · cites this paper as [32]
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“…burden was assessed with the Caregiver Burden Interview (Zarit, Bach-Reever, & Peterson, 1980) in 27 studies; other studies used the Caregiver Strain Index (Robinson, 1983; 6 studies), the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983; 5 studies), and other scales (56 studies).”
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“…to rate the participant’s memory functioning; Hospital Anxiety and Depression Scale (Snaith & Zigmond, 1994) – used by both participant and relative to report their own current mood; Caregiver Strain Index (CSI) (Robinson, 1983) – completed by the relative to indicate current level of strain.”
MethodCaregiving Spouses Physical and Mental Health in Perspective
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“…specific outcomes that reflected: • Measure of achievement of intended goals for treatment, e.g. goal attainment scaling or other measure of goal achievement;• Impact on caregivers (measured with Caregiver Strain Index (CSI (Robinson 1983))); We reported any adverse events from these interventions.”
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“Strain was measured with the Caregiver Strain Index (13 items ).(29) Mental well-being and vitality were measured with the Short-Form-36 scales mental well-being (five items) and vitality (four items).”
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“The Caregiver Strain Index (CSI) (Robinson, 1983) was used to assess the level of strain experienced by the spouse in association with the caregiving role.”
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“Many such instruments are available, like the often used Caregiver Strain Index (Robinson 1983) and Zarit Burden Interview (Zarit et al. 1980).”
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“…(b) the Relatives’ Stress Scale (Greene, Smith, Gardiner & Timbury, 1982); (c) Rabins, Mace, and Lucas’ Structured Interview (1982); (d) Caregiver Strain Index (Robinson, 1983); (e) Montgomery, Gonyea, and Hooyman’s Inventories (1985); and (f) Caregiver Hassles Scale (Kinney & Stephens, 1989).”
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“Caregiver Strain Index (CSI; Robinson, 1983).”
The needs and experiences of caregivers of individuals with multiple sclerosis: a systematic review
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BackgroundMethodInfluentialCaregiver burden in amyotrophic lateral sclerosis: A systematic review
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“Caregiver Strain Index (CSI; Robinson, 1983) was used to assess perceived strain.”
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“The present study used direct statements from caregivers in early, middle, late, and postdeath stages who participated in Meuser and Marwit’s (2001) focus groups, along with additional measures such as the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), the Anticipatory Grief Scale (AGS;…”
BackgroundInfluentialRelearning face-name associations in early Alzheimer's disease.
Clare, L., Wilson, B. A., Carter, G., Roth, I., & Hodges, J. R. (2002) · Neuropsychology · doi:10.1037/0894-4105.16.4.538 · Cited by 185 · see citing works
Caregiver-assisted coping skills training for lung cancer: results of a randomized clinical trial
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“The CSI has demonstrated high internal consistency (41) and construct validity (40).”
BackgroundMethodInfluentialPrognosis of patients after hemicraniectomy in malignant middle cerebral artery infarction
Walz, B., Zimmermann, C., Böttger, S., & Haberl, R. L. (2002) · Journal of Neurology · doi:10.1007/s00415-002-0798-x · Cited by 161 · see citing works
“The family’s burden was assessed by the Caregiver Strain Index [28].”
MethodInfluentialBurden of Informal Caregiving for Stroke Patients
van Exel, J. N. A., Koopmanschap, M. A., van den Berg, B., Brouwer, W. B. F., & van den Bos, G. A. M. (2004) · Cerebrovascular Diseases · doi:10.1159/000081906 · Cited by 160 · see citing works
Goldberg, S. E., Bradshaw, L. E., Kearney, F. C., Russell, C., Whittamore, K. H., Foster, P. E. R., Mamza, J., Gladman, J. R. F., Jones, R. G., Lewis, S. A., et al. (2013) · BMJ · doi:10.1136/bmj.f4132 · Cited by 156 · see citing works
Hou, R. J., Wong, S. Y.-S., Yip, B. H.-K., Hung, A. T. F., Lo, H. H.-M., Chan, P. H. S., Lo, C. S. L., Kwok, T. C.-Y., Tang, W. K., Mak, W. W. S., et al. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000353278 · Cited by 150 · see citing works
Proxy and self-report agreement on the Stroke and Aphasia Quality of Life Scale-39
Hilari, K., Owen, S., & Farrelly, S. J. (2007) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.2006.111476 · Cited by 154 · see citing works
Factors associated with high burden in caregivers of older adults with cancer
Hsu, T., Loscalzo, M. J., Ramani, R., Forman, S. J., Popplewell, L. L., Clark, K. L., Katheria, V., Tao, F., Strowbridge, R., Rinehart, R., et al. (2014) · Cancer · doi:10.1002/cncr.28765 · Cited by 153 · see citing works
“86 and has good construct validity.(26) Answers are dichotomous (yes/no) on the CSI, and higher values indicate more burden (score range, 0-13).”
BackgroundMethodQuality of Life: Impact of Chronic Illness on the Partner
Rees, J., O’Boyle, C. A., & MacDonagh, R. (2001) · Journal of the Royal Society of Medicine · doi:10.1177/014107680109401103 · Cited by 151 · see citing works
Martínez‐Martín, P., Rodríguez‐Blázquez, C., & Forjaz, M. J. (2012) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.11.106 · Cited by 152 · see citing works
Chen, J., Jin, W., Dong, W. S., Jin, Y., Qiao, F. L., Zhou, Y. F., & Ren, C. C. (2016) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000000559 · Cited by 152 · see citing works
“The Berg Balance Scale (BBS) was used to assess balance, which records participants’ ability to perform 14 activities, each of which is rated on a 5-point Likert scale.(24,25) The MRS is a 7-level scale (0–6) for assessing global disability.”
