Supporting Family Carers after Stroke and the Impact of Post-Stroke Apathy

Farrell, Laura Jane (2025) Supporting Family Carers after Stroke and the Impact of Post-Stroke Apathy. Doctoral thesis, University of East Anglia.

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Abstract

Background: Stroke is the leading cause of death and disability. Survivors frequently rely on family, but stroke carers show increased rates of anxiety and depression. One in three stroke survivors experience apathy. This is under-researched in stroke but known to be associated with detrimental effects on caregiver mental health and well-being in other populations.

Aims: This thesis aimed to investigate the types and effectiveness of interventions provided to informal stroke carers. Additionally, it examined informal stroke carers' experiences of motivational changes after stroke. Finally, it sought to test the criterion validity of the Dimensional Apathy Scale-Informant-rated version (DAS-I) with informal stroke carers.

Method: A systematic review investigated randomised control trials of informal stroke carer interventions for caregiver burden, quality of life, depression and/or anxiety. An empirical study identified informal carers’ supporting stroke survivors with at least one subtype of apathy, using unidimensional and multidimensional apathy scales. Informal stroke carers' experiences of post-stroke apathy were explored using semi-structured interviews. The psychometric properties and validity of the DAS-I were compared to a frequently used unidimensional apathy scale.

Results: The systematic review identified four common characteristics of interventions associated with improved stroke carers’ mental health and well-being: increased contact time, longer duration, remote delivery, and skills-based problem-solving content. In the empirical paper, three overarching themes were identified: Emotional Expression and Reflection, Impact on Life, and Things that Helped. Stroke carers reported practical support was the most needed but least available intervention, whereas emotional support was accessible from peers and faith groups. The DAS-I was found to have good internal consistency but poor convergent validity.

Conclusions: This thesis portfolio highlights a disconnect between the characteristics of existing interventions for supporting stroke carer mental health and well-being and the forms of support accessed or sought by carers of stroke survivors with apathy.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	27 Oct 2025 11:15
Last Modified:	27 Oct 2025 11:15
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100776
DOI:

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