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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Method
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Method
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Background
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Method
Development of the Head and Neck Cancer Caregiving Task Inventory
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“…(5-20) Emotional involvement (3-12) Environment (3-12) --------- NA Easy Free Hypothesis testing Caregiver Strain Index (CSI) Utens, 2014 34 Robinson, 1983 92 13 items yes/no 0-13 --------- 5 min or less Easy Free No Carers’ Assessment of Difficulties Index (CADI) Figueiredo, 2014 38…”
Background
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BackgroundInfluential
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NHG-Standaard Dementie (derde herziening)+
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BackgroundMethodInfluential
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Method
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Method
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Background
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“Higher scores indicate a higher the level of psychological stress, with a score of 7 or higher indicated a great level of stress [4, 39].”
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“The maximum possible score is 13 and caregivers who score seven or more are considered to be at risk of clinical distress [23-25].”
Background
Single case experimental design study of Carer facilitated Errorless Learning in a patient with severe memory impairment following TBI
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“– Caregiver Strain Index (CSI) [14] Results are presented in Table 3, within the results section.”
Life satisfaction and family strengths of older couples
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Medical Crises in Older People: cohort study of older people attending acute medical units, developmental work and randomised controlled trial of a specialist geriatric medical intervention for high-risk older people; cohort study of older people with mental health problems admitted to hospital, developmental work and randomised controlled trial of a specialist medical and mental health unit for general hospital patients with delirium and dementia; and cohort study of residents of care homes and interview study of health-care provision to residents of care homes
Gladman, J. R. F., Harwood, R., Conroy, S., Logan, P., Elliott, R. A., Jones, R. G., Lewis, S., Dyas, J., Schneider, J. M., Porock, D. C., et al. (2015) · Programme Grants for Applied Research · doi:10.3310/pgfar03040 · Cited by 14
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Sensory impairment and recovery after stroke
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The Burden of Care in Instances of Chronic Non-communicable Disease
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“Robinson BC. Validation of a Caregiver Strain Index.”
Background
Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): study protocol for a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture [ISRCTN22464643]
Williams, N. H., Hawkes, C., Din, N. U., Roberts, J. L., Charles, J. M., Morrison, V. L., Hoare, Z., Edwards, R. T., Andrew, J. G., Alexander, S., et al. (2015) · Pilot and Feasibility Studies · doi:10.1186/s40814-015-0008-0 · Cited by 14
“Carers will be asked to complete a carer burden questionnaire [20] at baseline and at follow-up.”
Background
Assessments for Caregivers of Hospitalized Older Adults
Fields, B., Turner, R. L., Naidu, M., Schulz, R., James, A. E., & Rodakowski, J. L. (2018) · Clinical Nursing Research · doi:10.1177/1054773818816207 · Cited by 14
“Likewise, the Caregiver Strain Index is a commonly used measure of objective and subjective elements of strain for caregivers of older adults that were recently discharged home (Robinson, 1983).”
Background
Development and validation of a screener based on interRAI assessments to measure informal caregiver wellbeing in the community
Betini, R., Hirdes, J. P., Curtin-Telegdi, N., Gammage, L., Vansickle, J., Poss, J. W., & Heckman, G. A. (2018) · BMC Geriatrics · doi:10.1186/s12877-018-0986-x · Cited by 14
“The Caregiver Strain Index (CSI), an assessment to identify caregivers experiencing strain [37, 38], was completed by the caregiver.”
Effect of an intensive 3-day social cognitive treatment (can do treatment) on control self-efficacy in patients with relapsing remitting multiple sclerosis and low disability: A single-centre randomized controlled trial
Jongen, P. J., van Mastrigt, G. A. P. G., Heerings, M. A. P., Visser, L. H., Ruimschotel, R. P., Hussaarts, A., Duyverman, L., Valkenburg-Vissers, J., Cornelissen, J., Bos, M., et al. (2019) · PLoS ONE · doi:10.1371/journal.pone.0223482 · Cited by 14
“Abbreviations: CDT, Can do treatment; CSI, Caregiver Strain Index; EDSS, Expanded Disability Status Scale; HADS, Hospital Anxiety and Depression Scale; HRQoL, Health-Related Quality of Life; IPA, Impact on Participation and Autonomy; MSSES, Multiple Sclerosis Self-Efficacy Scale; RRMS, Relapsing Remitting Multiple Scl…”
BackgroundMethodInfluential
Approaches to Assessing Burden in Caregivers of Patients with Cirrhosis
Yanny, B., Pham, N. V., Saleh, H., & Saab, S. (2020) · Journal of Clinical and Translational Hepatology · doi:10.14218/jcth.2019.00054 · Cited by 15
“We suggest this tool be used as a pathway to determine the reason for the patient’s caregiver’s most serious concern, and based on the concern, another in depth tool may be utilized to further evaluate the burden.(16,17) Caregiver benefit index: This index examines benefits perceived by transplant caregivers in 12 are…”
BackgroundMethod
Coping and Burden Among Informal HIV Caregivers
Engler, P. A., Anderson, B. J., Herman, D. S., Bishop, D. S., Miller, I. W., Pirraglia, P. A., Hayaki, J., & Stein, M. D. (2006) · Psychosomatic Medicine · doi:10.1097/01.psy.0000245901.82935.cb · Cited by 14
“degree of caregiver strain or burden (23).”
