Psychological distress and family functioning in stroke patients and their caregivers: changes over time and associations with outcomes

Introduction: The aim of this longitudinal study was to explore change over time in psychological distress and family functioning of stroke patients and their caregivers and to verify if and which dimensions of family functioning were significantly associated with patients' functional recovery and caregivers' psychological distress. Methods: A sample of 40 Italian stroke survivors (age: 71.8 ± 12.5; 52.5% male) and 36 family caregivers (age: 58.8 ±9.0; 41.7% male) completed the Symptom Questionnaire (SQ) and the Family Assessment Device (FAD) at the admission to the rehabilitation hospital and 6 months after discharge. Stroke survivors' functional status was measured using the Functional Independence Measure (FIM) on admission to and discharge from rehabilitation. Results: Six months after hospital discharge, both patients and caregivers reported a significant decrease in SQ anxiety (p ≤ 0.05), with stroke patients showing a reduction in SQ somatic symptoms (p ≤ 0.05) as well. A significant deterioration over time in FAD general family functioning, roles, behavior control, and affective involvement was observed only in patients who reported also an association between FAD behavior control at hospital admission and recovery in the FIM cognitive domain at discharge (p ≤ 0.05). In caregivers, perception of family functioning at hospital admission significantly predicted caregivers' SQ hostility at 6 months after discharge (p ≤ 0.05), while FAD affective involvement was associated with SQ somatic symptoms (p ≤ 0.05). Conclusions: These data highlight the utility in the Italian setting of the adoption of a psychosocial assessment and a family-systems approach in stroke rehabilitation.