A little knowledge: caregiver burden in schizophrenia in Malawi

Associations of Caregiving Knowledge and Skills With Caregiver Burden, Psychological Well-Being, and Coping Styles Among Primary Family Caregivers of People Living With Schizophrenia in China

Background: There is a lack of clarity regarding the correlation of caregiving knowledge and skills with caregiving experiences of people living with schizophrenia (PLSs). To address this gap, this comprehensive study examines the relationships of caregiving knowledge and skills to the primary family caregiver's experiences of burden, psychological well-being (stress, anxiety, depression, caregiving rewarding feelings), and coping styles in China. Methods: A total of 395 primary family caregivers of PLSs were enrolled in a cross-sectional study between May 2019 and September 2019. Each family caregiver was independently assessed on caregiving knowledge and skills, caregiver burden, and psychological well-being, as well as coping styles. Results: A higher level of caregiving knowledge and skills was positively correlated with less stress (b = -0.48, P < 0.001), anxiety (b = -0.23, P = 0.029), depression (b = -0.29, P = 0.013), and more caregiving rewarding feelings (b = 0.54, P < 0.001). Also, caregivers with more knowledge and skills were more inclined to adopt positive coping strategies (b = 0.44, P < 0.001). Despite these differences, caregivers with different levels of caregiving knowledge and skills reported comparable caregiver burden (b = 0.11, P = 0.705) and the use of a passive coping style (b = 0.10, P = 0.169). Conclusion: Caregiving knowledge and skills are a reliable predictor of psychological well-being and active coping among the primary family caregivers of PLSs. These findings inform the development of psychoeducational interventions to support family caregivers of PLSs.

Relationship between Caregiver Burden and Expressed Emotion in Families of Schizophrenic Patients

BACKGROUND:

Schizophrenia is a clinical syndrome that is variable, but highly disturbing; its psychopathology involves cognition, emotion, perception, and other aspects of behaviour. Schizophrenic patients who are hospitalised, who return to a family environment characterised by high levels of criticism, excessive emotional involvement, or hostility (referred to as high expressed emotion) are more likely to experience the recurrence than schizophrenic patients returning to families characterised by low expressed emotion.

AIM:

We aimed to investigate the level of care load in the families of schizophrenic patients.

METHODS:

This research is an analytic study with a cross-sectional approach. The research site is in the outpatient installation of BLUD Mental Health Hospital of North Sumatra Province using consecutive non-probability sampling. The samples are family members who carry schizophrenic patients go to an outpatient installation at the BLUD Mental Health Hospital of North Sumatra Province that meets the inclusion and exclusion criteria.

RESULTS:

The burden of care for the families of the most schizophrenic patients was mid load as many as 36 people, namely 36%, the light burden of 34 people, 34%, no burden of 18 people, 18%, and the heavy burden of 12 people, 12%. There is a significant relationship between the burden of treatment with expressed emotion, which is 0.004 (p < 0.05).

CONCLUSION:

In this study, we showed a significant relationship between the burden of treatment with expressed emotion (p = 0.004). This study is by the study conducted by Darwin in 2013, and Carra in 2012, which showed that there was a significant relationship between the burden of treatment with expressed emotion in the families of schizophrenic patients. Other studies also show that the burden of care has an impact on emotional, physical health, social life, and financial status as a result of caring for sick people.

Burden experienced by caregivers of schizophrenia patients and its related factors

Background: Deinstitutionalization of patients with schizophrenia shifted the primary locus of care from psychiatric hospitals to family and informal caregivers. Family members often play a vital role as caregivers in the lives of individuals with schizophrenia and other serious mental illnesses. This study aimed to assess the burden experienced by the caregivers of patients with schizophrenia and to evaluate its correlation with some demographic characteristics of patients, their caregivers, and the level of expressed emotion in the family.

Methods: This descriptive-analytic study was conducted on 172 schizophrenic patients and their primary caregivers, selected from the outpatient department of a psychiatric hospital in Tehran, Iran, using convenience sampling. Caregivers were evaluated with Zarit Burden Interview and Family Questionnaire to assess the burden experienced by the caregivers and the level of expressed emotion in the family, respectively. Data were analyzed using Spearman correlation coefficient and linear regression method. Data were analyzed using SPSS software (Version 21) and significance level was set at p< 0.05.

Results: The level of burden experienced by most of primary caregivers was higher than moderate. The scores obtained in the subscales of emotional over involvement and critical comments were higher than the cutoff point in 51.7% and 64.5% of caregivers, respectively, and the scores had a significant direct correlation with the burden experienced by the caregivers. The findings of multiple linear regression showed that lower family income (β= -0.33, p< 0.001), higher duration of disorder (β= 0.19, p= 0.006), and younger age at onset of the disorder (β= -0.26, p= 0.001) were predictive of higher burden of disease on caregivers.

Conclusion: Based on the results, some demographic factors of the primary caregivers, patients, and their family significantly affected the burden experienced by the primary caregivers. Most of the caregivers had high expressed emotions and a significant direct association existed between the expressed emotions and the burden experienced.

