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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Items 401–500 of 998

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Background
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BackgroundMethod
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Method
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Method
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Method
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“Robinson B. Validation of a Caregiver Strain Index.”
BackgroundMethodInfluential
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Background
Measurement and the interpretation of burden in the Alzheimer's disease experience
Gubrium, J. F., & Lynott, R. J. (1987) · Journal of Aging Studies · doi:10.1016/0890-4065(87)90018-1 · Cited by 42
“Borgatta 1985; Morycz 1980, 1985; Poulshock and Deimling 1984; Robinson 1983; Zarit, Reever, and Bach-Peterson 1980).”
BackgroundMethod
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Caregiver Strain Index.
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“The Caregiver Strain Index (CSI) is a questionnaire that assesses caregiver stress developed by Robinson [46] and translated into Thai version by Oupra [47].”
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“However, the CSI is highly correlated with subjective perceptions of caregiving.(43) Items are scored dichotomously, with higher scores corresponding to higher strain.”
BackgroundMethod
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MethodInfluential
Trends in caregiving intervention research
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Method
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Influential
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“The CSI has been shown to have excellent internal consistency and to be associated with caregiver physical and mental health (4, 15).”
BackgroundInfluential
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Method
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“The Caregiver Strain Index (CSI; Robinson, 1983) was used to assess the level of burden/strain experienced by caregivers.”
Influential
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“Caregiver Burden Caregivers completed the Caregiver Strain Index (CSI), a 13item measure of caregiver burden, via the touchscreen interface [27].”
Method
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“, 1978) and the Caregiver Strain Index (Robinson, 1983).”
BackgroundMethodInfluential
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“Peters et al [38] similarly reported higher correlations between the PDQ-39 and MCSI (rs = 0.56, p< .001) than the generic SF-12 in care-recipients and the MCSI (physical component: rs =−0.33; p< .001; mental component: rs =−0.41, p< .001 [note that SF-12 and MCSI are scored in different directions, leading to negativ…”
MethodInfluential
An evaluation of neurobehavioural problems as perceived by family members and levels of family stress 1–3 years following traumatic brain injury in Japan
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“The older adult patient may then have a consultation by a GENIE, who completes a variety of screens focusing on fall risk,(21) agitation,(22) delirium,(23) depression,(24) nutrition,(25) elder abuse,(26) cognitive impairment,(27,28) functional impairment,(29) palliative care,(30) and caregiver strain.(31) Completing s…”
Background
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Vloothuis, J. D. M., Mulder, M., Nijland, R. H. M., Konijnenbelt, M. H., Mulder, H., Hertogh, C. M. P. M., van Tulder, M. W., Kwakkel, G., & van Wegen, E. E. H. (2015) · BMC Neurology · doi:10.1186/s12883-015-0440-z · Cited by 37
“The CSI+ is proven valid and responsive [60–62].”
Background
Spouse Caregivers of Kidney Transplant Patients: Quality of Life and Psychosocial Outcomes
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Siblings of children with severe emotional disturbances: Risks, resources, and adaptation.
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“Caregiver Strain (CSI; Robinson, 1983): This 13-item scale assesses common caregiving stressors (e.g., physical health, emotional symptoms, social activities), and is well suited for Kilmer et al. Page 5 Am J Orthopsychiatry.”
Background
Enhancing Social Support Among People with Cardiovascular Disease: a Systematic Scoping Review
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Kruithof, W. J., Post, M. W. M., & Visser‐Meily, J. M. A. (2015) · Clinical Rehabilitation · doi:10.1177/0269215515570378 · Cited by 37
Depression and anxiety in memory clinic attenders and their carers: implications for evaluating the effectiveness of cognitive rehabilitation interventions
Clare, L., Wilson, B. A., Carter, G., Breen, K., Berríos, G. E., & Hodges, J. R. (2002) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.735 · Cited by 37
The families of the institutionalized dementing elderly: A preliminary study of stress in a French caregiver population
Ritchie, K. A., & Ledésert, B. (1992) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.930070103 · Cited by 37
Respite Use and Caregiver Well-Being in Families Caring for Stable and Declining AD Patients
Deimling, G. T. (1992) · Journal of Gerontological Social Work · doi:10.1300/j083v18n03_09 · Cited by 37
Pre-discharge home assessment visits in assisting patients’ return to community living: A systematic review and meta-analysis
Lockwood, K. A., Taylor, N. F., & Harding, K. E. (2015) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-1942 · Cited by 36
Effectiveness of a psychoeducational programme for informal caregivers of older adults
Alves, S., Teixeira, L., Azevedo, M. J., Duarte, M. G., & Paúl, C. (2015) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.12222 · Cited by 36
Effectiveness and cost-effectiveness of early assisted discharge for Chronic Obstructive Pulmonary Disease exacerbations: the design of a randomised controlled trial
Utens, C. M. A., Goossens, L. M. A., Smeenk, F. W. J. M., et al. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-618 · Cited by 36
Sobrecarga sentida por la figura del cuidador principal en una cohorte de pacientes pluripatológicos
Moreno-Gaviño, L., Bernabeu‐Wittel, M., Álvarez-Tello, M., Gómez, M. R., Colombo, P. B., Cassani-Garza, M., Baturone, M. O., & Morillo, J. S. G. (2008) · Atención Primaria · doi:10.1157/13118062 · Cited by 38
Carers for older people with co‐morbid cognitive impairment in general hospital: characteristics and psychological well‐being
Bradshaw, L. E., Goldberg, S. E., Schneider, J. M., & Harwood, R. (2012) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.3871 · Cited by 36
“Some carers did not complete all items on the CSI and GHQ12 scales (18 for CSI, 10 with one item not completed and 8 for GHQ12, 3 with one item not completed).”
