Spirituality Tied to Better Quality of Life for Stroke Survivors and Their Caregivers

By Lisa Rappaport

May 28, 2020

(Reuters Health) - Higher levels of spirituality are associated with a better quality of life for stroke survivors and the people who care for them, a new study in Italy suggests.

Researchers surveyed 223 stroke survivor-care partner dyads at discharge from rehabilitation and every three months for one year. The stroke survivors had low-to-medium disabilities, and no other major health issues; patients were excluded if they had preexisting physical or cognitive impairment, cancer, or kidney failure.

The stroke patient’s spirituality significantly moderated the association between care partner depressive symptoms and survivor psychological quality of life (QOL), the study found. Survivor spirituality also moderated the association between the care partner's depressive symptoms and the partner's physical and psychological QOL. The care partner's spirituality level also was significantly positively associated with their own physical QOL, the study team reports in Circulation: Cardiovascular Quality and Outcomes.

The findings offer some of the first evidence that depression, a common experience after stroke, may be moderated by survivors' level of spirituality, said lead study author Dr. Gianluca Pucciarelli, a research fellow in the Department of Biomedicine and Prevention at the University of Rome Tor Vergata.

"The results of this study highlight the protective role of spirituality, understood not as religiosity but as the individual's perception of life within the context of the culture and value systems of the society and in relation to the individual's goals, expectations, standards, and concerns," Dr. Pucciarelli said by email.

"Being a coping variable, spirituality may alter the meaning of the events, making them less stressful in nature, moderate the negative associations leading to problems or manage the level of emotional response to stressors," Dr. Pucciarelli added.

At each follow-up, researchers assessed participants’ quality of life using the 26-item WHOQOL-BRIEF, mental health using the 14-item Hospital Anxiety and Depression Scale, and spirituality using the 32-item WHOQOL-SRPB.

Stroke survivors' mean age was 70.7, and their mean time from the stroke to discharge from rehabilitation was 43 days. Caregivers' mean age was 52.3; most were women.

Among the caregivers, 63% lived with stroke survivors. Non-spouse caregivers were either children (50%), siblings (4.5%) or friends (9.5%)

At baseline, mean survivor and care partner depressive symptom scores were 9.49 and 7.18, respectively, out of a possible score of 0 to 21 for each subscale. Mean survivor spirituality score was 43.82, while caregiver spirituality was 45.69, out of a possible 100.

Spirituality of survivors didn't appear to predict or moderate longitudinal associations between quality of life and mental health, the study team notes. It's possible that's because the baseline assessment was done at discharge from neurorehabilitation, and not immediately after the stroke.

One limitation of the study is that it was done in a predominantly Catholic country, and results might be different in societies with other predominant religions, the study team notes. Results also might be different with stroke survivors who had worse disabilities or serious comorbidities, a population that was excluded from the current analysis.

The study also doesn't address whether active participation in a religious community at baseline or at the time of stroke, and connection with this community, improves quality of life, said Dr. Joseph Broderick, director of the University of Cincinnati Gardner Neuroscience Institute, in Ohio. It's also not clear how big a support network stroke patients had at baseline.

"The presence of a supportive community, beyond the one caregiver, is likely to be associated with less depression and better quality of life for both patient and caregiver," Dr. Broderick, who wasn't involved in the study, said by email. "Stroke recovery is not just about moving and speaking better but maintaining connections with people and finding meaning and purpose in a very changed situation."

SOURCE: https://bit.ly/2X4EsHk Circulation: Cardiovascular Quality and Outcomes, online May 26, 2020.