Psychometric properties of the Spanish version of the involvement evaluation questionnaire in caregivers of patients with borderline personality disorders

The involvement evaluation questionnaire (IEQ) was created to evaluate the caregiver's experience of burden and the consequences of providing care to people with psychotic disorders. To date, the IEQ has not been validated with caregivers of people diagnosed with borderline personality disorder (BPD). The main objective of the study was to confirm the psychometric properties and factorial structure of the Spanish version of the IEQ in 151 caregivers of people with BPD, with an average age of 54.52 (SD = 9.91). Two models were tested by means of confirmatory factor analysis, following the original factor structure. The Models 1 and 2 displayed adequate fit, with comparative fit index and Tucker-Lewis index > 0.90 and root-mean-square root of approximation < 0.08; however, Model 2 was more parsimonious. The Cronbach's alphas are adequate, ranging from 0.70 to 0.85. The consequences of providing care to people with BPD had a low or moderate association with the Level of Expressed Emotion scores. IEQ scores of caregivers of people diagnosed with BPD with psychiatric comorbidity did not differ from those of caregivers of people diagnosed with BPD without psychiatric comorbidity. The IEQ has adequate psychometric properties and can be utilized to assess burden in caregivers of people with BPD.

Description of the inpatient population and care received at a psychiatric unit in Lilongwe, Malawi

Like in much of Sub-Saharan Africa, descriptive data about psychiatric inpatients and inpatient psychiatric care in Malawi is limited. This study describes the inpatient population at the Bwaila Hospital Psychiatric Unit in Lilongwe, Malawi, as well as treatments received and treatment outcomes. Records of 419 psychiatric inpatients hospitalized from January 1, 2011 to December 31, 2011 were reviewed. Patients were primarily male (73.0%) and were most commonly referred from district hospitals (46.4%). Nearly all patients were involuntarily hospitalized under Malawi's Mental Treatment Act (94.2%). Schizophrenia (30.1%), cannabis use disorder (27.9%) and alcohol use disorder (25.1%) were the most common diagnoses. Suicidal ideation was reported by 4.8% of patients and 2.4% had attempted suicide prior to admission. Homicidal ideation was reported by 7.3% of patients and 5.1% of patients assaulted another patient during their hospitalization. Mean length of stay was 22.1 ± 27.7 days (range: 1.0-243.0). Chlorpromazine (81.3%), diazepam (75.8%), carbamazepine (59.8%) and fluphenazine (56.0%) were the most commonly used medications on the ward. Stabilization and discharge to home was the most common outcome (68.0%), followed by transfer to another hospital (19.5%), discharge against medical advice (8.2%), abscondment (3.4%) and death (1.0%).

Quality of life in family caregivers of schizophrenia patients in Spain: caregiver characteristics, caregiving burden, family functioning, and social and professional support

OBJECTIVE

Caregivers experience physical and mental stress that ends up lowering their quality of life (QoL). Our goal was to research (a) the level of caregivers QoL; (b) the relationships between the demographic characteristics of the caregivers, their caregiving burden, their family functioning, their social and professional support and their QoL and (c) the best predictors of caregivers QoL.

METHODS

100 key caregivers (70% parents, 8% spouses, 17% siblings and 5% children) were studied using the world health organization quality of life-Bref (WHOQOL-BREF) to research their QoL, the Zarit Scale to assess their perception of their caregiving burden, the Social Network Questionnaire to examine their social support, the Family APGAR to assess the satisfaction with social support from the family and a professional support scale (Escala de Apoyo Profesional) to determine the professional support received by caregivers was performed.

RESULTS

Scores on the WHOQOL-BREF in the Physical, Psychological, Social and Environment domains were 15.0 (SD = 3.7), 13.3 (SD = 4.2), 11.0 (SD = 4.7) and 13.5 (SD = 3.1), respectively. Through bivariate analysis, the dimensions that showed a positive significant association with QoL were being a young male caregiver who was a working father with a high educational level and help from other family members. Caregivers of patients who were older and had a later onset of the illness, a lower score on the Zarit Scale and a high score on the Social Network Questionnaire, Family APGAR and Escala de Apoyo Profesional showed higher QoL. Many of these variables made a unique contribution in the multivariate analysis.

CONCLUSIONS

There is a significant association between the caregiver's burden and their QoL. Regression analysis showed that the best predictors of QoL were caregiving burden, social support and professional support.

Perceived Stress in Family Caregivers of Individuals With Mental Illness

The current study aimed to measure the stress levels of family caregivers of individuals with mental illness and compare their stress levels according to the diagnosis and other sociodemographic characteristics. The sample comprised 310 family caregivers of individuals with mental illness in Jordan. Family caregivers completed a demographic checklist and the Arabic version of the Perceived Stress Scale 10-Item (PSS-10) questionnaire. A significant difference was found in PSS-10 levels among family caregivers according to gender, diagnosis of their family member, and time since diagnosis. Female caregivers reported significantly higher stress levels than male caregivers. Family members of individuals with schizophrenia reported the highest stress levels (p < 0.001). Results also indicated that there was a significant negative correlation between PSS-10 levels of family caregivers and time since diagnosis. Investigating stress levels in family members of individuals with mental illness may be helpful when designing interventions to reduce such stress. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 30-35.].

