Stroke Survivors' Dependency Level and Informal Caregivers' Quality of Life in Kelantan, Malaysia: Examining the Mediating Role of Psychological Distress

Background: Caring for stroke survivors can affect the caregiver's life, especially with the increment of patients' dependency level. This led to depression, anxiety, and stress in the caregiver, impacting their quality of life (QoL). This study aims to model relationships between caregivers' factors and stroke survivors' factors with caregivers' QoL and to estimate the mediation effects of caregivers' depression, anxiety, and stress in the relationships between stroke survivors' dependency level and caregivers' QoL. Methods: Data from a cross-sectional study with a sample size of 250 subjects was analyzed. Linear regression was done to model the relationship between stroke survivors' factors and caregivers' factors with caregivers' QoL. Hayes's PROCESS macro model 4 for bootstrapping indirect effects was used to estimate the mediation effects of depression, anxiety, and stress in the relationship between stroke survivors' dependency level and caregivers' QoL. Results: Stroke survivors' dependency levels that were measured by the Modified Barthel Index score (b=0.14; 95% CI: 0.07, 0.20), caregivers' depression score (b=-0.81; 95% CI:-1.44,-0.20), and caregivers' anxiety score (b=-0.73; 95% CI:-1.34,-0.12) were found to be associated with caregivers' QoL. Caregivers' depression score (effect=0.02; 95% CI for bootstrapping: 0.01, 0.04) and caregivers' anxiety score (effect=0.01; 95% CI for bootstrapping: 0.01, 0.04) were found as partial mediators in the relationship between stroke survivors' dependency level and caregivers' QoL. Conclusion: Stroke survivors' dependency level and caregivers' depression and anxiety significantly impact caregivers' QoL, with the latter factors partially mediating this relationship. Interventions such as providing caregivers with psychological support, stress management programs, and training in caregiving skills could help mitigate these impacts and improve caregivers' QoL.