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Ferentinos P, Douki S, Kourkouni E, Dragoumi D, Smyrnis N, Douzenis A. Differential correlates of criticism versus emotional overinvolvement towards patients with schizophrenia living in halfway houses or with their families. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02609-7. [PMID: 38296844 DOI: 10.1007/s00127-023-02609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE This study systematically searched for differential correlates of criticism vs. emotional overinvolvement (EOI) towards patients with schizophrenia in families and halfway houses, which have only incidentally been reported in previous research. Identified patterns were compared across settings. METHODS We included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the expressed emotion (EE) of 22 psychiatric nurses or 56 parents, respectively, through Five Minutes Speech Samples. Each nurse rated 1-12 inpatients and each inpatient was rated by 2-5 nurses. Each outpatient was rated by one or both parents. As EE ratings had a multilevel structure, weighted Spearman correlations of criticism and EOI with various patient- and caregiver-related characteristics were calculated and compared with Meng's z-test. RESULTS Criticism was weakly negatively correlated with EOI in nurses but negligibly in parents. Distinct patterns of significant differential correlates arose across settings. Outpatients' aggressive behavior and parents' related burden were mainly associated with higher criticism. Inpatients' symptoms (agitation/aggression, negative and other psychotic symptoms) and nurses' burnout (Depersonalization) were mainly associated with lower EOI. Inpatients' perceived criticism and outpatients' previous suicide attempts were equally associated with higher criticism and lower EOI (mirror correlations). Finally, various inpatient attributes (older age, chronicity, unemployment and smoking) triggered higher EOI only. Inpatients' age, psychopathology (esp. agitation/aggression and negative symptoms) and perceived criticism survived adjustment for multiple comparisons. CONCLUSION Our findings suggest setting-specific pathogenetic pathways of criticism and EOI and might help customize psychoeducational interventions to staff and families.
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Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece.
| | - Stamatina Douki
- Department of Psychiatry, "Evangelismos" General Hospital, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research, Athens, Greece
| | - Dimitra Dragoumi
- Department of Psychiatry, "Evangelismos" General Hospital, Athens, Greece
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Athanassios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
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AŞKAN T, ÇALIK VAR E, ÖZKAN B. Relationship Between Married Individuals' Relations with Their Family of Origin and Coping Styles with Stress. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2022. [DOI: 10.18863/pgy.1116904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study aims to determine the relationship between the family of origin relations and coping styles with stress in the married individuals. This research, which was conducted as a relational screening model was carried out with 150 married and at least high school graduates living in Ankara, selected with a purposeful sample. The data was obtained using the Information Form, Family of Origin Relations Inventory (FORI) and Styles of Coping Inventory (SCI). In married individuals,(n=150) the mean total score of SCI was 78.32±7.98; The mean total score of the FORI was found to be 26.51±4.50. There was no significant relationship between the total scores of FORI and SCI; It was determined that there is a positive correlation between the self-confident approach, helpless approach and submissive approach, which are the sub-dimensions of SCI, and the total score of the FORI. As a result, it was found that there was no relationship between family of origin relations and stress coping styles in married individuals, but as the relations with the family of origin relations improved, the use of self-confident approach, helpless approach and submissive approach increased among coping styles. For this reason, it is recommended to plan psychosocial interventions that will raise awareness about the relationship between their family of origin relations and their coping styles in order to enable married individuals to cope functionally.