Methodology of the Stroke Self-Management Rehabilitation Trial: An International, Multisite Pilot Trial
Jones, K., Bhattacharjee, R., Krishnamurthi, R., et al. (2014) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2014.08.029 · Cited by 14
Evaluating an extended rehabilitation service for stroke patients (EXTRAS): study protocol for a randomised controlled trial
Rodgers, H., Shaw, L. C., Cant, R., Drummond, A. E., Ford, G. A., Förster, A., Hills, K., Howel, D., Laverty, A.-M., McKevitt, C., et al. (2015) · Trials · doi:10.1186/s13063-015-0704-3 · Cited by 14
“This is because the Caregiver Strain Index asks some sensitive questions about the impact of stroke upon the carer [21]; a carer may modify their answer if they could be overheard on the telephone by the patient.”
BackgroundMethod
Facilitating return to work through early specialist health-based interventions (FRESH): protocol for a feasibility randomised controlled trial
Radford, K., Phillips, J. S., Jones, T. M., et al. (2015) · Pilot and Feasibility Studies · doi:10.1186/s40814-015-0017-z · Cited by 14
“Secondary measures of effectiveness collected at 3-, 6and 12-month post randomisation include hospital anxiety and depression scale [30], extended activities of daily living [31], community integration questionnaire [32], EuroQol EQ-5D-3 L [33], work productivity and activity impairment questionnaire [34], carer-strai…”
Method
Design and validation of an electrophysiological based tool to assess chronic stress. Case study: burnout syndrome in caregivers
Mir, S. A., Pagès, E. G., López, B., Ribeiro, T. C., Rey, J. M. G., & Aguiló, J. (2020) · Stress · doi:10.1080/10253890.2020.1807512 · Cited by 16
“Different scales have emerged, such as the Burden Inventory (Zarit et al., 1980) or Caregiver Strain Index (Robinson, 1983), but there is no consensus and these can be easily biased due to their subjective nature.”
Background
Patient Preferences in Rare Diseases: A Qualitative Study in Neuromuscular Disorders to Inform a Quantitative Preference Study
Jimenez‐Moreno, C., van Overbeeke, E., Pinto, C. A., Smith, I. P., Sharpe, J. A., Ormrod, J. S., Whichello, C. L., de Bekker-Grob, E. W., Bullok, K. E., Levitan, B. S., et al. (2021) · Patient · doi:10.1007/s40271-020-00482-z · Cited by 14
Exploring Self-Efficacy and Hardiness in Spousal Caregivers of Individuals with Dementia
DiBartolo, M. C. (2002) · Journal of Gerontological Nursing · doi:10.3928/0098-9134-20020401-07 · Cited by 14
Development and feasibility testing of an AI-powered chatbot for early detection of caregiver burden: protocol for a mixed methods feasibility study
Shankar, R., Bundele, A., Yap, A. E., & Mukhopadhyay, A. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1553494 · Cited by 14
“Traditional assessment methods, such as the Zarit Burden Interview (ZBI) (9) and the Caregiver Strain Index (CSI) (10), rely on infrequent self-report measures that may not capture the dynamic nature and contextual factors in ﬂ uencing caregiver burden.”
A structured multicomponent group programme for carers of people with acquired brain injury: Effects on perceived criticism, strain, and psychological distress
Fortune, D. G., Rogan, C., & Richards, H. L. (2015) · British Journal of Health Psychology · doi:10.1111/bjhp.12159 · Cited by 16
How Is the Caregiver Doing? Capturing Caregivers’ Experiences With a Reflective Toolkit
Bosch, L., Kanis, M., Dunn, J. A., Stewart, K. A., & Kröse, B. (2019) · JMIR Mental Health · doi:10.2196/13688 · Cited by 13
“It should be noted that the CSI instrument was originally developed to screen partners of older adults for caregiver strain.”
Influential
Developing and Implementing a Geriatric Emergency Department (GED): Overview and Characteristics of GED Visits
Shadyab, A. H., Castillo, E. M., Chan, T. C., & Tolia, V. M. (2021) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2021.02.036 · Cited by 13
Improving Caregiver Health through Systematic Assessment and a Tailored Plan of Care
Camicia, M., Lutz, B. J., Stram, D. A., Tucker, L.-Y. S., Ray, C., & Theodore, B. R. (2021) · Western Journal of Nursing Research · doi:10.1177/01939459211045432 · Cited by 14
“Pont et al., (2020) identified caregiver burden (measured by the MCSI) in 21% of stroke caregivers at 6 months and 62% at 12 months.”
