Sources of stress and outcomes in carepartners of persons with chronic heart failure

Abstract

Abstract Background Serving as a carepartner (CP) for someone with chronic heart failure (HF) can be challenging and difficult and may yield adverse psychological outcomes. Sources of HF CP burden and strain may come from physical, informational, and tangential demands. Yet additional life events and sources of stress may be present and compound experiences of HF CPs. Greater understanding of the factors associated with stress sources is needed to direct CP assessment and interventions. Purposes To explore the contributions of CP perceptions of HF care burden and strain, other sources of stress from occupational type and working status, and financial concerns to CP psychological outcomes and to examine the influence of social support in mitigating these outcomes. Methods CPs of persons with chronic HF, defined as providing care for the person with HF at least 4 hours a week, were enrolled. Baseline variables and measures were demographics (age, marital status, education), sources of stress (CP perceived strain and burden [Oberst, STRAIN], caring for others, occupation type, working status, and financial concerns. Psychological outcomes were overall perceived stress (PSS) and depression (CES-D) with social support measured by the Enriched Social Support Inventory (ESSI). Relationships among stress sources and outcomes were assessed using best model subsets regression analysis (Akaike information criterion) comparing the models with and without adjusting for social support. For each model, age, caring for others, CG strain (mental and physical), CG burden (time and difficulty), financial worry, occupation type and status were considered for the model. Results CPs of persons with HF (n=127; 92% women; 58% Black; primarily spouses and adult children) were included. For stress, the best model included age, caring for others, mental strain, occupation and CP burden of difficulty and time (adjusted r2=0.381). After adjusting for social support, occupation type was not significant, and adjusted r2 increased to 0.462. For depression, caring for others and CP burden (difficulty) were included in the best model subset (adjusted r2=0.208). After adjusting for social support, caring for others was not significant, and the adjusted r2 increased to 0.286. Conclusion Sources of stress from higher perceived CP burden of the person with HF, occupation type, and having other caregiving roles contributed to overall stress with social support mitigating the effects of occupation type and caring for others. These findings support further study of comprehensive assessments of sources of stress and their contributions to adverse psychological outcomes for CPs within the context of social support to tailor CP interventions to the CP’s specific needs. The consistent role of social support in attenuating psychological stress warrants study of ways to clinically incorporate social support into interventions to improve outcomes for CPs.