Acute Patient Distress Is Associated With Poorer Caregiver Health Independent of Stroke Severity

Abstract Purpose. We examined how quality of life, distress and burden evolve jointly in stroke survivors and caregivers over the first year after stroke, and whether their associations depend on neurological severity. Methods. Prospective single-center cohort of stroke patient-caregiver dyads assessed at baseline, 3 and 12 months, with control dyads without recent stroke assessed once, using the SF-36, Distress Thermometer and Zarit Burden Interview. Dyadic associations were examined with Spearman correlations (bootstrap confidence intervals), and caregiver trajectories with linear mixed models. Benjamini-Hochberg-adjusted p values (q) were computed within planned comparison groups. Results. Twenty stroke and 17 control dyads were analyzed. After correction, patients and caregivers differed only in SF-36 Role Limitations-Physical at 12 months. In the stroke group, greater acute patient distress was associated with poorer caregiver general health (rho = -0.76, 95% CI -0.93 to -0.42, q = 0.034, n = 17); it persisted after adjustment for stroke severity (partial rho = -0.77) and was absent in controls (rho = +0.40; between-group q = 0.049). Caregiver distress declined nominally (-0.14 points/month, 95% CI -0.28 to -0.01) whereas burden did not (+0.17, 95% CI -0.14 to +0.47); 8 of 18 caregivers worsened and 8 improved in burden. Conclusion. Greater acute patient distress was associated with poorer caregiver general health, not explained by stroke severity in this predominantly mild cohort. Caregiver burden was stable at group level despite marked individual variation. These findings suggest assessing caregiver health when patients report high acute distress and reassessing burden during follow-up.