Psychosocial problems, quality of life, and caregiver burden among stroke caregivers in India


  • Conflict of interest: None declared.

Correspondence: Jeyaraj D. Pandian*, Betty Cowan Research and Innovation Centre, Christian Medical College, Ludhiana, Punjab 141008, India.


Dear editor,

From November 1, 2008 to February 1, 2010, patients were interviewed after more than one-month poststroke. Anxiety and depression were recorded using the Hospital Anxiety and Depression Scale. The World Health Organization (WHO) Quality of Life Instrument (WHOQOL-Bref) was used, and caregiver burden was evaluated using modified caregiver strain index (modified CSI).

One-hundred fifty-two caregivers participated (mean age 40·5 ± 13·8 years (range 17 to 78); women 104 (68·4%)). Majority of the caregivers (100 (65·8%)) belonged to joint families. Mean duration of follow-up was 18·9 ± 26·7 months (range 1 to 147), and 113 (74·3%) patients had an ischemic stroke. Anxiety was seen in 72 (47%) caregivers and 66 (43%) had depression. The mean transformed scores for the domains of WHOQOL were as follows: physical 57·6 ± 13·5; psychological 62·9 ± 14·7; social 72·6 ± 19·4; and environmental 62·8 ± 17·9.

The mean score for modified CSI was 12·6 ± 6·8 and caregiver strain was seen in 129 (85%) subjects. In the multivariate logistic regression analysis, anxiety was the predictor of caregiver strain (Table 1). Ischemic stroke and WHOQOL psychological domain were the predictors of depression (Table 1).

Table 1. Factors predicting WHOQOL, HADS, and modified CSI in multivariate logistic regression analysis
 VariablesAdjusted odds ratiob95% CIP-valuec
  1. aAnxiety and depression were not included in the model.
  2. bVariables adjusted include, age, gender, income, education, family type, stroke type, duration of follow-up, and outcome (mRs).
  3. cP < 0·005 significant (Bonferroni correction for multiple comparisons).
  4. WHOQOL, World Health Organization Quality of Life Instrument; HADS, Hospital Anxiety and Depression Scale; CSI, caregiver strain index.
Physical domainDepression3·111·42–6·840·005
Psychological domainaModified CSI2·221·08–4·540·03
Social domainDepression4·291·90–9·68<0·0001
Environmental domainDepression5·262·21–12·49<0·0001
AnxietyCaregiver age10·501·47–74·880·02
Modified CSI0·230·09–0·530·001
DepressionCaregiver gender2·590·98–6·860·05
Type of stroke0·210·08–0·570·002
Psychological domain5·211·88–14·450·001
Modified CSISocial domain0·290·11–0·810·02

Anxiety (47%) and depression (43%) frequency was lower in our cohort compared with the Kolkata study from India (anxiety and depression 76%) [1]. The caregivers in our study were found to have high scores on all four domains of WHOQOL in contrast with studies from Nigeria [2] and the Netherlands [3], where low scores were observed in caregivers for all the domains of QOL. Despite high scores in QOL, our cohort experienced a high caregiver strain.

The better QOL and low frequency of anxiety and depression could be related to the good social support that caregivers and patients receive in a joint family. This also enables them to cope with a high caregiver strain.

  • Rinu Susan Raju, Parmdeep Kaur, and Jeyaraj D. Pandian*

  • Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, Punjab, India