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

Efficacy of a culturally tailored intervention on perceived stigma among women living with HIV/AIDS in China: A randomized clinical trial

BACKGROUND

Despite evidence supporting the efficacy of culturally tailored interventions in reducing stigma, such approaches are lacking for women living with HIV/AIDS (WLWHAs) in China. We conducted this study to determine the efficacy of the culturally tailored Helping Overcome Perceived Stigma (HOPES) intervention in reducing perceived stigma among WLWHAs in China.

METHODS

A single-blinded, two-arm parallel-group randomized clinical trial was conducted from 2023 to 2024 in South and Southwest China. WLWHAs from four hospitals were assigned using a WeChat-embedded randomization application to the control group (usual care) or the HOPES intervention. Data analysts remained blinded. Interventions were conducted virtually using Leave No One Behind (LNOB) platform for 3 months. The primary outcome, perceived stigma score, was assessed at baseline, immediately after the intervention and at 3 months post-intervention using 7 items from the HIV/AIDS Stigma Experience Questionnaire (HASEQ), with data analyzed through repeated measures analysis.

RESULTS

Of 136 WLWHAs screened, we randomized 101 WLWHAs (50 HOPES; 51 controls). The HOPES group demonstrated a statistically significant reduction in perceived stigma scores immediately after the intervention (-3.86 points, 95 % CI: 5.34 to -2.38, P < .001) and at three months post-intervention (-5.83 points, 95 % CI: 7.20 to -4.47, P < .001) compared to the control group.

CONCLUSION

The findings demonstrate HOPES' efficacy in reducing perceived stigma in WLWHA. However, the clinical significance of these changes needs further investigation. Future research should focus on defining meaningful patient-reported thresholds, assessing long-term impact, and optimizing delivery methods.

The recovery experiences of individuals with schizophrenia in northwestern Ethiopia

Introduction

Schizophrenia recovery is perceived as a one-time symptom remission. However, it is a process that may continue throughout an individual's life. Understanding the recovery experience of a person with schizophrenia is an essential component of filling the mental health service gap and enhancing a smooth recovery process. The objective of this study was to explore the recovery experience of individuals with schizophrenia in a developing country.

Methods

To understand these experiences, we used qualitative research. Seventeen participants were purposefully selected from two hospitals in Northwestern Ethiopia. Semi-structured, in-depth interviews were conducted, and data was analyzed using Interpretive Phenomenological Analysis.

Results

Finally, four themes were generated: the first theme was the meaning of recovery. The definition of schizophrenia recovery differs from person to person based on their personal experience. For some, recovery means becoming free of symptoms, and for others, helping their family and being economically independent. The second theme was obstacles to recovery. The obstacles included limited understanding from family members, decreased social engagement, financial dependency, hopelessness, and suicidal thoughts. The third theme was support by family and employers. Participants received support from people around them. Family members mainly provided support by feeding, clothing, giving medications, and taking them to spiritual places. The fourth theme was coping strategies used to manage illness, which included medication adherence, visiting holy water sites and traditional healers, and listening to spiritual lessons.

Conclusion

Generally, participants focused on recovery from illness by emphasizing being free from symptoms to start their regular life. However, some of them were interested in pursuing education and engaging in work. The meaning given for recovery determines the kind of recovery process individuals have. Accepting that schizophrenia is a lifelong disorder, following medical treatments, finding ways to be active in their social life, and engaging in day-to-day activities are crucial components of recovery. In addition, since support from family members is vital, creating awareness creation programs for family members and the community is essential. Finally, psychosocial support and vocational training are important strategies that need to be considered to support recovery.

Current strategies in the reduction of stigma among caregivers of patients with mental illness: a scoping review

Mental healthcare and wellness are a global concern and have increasingly become an essential service and priority from a human rights perspective. However, negative attitudes towards mental health, such as stigmatisation and discrimination from communities and family members, continue to pose challenges for deinstitutionalisation and home care of mentally ill persons. This study aimed to review the literature on the content and implementation methods of stigma reduction interventions for family/community caregivers of patients with mental illness to inform the development of an anti-stigma intervention for such caregivers in low- and middle-income countries like South Africa. A scoping literature review was conducted of English language studies published from 2008 to 2019 in peer-reviewed journals, using established guidelines for the study objectives. Primary interventions targeting caregivers of mental health patients were searched from PsycINFO, ScienceDirect, CINAHL, and Medline. In total, nine full-text articles were extracted for inclusion in the review, indicating a scarcity of literature on anti-stigma interventions aimed at primary caregivers of mental health patients. Interventions varied in terms of educational content, duration, delivery methods, and sample sizes. Intervention delivery was primarily through face-to-face, telephone, and online methods. Anti-stigma interventions for caregivers of patients with mental illness are varied and show positive short-term impacts on mental health stigma reduction among family caregivers. The evolution of health systems is a feasible approach towards integrating learning and trials that are needed to assess long-term impacts.

Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries

Stigma is one of the main barriers for the full implementation of mental health services in low- and middle-income countries (LMICs). Recently, many initiatives to reduce stigma have been launched in these settings. Nevertheless, the extent to which these interventions are effective and culturally sensitive remains largely unknown. The present review addresses these two issues by conducting a comprehensive evaluation of interventions to reduce stigma toward mental illness that have been implemented in LMICs. We conducted a scoping review of scientific papers in the following databases: PubMed, Google Scholar, EBSCO, OVID, Embase, and SciELO. Keywords in English, Spanish, and Portuguese were included. Articles published from January 1990 to December 2017 were incorporated into this article. Overall, the studies were of low-to-medium methodological quality-most only included evaluations after intervention or short follow-up periods (1-3 months). The majority of programs focused on improving knowledge and attitudes through the education of healthcare professionals, community members, or consumers. Only 20% (5/25) of the interventions considered cultural values, meanings, and practices. This gap is discussed in the light of evidence from cultural studies conducted in both low and high income countries. Considering the methodological shortcomings and the absence of cultural adaptation, future efforts should consider better research designs, with longer follow-up periods, and more suitable strategies to incorporate relevant cultural features of each community.

Effectiveness of the Japanese standard family psychoeducation on the mental health of caregivers of young adults with schizophrenia: a randomised controlled trial

BACKGROUND

This study examined the effects of the standard model of family psychoeducation (SM-FPE) in Japan on the mental health of relatives who care for young patients with a psychotic disorder.

METHODS

Stratified by recent-onset/chronic psychosis, 74 caregivers of outpatients aged 30.1 years (mean) were randomly assigned to receive TAU (treatment as usual) alone or TAU plus SM-FPE. All outcomes were measured at baseline, at the end of the intervention (10 weeks), and 1 month post-intervention (14 weeks). The primary outcome was the trait anxiety of caregivers at 14 weeks. Secondary outcomes included caregivers' state anxiety, psychological distress, care burden, and expressed emotion. Integrating these secondary outcomes, a conceptual framework of caregivers' health state was assessed via structural equation modelling.

RESULTS

Compared with TAU alone, SM-FPE plus TAU did not significantly improve all caregivers' individual outcomes. Direct effects of the intervention were observed in the caregivers of chronic patients as significant improvements of their overall mental health state at 10 weeks, which indirectly continued until 14 weeks. However, such intervention effects were not observed in the caregivers of recent-onset patients.

CONCLUSIONS

The lack of effectiveness in the recent-onset stage suggests that the usefulness of the SM-FPE needs to be corroborated by further research.

TRIAL REGISTRATION

The study protocol was retrospectively registered at ClinicalTrials.gov (registration number: NCT01731977; date of registration: 22 November 2012).

Body Image Distortion Following Social Rejection or Acceptance Cues

Introduction: Body image has been shown to be subject to explicit, body-related feedback influences, yet little attention has been paid to subtle feedback about overall social acceptability. The current study tested competing hypotheses regarding women's body image after being primed with cued social rejection or acceptance. Whereas sociometer theory predicts that women will perceive their bodies more negatively following a social rejection prime, self-enhancement theory predicts the opposite.

Method: A total of 105 female undergraduate students underwent a conditioning procedure in which distinctive tones were paired with signs of social rejection or acceptance. After this, body distortion (measured by a participant-adjusted virtual image), self-reported body satisfaction and affect were measured, while one of the tones sounded repeatedly in the background.

Results: Compared with the acceptance condition, rejection condition participants reported greater state negative affect, F(1, 103) = 4.41, p = .04, greater state positive affect, F(1, 103) = 5.52, p = .02, and perceived their bodies as being smaller, F(1, 103) = 6.53, p = .01, consistent with the expectations of self-enhancement theory.

