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).
|Variables||Adjusted odds ratiob||95% CI||P-valuec|
|Psychological domaina||Modified CSI||2·22||1·08–4·54||0·03|
|Type of stroke||0·21||0·08–0·57||0·002|
|Modified CSI||Social domain||0·29||0·11–0·81||0·02|
Anxiety (47%) and depression (43%) frequency was lower in our cohort compared with the Kolkata study from India (anxiety and depression 76%) . The caregivers in our study were found to have high scores on all four domains of WHOQOL in contrast with studies from Nigeria  and the Netherlands , 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.