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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“…m esp en t c ar eg iv in g. Ca re gi ve r st ra in w as m od er at ely in te rc or re la te d w ith th e an xi - et y, h os til ity , a nd d ep re ss io n. (c o n ti n u e d ) 206 Rehabilitation nursing • Vol. 31, no. 5 • September/october 2006 plans, and disturbance in sleep (Robinson, 1983).”
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Michels, C. T. J., Boulton, M. G., Adams, A., Wee, B. L., & Peters, M. (2015) · Palliative Medicine · doi:10.1177/0269216315601930 · Cited by 51
Return to Work 2–5 Years After Stroke: A Cross Sectional Study in a Hospital-Based Population
Arwert, H. J., Schults, M.-L., Meesters, J. J. L., Wolterbeek, R., Boiten, J., & Vlieland, T. P. M. V. (2016) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-016-9651-4 · Cited by 49
“Caregiver strain was measured using the Caregiver strain index (CSI): This questionnaire consists of 13 items to assess the subjective care load of the caregiver [33], range from 0 to 13; higher means more caregiver strain.”
Method
Burden faced by caregivers of stroke patients who attend rural-based medical teaching hospital in western India
Desai, S., Mandowara, B., Patel, A., et al. (2019) · Annals of Indian Academy of Neurology · doi:10.4103/aian.aian_406_18 · Cited by 49
“Positive responses to seven or more items on the index indicate a greater level of strain[8] 4.”
Caregiving Consequences Inventory: a measure for evaluating caregiving consequences from the bereaved family member's perspective
Sanjo, M., Morita, T., Miyashita, M., Shiozaki, M., Sato, K., Hirai, K., Shima, Y., & Uchitomi, Y. (2008) · Psycho-Oncology · doi:10.1002/pon.1447 · Cited by 49
“In Japan and overseas, both a Caregiving Burden Scale with a clear domain structure [42,43] and one without a clear structure [44,45] are used.”
Method
Factors associated with strain in informal caregivers of stroke patients
Chang, K., Hung, J.-W., Huang, Y., Chen, J., Liao, L.-N., Lin, C., & Chuo, C.-Y. (2012) · Biomedical Journal · doi:10.4103/2319-4170.105479 · Cited by 49
“A CSI score ≥ 7 was considered an indicator of considerable strain.((26))”
BackgroundMethod
Empathic Accuracy Deficits in Patients with Neurodegenerative Disease: Association with Caregiver Depression
Brown, C. L., Lwi, S. J., Goodkind, M. S., Rankin, K. P., Merrilees, J. J., Miller, B. L., & LEVENSON, R. W. (2017) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2017.10.012 · Cited by 55
The reliability, validity and feasibility of tools used to screen for caregiver burden: a systematic review
Whalen, K. J., & Buchholz, S. W. (2009) · JBI Library of Systematic Reviews · doi:10.11124/jbisrir-2009-213 · Cited by 49
Decision aids for respite service choices by carers of people with dementia: development and pilot RCT
Stirling, C., Leggett, S. C., Lloyd, B., Scott, J. L., Blizzard, L., Quinn, S. J., & Robinson, A. (2012) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-12-21 · Cited by 49
“Robinson B: Validation of a Caregiver Strain Index.”
Method
Burden and psychological effects : caregiver experiences in a psychiatric outpatient unit in Lagos, Nigeria
Oshodi, Y., Adeyemi, J. D., Aina, O., Suleiman, T., Erinfolami, A. R., & Umeh, C. (2012) · African Journal of Psychiatry · doi:10.4314/ajpsy.v15i2.13 · Cited by 50
Psychological Distress in Caregivers of Liver and Lung Transplant Candidates
Meltzer, L. J., & Rodrigue, J. R. (2001) · Journal of Clinical Psychology in Medical Settings · doi:10.1023/a:1011317603415 · Cited by 47
“For this study, caregiver strain is defined as enduring problems such that strain can be interchanged with stress (Robinson, 1983).”