Discussion: Implications of these findings are discussed regarding improved understanding of body image disturbance as well as development of novel clinical treatments.

The effect of a family intervention on primary caregivers psychological outcomes: Findings from the integrative literature review

AIMS

This literature review examines the effectiveness of the family interventions (FIs) targeted at the primary caregivers of people diagnosed with schizophrenia on improving the knowledge level of schizophrenia and health-related outcomes.

METHODS

A total of nine studies were reviewed from December 1999 to May 2017. The methods described by the Center for Reviews and Dissemination were used to guide this review.

RESULTS

The FIs showed consistent improvement in the knowledge level of schizophrenia among participants for various follow-up intervals. In addition, FIs were found to be superior to treatment as usual in influencing health-related outcomes.

CONCLUSIONS

Implications of the findings for mental healthcare practice to include primary caregivers with the patient in the treatment process.

Correlates of Negative Attitudes towards Medication in People with Schizophrenia

Attitudes towards psychiatric medication are an important factor influencing the success of treatment. Mental health care in the region of Central and Eastern Europe remains biologically oriented, yet the attitudes of people with severe mental illnesses are largely unknown. In the present study, we aimed to analyze factors of attitudes toward psychopharmacological drugs among people with schizophrenia spectrum disorder who use community social services in the Czech Republic. Drug Attitude Inventory (DAI) was used as a primary research instrument and data were analyzed using a multivariable linear regression. The majority of respondents (78%) had positive attitudes towards psychopharmacological treatment. Additionally, attitudes towards psychopharmaceutic drugs did not differ with regard to sociodemographic characteristics except for family status. There was a significant negative correlation with the level of self-stigmatization and a significant positive correlation with the duration of treatment. Respondents who had repeated experiences with discontinuation of medication without a prior consultation with a psychiatrist had significantly worse attitudes towards medication than respondents without this experience. This study revealed evidence of a strong relationship between the attitudes toward medication and a history of discontinuation of taking medication and duration of treatment. Therefore, we suggest that interventions focused preventing the internalization of stigmatizing attitudes towards mental illness should be available to people with schizophrenia spectrum disorder, especially in the early stages of the illness - irrespective of the patient's age.

Interventions to reduce stigma towards people with severe mental illness: Systematic review and meta-analysis

This review evaluates the evidence on what interventions are effective in reducing public stigma towards people with severe mental illness, defined as schizophrenia, psychosis or bipolar disorder. We included 62 randomised controlled trials of contact interventions, educational interventions, mixed contact and education, family psychoeducation programs, and hallucination simulations. Contact interventions led to small-to-medium reductions in stigmatising attitudes (d = 0.39, 95% CI: 0.22 to 0.55) and desire for social distance (d = 0.59, 95% CI: 0.37 to 0.80) post-intervention, but these were reduced after adjusting for publication bias (d = 0.24 and d = 0.40, respectively). Effects did not vary by type or length of contact. Effects at follow-up were smaller and not significant. Education interventions led to small-to-medium reductions in stigmatising attitudes (d = 0.30, 95% CI: 0.14 to 0.47) and desire for social distance (d = 0.27, 95% CI: 0.08 to 0.46) post-intervention. Small improvements in social distance persisted up to 6 months later (d = 0.27, 95% CI: 0.05 to 0.49), but not attitudes (d = 0.03, 95% CI: -0.12 to 0.18). The combination of contact and education showed similar effects to those that presented either intervention alone, and head-to-head comparisons did not show a clear advantage for either kind of intervention. Family psychoeducation programs showed reductions in stigma post-intervention (d = 0.41, 95% CI: 0.11 to 0.70). The effectiveness of hallucination simulations was mixed. In conclusion, contact interventions and educational interventions have small-to-medium immediate effects upon stigma, but further research is required to investigate how to sustain benefits in the longer-term, and to understand the active ingredients of interventions to maximise their effectiveness.

Objective and subjective burden in relatives of patients with schizophrenia and its influence on care relationships in Chile

This study examined the burden on family members of patients with schizophrenia in a Chilean community. Sixty-five caregivers underwent the Subjective and Objective Family Burden Interview. The results showed moderate to high levels of subjective burden and low levels of support from others in providing care. Burden and containment of disturbed behaviour were correlated with worse relationships between patients and caregivers, with the latter spending less time working outside the home. The assessed sample showed a similar pattern of burden to that of caregivers from developed countries; however, the extent of the burden tended to be higher in Chilean caregivers.