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Affiliation(s)
| | - Esra ÇALIK VAR
- ANKARA YILDIRIM BEYAZIT ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, SOSYAL HİZMET BÖLÜMÜ, SOSYAL HİZMET PR
| | - Birgül ÖZKAN
- ANKARA YILDIRIM BEYAZIT ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, HEMŞİRELİK BÖLÜMÜ
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Dogan B, Ozmen S, Memis CO, Sair A, Akyol A, Sevincok L. Affective temperament traits may explain high expressed emotion in caregivers of patients with Alzheimer's disease. Psychogeriatrics 2020; 20:746-753. [PMID: 32638506 DOI: 10.1111/psyg.12588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/16/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The negative interactions between Alzheimer's disease (AD) patients and their caregivers may provoke criticism, hostility, and emotional overinvolvement that characterise highly expressed emotion (EE) attitudes. In this study, we hypothesised that affective temperament traits of AD caregivers are related to their high EE levels independent from other patient and caregiver characteristics. METHODS Eighty AD patients were assessed through Clinical Dementia Rating Scale (CDR), and Mini-Mental State Examination. Expressed Emotion Scale (EES), Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire, and Hamilton Depression Rating Scale were applied to the caregivers. The high (n = 41) and low EE caregivers (n = 39) were compared with respect to some sociodemographic and clinical characteristics of the patients and caregivers, and affective temperament traits of caregivers. The associations of caregiver EES scores with multiple variables related to patients and caregivers were examined by Pearson correlation tests. We performed multiple linear regression analysis to determine the possible predictors of total EES scores. RESULTS High EE caregivers had significantly higher depressive, cyclothymic, and anxious temperament traits than in low EE subjects. A weak positive correlation was found between the total EES scores and Personal Care scores of CDR. Home and hobbies subscale scores of CDR had a moderately significant positive correlation with total EES scores. There was also moderate significant positive correlations between total EE scores and depressive, cyclothymic, anxious, and irritable temperament traits. Linear regression analysis indicated that depressive temperament significantly predicted the high levels of caregiver EE. CONCLUSION These findings suggest that caregivers' depressive temperament is predominantly related to their EE levels even after controlling for the severity of AD, and lower educational level of caregivers. Our results may provide evidence that high EE might be a reflection of caregivers' depressive temperament traits, in accordance with the trait hypothesis.
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Affiliation(s)
- Bilge Dogan
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - Simel Ozmen
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
| | | | - Ahmet Sair
- Department of Neurology, Adnan Menderes University, Aydin, Turkey
| | - Ali Akyol
- Department of Neurology, Adnan Menderes University, Aydin, Turkey
| | - Levent Sevincok
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
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Avcıoğlu MM, Karanci AN, Soygur H. What is related to the well-being of the siblings of patients with schizophrenia: An evaluation within the Lazarus and Folkman's Transactional Stress and Coping Model. Int J Soc Psychiatry 2019; 65:252-261. [PMID: 30939972 DOI: 10.1177/0020764019840061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Schizophrenia is a chronic mental illness that strongly affects not only the patients with schizophrenia, but also their families and close relatives. So far, family research on patients with schizophrenia has mainly focused on parents, but has neglected siblings. AIM This study aims to evaluate the well-being of 103 siblings of patients with schizophrenia within the Lazarus and Folkman's Transactional Coping and Stress Model. MATERIALS A Sociodemographic Information Form, Subjective Well-being Scale, Zarit Caregiver Burden Scale, Multidimensional Perceived Social Support Scale, Ways of Coping Scale and Shortened Perceived Parental Rearing Styles Form were administered to the siblings of patients with schizophrenia. RESULTS The results of this study revealed that well-being was associated with perceived mother overprotection, perceived social support, problem-focused coping and indirect coping. Social support moderated the relationship between burden and well-being as a buffering factor. CONCLUSION Therefore, siblings of patients with schizophrenia should be given access to social support and their problem-focused coping strategies should be strengthened. Besides, parents should be supported to provide suitable care for the siblings of patients with schizophrenia.
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Affiliation(s)
| | - Ayşe Nuray Karanci
- 2 Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Haldun Soygur
- 3 Federation of Schizophrenia Associations, Ankara, Turkey
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Abstract
BACKGROUND Expressed emotion (EE) is detrimental to patients with schizophrenia, mood disorders, eating disorders and many other psychiatric and neurological disorders. However, majority of the EE literature is generated from the west, and the results of those studies may have limited application in Indian setting. Hence, we conducted this review with the main aim of understanding EE research in India and its potential role in the course and outcome of psychiatric disorders and other chronic illnesses. METHODS Using keywords, we performed searches of electronic databases (PubMed, IndMed, PsychInfo, Science-Direct and Google Scholar) and internet sources and a manual search in the bibliography of the retrieved articles to identify potential original research articles on EE in India. RESULTS As per the selection criteria, 19 reports of 16 studies were included and reviewed. The sample size of the EE studies ranged from 20 to 200, and majority of the studies were conducted in psychosis/schizophrenia, followed by obsessive compulsive disorder and epilepsy. Although high EE was found in most of the studies, the impact of EE on illness outcome is not well explored and only two studies examined the relationship between EE and relapse. DISCUSSION AND CONCLUSION There is a dearth of studies on EE, especially its relationship with relapse or clinical outcomes in the Indian context. We recommend more studies in these areas which may be helpful for clinical decisions and advancement of context knowledge in EE.
