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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BackgroundMethod
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Method
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Method
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“Carer strain (caregiver strain index) [90].”
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Method
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“Caregiver Strain Index (CSI).”
BackgroundMethodInfluential
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Slade, A. L., Fear, J., & Tennant, A. (2006) · BMC Health Services Research · doi:10.1186/1472-6963-6-31 · Cited by 28
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Nejad, Z. K., Aghdam, A. M., Hassankhani, H., & Sanaat, Z. (2015) · Iranian Red Crescent Medical Journal · doi:10.5812/ircmj.21627 · Cited by 26
“86) and the construct validity is supported by correlations with the physical and emotional health of the caregiver and with subjective views of the caregiving situation (23).”
Background
Approaches to capturing the financial cost of family care-giving within a palliative care context: a systematic review
Gardiner, C., Brereton, L., Frey, R. A., Wilkinson‐Meyers, L., & Gott, M. (2015) · Health & Social Care in the Community · doi:10.1111/hsc.12253 · Cited by 27
Relationship quality among HIV patients and their caregivers
Miller, I. W., Bishop, D. S., Herman, D. S., & Stein, M. D. (2006) · AIDS Care · doi:10.1080/09540120600624278 · Cited by 27
“Data concerning the reliability and validity of the CSI has been previously published (Robinson, 1983).”
Background
Evaluation design of a reactivation care program to prevent functional loss in hospitalised elderly: A cohort study including a randomised controlled trial
Asmus-Szepesi, K. J., de Vreede, P. L., Nieboer, A. P., van Wijngaarden, J. D. H., Bakker, T. J. E. M., Steyerberg, E. W., & Mackenbach, J. P. (2011) · BMC Geriatrics · doi:10.1186/1471-2318-11-36 · Cited by 30
“Subjective burden of care is measured with the Self Rated Burden Scale and Caregiver Strain Index or CSI [72,73].”
Method
Sentido de coherencia y sobrecarga subjetiva, ansiedad y depresión en personas cuidadoras de familiares mayores
López‐Martínez, C., Osuna, A. F., & Casado, R. D. P. (2017) · Gaceta Sanitaria · doi:10.1016/j.gaceta.2017.09.005 · Cited by 27
Training nurses in a competency framework to support adults with epilepsy and intellectual disability: the EpAID cluster RCT
RING, H. A., Howlett, J., Pennington, M., Smith, C., Redley, M., Murphy, C., Hook, R. W., Platt, A., Gilbert, N., Jones, E., et al. (2018) · Health Technology Assessment · doi:10.3310/hta22100 · Cited by 27
Effects of a community intervention program for dementia on mental health: the importance of secondary caregivers in promoting positive aspects and reducing strain
Paúl, C., Teixeira, L., Duarte, N. S. C., Pires, C. L., & Ribeiro, Ó. M. (2018) · Community Mental Health Journal · doi:10.1007/s10597-018-0345-6 · Cited by 27
“The Modified Caregiver Strain Index (M-CSI, Thornton and Travis 2003) is a modified version of the Caregiver Strain Index originally developed by Robinson (1983).”
Method
Burden and Anxiety in Family Caregivers in the Hospital That Debut in Caregiving
Pérez‐Cruz, M., Parra‐Anguita, L., López‐Martínez, C., Moreno-Cámara, S., & Casado, R. D. P. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16203977 · Cited by 27
“Data were collected during the second semester of 2015 via a structured interview in order to ask the ad hoc questions related to the care provided (daily hours and number of ADLs, hours of surveillance and supervision, gender, relationship, and the sociodemographic data required to describe the study sample), and als…”
Method
Chronic psychosocial stress: does it modulate immunity to the influenza vaccine in Hong Kong Chinese elderly caregivers?
Wong, S. Y. S., Wong, C. K., Chan, F. W. K., Chan, P. K. S., Ngai, K. L. K., Mercer, S. W., & Woo, J. (2012) · AGE · doi:10.1007/s11357-012-9449-z · Cited by 31
“1983) and CSI (Chinese version) (Robinson 1983) were used to measure stress levels of the subjects.”
Method
The effectiveness of an augmented cognitive behavioural intervention for post-stroke depression with or without anxiety (PSDA): the Restore4Stroke-PSDA trial
Kootker, J. A., Fasotti, L., Rasquin, S. M. C., Heugten, C. M. V., & Geurts, A. C. H. (2012) · BMC Neurology · doi:10.1186/1471-2377-12-51 · Cited by 26
“In addition to patient-related outcomes we will also assess caregivers’ emotional and practical burden with the HADS, the Involvement Evaluation Questionnaire (IEQ) [44] and the Caregiver Strain Index (CSI) [6,45,46].”