Evidence for effective interventions to reduce mental-health-related stigma and discrimination

Stigma and discrimination in relation to mental illnesses have been described as having worse consequences than the conditions themselves. Most medical literature in this area of research has been descriptive and has focused on attitudes towards people with mental illness rather than on interventions to reduce stigma. In this narrative Review, we summarise what is known globally from published systematic reviews and primary data on effective interventions intended to reduce mental-illness-related stigma or discrimination. The main findings emerging from this narrative overview are that: (1) at the population level there is a fairly consistent pattern of short-term benefits for positive attitude change, and some lesser evidence for knowledge improvement; (2) for people with mental illness, some group-level anti-stigma inventions show promise and merit further assessment; (3) for specific target groups, such as students, social-contact-based interventions usually achieve short-term (but less clearly long-term) attitudinal improvements, and less often produce knowledge gains; (4) this is a heterogeneous field of study with few strong study designs with large sample sizes; (5) research from low-income and middle-income countries is conspicuous by its relative absence; (6) caution needs to be exercised in not overgeneralising lessons from one target group to another; (7) there is a clear need for studies with longer-term follow-up to assess whether initial gains are sustained or attenuated, and whether booster doses of the intervention are needed to maintain progress; (8) few studies in any part of the world have focused on either the service user's perspective of stigma and discrimination or on the behaviour domain of behavioural change, either by people with or without mental illness in the complex processes of stigmatisation. We found that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term. However, the evidence for longer-term benefit of such social contact to reduce stigma is weak. In view of the magnitude of challenges that result from mental health stigma and discrimination, a concerted effort is needed to fund methodologically strong research that will provide robust evidence to support decisions on investment in interventions to reduce stigma.

Non-pharmacological interventions for caregivers of patients with schizophrenia: A meta-analysis

It has been estimated that about 50-80% of patients with schizophrenia live with or closely contact with their caregivers, and rely on them for housing, and emotional and financial supports. Caregiving experience is usually described as stressful for their caregivers. Non-pharmacological interventions seem to be beneficial to improving life quality. However, there is still no meta-analysis focused on this topic to give an overview.We searched the electronic databases includingPubMed, EMBASE, CINAHL, Cochrane Library and China National Knowledge Infrastructure, respectively from the beginning of database to July 2015 for all the randomized controlled trialsevaluating the caregiver interventions. Continuous data were expressed mean differences (MD) with 95% confidential intervals (CIs). Standardized mean difference was planned to express, if different scales were used to measure the same outcome. We pooled the results using a random-effect model.As a result, nine studies met the inclusion criteria, comprising 608 randomized participants. In which, 321 participants were in interventional group, while 287 participants were in control group. Concerning the care burden, there was significant difference found between non-pharmacological interventions and control groups (n=290, MD -2.10, 95% CI -3.46 to -0.74, P=0.002; level of heterogeneity τ(2)=1.81, χ(2)=62.13, df=3, P<0.00001, I(2)=95%). However, no differences were found in family support, family functioning and satisfaction. Of note, our meta-analysis demonstrated the efficacy of non-pharmacological interventions for caregivers of schizophrenia, and supported the application in the clinical practice. However, all the conclusions should be explained cautiously and further confirmation is required by well-designed trials with large sample.

Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review

BACKGROUND

Most research on interventions to counter stigma and discrimination has focused on short-term outcomes and has been conducted in high-income settings.

AIMS

To synthesise what is known globally about effective interventions to reduce mental illness-based stigma and discrimination, in relation first to effectiveness in the medium and long term (minimum 4 weeks), and second to interventions in low- and middle-income countries (LMICs).

METHOD

We searched six databases from 1980 to 2013 and conducted a multi-language Google search for quantitative studies addressing the research questions. Effect sizes were calculated from eligible studies where possible, and narrative syntheses conducted. Subgroup analysis compared interventions with and without social contact.

