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Preventing Chronic Emotional Distress in Stroke Survivors and Their Informal Caregivers

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Abstract

Background/Objective

Chronic emotional distress (e.g., depression, anxiety, post-traumatic stress) is common after stroke and interdependent between patients and their informal caregivers. We measured stroke survivors’, caregivers’, and neurocritical care nurses’ views of primary drivers of distress during the stroke experience, and needs and preferences for the structure, topics, mode of delivery, and timing of an intervention to promote emotional recovery.

Methods

We conducted semi-structured interviews with 24 patient–caregiver dyads within the Neuroscience Intensive Care Unit (Neuro-ICU). Additionally, we conducted two focus groups with 15 nurses. Interviews and focus groups were audio-recorded, transcribed, and coded using NVivo 11 (QSR International) software.

Results and Conclusions

The challenges and impacts of stroke most commonly reported by dyads were: uncertainty about future health, fear of recurrent strokes, negative emotions, and role changes post-stroke. Dyads and nurses agreed that resiliency skills such as mindfulness/focusing on the present, problem solving, gratitude/optimism, self-care, interpersonal communication and developing a supportive team of family, friends, and medical staff are beneficial to optimize recovery. The potential barrier to intervention delivery was accessibility, due to challenges of time and travel to appointments. Participants agreed that starting the intervention at hospitalization and continuing via live video after discharge is an ideal delivery modality. Stroke survivors, caregivers, and Neuro-ICU nurses believe that a resiliency skills-based intervention to prevent chronic emotional distress is necessary and urgent. This qualitative study provides valuable information on the challenges faced by dyads, intervention topics to prioritize, and strategies to maximize feasibility, acceptability, and effect.

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Acknowledgements

We thank Catherine Pierre-Louis for assistance with the qualitative analyses. We thank the Neuro-ICU nursing team for feedback with the design of the qualitative interviews and assistance with recruitment.

Funding

This study was possible due to a Grant in Aid (228671) from the American Heart Association awarded to Ana-Maria Vranceanu, a grant from the Brain Aneurysm Foundation (229663) awarded to Ana-Maria Vranceanu, and support from Henry and Allison McCance Center for Brain Health

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Authors and Affiliations

  1. Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA

    Jessica L. McCurley, Christopher J. Funes, Emily L. Zale, Ann Lin, Michelle Jacobo, Jamie M. Jacobs & Ana-Maria Vranceanu

  2. Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA

    Jessica L. McCurley, Emily L. Zale, Michelle Jacobo, Jamie M. Jacobs, Jonathan Rosand & Ana-Maria Vranceanu

  3. Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA

    Jessica L. McCurley, Danielle Salgueiro, Tara Tehan, Jonathan Rosand & Ana-Maria Vranceanu

  4. Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, USA

    Jonathan Rosand

Authors
  1. Jessica L. McCurley
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  2. Christopher J. Funes
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  3. Emily L. Zale
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  4. Ann Lin
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  5. Michelle Jacobo
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  6. Jamie M. Jacobs
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  7. Danielle Salgueiro
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  8. Tara Tehan
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  9. Jonathan Rosand
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  10. Ana-Maria Vranceanu
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Contributions

All authors contributed sufficiently to this scientific work and met criteria for authorship.

Corresponding author

Correspondence to Ana-Maria Vranceanu.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by our Institutional Review Board ethics committee.

Additional information

Work performance site: Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School

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McCurley, J.L., Funes, C.J., Zale, E.L. et al. Preventing Chronic Emotional Distress in Stroke Survivors and Their Informal Caregivers. Neurocrit Care 30, 581–589 (2019). https://doi.org/10.1007/s12028-018-0641-6

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  • DOI: https://doi.org/10.1007/s12028-018-0641-6

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