Assessment of the burden on caregivers of patients with mental disorders in Jeddah, Saudi Arabia

BACKGROUND

Mental disorders are considered important public health problems not only to people with mental illness but also their caregivers. As is the case in many countries, the deinstitutionalization of mental health services in Saudi Arabia, has meant that informal caregivers are shouldering responsibilities for which they are not usually prepared; therefore, the current study was aimed at assessment of the burden on caregivers of people with mental illness.

METHODS

Through a cross-sectional design, a sample of the caregivers of people with mental illness (n = 377) was selected randomly from a psychiatric hospital in Jeddah. An Arabic version of the Involvement Evaluation Questionnaire (IEQ) was used for collection of data. The data were analyzed on the subscale scores and the 27 items in two ways. First, we used the summed scores for the subscales based on the Likert scale (0-4) for univariate and multivariate statistical analyses, as recommended. We also used parametric statistics (t-tests, one-way ANOVA) because the IEQ subscale scores were fairly normally distributed.

RESULTS

Males constituted more than one-half of the participating caregivers (55%), with a mean age of 36.6, SD = 11.4 years. As reported by the caregivers, most of the patients were males (62.7%) with a mean age of 33.8, SD = 13.7 years and a range of 17-90 years old. The total mean IEQ burden score of the caregivers was 38.4, SD = 17.5. "Tension" was significantly prominent among younger caregivers aged ≤30 years. "Worrying" was significantly higher among caregivers living with their spouse and children and those living in families with relatively fewer members (<6 members). "Urging" was significantly higher among caregivers who are living with the patient in the same household and those who had been in close contact with the patient for 28 days in the four weeks prior to the study (13.4, SD = 6.8) p < 0.05. Meanwhile, "Urging" was also significantly higher among caregivers caring for mentally ill females (13.5, SD = 6.6) and those not receiving any kind of professional support (12.8, SD = 6.7). The overall burden and the subscale scores were highest among caregivers caring for a close relative such as a parent (44.1, SD = 17.6), son/daughter (39.1, SD = 12.9), sibling (37.1, SD = 18.6), or spouse (37.1, SD = 18.6) p < 0.05.

CONCLUSION

Care for people with mental illness is burdensome for their caregivers, the magnitude of burden is potentially augmented by factors related to the patients and households. These factors should be considered when planning for preparing caregivers to cope with people with mental illness in Saudi Arabia.

Assessment of the consequences of caregiving in psychosis: a psychometric comparison of the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ)

Background

The Zarit Burden Interview (ZBI) was originally developed to assess the level of subjective burden in caregivers of people with dementia. The Involvement Evaluation Questionnaire (IEQ) is amongst the leading scales to assess caregiving consequences in severe mental illness. We aimed to compare the psychometric properties of the ZBI, a generic tool, and of the IEQ, a more specific tool to assess the consequences of caregiving in schizophrenia and related disorders.

Methods

Secondary analyses of a 16-week, randomized controlled trial of a psychoeducational intervention in 223 primary caregivers of patients with schizophrenia or schizoaffective disorder. Psychometric properties (internal consistency, convergent and discriminative validity, and sensitivity to change) were evaluated for both ZBI and IEQ.

Results

Internal consistency was good and similar for both scales (ZBI: 0.91, 95% CI: 0.89, 0.94; IEQ: 0.86, 95% CI: 0.83, 0.89). Convergent validity was relevant for similar domains (e.g. ZBI total score vs IEQ-tension r = 0.69, 95% CI: 0.61, 0.75) and at least moderate for the rest of domains (ZBI total score, personal strain and role strain vs IEQ-urging and supervision). Discriminative validity against psychological distress and depressive symptoms was good (Area Under the Curve [AUC]: 0.77, 95% CI: 0.71, 0.83; and 0.69, 95% CI: 0.63, 0.78 – for ZBI against GHQ-28 and CES-D respectively; and AUC: 0.72, 95% CI: 0.65, 0.78; and 0.69, 95% CI: 0.62, 0.77 – for IEQ against GHQ-28 and CES-D respectively). AUCs against the reference criteria did not differ significantly between the two scales. After the intervention, both scales showed a significant decrease at endpoint (p-values < 0.001) with similar standardised effect sizes for change (-0.36, 95% CI: -0.58, -0.15 – for ZBI; -0.39, 95% CI: -0.60, -0.18 – for IEQ).

Conclusions

Both ZBI and IEQ have shown satisfactory psychometric properties to assess caregiver burden in this sample. We provided further evidence on the performance of the ZBI as a general measure of subjective burden.

Trial registration

(ISRCTN32545295).