MethodInfluential
Family functioning, burden, and reward in the caregiving for chronic mental illness.
Heru, A. M. (2000) · Families Systems & Health · doi:10.1037/h0091855 · Cited by 36
The Experience of Caregiving: Differences Between Behavioral Variant of Frontotemporal Dementia and Alzheimer Disease
Wong, C. C., Merrilees, J. J., Ketelle, R., Barton, C., Wallhagen, M. I., & Miller, B. L. (2011) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e318233154d · Cited by 38
How do Proxies’ Perceptions of Patients’ Pain, Anxiety, and Depression Change during the Bereavement Period?
McPherson, C. J., & Addington-Hall, J. M. (2004) · Journal of Palliative Care · doi:10.1177/082585970402000104 · Cited by 36
“and depression were determined using the Caregiver Strain Index (CSI) (31)/ State Anxiety Inventory (SAl) (Form STAI Y-l) (32)/ and the Beck Depression Inventory (BOI-II) (33).”
Method
Revised Memory and Behavior Problems Checklist
Johnson, M. M. S., Wackerbarth, S. B., & Schmitt, F. A. (2001) · Clinical Gerontologist · doi:10.1300/j018v22n03_09 · Cited by 36
Living with an Impaired Elderly Person: The Informal Caregiver's Physical and Mental Health
Jutras, S., & Lavoie, J.-P. (1995) · Journal of Aging and Health · doi:10.1177/089826439500700103 · Cited by 36
Projecting social support needs of informal caregivers in Malaysia
Ah, S. H. A. B., Weatherley, R. A., Omar, N., Abdullah, F., & Aun, N. S. M. (2013) · Health & Social Care in the Community · doi:10.1111/hsc.12070 · Cited by 40
“1986) and the Caregiver Strain Index (Robinson 1983).”
Method
Factors associated with long-term functional and psychological outcomes in persons with moderate to severe traumatic brain injury
Khan, F., Amatya, B., Judson, R., Chung, P., Truesdale, M., Elmalik, A., & Galea, M. P. (2016) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-2084 · Cited by 35
Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders
Pennington, L., Akor, W., Laws, K., & Goldbart, J. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012507.pub2 · Cited by 35
“Published by John Wiley & Sons, Ltd. ii) family stress and coping (e.g. Questionnaire on Resources and Stress (Friedrich 1983) or Carer Strain Index (Robinson 1983)); iii) satisfaction of patient and family with treatment (e.g. rating scales developed for individual studies, Patient Satisfaction…”
Background
Needs of Informal Caregivers of Patients With Head and Neck Cancer: A Systematic Review
Wang, T., Mazanec, S. R., & Voss, J. G. (2020) · Oncology nursing forum · doi:10.1188/21.onf.11-29 · Cited by 36
“, 1990), the Caregiver Strain Index (Robinson, 1983), and Carer Quality of Life survey (Brouwer et al.”
BackgroundMethodInfluential
Caregiving in the Philippines: A quantitative survey on adult-child caregivers’ perceptions of burden, stressors, and social support
Varona, R., Saito, T., Takahashi, M., & Kai, I. (2006) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2006.07.007 · Cited by 35
Finding care for the caregiver? Active participation in online health forums attenuates the negative effect of caregiver strain on wellbeing
Tanis, M., Das, E. H. H. J., & Fortgens-Sillmann, M. (2011) · Communications · doi:10.1515/comm.2011.003 · Cited by 35
“Caregiver strain was measured by the Caregiver Strain Index (Robinson, 1983).”
Method
Course of social support and relationships between social support and life satisfaction in spouses of patients with stroke in the chronic phase
Adriaansen, J. J. E., van Leeuwen, C. M. C., Visser‐Meily, J. M. A., van den Bos, G. A. M., & Post, M. W. M. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2010.12.011 · Cited by 34
“Stress was operationalized as caregiver strain and was measured using the caregiver strain index (CSI) [28], consisting of 13 items and a total range score of 0–13.”
