Mindfulness-based interventions for care partnerships experiencing anxiety and depression symptoms after stroke: a mixed methods study

Introduction: Mindfulness can improve anxiety and depression symptoms, but few studies evaluate mindfulness-based interventions (MBIs) with care partnerships affected by stroke. Care partnership involves someone with a chronic condition and their partner (e.g. spouse, caregiver) working together in a partnership.

Aim: Study the experiences and outcomes for care partnerships using MBIs together after stroke.

Methods: Systematic mixed studies review and mixed methods case study research. The thesis was ethically approved and completed 2016-2021. The systematic review examined change to stress, anxiety symptoms, depression symptoms, mindfulness, and relationships after using MBI. Mixed methods case study research recruited care partnerships experiencing anxiety symptoms and/or depression symptoms after stroke. Participants received an online MBI called Be Mindful and data was collected weeks 0, 4, and 8. Data collection involved the Hospital Anxiety Depression Scale, the Mutuality Scale, the Mindful Attention Awareness Scale, and post-intervention interviews. Potential for effectiveness was evaluated with effect direction and minimal clinically important difference (MCID). Interpretative Phenomenological Analysis (IPA) explains the findings.

Results: The systematic review included 10 studies and found MBIs improve mindfulness, stress, anxiety symptoms, and depression symptoms. Qualitative synthesis produced the mindfulness with care partnerships themes. The mixed methods case study research recruited 5 care partnerships (10 participants). Most care partnerships were white, living together, and spouses. Be Mindful adherence was between 0%-100%. Participants improved mindfulness (n=8, 80%), anxiety symptoms (n=7, 70%), depression symptoms (n=4, 40%), and mutuality (n=3, 30%). MCID was achieved for anxiety symptoms (n=5, 50%) and depression symptoms (n=2, 20%). IPA found evidence of conflicting and contradictory experiences so dialectical tension was used to articulate the continuum of perspectives and themes produced in the analysis.

Conclusion: Care partnerships using MBIs can experience improvements in mindfulness, anxiety symptoms, and depression symptoms. This thesis makes an original contribution to knowledge by exploring the experience and outcomes for care partnerships using MBIs together. This thesis highlights the value of MBIs for care partnerships, but the findings are preliminary and more research is needed before making firm recommendations.