Psychometric Properties and Correlates of the Beck Hopelessness Scale in Family Caregivers of Nigerian Patients with Psychiatric Disorders in Southwestern Nigeria

Objectives:

To examine the construct and correlates of hopelessness among family caregivers of Nigerian psychiatric patients.

Materials and Methods:

This is a cross-sectional, descriptive study involving 264 family caregiver-patients’ dyads recruited from two university teaching hospitals psychiatric clinics in Southwestern Nigeria.

Results:

Exploratory factor analysis revealed a two-factor 9-item model of the Beck Hopelessness Scale (BHS) among the family caregivers. Confirmatory factor analysis of the model revealed satisfactory indices of fitness (goodness of fit index = 0.97, comparative fit index = 0.96, Chi-square/degree of freedom (CMIN/DF) = 1.60, root mean square error of approximation = 0.048, expected cross-validation index = 0.307, and standardized root mean residual = 0.005). Reliability of the scale was modestly satisfactory (Cronbach's alpha 0.72). Construct validity of scale was supported by significant correlations with the family caregivers’ scores on the Zarit Burden Interview, mini international neuropsychiatric interview suicidality module, General Health Questionnaire-12 (GHQ-12), and Patient Health Questionnaire-9. The greatest variance in the family caregivers’ scores on the BHS was contributed by their scores on the psychological distress scale (GHQ-12).

Conclusions:

The BHS has adequate psychometric properties among Nigerian psychiatric patients’ family caregivers. There is the need to pay attention to the psychological well-being of the family caregivers of Nigerian psychiatric patients.

Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe

Background

Mental health service resources are inadequate in low-income countries, and families are frequently expected to provide care for their relative with a mental disorder. However, research on the consequences of caregiving has been limited in low-income countries, including Zimbabwe.

Objective

The study explored the perceived impact of mental illness, reported coping strategies and reported needs of the family members of persons diagnosed with bipolar affective disorder or schizophrenia attending a psychiatric hospital in Harare, Zimbabwe.

Methods

A purposive sample of 31 family members participated in in-depth interviews and focus group discussions using standardised study guides. Participants were also screened for common mental disorders (CMDs) using the 14-item Shona Symptom Questionnaire. Qualitative data were analysed thematically using NVivo 8 qualitative data analysis software. Statistical Package for Social Sciences (SPSS version 16) was used for descriptive quantitative data analysis.

Results

Caregivers experienced physical, psychological, emotional, social and financial burdens associated with caregiving. They used both emotion-focused and problem-focused coping strategies, depending on the ill family members’ behaviours. Seeking spiritual assistance emerged as their most common way of coping. Twenty-one (68%) of the caregivers were at risk of CMDs (including three participants who were suicidal) and were referred to a psychiatrist for further management. Caregivers required support from healthcare professionals to help them cope better.

Conclusion

Caregivers of patients attending psychiatry hospitals in Zimbabwe carry a substantial and frequently unrecognised burden of caring for a family member with a mental disorder. Better support is needed from health professionals and social services to help them cope better. Further research is required to quantitatively measure caregiver burden and evaluate potential interventions in Zimbabwe.

Burden on Caregivers of Patients with Schizophrenia and Related Factors

INTRODUCTION

Caregivers of patients with schizophrenia are under the burden of continuous and difficult processes. Determination of the factors related to caregiver burden in schizophrenia may help find strategies to decrease the burden. This study aimed at investigating the factors associated with caregiver burden among relatives of patients with schizophrenia.

METHODS

Eighty-eight caregivers of patients under treatment for schizophrenia for at least 1 year were included in the study. The Zarit Caregiver Burden Interview was used for the assessment of caregiver burden. Sociodemographical data, the level of knowledge about schizophrenia, clinical impression scale, and global assessment of functioning were used to evaluate the related factors.

RESULTS

Caregiver burden was negatively correlated with income level and functionality of the patient and was positively correlated with the age of the caregiver, the daily time spent with the patient, and the number of hospitalizations of the patient (p<0.05). There was no significant correlation between the caregivers' knowledge about schizophrenia and caregiver burden (p<0.05). Living in the same house with the patient was a positive predictor, whereas functionality and income level of the patient and education level of the caregiver were negative predictors (p<0.05).

CONCLUSION

This study highlighted the importance of setting targets for improving the functionality of patients in the design and implementation of rehabilitation and support programs for patients with schizophrenia. Additionally, providing higher income for patients, creating conditions for an independent life, and increasing incentives for younger caregivers with a higher educational level may help decrease caregiver burden.

Illness representation and sense of coherence in dementia caregiving

The objectives of this study were to describe illness representations in dementia caregiving and examine the relationship between illness perceptions and carers’ sense of coherence. Illness perceptions were assessed by the Brief Illness Perception Questionnaire. We measured sense of coherence, symptoms of anxiety and depression and carer burden. Regression analyses indicated that after controlling for demographic factors, burden and psychological distress in carers, illness coherence and emotional responses to the disease independently contributed towards explaining variance in carers’ sense of coherence. Results provide support for the usefulness of the self-regulation model in understanding dementia caregiving.

