Understanding the interplay between lifestyle factors and emotional distress for hemorrhagic stroke survivors and their informal caregivers: Protocol for a mixed methods dyadic natural history study

• Published in: PloS one 2022-01, Vol.17 (1), p.e0261635
• Main Authors: Lester, Ethan G, Fishbein, Nathan S, Higgins, Olivia, Rosand, Jonathan, Vranceanu, Ana-Maria
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adult; Aged; Alcohol Drinking - psychology; Anxiety; Anxiety - psychology; Behavior; Biology and Life Sciences; Blood pressure; Brain research; Care and treatment; Caregivers; Caregivers - psychology; Depression - psychology; Diet; Emotional behavior; Enrollments; Female; Health aspects; Hemorrhage; Hospitalization; Hospitals; Humans; Informed consent; Life Style; Lifestyles; Male; Medicine and Health Sciences; Mental depression; Middle Aged; Mixed methods research; Morbidity; Neurology; Nursing; Patients; Physical activity; Psychiatry; Psychological aspects; Psychological Distress; Research and Analysis Methods; Risk analysis; Risk factors; Smoking; Social Sciences; Stress (Psychology); Stress, Psychological - psychology; Stroke; Stroke - complications; Stroke - psychology; Stroke patients; Study Protocol; Surveys; Survival; Survivors - psychology; Target recognition
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0261635

Emotional distress (depression, anxiety, and PTS) and unhealthy lifestyle factors (e.g., smoking, alcohol consumption, poor diet, limited physical activity, medication adherence) are common in hemorrhagic stroke (HS) survivors and may increase risk for recurrence, morbidity, and mortality. Emotional distress and unhealthy lifestyle factors tend to be interdependent between survivors and their informal caregivers (e.g., family and friends who provide unpaid care; together called dyads), such that one partner's lifestyle and coping behaviors influence the other's behaviors, yet no research has closely examined this relationship in HS dyads over time. We will conduct a mixed methods study to quantitatively and qualitatively understand the longitudinal relationship between emotional distress and lifestyle factors across time in this population (HS dyads) to identify treatment targets to prevent emotional distress chronicity and stroke recurrence. In aim 1, we will assess emotional distress (i.e., depression, anxiety, and PTS) and lifestyle factors (smoking, alcohol consumption, poor diet, limited physical activity medication adherence/blood pressure control) in dyads of survivors of HS and their caregivers (N = 80), at three separate time points (hospitalization in the Neuro-ICU, 1, and 3 months later). We hypothesize that 1) lifestyle factors and emotional distress will be interrelated within and across time for both survivors and caregivers, and 2) lifestyle factors and emotional distress will be interdependent between survivors and caregivers. We also aim to explore the nuanced interplay between lifestyle factors and emotional distress and gain in depth information on barriers and facilitators for a dyadic intervention to optimize lifestyle behaviors and emotional functioning in HS dyads. Eligible patients will be adults who have a caregiver also willing to participate. Patients will be referred for study participation by the nursing team who will ensure that they are cognitively able to meaningfully participate. Multilevel dyadic modeling (i.e., actor-partner interdependence model; APIM) with distinguishable dyads will be used to determine influences of these factors onto each other over time. In Aim 2, we will conduct live video qualitative dyadic interviews (N = 20 or until theme saturation) at all time points from the same participants with and without emotional distress and at least one lifestyle risk factor, to understand the nuanced relationships bet