When couples disagree on stroke recovery, one partner can suffer

An innovative study from a University of Cincinnati (UC) social work researcher has found that when a stroke survivor and his or her caregiving spouse disagree on the survivor's rate of recovery, the caregiving spouse is more likely to experience depression and emotional distress.

Assistant Professor Michael McCarthy, PhD, working with co-author Karen Lyons at the Oregon Health and Science University, interviewed 35 couples in which one spouse had experienced a stroke within the past three years.

In separate sessions, stroke survivors and their spouses discussed the survivor's recovery, including the performance of daily functions, their memory and ability to problem solve. In the first mixed-method study in the topic, both quantitative and qualitative data showed that spouses rated rehabilitation progress as significantly worse than survivors—and that this discrepancy was associated with spouse depression.

"We found that spouses rated their partners' recovery worse than survivors rated it themselves, and that this discrepancy predicted depressive symptoms in the spouses," says McCarthy.

"So if the wife has a stroke," he continues, "and she believes, for example, that she can still drive but her husband doesn't—the difference in their perception is predictive of the husband's emotional distress. We were able to quantify and capture a different kind of worry and stress that caregiving spouses can experience and connect it to their outcomes."

He adds that the magnitude of the discrepancy in perceptions between survivors and spousal caregivers is key to predicting depression in spousal caregivers—which can then cycle back onto the survivors.

McCarthy says there is some evidence that wives may be particularly susceptive to caregiver worry, as are spouses in strong, fulfilling relationships. With studies demonstrating that stroke caregivers have higher rates of depression than the general public and may be at higher risk for stroke themselves as well as premature death, caregiver mental health has profound consequences.

McCarthy hopes the study can help social work and other rehabilitation practitioners working with stroke survivors. Overall, he says health care needs to broaden the conversation around stroke recovery: from focusing solely on the patient to considering the patient-spouse couple as a unit.

"How the spouse is doing matters in the equation," he says. "They need as much care, if not more in some ways, as the patient. We need to bring partners together in the rehabilitation process, to align each person's expectations and perceptions in order to achieve the best outcomes."

His paper, "Incongruence between stroke survivor and spouse perceptions of survivor functioning and effects on spouse emotional health," has been published online in the journal Aging & Mental Health.