Cited by 1,426Nursing care and researchIntergenerational Family Dynamics and CaregivingFamily Caregiving in Mental Illness

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Validation of a Caregiver Strain Index

Robinson, B. C.·1983·Journal of Gerontology

DOI 10.1093/geronj/38.3.344

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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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Background
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BackgroundMethodInfluential
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BackgroundInfluential
Relearning 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
Caregiver-assisted coping skills training for lung cancer: results of a randomized clinical trial
Porter, L. S., Keefe, F. J., Garst, J., Baucom, D. H., McBride, C. M., McKee, D. C., Sutton, L., Carson, K., Knowles, V., Rumble, M., et al. (2011) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2010.04.014 · Cited by 157
“The CSI has demonstrated high internal consistency (41) and construct validity (40).”
BackgroundMethodInfluential
Prognosis 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
“The family’s burden was assessed by the Caregiver Strain Index [28].”
MethodInfluential
Burden 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 163
Care in specialist medical and mental health unit compared with standard care for older people with cognitive impairment admitted to general hospital: randomised controlled trial (NIHR TEAM trial)
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
The Effects of Mindfulness-Based Stress Reduction Program on the Mental Health of Family Caregivers: A Randomized Controlled Trial
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
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
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 162
“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).”
BackgroundMethod
Quality 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
Quality of life and burden in caregivers for patients with Parkinson’s disease: concepts, assessment and related factors
Martínez‐Martín, P., Rodríguez‐Blázquez, C., & Forjaz, M. J. (2012) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.11.106 · Cited by 161
Effects of Home-based Telesupervising Rehabilitation on Physical Function for Stroke Survivors with Hemiplegia
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
“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.”
Method
FAMILY CAREGIVERS
Schumacher, K. L., Beck, C. A., & Marren, J. M. (2006) · AJN American Journal of Nursing · doi:10.1097/00000446-200608000-00020 · Cited by 154
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
“The caregiver strain index (CSI; Robinson, 1983) was used to assess the level of strain experienced by the caregiver.”
MethodResult
The COPE index--a first stage assessment of negative impact, positive value and quality of support of caregiving in informal carers of older people
McKee, 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
“…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.,…”
Background
Caregiver 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 154
“The 13-item Caregiver Strain Index (CSI) [34] measures 964 L.”
Background
Communication and Low Mood (CALM): a randomized controlled trial of behavioural therapy for stroke patients with aphasia
Thomas, S. A., Walker, M. F., Macniven, J. A., Haworth, H., & Lincoln, N. B. (2013) · Clinical Rehabilitation · doi:10.1177/0269215512462227 · Cited by 149
Caregiver burden and emotional problems in partners of stroke patients at two months and one year post-stroke: Determinants and prediction
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
“The CSI has a good validity [18,19], and is commonly used in clinical practice [20].”
MethodInfluential
Systematic 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 149
A qualitative study of the transition from hospital to home for individuals with acquired brain injury and their family caregivers
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
“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].”
BackgroundMethod
Measurement 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 141
Psychosocial Functioning of Spouses of Patients With Stroke From Initial Inpatient Rehabilitation to 3 Years Poststroke
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
Caregiver Burden among Caregivers of Patients with Mental Illness: A Systematic Review and Meta-Analysis
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
“Two studies each employed the Caregiver Strain Index [81] and Burden Assessment Scale [82].”
Method
Palliative 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
“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)
DOI: 10.1093/geronj/38.3.344
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 › Nursing › Research and Theory › 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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Validation of a Caregiver Strain Index

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