Review Article
The Global Prevalence of Anxiety and Depressive Symptoms Among Caregivers of Stroke Survivors

https://doi.org/10.1016/j.jamda.2016.08.014Get rights and content

Abstract

Objective

The global prevalence of depressive and anxiety symptoms among caregivers of stroke survivors is unknown. Given the high index of caregiver burden, this meta-analysis aims to evaluate the pooled prevalence of depressive and anxiety symptoms among caregivers of stroke survivors globally and to determine underlying moderators.

Methods

The authors searched PubMed, Embase, PsychINFO, BIOSIS, Science Direct, and Cochrane CENTRAL databases from inception to June 2016, and relevant articles were selected in accordance to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We calculated the pooled prevalence proportion of depressive and anxiety symptoms among caregivers of stroke survivors. Meta-regression was performed to identify important moderators which contribute to heterogeneity.

Results

The literature search generated 1259 records, and 34 full-text articles were reviewed in details. Twelve studies met the inclusion criteria and comprised of 1756 caregivers. The pooled prevalence of depressive symptoms was 40.2% (95% confidence interval 30.1%–51.1%) and anxiety symptoms 21.4% (95% confidence interval 11.6%–35.9%) among caregivers of stroke survivors based on the random-effects model. There was significant heterogeneity. Meta-regression was conducted to account for the heterogeneity of the prevalence. For depressive symptoms, female sex of caregivers and stroke survivors, as well as Caucasian ethnicity of caregivers were associated with high prevalence of depression. Spousal and child relationship of caregivers to stroke survivors were associated with low prevalence of depression. For anxiety symptoms, meta-regression could not be conducted because insufficient number of studies provided information on the moderators.

Conclusions

This meta-analysis has identified the high prevalence of depressive and anxiety symptoms among caregivers of stroke survivors, which were 40.2% and 21.4%, respectively. Meta-regression has identified that female sex of caregivers and stroke survivors as well as Caucasian race were associated with higher prevalence of depression. The findings of this study would help to guide interventions that aim to reduce psychiatric morbidity of caregivers of stroke survivors.

Section snippets

Search Strategy

The following online databases were searched from inception to June 1, 2016: PubMed (from 1966), Embase (from 1980), PsychINFO (from 1806), BIOSIS (from 1926), Science Direct (from 2006), and Cochrane CENTRAL (from 1993). The predetermined search terms used to identify potential articles are listed as follows: caregiver, stroke, depress*, anxiety, epidemiology, prevalence, rate, mental disorder*, psychiatric disorder*, psych*, mental*, burden*, outcome*. An asterisk after a term means that all

Results

A total of 1259 published abstracts were screened and 34 full-text articles were reviewed, and 12 articles were selected based on our inclusion criteria. These articles had data on depressive and/or anxiety symptoms. Twelve studies comprising 1756 persons were included in this systematic review and meta-analysis (Figure 1). Of the 11 studies on depressive symptoms included, 6 were conducted in North America, 3 in Europe, and 2 in Asia. Of the 3 studies on anxiety symptoms included, 2 were

Discussion

This meta-analysis represents, to our knowledge, the first meta-analytical study aimed to estimate the prevalence of depressive and anxiety symptoms in caregivers of stroke survivors worldwide. The prevalence of most common depressive symptom, dysphoric mood, in the general population was estimated to be 17.8%,31 and the aggregated prevalence of depressive symptoms (40.2%) in caregivers of stroke survivors is nearly 2 times of that. This suggests that caregivers of stroke survivors are at much

Conclusions

In conclusion, this meta-analytical review identified that the prevalence of depressive and anxiety symptoms among caregivers of stroke survivors were 40.2% and 21.4%, respectively. Meta-regression showed that female sex of caregivers and stroke survivors and the Caucasians race were significantly associated with higher prevalence of depression. Higher proportion of spouse and children as caregivers were associated with lower prevalence of depression. Spouses and children may have more positive

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