Relationship of caregiver burden with coping strategies, social support, psychological morbidity, and quality of life in the caregivers of schizophrenia

AIM

To evaluate the relationship of caregiver burden as assessed by using Hindi Involvement Evaluation Questionnaire (IEQ) with coping strategies, social support, psychological morbidity, and quality of life of caregivers of patients with schizophrenia. Additionally, the relationship of caregiver-burden with sociodemographic variables, and clinical variables, including severity of psychopathology and level of functioning of patients, was studied.

METHODOLOGY

The study included 100 patients with schizophrenia and their caregivers recruited by purposive random sampling.

RESULTS

Among the four domains of IEQ, highest number of correlations emerged with tension domain. Tension domain had positive correlation with the caregiver being single, time spent in caregiving per day, and use of avoidance, collusion, and coercion as coping strategies. Additionally, tension domain was associated with poor quality of life in all the domains of WHO-QOL Bref and was associated with higher psychological morbidity. Worrying urging-I domain of IEQ correlated with frequency of visits, higher use of problem focused coping and poor physical health as per the WHO-QOL Bref. Worrying urging-II domain of IEQ had positive correlation with higher level of positive symptoms, lower level of functioning of the patient, younger age of caregiver, caregiver being unmarried, and higher use problem focused and seeking social support as coping strategies. Supervision domain of IEQ correlated positively with lower income, being an unmarried caregiver, from an urban locality and non-nuclear family. Supervision domain was associated with poor physical health as assessed by WHO-QOL Bref.

CONCLUSION

Caregiving burden, especially tension is associated with use of maladaptive coping strategies, poor quality of life and higher level of psychological morbidity in caregivers.

Empowering caregivers: impact analysis of FamilyLink Education Programme (FLEP) in Hong Kong, Taipei and Bangkok

BACKGROUND

Education and support for caregivers is lacking in Asia and the peer-led FamilyLink Education Programme (FLEP) is one of the few provisions to address this service gap. This study aims to evaluate quantitatively its efficacy in reducing subjective burdens and empowering the participants.

METHOD

One hundred and nine caregiver participants in three Asian cities were successfully surveyed at pre-intervention, post-intervention and six-month intervals with a number of standard inventories. Mixed analysis of variance (ANOVA) procedures showed significant programme impact over time intervals for all sites, and subsequently an empowerment measurement model was tested.

RESULTS

FLEP was found effective in reducing worry and displeasure, significantly improving intra-psychic strain, depression and all empowerment measures. The measurement model had an acceptable good fit. Baseline difference showed no interference with the programme efficacy.

CONCLUSIONS

Apart from the initial support for FLEP, the current study also provides some hindsight on the empowerment practice in mental health for Asia, whose sociocultural political contexts are vastly different from that of the developed countries. It remains to be seen whether qualitative data or more stringent research design will yield consistent results and whether FLEP can also work in rural areas.

Correlates of Caregiver Burden among Family Members of Patients with Schizophrenia in Lagos, Nigeria

Family members of patients with schizophrenia have enormous roles in the care of their patients, which could negatively impact their well being. Development of interventions targeted at alleviating the burden of informal care giving is hinged on the recognition of the factors associated with the various dimensions of burden. This study determined the correlates of caregiver burden among family members of patients with schizophrenia in Lagos, Nigeria. The study instruments included the Zarit burden interview (ZBI) and the positive and negative syndrome scale for schizophrenia (PANSS). Exploratory factor analysis of the ZBI produced a five-factor structure with "financial/physical strain", "time/dependence strain", "emotional strain", "uncertainty", and "self-criticism" domains. On multiple regression analyses, total PANSS scores, poor social support, and lower educational levels of caregivers were predictive of higher burden scores on the "financial/physical strain", "time/dependence", and "emotional strain" domains. Longer duration of illness, shorter patient-caregiver contact time, and being a female caregiver were predictive of higher burden scores on the "uncertainty", "self-criticism", and "emotional strain" domains, respectively. There is need for interventions to alleviate the burden on caregivers of patients with schizophrenia in Nigeria. These strategies must include comprehensive social support and improve access to services for patients and their caregivers.

Schizophrenia trials conducted in African countries: a drop of evidence in the ocean of morbidity?

Objective

To quantify schizophrenia trialling activity in African countries and to describe the main features of these trials.

Methods

We searched the Cochrane Schizophrenia Group Register, which contains 16,000 citations to 13,000 studies relating only to people with schizophrenia or schizophrenia-like illness, to identify schizophrenia trials conducted in Africa without time limitation.

Results

A total of 38 trials met the inclusion criteria and were included in our analysis. Of the 54 countries of Africa, only 8 produced at least one trial: South Africa produced the majority of trials (20 out of 38 trials, 53%), followed by Nigeria (7 out of 38 trials, 18%) and Egypt (4 out of 38 trials, 11%). The majority of studies investigated the efficacy of pharmacological interventions, were short in duration, and employed a double-blind design. The quality of reporting was generally poor. We found six trials comparing antipsychotics from the WHO Essential List of Medicine versus new generation antipsychotics. In terms of efficacy and acceptability, these studies failed to show any advantage of newer antipsychotics over first-generation agents.

