Depression, Depressive Symptoms, Post-stroke Depression, Stroke
Conditions
Keywords
couples, positive psychology, behavioral intervention, stroke, depression, wellbeing, caregiver
Brief summary
This study aims to pilot test an 8-week, self-administered dyadic (couples-based) positive psychology intervention for couples coping with stroke using a randomized, waitlist control design. Mood and well-being will be assessed pre- and post-intervention, and at 3-month follow-up. It is expected that both partners will demonstrate improvement in mood and well-being.
Detailed description
Stroke survivors and spousal caregivers face significant challenges, yet interventions to support couples after stroke are largely lacking. Depressive symptoms post-stroke occur in 30-50% of survivors and partner caregivers, and have significant consequences on function and quality of life. Further, mood and psychosocial well-being are reciprocal in couples, meaning if one partner is depressed, the other is more likely to be depressed. Sustaining well-being in both partners is important for continued engagement in rehabilitation and re-integration into the community, yet existing interventions are aimed at the individual rather than the couple. This study will address this gap by testing an innovative dyadic (couples-based) intervention using a new approach based on positive psychology that focuses on the strengths in the relationship in order to foster resilience in the couple. Using a randomized waitlist control design, this pilot study aims to determine whether an 8-week dyadic positive psychology-based intervention (PPI) can improve mood and subjective well-being as assessed by established outcome measures in 24 couples coping with stroke. The intervention consists of self-administered PPI activities, such as expressing gratitude and practicing acts of kindness, which participants complete individually and as a couple. Two potential pathways will be explored for the PPI: (a) enhanced quality of interactions as couples deal with daily life demands and (b) improvements in mood that are contagious among couples. If found effective, couples with greater well-being may be better emotionally equipped to cope with the sequelae of stroke by reducing stress and depressive symptoms, and increasing participation in meaningful activities and quality of life.
Interventions
BEHAVIORALDyadic (couples-based) positive psychology intervention
Self-administered behavioral intervention in which participants complete at least 2 activities alone and 2 together each week for 8 weeks. Positive psychology activities include expressing gratitude, practicing acts of kindness, fostering relationships, working toward a goal, focusing on the positive, spirituality, and savoring.
Sponsors
University of Utah
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Waitlist control design; participants are assigned to receive intervention or be waitlisted for 4-6 weeks and then receive intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Couples consist of one partner who had an ischemic or hemorrhagic stroke \>3 months ago and a cohabiting partner (\> 1 year) who self-identifies as the caregiver and is willing to enroll in the study; * Either one or both partner(s) report depressive symptoms as assessed by the PROMIS-D (no formal diagnosis is required).
Exclusion criteria
* the caregiver has had a stroke or other major neurological condition; * either partner is unable to understand the printed English instructions; * either partner scores \<19 (the established cut-off for mild cognitive impairment) on the Montreal Cognitive Assessment (MoCA), a validated screening instrument for cognitive performance.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PROMIS Depression-SF | Change from baseline to 8 weeks (post-intervention) | An 8-item measure of depressive symptoms in which participants rate how they have felt over the past 7 days (e.g., I felt worthless, I felt unhappy) on a 5-point Likert scale from never to always). Higher scores are worse. |
| NeuroQOL Positive Affect and Wellbeing-SF | Change from baseline to 8 weeks (post-intervention) | A 9-item measure of wellbeing in which participants rate how they have felt lately (e.g., my life had purpose, I felt hopeful) on a 5-point Likert scale from never to always. Higher scores are better |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Stroke Impact Scale | Change from baseline to 8 weeks (post-intervention) | A 60-item stroke-specific quality of life measure in which participants rate how stroke has impacted them across 8 domains (e.g., strength of affected arm, communication, activities of daily living) on a 5-point Likert scale (not difficult to cannot do at all). Higher scores are better (indicate better quality of life) |
| Positive Affect and Negative Affect Schedule (PANAS) | Change from baseline to 8 weeks (post-intervention) | A measure of positive affect and negative affect; participants rate a list of 20 adjectives that describes them (e.g., afraid or excited) on a 5-point Likert scale from Not at all to Extremely. Scores are summed for two subscales (positive affect, negative affect), and higher scores indicate having more of either positive or negative affect |
Other
| Measure | Time frame | Description |
|---|---|---|
| Caregiver Strain Index | Change from baseline to 8 weeks (post-intervention) | A 13-item measure of caregiver strain, in which participants respond yes (1 point) or no (0 points) to items including sleep is disturbed, and it is inconvenient; higher scores mean more strain |
| Dyadic Coping Inventory | Change from baseline to 8 weeks (post-intervention) | A 39-item measure of coping for couples in which participants indicate how they (as a couple) cope with stress on a 5-item Likert scale from very rarely to very often. Higher scores indicate better/more adaptive coping |
Countries
United States
Outcome results
None listed