RESULTS

Eighty studies (n = 422 653) were included in the review. For studies with medium or long-term follow-up (72, of which 21 had calculable effect sizes) median standardised mean differences were 0.54 for knowledge and -0.26 for stigmatising attitudes. Those containing social contact (direct or indirect) were not more effective than those without. The 11 LMIC studies were all from middle-income countries. Effect sizes were rarely calculable for behavioural outcomes or in LMIC studies.

CONCLUSIONS

There is modest evidence for the effectiveness of anti-stigma interventions beyond 4 weeks follow-up in terms of increasing knowledge and reducing stigmatising attitudes. Evidence does not support the view that social contact is the more effective type of intervention for improving attitudes in the medium to long term. Methodologically strong research is needed on which to base decisions on investment in stigma-reducing interventions.

Psychoeducation for siblings of people with severe mental illness

BACKGROUND

Many people with severe mental illness (SMI) have siblings. Siblings are often both natural agents to promote service users' recovery and vulnerable to mental ill health due to the negative impact of psychosis within the family. Despite a wealth of research evidence supporting the effectiveness of psychoeducation for service users with SMI and their family members, in reducing relapse and promoting compliance with treatment, siblings remain relatively invisible in clinical service settings as well as in research studies. If psychoeducational interventions target siblings and improve siblings' knowledge, coping with caring and overall wellbeing, they could potentially provide a cost-effective option for supporting siblings with resulting benefits for service users' outcomes.

OBJECTIVES

To assess the effectiveness of psychoeducation compared with usual care or any other intervention in promoting wellbeing and reducing distress of siblings of people affected by SMI.The secondary objective was, if possible, to determine which type of psychoeducation is most effective.

SEARCH METHODS

We searched the Cochrane Schizophrenia Group Trials Register and screened the reference lists of relevant reports and reviews (12th November 2013). We contacted trial authors for unpublished and specific data on siblings' outcomes.

SELECTION CRITERIA

All relevant randomised controlled trials focusing on psychoeducational interventions targeting siblings of all ages (on their own or amongst other family members including service users) of individuals with SMI, using any means and formats of delivery, i.e. individual (family), groups, computer-based.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the abstracts and extracted data and two other authors independently checked the screening and extraction process. We contacted authors of trials to ascertain siblings' participation in the trials and seek sibling-specific data in those studies where siblings' data were grouped together with other participants' (most commonly other family members'/carers') outcomes. We calculated the risk difference (RD), its 95% confidence interval (CI) on an intention-to-treat basis. We presented continuous data using the mean difference statistic (MD) and 95% CIs. We assessed risk of bias for the included study and rated quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

MAIN RESULTS

We found 14 studies that included siblings amongst other family members in receipt of psychoeducational interventions. However, we were only able to include one small trial with relevant and available data (n = 9 siblings out of n = 84 family member/carer-participants) comparing psychoeducational intervention with standard care in a community care setting, over a duration of 21 months. There was insufficient evidence to determine the effects of psychoeducational interventions compared with standard care on 'siblings' quality of life' (n = 9, MD score 3.80 95% CI -0.26 to 7.86, low quality of evidence), coping with (family) burden (n = 9, MD -8.80 95% CI -15.22 to -2.34, low quality of evidence). No sibling left the study early by one year (n = 9, RD 0.00 CI -0.34 to 0.34, low quality of evidence). Low quality and insufficient evidence meant we were unable to determine the effects of psychoeducational interventions compared with standard care on service users' global mental state (n = 9, MD -0.60 CI -3.54 to 2.38, low quality of evidence), their frequency of re-hospitalisation (n = 9, MD -0.70 CI -2.46 to 1.06, low quality of evidence) or duration of inpatient stay (n = 9, MD -2.60 CI -6.34 to 1.14, low quality of evidence), whether their siblings received psychoeducation or not. No study data were available to address the other primary outcomes: 'siblings' psychosocial wellbeing', 'siblings' distress' and adverse effects.

AUTHORS' CONCLUSIONS

Most studies evaluating psychoeducational interventions recruited siblings along with other family members. However, the proportion of siblings in these studies was low and outcomes for siblings were not reported independently from those of other types of family members. Indeed, only data from one study with nine siblings were available for the review. The limited study data we obtained provides no clear good quality evidence to indicate psychoeducation is beneficial for siblings' wellbeing or for clinical outcomes of people affected by SMI. More randomised studies are justified and needed to understand the role of psychoeducation in addressing siblings' needs for information and support.