Method
Design Opportunities for Supporting Informal Caregivers
Bosch, L., & Kanis, M. (2016) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/2851581.2892354 · Cited by 28
Psychometric Properties of a Modified Version of the Caregiver Reaction Assessment Scale Measuring Caregiving and Post-Caregiving Reactions of Caregivers of Cancer Patients
Bachner, Y. G., O’Rourke, N., & Carmel, S. (2007) · Journal of Palliative Care · doi:10.1177/082585970702300203 · Cited by 26
Impact of Passive In-Home Health Status Monitoring Technology in Home Health: Outcome Pilot
Alwan, M., Mack, D. C., Dalal, S., Kell, S., Turner, B. L., & Felder, R. A. (2006) · Transdisciplinary Conference on Distributed Diagnosis and Home Healthcare (D2H2) · doi:10.1109/ddhh.2006.1624802 · Cited by 27
“The Satisfaction With Life Scale (SWLS), Caregiver Strain Index (CSI) [10], and Caregiver Burden Interview (CBI) [11] were administered before and after Informal Caregivers were provided with access to reports.”
MethodInfluential
GERIATRIC ASSESSMENT
Palmer, R. M. (1999) · Medical Clinics of North America · doi:10.1016/s0025-7125(05)70177-2 · Cited by 28
The Impact of Metrifonate Therapy on Caregivers of Patients with Alzheimer's Disease: Results from the MALT Clinical Trial
Shikiar, R., Shakespeare, A., Sagnier, P., Wilkinson, D., McKeith, I. G., Dartigues, J., & Dubois, B. (2000) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2000.tb02645.x · Cited by 27
Prevalence and predictive factors of strain among caregivers of people with disability: results from R-Care community survey, Kerala, India
Devassy, S. M., Grills, N., Scaria, L., Benny, A. M., & Joubert, L. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1965231 · Cited by 26
Alzheimer’s Disease Caregiver Characteristics and Their Relationship with Anticipatory Grief
Pérez-González, A., Celaya, J. V., & Guàrdia‐Olmos, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168838 · Cited by 28
“With regard to the Spanish version of the Caregiver Strain Index (CSI) [34] validated by [35], it is a self-report measure composed of 13 items with true–false dichotomous response options that assess the degree of overexertion of caregivers.”
MethodInfluential
Coping, subjective burden and anxiety among family caregivers of older dependents
Casado, R. D. P., Pérez‐Cruz, M., & Osuna, A. F. (2014) · Journal of Clinical Nursing · doi:10.1111/jocn.12561 · Cited by 26
A Long-Term Follow-Up Programme for Maintenance of Motor Function after Stroke: Protocol of the life after Stroke—The LAST Study
Askim, T., Langhammer, B., Ihle‐Hansen, H., Magnussen, J., Engstad, T. A., & Indredavik, B. (2012) · Stroke Research and Treatment · doi:10.1155/2012/392101 · Cited by 26
“Finally Caregiver Strain Index (CSI) [35] is chosen to measure the burden of having a spouse or another significant family member suffering from stroke.”
Background
Individual nutrition therapy and exercise regime: A controlled trial of injured, vulnerable elderly (INTERACTIVE trial)
Thomas, S., Humphreys, K. J., Miller, M., Cameron, I. D., Whitehead, C., Kurrle, S. E., Mackintosh, S. F., & Crotty, M. (2008) · BMC Geriatrics · doi:10.1186/1471-2318-8-4 · Cited by 26
“In addition caregivers will also complete a caregiver burden and strain index [42,43].”
Background
Design of a Randomised Controlled Trial (RCT) on the effectiveness of a Dutch patient advocacy case management intervention among severely disabled Multiple Sclerosis patients
Wynia, K., Annema, C., Nissen, H., Keyser, J. D., & Middel, B. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-142 · Cited by 26
Supporting carers to manage pain medication in cancer patients at the end of life: A feasibility trial
Latter, S. M., Hopkinson, J. B., Lowson, E., Hughes, J. A., Hughes, J., Duke, S., Anstey, S., Bennett, M., May, C. R., Smith, P. W. F., et al. (2017) · Palliative Medicine · doi:10.1177/0269216317715197 · Cited by 26
“Measures assessed for acceptability and responsiveness to CCMM exposure in carers were knowledge, beliefs and skills in cancer pain medicines management (Family Pain Questionnaire 26 ); self-efficacy in pain management (Zeiss Caregiver Problem-Solving Self-Efficacy 27 ) and strain (Caregiver Strain Index 28 ).”
