Marital relationships after stroke: a thematic analysis of wives’ perceptions

Background: Many partners of stroke survivors assume the role of informal caregiver. Little is known about how this informal care-giving role impacts on the partnership relationship. Method: A systematic literature review evaluated the evidence of fourteen studies, ten quantitative and four qualitative, looking at the psychological impact of informal caregiving on the partnership relationship. Evidence from the wider informal caregiving population suggested that caregivers experience high levels of depression, reduced psychological functioning and deterioration in interpersonal relationships however this review found a paucity of clear and robust evidence for the spousal caregiver as distinct from other familial caregivers. To address this gap within the literature, a qualitative study was conducted using semi-structured interviews to investigate the lived experience of six female spousal caregivers whose husbands had survived a stroke. The transcribed interviews were analysed using a process of thematic analysis as described by Braun and Clarke (2006). Results: Spouses of stroke survivors experienced a dramatic change in their relationship after their partner’s stroke. Primary and secondary loss, increased responsibility, adaptation, evaluation and acceptance themes were developed into a dynamic thematic map. The loss of aspects of both their husband’s traditional role and the reflexive nature of the relationship impacted on the quality of the relationship as a whole. The processes of evaluation and adaptation both used talking as an important strategy. Conclusions: Little is known about the caregiving trajectory for spousal partners of stroke survivors. The current study makes a significant contribution to the evidence base and suggests that the changing nature of the partnership’s interpersonal dynamics may underpin some of the negative outcomes for spousal caregivers and that a greater understanding of these underlying processes may help services to provide appropriate and timely support to this population.