Perceptions of psychosocial disability amongst psychiatric service users and caregivers in South Africa

BACKGROUND

In many parts of South Africa there is little support for people with psychosocial disability caused by schizophrenia, beyond provision of psychotropic medications. Appropriate community-based psychosocial rehabilitation interventions are a crucial element of mental health service development.

OBJECTIVES

This study aimed to use an explanatory model of illness framework to document experiences of illness, disability and recovery amongst service users with schizophrenia and their caregivers in a poorly resourced area in the North West Province. Data were used to provide recommendations for a contextually appropriate non-specialist facilitated group psychosocial rehabilitation intervention.

METHOD

Eighteen in-depth individual interviews were conducted: nine with schizophrenia service users and nine with caregivers. Interviews were conducted by two trained field researchers; both clinical psychologists fluent in the first language of participants. All interviews were recorded, translated and transcribed. Data were thematically analysed using NVivo 9.

RESULTS

Participants linked the illness to witchcraft, poverty and stress. Family conflict was recognised in the course of the illness, causing stress and challenges for emotional well-being. Knowledge of diagnosis and biomedical treatment was minimal. Key factors recognised by service users as promoting recovery were the ability to work, and the support of traditional healers and religious structures.

CONCLUSION

Based on the findings of this study, a group psychosocial rehabilitation intervention emerged as a recommendation, with the incorporation of psycho-education, adherence support, coping skills, and opportunities for income generation and productive activity. The importance of also enlisting the support of religious leaders and traditional healers in supporting recovery is emphasised.

Developing visually based, low-literacy health education tools for African Americans with psychotic disorders and their families

Schizophrenia presents particular challenges to health literacy, partly due to associated neurocognitive deficits. In order to develop engaging, recovery-oriented, visually based psychoeducational tools pertaining to psychotic disorders, thirty-nine individuals, consisting of mental health service users with serious mental illnesses, family members, and mental health professionals, participated in informal discussions. Using suggestions from these groups, the first two psychoeducational booklets of a planned series were developed in collaboration with a graphic designer and visual artist. Content of the booklets was developed addressing four components: knowledge, self-efficacy/self-management, incorporating a workbook format, and planning/contracting. In a follow-up discussion group, mental health service users provided positive feedback on the completed booklets. The finished booklets are practical, accessible, engaging, and low-literacy. These and other innovative approaches are needed to enhance mental health care, promote self-efficacy/empowerment, and encourage communication between service users, family members, and providers, especially in light of limited health literacy, illness-related neurocognitive impairments, and stigma.

[Psychosocial interventions in severe mental illness: evidence and recommendations: psychoeducation, social skill training and exercise]

This paper summarizes the results of a systematic literature search on three widely used psychosocial interventions for people with severe mental illness: psychoeducation for patients and relatives, social skill training and physical exercise. Based on this evidence, recommendations given in the S3 guidelines on psychosocial therapies in severe mental illness of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) will be reported. Areas of future research are identified.

Human resources for mental health care: current situation and strategies for action

A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries.

Attitudes and burden in relatives of patients with schizophrenia in a middle income country

Background

Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia.

Methods

We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica.

Results

Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R² = .104, F = 4,55; p = .039).

Conclusions

Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context.

[Burden of care in Aymara caregivers of patients with schizophrenia]

INTRODUCTION

The introduction of anti-psychotic medication and the de-institutionalization have placed on the hands of their relatives the responsibility for their informal care. Many times, this role carries a high level of burden for all family members. There exist a few studies that approach this subject matter in groups of ethnic minority. The aim of this research was to describe the levels of burden in Aymaras caregivers (aborigines who are located on the highlands of Northen Chile) from Schizophrenia patients.

MATERIAL AND METHODS

The sample corresponds to 45 caregivers of patients with schizophrenia that receive treatment at the Mental Health Services in the city of Arica, Chile.

RESULTS

[corrected] Zarit Burden Scale classifies all Aymara relatives in the category of "Intense Burden", unlike not Aymara relatives, which classified as "Low Burden". Significant differences are observed in the subscale of incompetence where the Aymara Cargivers perceive not to feel able of taking care of the patient with the available resources.

CONCLUSIONS

It is concludes that belonging to this ethnic minority would increase the psychopathological risk that caregivers of psychiatric patients experience.