caregiver, coping skills, depressive symptoms, mixed methods, stroke



  1. King, Rosemarie B. PhD, RN, FAHA, FAAN
  2. Raad, Jason H. PhD
  3. Flaherty, Jennifer PhD
  4. Hartke, Robert J. PhD, MPH


BACKGROUND: Mixed-method studies can shed light on the mechanisms through which interventions effectively reduce caregiver depression.


OBJECTIVE: The objective of this qualitative study was to understand factors contributing to reduced depressive symptoms in stroke caregiver treatment responders compared with nonresponders.


METHODS: A mixed-methods explanatory sequential design was used to assess cognitive behavioral coping use and helpfulness in reducing depression among experimental study treatment responders and nonresponders. Using purposive sampling at 1-year of caregiving, we selected responders who were not depressed or demonstrated reduction to probable depression and nonresponders whose scores indicated worsened or new depression. Participants responded to semistructured interviews on life changes and the use and helpfulness of intervention coping strategies. Thematic analysis identified codes and themes.


RESULTS: Twelve of 25 participants were responders. We identified 2 overarching outcome themes: "It was about me, changing to make life better" (responders) and "Lamenting our changed lives" (nonresponders). Five subthemes related to coping were identified. Whereas responders coped actively and were less dependent on the counseling relationship, nonresponders were passive in coping and more dependent on the initial counseling relationship. Anger or previous psychologic treatment was found in more than a quarter of nonresponders and in no responders. Negative life change was found in 9 of 13 nonresponders compared with 1 responder.


CONCLUSION: Findings support the helpfulness of cognitive behavioral coping. For many caregivers, engagement interviews and a more intense, longer intervention, such as stepped care and anger management, are indicated to mitigate treatment resistance and depressive symptoms, respectively.