Spinal Cord Injury/Disorder Function, Affiliate Stigma, and Caregiver Burden in Turkey

Background: The association among spinal cord injury and disorder (SCI/D) function, caregiver affiliate stigma, and caregiver depression and burden has not been adequately studied. In Turkey, a region with a developing healthcare infrastructure, SCI/D caregivers may have a higher responsibility of care given limited resources and may experience greater psychological distress associated with caregiving than in more developed healthcare systems. Objective: To examine whether SCI/D function, caregiver affiliate stigma, and caregiver burden and depression in Turkey are associated with each other. Design: Cross-sectional survey design. Setting: Participants were recruited from the Turkish Spinal Cord Injury Foundation and from the SCI/D service at Istanbul Physical Rehabilitation Hospital. Participants: A total of 82 SCI/D caregivers in Turkey. Interventions: Not applicable. Main Outcome Measures: Barthel Index, Affiliate Stigma Scale, Zarit Burden Interview, and Patient Health Questionnaire-9. Results: In an initial path model using bootstrapping, SCI/D function did not predict affiliate stigma, and once this path was trimmed, a final path model suggested that SCI/D function and affiliate stigma predicted caregiver burden, which in turn predicted caregiver depression. Burden partially mediated the effects of both SCI/D function and affiliate stigma on caregiver depression. All paths in the final model were statistically significant, and the fit indices suggested good fit. Conclusions: Because affiliate SCI/D function and stigma exerted a cascade of statistical effects across caregiver burden and depression, interventions should be developed and tested to help caregivers cope with low SCI/D function and combat affiliate stigma, preventing it from exerting harmful effects. Previously developed caregiver interventions should be translated and culturally adapted for a Turkish context, given that the burden and depression outcomes these interventions target are highly relevant for Turkish SCI/D caregivers.