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Affiliation(s)
- Anvar Sadath
- Department of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Kozhikode, Kerala, India
| | - Ram Kumar
- Department of Psychiatry, Government Medical College, Kollam, Kerala, India
| | - Magnus Karlsson
- Department of Social Work, Linneaus University, Vaxjo, Sweden
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Attepe Özden S, Tuncay T. The experiences of Turkish families caring for individuals with Schizophrenia: A qualitative inquiry. Int J Soc Psychiatry 2018; 64:497-505. [PMID: 29862853 DOI: 10.1177/0020764018779090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In Turkey, individuals with schizophrenia usually live with their families. Therefore, families are main caregivers and face psychological, financial and social problems. AIM The aim of this study is to understand the personal burdens and coping strategies, and social support affecting the families that provide care to the individuals with schizophrenia. METHODS In-depth interviews were conducted with 31 members of 12 families. RESULTS Four themes were formed: learning and accepting the disorder, caregiving, social dimensions and service dimensions. Families have a problem with accepting this order and caregiving affects their quality of life both financially and socially. As schizophrenia is one of the reasons for being isolated from community, families prefer hiding it. Although families are satisfied with community-based systems, they need long-term solution, training and financial aid. CONCLUSIONS To reduce the burden, family therapies, education and psychological support should be provided for families, and job opportunities, long-term caregiving services and psychological support should be provided for individuals with schizophrenia.
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Affiliation(s)
- Seda Attepe Özden
- 1 Department of Social Work, Faculty of Health Sciences, Baskent University, Ankara, Turkey
| | - Tarık Tuncay
- 2 Department of Social Work, Hacettepe University, Ankara, Turkey
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Chen CK, Clayton K, Chodosh J. The Relationship Between "What We Believe" and "How We Care" Among Daughters Caring for a Parent With Dementia. Am J Alzheimers Dis Other Demen 2017; 32:90-95. [PMID: 28116927 PMCID: PMC10852901 DOI: 10.1177/1533317517689875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study attempted to better understand factors associated with relationship conflict between daughters and their parents with dementia. We examined data from 77 daughters self-identified as primary caregivers of a parent with dementia to test the hypothesis that daughters' belief that a parent with dementia can control their symptoms is associated with more conflict, defined as high expressed emotion (EE). Participants completed self-report questionnaires assessing beliefs about parents' ability to control symptoms, stress, relationship conflict, parent agitation, and cognitive status. Results indicated that greater intensity of daughters' belief that their parent can control dementia-related symptoms was associated with more relationship conflict or "high EE" (β = 0.57, P < .001). Daughters' beliefs about parental behavior may contribute to caregiver stress and exacerbate negative behaviors exhibited by individuals with dementia. Educating caregivers about parental behaviors and examining factors underlying caregiver interpretations of these behaviors hold promise for reducing caregiver stress.
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Affiliation(s)
- Cory K. Chen
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Psychiatry, New York University, New York, NY, USA
| | | | - Joshua Chodosh
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Medicine, New York University, New York, NY, USA
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Sadath A, Muralidhar D, Varambally S, Gangadhar BN, Jose JP. Do stress and support matter for caring? The role of perceived stress and social support on expressed emotion of carers of persons with first episode psychosis. Asian J Psychiatr 2017; 25:163-168. [PMID: 28262142 DOI: 10.1016/j.ajp.2016.10.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 08/26/2016] [Accepted: 10/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Caring for a person with first episode psychosis (FEP) is a challenging and distressing task for the carers. The carers' stress in the early stage of psychosis can increase their expressed emotion (EE) while social support is hypothesized to decrease EE. However, the influence of stress and social support on carers' EE is not well understood in FEP. AIM To examine how the stress and social support shape expressed emotion in the carers of FEP. METHODS Seventy one carers of the patients with non-affective FEP were recruited from the inpatient psychiatry ward of a tertiary mental health care center in South India. The family questionnaire, perceived stress scale and multidimensional scale of perceived social support were used to measure their EE, stress and social support respectively. RESULTS Carers experienced high level of perceived stress, EE and poor social support. Perceived stress significantly increased EE (β=0.834; p<0.001) and social support did not significantly influence EE (β=-0.065; p>0.05). Perceived stress predicted 76 percent of the variance on EE (Adjusted R2=0.761). CONCLUSION The results emphasize high level of stress and EE in carers of patients with FEP that implies the need for appropriate psychosocial interventions to manage their stress.