Conclusions

We observed an impressive mismatch between the number of individuals with schizophrenia living in African countries, estimated to be around 10 million, and the overall number of patients included in African trials, which is less than 2,000. These few trials were of low quality and appeared not to reflect the real needs of the population. We argue that the concept of pragmatism should be introduced into the design of randomized trials in African countries. Pragmatic trials should investigate whether treatments, given in real-world circumstances, really have clinically meaningful effects.

Caregiving in severe mental illness: the psychometric properties of the Involvement Evaluation Questionnaire in Portugal

BACKGROUND

Despite the achievements of previous research, caregiving assessments in severe mental illness should be crossculturally validated in order to define risk groups or to evaluate family work. This study reports on the psychometric properties of the European version of the Involvement Evaluation Questionnaire (IEQ-EU) in Portugal.

METHODS

A Portuguese translation of the IEQ-EU was developed according to the 'European Psychiatric Services: Inputs Linked to Outcome Domains and Needs' (EPSILON) group guidelines. We then studied 194 caregivers who were related to patients with schizophrenia spectrum disorders in psychiatric outpatient services. All relatives were assessed using the IEQ-EU. In order to describe the corresponding patients' sample, the majority (n = 162) was evaluated with the World Health Organization Disability Assessment Schedule (WHO-DAS II); 108 patients were also assessed with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF).

RESULTS

The factor structure of the Portuguese version of the questionnaire was similar to the original; internal consistency was good, with Cronbach's α ranging from 0.71 to 0.87 in the IEQ-EU scales (total score and domains: tension, supervision, worrying, urging); test-retest reliability yielded intraclass correlation coefficients (ICCs) from 0.80 to 0.94, concerning the same scores. Ecological validity was confirmed. Most caregiving consequences were reported on the worrying domain of the IEQ-EU.

CONCLUSIONS

Validity and reliability of the Portuguese IEQ-EU translation were established. Specifically the four IEQ-EU subscale domains seem to be valid in Portugal.

Psychopathology and subjective burden amongst primary caregivers of people with mental illness in South-Western Nigeria

BACKGROUND

Most mentally ill persons reside with family members in sub-Saharan Africa with the primary caregiver having to cater for the patients' needs. The burden of this care giving may be associated with psychopathology in the carer.

AIMS

To examine the rate and correlates of psychopathology and subjective burden amongst primary caregivers of people with mental illness in South-Western Nigeria.

METHOD

Adult psychiatric outpatients (n = 338) from three centres were assessed for clinical and functioning status, while their adult primary caregivers (n = 338) were assessed for psychopathology (using the General Health Questionnaire-GHQ-12) and level of burden (using the Zarit's caregiver burden scale-ZCBS).

RESULTS

The mean caregivers' GHQ-12 score was 3.11 (SD 2.57) and mean ZBCS score was 42.85 (SD = 19.31) with a significant correlation between the two (r = 0.638, P < 0.001). 118 (34.9%) caregivers had significant psychopathology and 205 (60.7%) had significant (moderate/severe) burden. The independent associate of psychopathology was poor patient functioning either measured objectively (OR 6.43, 95% CI 3.12-13.29) or subjectively perceived by the carers (OR 6.28, 95% CI 2.46-17.94). Caregivers burden was independently associated with patients' poor functioning (OR 5.97, 95% CI 2.56-15.45), caregivers' being employed (OR 5.40, 95% CI 3.02-9.64) and being male (OR 2.62, 95% CI 1.50-4.59).

CONCLUSION

With the high level of psychopathology and burden amongst caregivers in this region, clinicians should be sensitive and review them periodically and to pick up signs of psychopathology which may necessitate attention. Caregivers should be encouraged to meet regularly to share their experiences and ventilate their emotions.

Schizophrenia in Malaysian families: A study on factors associated with quality of life of primary family caregivers

BACKGROUND

Schizophrenia is a chronic illness which brings detrimental effects in the caregivers' health. This study was aimed at highlighting the socio-demographic, clinical and psychosocial factors associated with the subjective Quality of Life (QOL) of Malaysian of primary family caregivers of subjects with schizophrenia attending an urban tertiary care outpatient clinic in Malaysia.

METHODS

A cross-sectional study was performed to study patient, caregiver and illness factors associated with the QOL among 117 individuals involved with caregiving for schizophrenia patients. The study used WHOQOL-BREF to assess caregivers' QOL and Brief Psychiatric Rating Scale (BPRS) to assess the severity of patients' symptoms. Social Readjustment Rating Scale (SRRS) assessed the stress level due to life events.

