Using a range of different methodologies this research attempts to address aspects of the caregiver-care-receiver relationship between individuals who have experienced a stroke and their (mainly spousal) carers. The research examines cognitions ( control, perceived disability) appraisals and relational factors (marital intimacy and interaction quality) and their impact on psychological well-being (anxiety and depression) in stroke patients and their carers. Study 1 examined stroke patients' and carers' psychological distress in a cross-sectional design. A small prospective sample of eight patient and carer pairs took part across all time-points. Results revealed that carers were more distressed than the stroke patients and perceived the person with stroke to have greater disability and less control over recovery. The correlations demonstrated the following: that appraisals of caring were associated with carer anxiety and depression; and that patients' perceived level of disability and control
associated with depression and anxiety. The data from the small prospective sample was only descriptively analysed but the results for the dyads exhibit large variation, with the exception of relationship satisfaction which decreased in all dyads across time. The decrease in relationship satisfaction is interesting as those patient and carers that were married rated their marital intimacy as high and unchanged from pre-stroke ratings; this finding was thought worthy of further investigation.
Study 2 examined qualitatively the impact of stroke on persons with stroke and their spouses, looking at the impact of the stroke on the patients' and carers' sense of self and relationship; Ten married couples took part in this study. The main themes found for patients and carers were: living with the aftermath of stroke; making sense; and negotiating care, with differing sub-themes for patients and carers. A second level of analysis in this study was the nature of the communication seen in these couples and the triangulation of couples' coded
communication styles with the quantitative data on depression and anxiety in Study 1. Those couples that exhibited conflicted or carer dominant styles of interaction had significantly more anxious carers than those with equal levels of interaction. To examine whether interaction differs as a result of caregiving, rather than as a normal variation in a relationship, it was thought important to use a different methodology to capture interaction.
Study 3 piloted a novel observational technique to examine whether stroke caregiving wives to husbands with stroke exhibited different interaction patterns than non-caregiving wives; 14 couples took part in this study. There were specific differences in caregiving wives who displayed more dominant and depersonalising behaviour than non-caregiving wives on a puzzle task. Overall caregiving couples were more depressed than non-caregiving couples.
Study 4 examined lay perceptions of stroke and caring using an adapted Illness Perceptions Questionnaire and Caring Impact Appraisal Scale with 83 adults. The results found gaps and confusion in the knowledge regarding stroke and this study addresses issues for health promotion and improved understanding by the wider population of stroke and its impact on individuals and carers.