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Affiliation(s)
- Anvar Sadath
- Institute of Mental Health and Neurosciences, Kozhikode, Kerala 673 008, India.
| | - D Muralidhar
- Department of Psychiatric Social Work, National Institute of Mental Health & Neuro-Sciences, Bangalore, 560 029, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health& Neuro-Sciences, Bangalore, 560 029, India
| | - B N Gangadhar
- Department of Psychiatry, National Institute of Mental Health& Neuro-Sciences, Bangalore, 560 029, India
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Roseliza-Murni A, Oei TPS, Fatimah Y, Asmawati D. Schizophrenia relapse in Kuala Lumpur, Malaysia: do relatives' expressed emotion and personality traits matter? Compr Psychiatry 2014; 55:188-98. [PMID: 23374905 DOI: 10.1016/j.comppsych.2012.12.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/19/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Schizophrenia which is perhaps the most disabling and puzzling form of a mental disorder is often conceptualized as 'gila' (lunacy or madness) by the Malaysian society. The debilitating nature of the disorder and recurrent relapse of its psychotic episodes have often been misunderstood and lead to confusion among the family members, who play the role as primary caregivers. While expressed emotion (EE) has been widely studied in the Western world, it is not well understood in Malaysia. OBJECTIVES This study aimed at investigating the predictive role of relatives' EE index and components as well as personality traits in relapse among schizophrenia patients in Kuala Lumpur and Klang Valley, Malaysia. METHODS A total of 160 subjects consisting of 80 patients diagnosed with chronic schizophrenia and 80 relatives were recruited to participate in Phase 1 of the study. Only patient-participants were followed-up 6 months later for Phase 2 of the study in order to check for possible relapse. The Family Questionnaire (FQ) and the short scale Eysenck Personality Questionnaire-Revised (EPQ-R) were administered to measure relatives' EE and personality traits, respectively. Patients' were considered to relapse if they were readmitted into psychiatric wards 6 months post-hospital discharge. RESULTS The findings revealed that the odds for patients to relapse were increased by 8 times when relatives demonstrated high-EE level. Relatives' critical comments (CC) turned out to be the strongest predictor with the odds to relapse increased by 12% when they demonstrated an increase in CC level. Relatives' personality traits particularly the extraversion trait also turned out to be the significant direct predictor to patients' relapse. Our results showed that a unit decrease in extraversion trait score predicted the odds for patients to relapse by 23%. DISCUSSIONS Our findings supported the Western findings on the significant role of relatives' high-EE level particularly the CC scale on the course of schizophrenia. The novelty of the current finding was demonstrated in the significant role of relatives' extraversion trait that directly predicted patients' relapse. Results also indicated the feasibility of EE in predicting relapse among schizophrenia patients in Klang Valley, Malaysia.
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Affiliation(s)
- AbRahman Roseliza-Murni
- School of Psychology & Human Development, Faculty of Social Sciences & Humanities, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia.
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Huang XY, Sun FK, Yen WJ, Fu CM. The coping experiences of carers who live with someone who has schizophrenia. J Clin Nurs 2008; 17:817-26. [PMID: 18279285 DOI: 10.1111/j.1365-2702.2007.02130.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to understand the coping experiences of carers living with a schizophrenic family member. Our research may be a valuable reference for mental health professionals seeking to improve the quality of care for people with schizophrenia and their carers. DESIGN We employed a qualitative descriptive phenomenological research methodology to understand the coping experiences of carers living with a schizophrenic family member. METHODS Purposive sampling and in-depth, face-to-face interviews were used to collect data. When data saturation was reached, the sample size comprised 10 carers (five men and five women). The interview focused on the carer's coping experience. During the process of data collection and data analyis we established epoches (bracketing) and returned to the reality of the carers' experience to keep the data objective. Narratives were analysed according to Colaizzi's seven steps method. RESULTS The two most commonly used coping mechanisms that emerged from this study were psychological coping strategies (cognitive, behavioural and emotional) and social coping strategies (religious, social and professional support). Furthermore, three factors were found in the study, including low social status, traditional help-seeking behaviours and feelings of shame. CONCLUSION Findings from this study demonstrate the importance of understanding the coping experiences of carers who have a family member with schizophrenia. Further research is needed to identify more important detailed factors that affect the coping strategies of carers. Relevance to clinical practice. Community mental health care professionals need to improve the quality of care for helping carers living with a family member who has schizophrenia. It is important to develop effective coping intervention strategies that help carers cope with the stress and strain of caring for a family member with schizophrenia.
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Affiliation(s)
- Xuan-Yi Huang
- School of Nursing, China Medical University, Taiwan.
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