RESULTS

The mean scores of WHOQOL-BREF in physical, psychological, social and environmental domains were 66.62 (14.36), 61.32 (15.52), 62.77 (17.33), 64.02 (14.86) consecutively. From multiple regression analysis, factors found to be significantly associated with higher QOL were higher educational level among caregivers in social and environmental domains; caregivers not having medical problem/s in physical and psychological domains; later onset and longer illness duration of illness in social domains; patients not attending day care program in environmental domain; lower BPRS score in physical and environmental domains. SRRS score of caregivers was also found to have a significant negative correlation with QOL in environmental and psychological domains. Other factors were not significantly associated with QOL.

CONCLUSION

Caregivers with more social advantages such as higher educational level and physically healthier and dealing with less severe illness had significantly higher QOL in various aspects. Supporting the caregivers in some of these modifiable factors in clinical practice is important to achieve their higher level QOL.

Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia

BACKGROUND

Although the burden experienced by families of people with schizophrenia has long been recognized as one of the most important consequences of the disorder, there are no reports from the Arab world. Following the example of the five-nation European (EPSILON) study, we explored the following research question: How does the relationship between domains of caregiving (as in the Involvement Evaluation Questionnaire--IEQ-EU) and caregiver psychic distress on the one hand, and caregiver's/patient's socio-demographics, clinical features and indices of quality of care, on the other hand, compare with the pattern in the literature?

METHOD

Consecutive family caregivers of outpatients with schizophrenia were interviewed with the IEQ-EU. Patients were interviewed with measures of needs for care, service satisfaction, quality of life (QOL) and psychopathology.

RESULTS

There were 121 caregivers (66.1% men, aged 39.8). The IEQ domain scores (total: 46.9; tension: 13.4; supervision: 7.9; worrying: 12.9; and urging: 16.4) were in the middle of the range for the EU data. In regression analyses, higher burden subscale scores were variously associated with caregiver lower level of education, patient's female gender and younger age, as well as patient's lower subjective QOL and needs for hospital care, and not involving the patient in outdoor activities. Disruptive behavior was the greatest determinant of global rating of burden.

CONCLUSION

Our results indicate that, despite differences in service set-up and culture, the IEQ-EU can be used in Kuwait as it has been used in the western world, to describe the pattern of scores on the dimensions of caregiving. Differences with the international data reflect peculiarities of culture and type of service. Despite generous national social welfare provisions, experience of burden was the norm and was significantly associated with patient's disruptive behavior. The results underscore the need for provision of community-based programs and continued intervention with the families in order to improve the quality of care.

Illness-related components for the family burden of relatives to patients with psychotic illness

BACKGROUND

Previous research has shown that symptom severity often implies an increased family burden. Few other illness-related variables have, however, been investigated in this context. This study investigates how family burden is affected by symptom, function, and cognition, as well as how the patient perceives his/her illness and quality of life.

METHOD

A total of 99 relatives, to as many patients diagnosed with psychosis and with their illness at a stable level, participated in this study. The relatives estimated their perceived burden, the patients rated the distress caused by their illness as well as the quality of their lives, and the care staff rated the patients' symptom and function as well as tested their cognitive abilities.

RESULTS

Increased family burden can be tied to the patients' increased symptom severity, to their impaired functioning as well as to the patients' higher self ratings regarding distress. The family burden is also connected to the patient's reduced working memory and reduced executive functioning, but this connection is not totally clear and should be further investigated. Of the variables that the patients were rated on, it was the overall functional ability measured with GAF that had the single most impact on perceived family burden.

CONCLUSIONS

Controlling of illness-related variables, such as symptoms, impaired functioning, impaired working memory and executive functioning, as well as the patients' own experiences of distress, is important in order to lessen the burden for the relatives. All aspects of family burden are, however, not explained by these factors, which is why further research within this realm is required.

Local suffering and the global discourse of mental health and human rights: an ethnographic study of responses to mental illness in rural Ghana

BACKGROUND

The Global Movement for Mental Health has brought renewed attention to the neglect of people with mental illness within health policy worldwide. The maltreatment of the mentally ill in many low-income countries is widely reported within psychiatric hospitals, informal healing centres, and family homes. International agencies have called for the development of legislation and policy to address these abuses. However such initiatives exemplify a top-down approach to promoting human rights which historically has had limited impact at the level of those living with mental illness and their families.

METHODS

This research forms part of a longitudinal anthropological study of people with severe mental illness in rural Ghana. Visits were made to over 40 households with a family member with mental illness, as well as churches, shrines, hospitals and clinics. Ethnographic methods included observation, conversation, semi-structured interviews and focus group discussions with people with mental illness, carers, healers, health workers and community members.

RESULTS

Chaining and beating of the mentally ill was found to be commonplace in homes and treatment centres in the communities studied, as well as with-holding of food ('fasting'). However responses to mental illness were embedded within spiritual and moral perspectives and such treatment provoked little sanction at the local level. Families struggled to provide care for severely mentally ill relatives with very little support from formal health services. Psychiatric services were difficult to access, particularly in rural communities, and also seen to have limitations in their effectiveness. Traditional and faith healers remained highly popular despite the routine maltreatment of the mentally ill in their facilities.