MethodSchumacher, K. L., Beck, C. A., & Marren, J. M. (2006) · AJN American Journal of Nursing · doi:10.1097/00000446-200608000-00020 · Cited by 154 · see citing works
The self-efficacy of family caregivers for helping cancer patients manage pain at end-of-life
Keefe, F. J., Ahles, T. A., Porter, L. S., Sutton, L., McBride, C. M., Pope, M. S., McKinstry, E., Furstenberg, C. P., Dalton, J., & Baucom, D. H. (2003) · Pain · doi:10.1016/s0304-3959(02)00448-7 · Cited by 152 · see citing works
“The caregiver strain index (CSI; Robinson, 1983) was used to assess the level of strain experienced by the caregiver.”
MethodResultMcKee, K., Philp, I., Lamura, G., Prouskas, C., Öberg, B. E., Krevers, B., Spazzafumo, L., Bień, B., Parker, C., Nolan, M., et al. (2003) · Aging & Mental Health · doi:10.1080/1360786021000006956 · Cited by 151 · see citing works
“…for use with informal carers of older people which tend to focus only on negative aspects of the caregiving process (e.g., Zarit et al., 1980; Robinson, 1983; Kinney and Stephens, 1989; Lawton, 1989; Novak & Guest, 1989; Vitaliano, 1991; Rankin et al., 1992; Schene et al., 1994; Pot et al.,…”
BackgroundCaregiver burden, time spent caring and health status in the first 12 months following stroke
Tooth, L. R., McKenna, K. T., Barnett, A. G., Prescott, C., & Murphy, S. (2005) · Brain Injury · doi:10.1080/02699050500110785 · Cited by 148 · see citing works
“The 13-item Caregiver Strain Index (CSI) [34] measures 964 L.”
BackgroundThomas, S. A., Walker, M. F., Macniven, J. A., Haworth, H., & Lincoln, N. B. (2013) · Clinical Rehabilitation · doi:10.1177/0269215512462227 · Cited by 149 · see citing works
Kruithof, W. J., Post, M. W. M., van Mierlo, M. L., van den Bos, G. A. M., Ginkel, J. M. D. M., & Visser‐Meily, J. M. A. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.04.007 · Cited by 146 · see citing works
“The CSI has a good validity [18,19], and is commonly used in clinical practice [20].”
MethodInfluentialSystematic review of respite care in the frail elderly
Shaw, C., McNamara, R. L., Abrams, K. R., Cannings-John, R. L., Hood, K., Longo, M., Myles, S., O'Mahony, S., Roe, B. H., & Williams, K. (2009) · Health Technology Assessment · doi:10.3310/hta13200 · Cited by 142 · see citing works
Turner, B., Fleming, J., Cornwell, P., Worrall, L. E., Ownsworth, T., Haines, T. P., Kendall, M. B., & Chenoweth, L. (2007) · Brain Injury · doi:10.1080/02699050701651678 · Cited by 145 · see citing works
“At the time interviews were conducted, family caregivers also completed the Care and Needs Scale (CANS), which measures the support needs of individuals with ABI [33], and the Caregiver Strain Index (CSI), which examines levels of strain experienced by caregivers of individuals with ABI [34].”
BackgroundMethodMeasurement and the Analysis of Burden
Montgomery, R. J. V., Stull, D. E., & Borgatta, E. F. (1985) · Research on Aging · doi:10.1177/0164027585007001007 · Cited by 143 · see citing works
Visser‐Meily, A., Post, M. W. M., van de Port, I. G. L., Maas, C. J. M., Forsberg‐Wärleby, G., & Lindeman, E. (2008) · Stroke · doi:10.1161/strokeaha.108.516682 · Cited by 142 · see citing works
Cham, C. Q., Ibrahim, N., Siau, C. S., Kalaman, C. R., Ho, M. C., Yahya, A. N., Visvalingam, U., Roslan, S. B., Rahman, F. N. A., & Lee, K. W. (2022) · Healthcare · doi:10.3390/healthcare10122423 · Cited by 166 · see citing works
“Two studies each employed the Caregiver Strain Index [81] and Burden Assessment Scale [82].”
MethodPalliative Care Needs of Seriously Ill, Older Adults Presenting to the Emergency Department
Grudzen, C. R., Richardson, L. D., Morrison, M. A., Cho, E., & Morrison, R. S. (2010) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2010.00907.x · Cited by 139 · see citing works
“A validated 13-item screening instrument for measuring caregiver burden was administered—the Caregiver Strain Index.(19) This index assesses physical, emotional, and financial aspects of stress in caring for a loved one.”
- Authors
- Robinson, B. C.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Robinson, B. C.
- Venue
- Journal of Gerontology
- Publisher
- Oxford University Press (OUP)
- Published
- 1983-05-01
- Volume
- 38
- Issue
- 3
- Pages
- 344-348
- ISSN
- 0022-1422 (ISSN-L)
- OpenAlex
- W2128077231
- Cited by
- 1,426
- References
- 0
- Citations by year
- 2026: 41 · 2025: 36 · 2024: 56 · 2023: 48 · 2022: 67 · 2021: 69 · 2020: 50 · 2019: 57 · 2018: 61 · 2017: 48 · 2016: 55 · 2015: 59 · 2014: 55 · 2013: 47 · 2012: 55
- FWCI
- 24.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gerontology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Social Sciences › Sociology and Political Science › Intergenerational Family Dynamics and Caregiving
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Keywords
- Caregiver Strain Index, caregiver burden, informal caregivers, family caregivers, spouses, cardiac surgery patients, older adults, intergenerational dependency, scale validation, construct validity
- MeSH terms
- Adult, Aged, Attitude to Health, Home Nursing, Humans, Life Style, Middle Aged, Surveys and Questionnaires, Stress, Psychological
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