BackgroundInfluential
Oesophageal cancer: caregiver mental health and strain
Donnelly, M., Anderson, L. A., Johnston, B. T., Watson, R. G. P., Murphy, S., Comber, H., McGuigan, J., Reynolds, J. V., & Murray, L. (2008) · Psycho-Oncology · doi:10.1002/pon.1337 · Cited by 48
“The measure has good internal consistency and construct validity [16] and high test–retest reliability [17].”
Background
Validation of the Chinese Version of the Modified Caregivers Strain Index among Hong Kong Caregivers: An Initiative of Medical Social Workers
Chan, W. C. H., Chan, C., & Suen, M. H. P. (2013) · Health & Social Work · doi:10.1093/hsw/hlt021 · Cited by 47
Recruiting older people into a large, community-based study of heart failure
Barnes, S., Gott, M., Payne, S. A., Parker, C., Seamark, D., Gariballa, S., & Small, N. (2005) · Chronic Illness · doi:10.1177/17423953050010040201 · Cited by 49
Effectiveness of the Restore4Stroke self-management intervention ”Plan Ahead!”: A randomized controlled trial in stroke patients and partners
Tielemans, N. S., Visser‐Meily, J. M. A., Schepers, V. P. M., Passier, P. E. C. A., van de Port, I. G. L., Vloothuis, J. D. M., Struyf, P., & Heugten, C. M. V. (2015) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-2020 · Cited by 48
Psychometric Evaluation of Kingston Caregiver Stress Scale
Sadak, T. I., Korpak, A. M., Wright, J., Lee, M. K., Noel, M. A., Buckwalter, K., & Soo Borson, B. (2017) · Clinical Gerontologist · doi:10.1080/07317115.2017.1313349 · Cited by 54
“Without such evidence of validity, direct side-by-side comparison of the KCSS with stress measures that are widely accepted in research (e.g., Zarit Burden Interview, Caregiver Strain Index), or direct evaluation of the KCSS by dementia caregivers and clinicians, we can offer only a preliminary recommendation of this…”
BackgroundInfluential
Supporting Caregivers of Frail Older Adults in an HMO Setting.
Toseland, R. W., McCallion, P., Smith, T., & Banks, S. (2004) · American Journal of Orthopsychiatry · doi:10.1037/0002-9432.74.3.349 · Cited by 48
Children's adjustment to a parent's stroke: determinants of health status and psychological problems, and the role of support from the rehabilitation team
Visser‐Meily, A., Post, M. W. M., Meijer, A. M., et al. (2005) · Journal of Rehabilitation Medicine · doi:10.1080/16501970510025990 · Cited by 48
“Perceived strain was measured with the Caregiver Strain Index (13 items) (18).”
Method
Wife Caregivers of Frail Elderly Veterans: Correlates of Caregiver Satisfaction and Caregiver Strain
Dorfman, L. T., Holmes, C. A., & Berlin, K. L. (1996) · Family Relations · doi:10.2307/584769 · Cited by 48
The Meaning of Daily Activity in Family Caregiving for the Elderly
Hasselkus, B. R. (1989) · American Journal of Occupational Therapy · doi:10.5014/ajot.43.10.649 · Cited by 48
“feeling of burden (Montgomery, Gonyea, & Hooyman, 1985; Zarit, Todd, & Zarit, 1986) and a sense of strain (Cantor, 1983; Robinson, 1983).”
Depression and caregiver burden experienced by caregivers of Jordanian patients with stroke
Kamel, A. M. A., Bond, A. E., & Froelicher, E. S. (2012) · International Journal of Nursing Practice · doi:10.1111/j.1440-172x.2012.02011.x · Cited by 47
Gastrostomy matters—The impact of pediatric surgery on caregiver quality of life
Pemberton, J., Frankfurter, C., Bailey, K., et al. (2013) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2013.02.012 · Cited by 47
“A cut-off of 7 is used, where a score over 7 suggests caregiver burden, and a score under 7 suggests low to no caregiver burden [30].”