Method
Caregiver Psychological Distress as a Barrier to Influenza Vaccination Among Community-Dwelling Elderly With Dementia
Thorpe, J. M., Sleath, B., Thorpe, C. T. K., Houtven, C. V., Blalock, S. J., Landerman, L., Campbell, W. H., & Clipp, E. (2006) · Medical Care · doi:10.1097/01.mlr.0000215905.36968.76 · Cited by 39
“Further, providers should consider using caregiver burden screening tools such as the Caregiver Strain Index or Zarit Burden Index to assist in rapidly identifying caregivers at risk for burnout and depression.(38,39) Finally, when depressive symptoms are detected, evidence-based treatment guidelines for depression sh…”
Method
Assessing pre‐death grief in cancer caregivers using the Marwit–Meuser Caregiver Grief Inventory (MM‐CGI)
Marwit, S. J., Chibnall, J. T., Dougherty, R., Jenkins, C., & Shawgo, J. (2007) · Psycho-Oncology · doi:10.1002/pon.1218 · Cited by 35
“Participants completed five self-report scales}all with documented reliability and validity}in this order: Center for Epidemiological Studies Depression Scale (CESD), 0–60 range [17]; Marwit– Meuser Caregiver Grief Inventory (MM-CGI), Total Grief (range 1⁄4 502250); Personal Sacrifice and Burden (PSB; range 1⁄4 18290)…”
Method
Quality of Life, Stigma and Burden Perception Among Family Caregivers and Patients with Psychiatric Illnesses in Jordan
Dalky, H. F., Qandil, A. M., Natour, A. S., & Janet, M. C. (2016) · Community Mental Health Journal · doi:10.1007/s10597-016-0028-0 · Cited by 37
“The CSI has a good evidence of reliability; a Cronbach’s alpha of 0.86 was reported (Robinson 1983).”
MethodInfluential
Current practice and barriers and facilitators to outcome measurement in aphasia rehabilitation: a cross-sectional study using the theoretical domains framework
Arnold, H. S., Wallace, S. J., Ryan, B., Finch, E., & Shrubsole, K. (2019) · Aphasiology · doi:10.1080/02687038.2019.1678090 · Cited by 35
“, 2003) and CSI (Caregiver Strain Index) (Robinson, 1983).”
A randomized controlled trial of day hospital and day centre therapy
Burch, S., Longbottom, J., McKay, M., et al. (1999) · Clinical Rehabilitation · doi:10.1191/026921599671803291 · Cited by 35
Relevance of Readmission of Elderly Patients Discharged From a Geriatric Unit
Andrews, K. L. (1986) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1986.tb06333.x · Cited by 35
Psychometric evaluation of the German Version of the Supportive Care Needs Survey for Partners and Caregivers (SCNS-P&C-G) of cancer patients
Sklenarova, H., Haun, M. W., Krümpelmann, A., Friederich, H., Huber, J. C., Thomas, M., Winkler, E. C., Girgis, A., Dinkel, A., Herzog, W., et al. (2015) · European Journal of Cancer Care · doi:10.1111/ecc.12325 · Cited by 34
Informal caregiver strain, preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: Results of a randomised controlled trial
Utens, C. M. A., van Schayck, O. C. P., Goossens, L. M. A., Mölken, M. R., DeMunck, D. R. A. J., Seezink, W., van Vliet, M., & Smeenk, F. W. J. M. (2014) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2014.01.002 · Cited by 34
“Informal caregiver strain was measured using the caregiver strain index (CSI) (Robinson, 1983).”
Method
The influence of symptom severity of palliative care patients on their family caregivers
Valero-Cantero, I., Casals, C., Carrión‐Velasco, Y., Barón-López, F. J., Martínez-Valero, F. J., & Vázquez‐Sánchez, M. Á. (2022) · BMC Palliative Care · doi:10.1186/s12904-022-00918-3 · Cited by 37
“Caregiver strain Caregiver strain was determined using the Caregiver Strain Index (CSI) questionnaire [30], which consists of 13 dichotomous (Yes–No) items.”
Method
Online Support for Employed Informal Caregivers
Klemm, P. R., Hayes, E. R., Diefenbeck, C. A., & Milcarek, B. I. (2013) · CIN Computers Informatics Nursing · doi:10.1097/cin.0000000000000009 · Cited by 37
“90.(42,43) Quality of life was defined as scores on the Caregiver Quality-of-Life Index (CQoL-I), a four-item scale that measures caregiver QOL in four domains: physical, psychological, social, and financial.”
Method
Coping strategies and anxiety in caregivers of palliative cancer patients
Perez-Ordóñez, F., Frías-Osuna, A., Romero-Rodríguez, Y., & Casado, R. D. P. (2016) · European Journal of Cancer Care · doi:10.1111/ecc.12507 · Cited by 34
Outcome Evaluation: An Essential Component for CNS Practice
Urden, L. D. (1999) · Clinical Nurse Specialist · doi:10.1097/00002800-199901000-00013 · Cited by 34
Toward a Cross-Cultural Understanding of Family Caregiving Burden
Lim, Y. M., Luna, I., Cromwell, S. L., Phillips, L. R., Russell, C. K., & de Ardon, E. T. (1996) · Western Journal of Nursing Research · doi:10.1177/019394599601800303 · Cited by 34

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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