Background
Participation and the Role of Neuropsychological Functioning in Myotonic Dystrophy Type 1
Heugten, C. M. V., Meuleman, S., Hellebrekers, D. M. J., Reenen, E. T. K., & Visser‐Meily, J. M. A. (2018) · Journal of Neuromuscular Diseases · doi:10.3233/jnd-170246 · Cited by 26
“Caregiver burden was measured using the Care-giver Strain Index (CSI) [23].”
Are reasons for care‐giving related to carers’ care‐related quality of life and strain? Evidence from a survey of carers in England
Rand, S. E., Malley, J., & Forder, J. (2018) · Health & Social Care in the Community · doi:10.1111/hsc.12634 · Cited by 25
Living with and Caring for Older Family Members
Berg‐Weger, M., Rubio, D. M., & Tebb, S. S. (2000) · Journal of Gerontological Social Work · doi:10.1300/j083v33n02_04 · Cited by 26
“…of family caregivers (Stone, Cafferata & Sangl, 1987); identify predictors and outcomes of stress/strain in caregivers (George & Gwyther, 1986; Robinson, 1983; Zarit, Reever & Bach-Peterson, 1980); and assess factors that place the caregiver at risk for negative mental health (Schulz,…”
Background
Enthusiasm and Moral Commitment: What Sustains Family Caregivers of Those With Dementia
Pierce, T., Lydon, J. E., & Yang, S. (2001) · Basic and Applied Social Psychology · doi:10.1207/153248301750123050 · Cited by 26
“Robinson (1983) and Zarit et al. (1980) found no such differences between spouse and adult child caregivers, whereas Harper and Lund (1990) noted that caregiving daughters who lived with the patient experienced a greater burden than spouse caregivers.”
BackgroundMethod
Gender differences in caregiver strain, needs for support, social support, and quality of life among spousal caregivers of persons with multiple sclerosis
Lee, E., Pieczynski, J., DeDios-Stern, S., Simonetti, C., & Lee, G. K. (2015) · Work · doi:10.3233/wor-152205 · Cited by 26
“88) [43].”
Non pharmacological interventions for spasticity in multiple sclerosis
Amatya, B., Mantia, L. L., Demetrios, M., & Khan, F. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009974 · Cited by 26
Assessment of Caregiver Inventory for Rett Syndrome
Lane, J. B., Salter, A. R., Jones, N. E., Cutter, G., Horrigan, J. P., Skinner, S. A., Kaufmann, W. E., Glaze, D. G., Neul, J. L., & Percy, A. K. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3034-3 · Cited by 25
“1980; Robinson 1983; Morycz 1985; Schwartz et al.”
An extended stroke rehabilitation service for people who have had a stroke: the EXTRAS RCT
Shaw, L. C., Bhattarai, N., Cant, R., Drummond, A. E., Ford, G. A., Förster, A., Francis, R. P., Hills, K., Howel, D., Laverty, A. M., et al. (2020) · Health Technology Assessment · doi:10.3310/hta24240 · Cited by 29
“Generic service 16 (30) 12 (44) 3 (41) 18 (58) 4 (13)”
Personal and Family Resources Related to Depressive and Anxiety Symptoms in Women during Puerperium
Alcalá, D. F., Osuna, A. F., & Casado, R. D. P. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17145230 · Cited by 25
“Perceived burden was assessed using the Caregiver Strain Index [53], a scale that measures the degree of overexertion of carers of dependent people in general.”
Method
Creation and Initial Validation of the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) Screening Tool
Shune, S., Resnick, B. M., Zarit, S. H., & Namasivayam-MacDonald, A. M. (2020) · American Journal of Speech-Language Pathology · doi:10.1044/2020_ajslp-20-00148 · Cited by 25
Measuring carer quality of life in Duchenne muscular dystrophy: a systematic review of the reliability and validity of self-report instruments using COSMIN
Carlton, J., Powell, P. A., & Project HERCULES Carer Group (2022) · Health and Quality of Life Outcomes · doi:10.1186/s12955-022-01964-4 · Cited by 29

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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