BackgroundMethod
Long-term health-related quality-of-life in patients with acquired brain injury and their caregivers
Vogler, J., Klein, A.-M., & Bender, A. (2014) · Brain Injury · doi:10.3109/02699052.2014.919536 · Cited by 46
“MCSI assesses the following stressors: inconvenience, confinement, family adjustments, changes in personal plans, competing demands on time, emotional adjustments, upsetting behaviour, personality changes in the patient, work adjustments, sleep disturbance, physical strain, financial strain and helplessness [27].”
Background
Rehabilitation in a primary care setting for persons with chronic illness – a randomized controlled trial
Richardson, J. A., Letts, L. J., Chan, D., Stratford, P. W., Hand, C. L., Price, D. J., Hilts, L., Coman, L., Edwards, M., Baptiste, S., et al. (2010) · Primary Health Care Research & Development · doi:10.1017/s1463423610000113 · Cited by 47
“97) and construct validity supported by correlations with physical and emotional health of the caregiver and subjective views of the caregiver (Robinson, 1983; Post et al., 2007).”
BackgroundInfluential
Caregiver Strain Index (CSI)
Sullivan, M. T. (2002) · Home Healthcare Now · doi:10.1097/00004045-200303000-00024 · Cited by 47
The Impact of Anticipatory Grief on Caregivers of Persons with Alzheimer's Disease
Walker, R. J., & Pomeroy, E. C. (1997) · Home Health Care Services Quarterly · doi:10.1300/j027v16n01_05 · Cited by 47
Family Functioning in the Caregivers of Patients with Dementia: One-Year Follow—up
Heru, A. M., & Ryan, C. E. (2006) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2006.70.3.222 · Cited by 46
“The Caregiver Strain Index (CSI; Robinson, 1983) consists of 13 items reflecting common stressors with a score of 7 or more indicative of significant strain.”
Method
Caring for a Spouse after Prostate Surgery: The Preparedness Needs of Wives
Giarelli, E., McCorkle, R. C., & Monturo, C. A. (2003) · Journal of Family Nursing · doi:10.1177/1074840703258317 · Cited by 47
“…study (2002), 59 lay caregivers of patients with hematological cancers were followed over time, and levels of preparedness and burden were measured by the Preparedness for Caregiving Scale (PCGS) (Archbold et al., 1990, 1992) and the Caregiver Strain Index (B. C. Robinson, 1983), respectively.”
Method
Web-based self-help intervention for partners of cancer patients based on acceptance and commitment therapy and self-compassion training: a randomized controlled trial with automated versus personal feedback
Köhle, N., Drossaert, C. H. C., ten Klooster, P. M., Schreurs, K. M. G., Hagedoorn, M., Van Uden-Kraan, C. F., Verdonck-de Leeuw, I. M., & Bohlmeijer, E. T. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06051-w · Cited by 45
“Caregiver strain was measured with the Caregiver Strain Index (CSI; 13 items; range 0–13) [25].”
Method
Measuring caregiver outcomes in palliative care: a construct validation study of two instruments for use in economic evaluations
Hoefman, R., Al‐Janabi, H., McCaffrey, N., Currow, D. C., & Ratcliffe, J. (2014) · Quality of Life Research · doi:10.1007/s11136-014-0848-8 · Cited by 45
“Other instruments are applicable in different caregiver populations, such as the Caregiver Strain Index [32], Caregiver Reaction Assessment [33, 34], Revised Caregiving Appraisal Scale [35], Family Strain Questionnaire [9, 36] or Zarit Burden Interview [7, 37].”
BackgroundMethod
Role of global stress in the health-related quality of life of caregivers: evidence from the Survey of the Health of Wisconsin
Litzelman, K., Skinner, H. G., Gangnon, R. E., Nieto, F. J., Malecki, K. M. C., & Witt, W. P. (2013) · Quality of Life Research · doi:10.1007/s11136-013-0598-z · Cited by 49
“Caregiver strain A 12-item version of the Caregiver Strain Index [14] was used to evaluate perceived strain among caregivers and asked respondents whether 12 statements applied to them because of caregiving (e.”
MethodInfluential

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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