BackgroundMethodInfluential
Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson’s disease. Protocol for a longitudinal, randomized clinical trial
Cubo, E., García‐Bustillo, Á., González, Á. A., Ramírez‐Sanz, J. M., Garrido‐Labrador, J. L., Valiñas‐Sieiro, F., Allende‐Río, M., Gonzalez-Bernal, J. J., González‐Santos, J., Díez-Pastor, J.-F., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0260889 · Cited by 13
“3) Patient’s health-related quality, caregiver burden, and comorbidities will be assessed using the Quality of life European Health Interview Survey-Quality of Life 8 item index [EUROHIS-QOL 8 item-index] [45]; the Parkinson’s disease summary index score (PDQ-39) [46], Zarit Caregiver Burden Inventory (ZCBI) [47], and…”
Method
Task-specific training versus usual care to improve upper limb function after stroke: the “Task-AT Home” randomised controlled trial protocol
van Vliet, P., Carey, L. M., Turton, A., Kwakkel, G., Palazzi, K. L., Oldmeadow, C. J., Searles, A., Lavis, H., Middleton, S., Galloway, M. E., et al. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2023.1140017 · Cited by 12
“Using similar assumptions, the study would have 80% power to detect differences between groups of 0.3 SDs on the WMFT, MAL, and the Caregiver Strain Index.”
MethodInfluential
Predictors of Burden for First-Ever Stroke Survivor’s Long-Term Caregivers: A Study of KOSCO
Lee, J.-W., Sohn, M. K., Lee, J., Kim, D. Y., Shin, Y., Oh, G., Lee, Y., Joo, M. C., Lee, S. Y., Han, J., et al. (2024) · Medicina · doi:10.3390/medicina60040559 · Cited by 13
“Contrary to the method used in the studies mentioned above, the questionnaire in our study did not reflect the actual provided care hours or labor intensity [49,50].”
Result
The Use of a Biplot in Studying Outcomes After Stroke
Wit, L. D., Molas, M., Dejaeger, E. W., et al. (2009) · Neurorehabilitation and neural repair · doi:10.1177/1545968309337137 · Cited by 13
“Finally, at the same time points, the burden on the patients’ principal caregiver was assessed using the Caregiver Strain Index (CSI).(19) The principal caregiver was defined as the person who helps the patient the most, but is not reimbursed.”
Method
An intensive social cognitive program (can do treatment) in people with relapsing remitting multiple sclerosis and low disability: a randomized controlled trial protocol
Jongen, P. J., Heerings, M. A. P., Ruimschotel, R. P., Hussaarts, A., Evers, S., Duyverman, L., Valkenburg-Vissers, J., Cornelissen, J., Bos, M., van Droffelaar, M., et al. (2016) · BMC Neurology · doi:10.1186/s12883-016-0593-4 · Cited by 14
“upon them [23, 24].”
Effects of family group conferences among high-risk patients of chronic disability and their significant others: study protocol for a multicentre controlled trial
Hillebregt, C. F., Scholten, E. W. M., Ketelaar, M., Post, M. W. M., & Visser‐Meily, J. M. A. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-018883 · Cited by 13
Measuring burden in caregivers of people with multiple sclerosis: psychometric properties of the CSI questionnaire
García‐Domínguez, J. M., Martínez‐Ginés, M. L., Carmona, O., et al. (2019) · Patient Preference and Adherence · doi:10.2147/ppa.s180863 · Cited by 13
“A total score of 7 or higher indicates a high level of caregiver burden.(18) The Spanish validated version of the instrument was used.”
Method
Caregivers’ effects of augmented cognitive-behavioural therapy for post-stroke depressive symptoms in patients: secondary analyses to a randomized controlled trial
Kootker, J. A., Heugten, C. M. V., Kral, B., Rasquin, S. M. C., Geurts, A. C. H., & Fasotti, L. (2019) · Clinical Rehabilitation · doi:10.1177/0269215519833013 · Cited by 13
Belastungen in der Betreuung von Parkinson-Patientinnen und - Patienten
Ransmayr, G. N. (2020) · Fortschritte der Neurologie · Psychiatrie · doi:10.1055/a-1120-8567 · Cited by 13
Instruments to assess the burden of care for family caregivers of adult palliative care patients
Pop, R. S., Payne, S. A., Ţînţ, D., Pop, C. P., & Mosoiu, D. V. (2022) · International Journal of Palliative Nursing · doi:10.12968/ijpn.2022.28.2.80 · Cited by 13
Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Goals-of-Care and Family/Surrogate Decision-Maker Data
Jaffa, M., Kirsch, H. L., Creutzfeldt, C. J., Guanci, M. M., Hwang, D. Y., LeTavec, D., Mahanes, D., Natarajan, G., Steinberg, A., Zahuranec, D. B., et al. (2023) · Neurocritical Care · doi:10.1007/s12028-023-01796-0 · Cited by 13
Caregiver role strain of older workers
Beitman, C. L., Johnson, J. L., Clark, A. L., et al. (2004) · Work · doi:10.3233/wor-2004-00345 · Cited by 13
“…also increased due to one’s impaired concentration, tired-ness, or emotional upsets associated with caregiving tasks [6–8, The older adult worker-caregivermay feel conﬂicted in attempts to balance work and ﬁnancial demands, those of other family members, and those of the care recipient [1,26,31].”

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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