Spouses of stroke patients. Psychological Well-Being and Life Satisfaction

Abstract

Aim: The aim of this study was to investigate longitudinal changes in spouses' psychological well-being and life satisfaction between the first weeks, four months and one year after their partners' stroke and to study the associations between spouses' psychological well-being and life satisfaction and characteristics of the spouses and stroke patients at these three points in time.Method: Eighty-three consecutively recruited spouses of first-ever stroke patients < 75 years participated. The spouses' self-rated psychological general well-being, life satisfaction and sense of coherence were measured in the first week, four months and one year after stroke in a semi-structured interview also including open questions about experiences of their ongoing life situation. The stroke patients' physical and cognitive impairments and level of self-care were documented in the first week and one year after stroke. Depression and astheno-emotional syndrome were documented at one year. The interview data were analysed with qualitative analysis methods. The quantitative data were analysed with non-parametric statistical methods.Results: In the first weeks, the spouses' psychological well-being was significantly lowered as compared with norm values. Four different categories of the concept of "view of the future" were developed on the basis of the interviews. The spouses' view of the future was strongly associated with their psychological well-being. Their sense of coherence was associated with satisfaction with social relationships and financial situation prior to stroke and with psychological well-being in the present. Four months after the stroke, the spouses' psychological well-being had increased. However, as compared with life prior to stroke, their life satisfaction was lower. There were no statistically significant changes in psychological well-being or life satisfaction between four months and one year. The spouses' sense of anxiety, depressed mood and vitality as well as satisfaction with their daily activities and leisure situation were significantly associated with the stroke patients' physical impairments and ability in self-care. Their sense of positive well-being and their satisfaction with the partner relationship and family life were significantly associated with the presence of cognitive impairments and astheno-emotional syndrome in the stroke patients. The spouses' and stroke patients' emotional health was related. The associations between the spouses' psychological well-being and the stroke patients' impairments were most marked at four months, except for sensorimotor impairment, while the associations between spouses' life satisfaction and the stroke patients' impairments were most marked at one year.Conclusion: The spouses' individual appraisal of the consequences for their personal lives seems to have a greater impact on their well-being than the patients' objective impairments in the first period after stroke. The visible physical impairments had a great impact on spouses' well-being in the firs phase, while the impact of cognitive and emotional impairments became more evident in everyday life. Some months after the initial crisis reaction, the psychological well-being of the spouses increased, while satisfaction with valuable domains of life decreased. Between four months and one year, individual changes were observed in both positive and negative directions. Spouses of stroke patients with persisting dependency often perceived a decline in life satisfaction.