CONCLUSION

Efforts to promote the human rights of those with mental illness must engage with the experiences of mental illness within communities affected in order to grasp how these may underpin the use of practices such as mechanical restraint. Interventions which operate at the local level with those living with mental illness within rural communities, as well as family members and healers, may have greater potential to effect change in the treatment of the mentally ill than legislation or investment in services alone.

Quality of life in caregivers of patients with schizophrenia: a literature review

Background

A couple of decades ago, hospitals or psychiatric institutions were in charge of caring for patients with schizophrenia; however, nowadays this role is performed by one or more patient's relatives. Evidence shows that informal caregivers experience negative changes in their quality of life (QOL). The aim of this study is to review the main factors associated with the QOL of caregivers of people with schizophrenia.

Methods

A search through databases from journals published last decade between 1998 and 2008 was performed. In accordance with the inclusion criteria, titles and abstracts of citations obtained from the search were examined independently by two authors and irrelevant articles discarded. The full text of those studies considered relevant by either reviewer were obtained and assessed independently. Where differences of opinion rose they were resolved by discussion. Out of the 258 references, 37 were included in the review.

Studies which assessed factors associated with caregivers of people with schizophrenia's quality of life were included and the information summarized.

Results

Evidence suggest that physical, emotional and economic distress affect negatively caregiver's QOL as a result of a number of unfulfilled needs such as, restoration of patient functioning in family and social roles, economic burden, lack of spare time, among other factors.

Conclusion

Decreased QOL may be associated with caregivers' burden, lack of social support, course of the disease and family relationships problems. In addition, in developing countries, QOL is affected by caregivers' economic burden. High quality research is needed in order to identify factors associated with QOL over time and testing the efficacy of interventions aiming to improve QOL in caregivers of patients with schizophrenia.

Effects of a psychoeducational intervention program on the attitudes and health perceptions of relatives of patients with schizophrenia

BACKGROUND

In recent years there has been increased interest in the role played by families in the treatment of patients with schizophrenia. Some family interventions may significantly reduce clinical difficulties and may have a positive impact, both emotionally and economically. The aim of this study is to assess the efficacy of a family psychoeducational program in changing attitude and health perceptions in relatives of patients with schizophrenia.

SAMPLE

45 relatives, key caregivers of patients with schizophrenia seen at a public mental health outpatient centre in Arica (Chile).

INSTRUMENTS

Attitudes of Relatives toward Schizophrenia Questionnaire and General Health Questionnaire SF-36.

PROCEDURE

The sample was randomly divided into a control group, in which caregivers received the usual treatment (a monthly interview with a psychiatric nurse), and an experimental group, which participated in a family psychoeducational intervention program in addition to the usual treatment. Medication of patients remained unchanged in both groups.

RESULTS

The psychoeducational program was effective in modifying caregivers' attitudes. However, it had no effect on their health perceptions.

CONCLUSIONS

This family psychoeducational treatment program modifies the negative attitudes of relatives towards schizophrenia. However, programs of this kind may not improve health problems; alternatively, their effects may only be seen in the long term.

The forgotten caregivers: Siblings of schizophrenic patients

Objective. The situation of caregivers of psychiatric patients is mostly focussed on burdens of parents or spouses of patients. The burden of siblings due to the illness, however, is mostly underestimated and disregarded. Methods. Thirty-seven narrative interviews with siblings of schizophrenia inpatients were analysed by using a summarizing content analysis. The founded global statements were quantitatively analysed. Regression-analysis as well as regression trees were used to evaluate the data linked with sociodemographic and disease-related variables of the patient and siblings. Results. The results showed a high proportion of siblings engaged in caregiving activities. A total of 492 individual statements were summarized in 26 global types of statements. The three most often reported burdens by the healthy siblings are: "Handling the symptoms of illness" (100%), "Emotional burden due to the illness of the sibling" (100%) and "Uncertainty in judging what amount of stress the patient can cope with" (81.1%). Linear regression and regression tree analysis show predictors for higher burdened siblings. Conclusion. Siblings of schizophrenia patients are burdened in various aspects and in a specific matter. Their special needs will therefore have to be recognised before they can receive appropriate intervention.

Gender aspects of parents' needs of schizophrenia patients

BACKGROUND

Most studies about the problems and needs of schizophrenia carers included only one care-giving relative, usually the patients' mothers.

METHODS

101 mothers and fathers of the same patients suffering from schizophrenia were included into this study. Their needs were assessed by means of the "Carers' Needs Assessment for Schizophrenia".

RESULTS

Mothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Overall, mothers reported higher numbers of problems and needs for intervention than fathers. The number of mothers' problems was predicted by not living with a partner and by a shorter duration of the patients' illness. The number of mothers' needs was predicted by more psychiatric symptoms, not living with a partner and a shorter duration of the patients' illness. Among fathers we could not identify any predictors, neither for the number of problems nor for the number of needs.

CONCLUSIONS

Fathers and mothers often report problems and frequently need professional support. Overall, mothers exhibited more problems and needs for interventions than fathers. The differences between mothers and fathers indicate the importance of considering the carer's gender in clinical work.