Lifelong maternal caregiving for children with schizophrenia

Positive and negative impacts of schizophrenia on family caregivers: a systematic review and qualitative meta-summary

PURPOSE

Schizophrenia places a heavy burden on the individual with the disorder, as well as on his or her family; this burden continues over the long course of the disease. This study aimed to provide an overview of the positive and negative impacts of schizophrenia on family caregivers.

METHODS

From April to June 2017, two investigators conducted a systematic review and meta-summary of studies obtained from five electronic databases and the footnotes and citations of eligible studies. Qualitative studies that explored the experiences of family caregivers of individuals with schizophrenia were included. Study findings published between 1993 and 2017 were extracted and synthesised using narrative and summative approaches.

RESULTS

After the removal of duplicates, independent reviewers screened 864 records. Subsequently, 46 full-text articles were assessed for eligibility and 23 papers were included in the synthesis. Negative impacts identified were traumatic experiences, loss of expectation of life and health, lack of personal and social resources, uncertainty and unpredictability, family disruption, conflict in interpersonal relationships, difficulty in understanding, and stigma and heredity. Meanwhile, the positive impacts identified were family solidarity, admiration, affirmation, affection, compassion, learning knowledge and skills, self-confidence, personal growth, and appreciation.

CONCLUSIONS

Analysis of the studies suggested that family members of individuals with schizophrenia face a series of traumatic situations during the course of the illness. Their subsequent experiences can be conceptualised as a continuous circle of caregiving, in which the positive impacts can be centrally positioned within the negative impacts.

Changes in Families' Caregiving Experiences through Involvement as Participants then Facilitators in a Family Peer-Education Program for Mental Disorders in Japan

A family peer-education program for mental disorders was developed in Japan, similar to existing programs in the United States and Hong Kong. Families that serve as facilitators in such programs may enhance their caregiving processes and, thereby, their well-being. This study's aim was to describe how families' caregiving experiences change, beginning with the onset of a family member's mental illness, through their involvement in a family group or peer-education program as participants then facilitators. Thus, this study was conducted in a family peer-education program for mental disorders in Japan. Group interviews were conducted with 27 facilitators from seven program sites about their experiences before, during, and after becoming facilitators. Interview data were coded and categorized into five stages of caregiving processes: (1) withdrawing and suppressing negative experiences with difficulty and regret; (2) finding comfort through being listened to about negative experiences; (3) supporting participants' sharing as facilitators; (4) understanding and affirming oneself through repeated sharing of experiences; and (5) finding value and social roles in one's experiences. The third, fourth, and fifth stages were experienced by the facilitators. The value that the facilitators placed on their caregiving experiences changed from negative to positive, which participants regarded as helpful and supportive. We conclude that serving as facilitators may improve families' caregiving processes.

Family caregiving for adults with schizophrenia and diabetes mellitus

Diabetes mellitus (DM) is common among those with schizophrenia, but little is known about family members' roles in the care of relatives who have both schizophrenia and DM. The purpose of this descriptive correlational study was to examine DM knowledge and caregiver burden among 27 family caregivers of people with schizophrenia and DM. Findings indicate that DM knowledge was low. Objective caregiver burden was highest for providing assistance with daily living activities. Subjective burden was highest for preventing the care recipient from keeping people awake at night and dealing with the care recipient's non-adherence to DM care. Family caregivers are in need of education and support in the caregiving role.

Experience of living with a family member with bipolar disorder

Bipolar disorder (BD) is a severe illness that has a serious impact on the lives of those affected and on their families. The aim of this study was to elucidate what it means for family members to live with an adult person who has BD, with reference to their views concerning the condition of the person affected and the future. During 2005, 17 family members of people with the disorder were interviewed, and the data obtained were subjected to a qualitative content analysis. The findings showed that family members felt alone with their experiences and struggled to make sense of and to maintain normality, as their life was encroached on by the condition. Bearing the burden of responsibility and control made it difficult for family members to focus on their own future. To build hope, they needed opportunities to share their experiences with others, increased understanding of the condition, and relief from the burden they bore. This study underlines the importance of strengthening support holistically for family members living with an adult person with BD. Support and interventions concerning these families' needs have to be developed and should be provided by all mental health-care services.

Mothers' everyday experiences of having an adult child who suffers from long-term mental illness

This paper aims to describe everyday life experiences of mothers who have an adult child with a long-term mental illness. Sixteen mothers were interviewed. A content analysis resulted in one main theme: My adult child who is struggling with mental illness is always on my mind, and three subthemes: (1) living a life under constant strain, (2) living with an emotional burden, and (3) seeing light in the darkness despite difficulties. Knowledge of mothers’ everyday life experiences is of great importance in order to support them and thereby increase the possibility of these mothers being a source of strength for their child.

Experiences and Demands of Families With Mentally Ill People at Home in Botswana

PURPOSE

To describe the experiences and demands of families who care for their mentally ill relatives at home in Botswana.

DESIGN

Grounded theory design with triangulated data sources.

METHODS

A convenience sample was drawn from both urban and rural areas and composed of both men and women. Data-collection methods included in-depth interviews, focus group discussions and field observations. Data were collected using an interview protocol in the local language. Interviews were audiotaped, transcribed, and translated into English. Analysis was done by open and axial coding and grouping like data together to generate core categories, using the constant comparison method.

FINDINGS

The interview data revealed a myriad of experiences and problems that families encountered in providing care to their relatives. The situation was perceived as difficult and burdensome because of lack of control and inadequate resources. The complexity of the situation required negotiation between the family members, their ill relatives, and health professionals.

CONCLUSIONS

This study indicated some of the difficulties caregivers encounter and the coping mechanisms they use to deal with the day-to-day care of their ill relatives. Community resources are needed to assist families to effectively care for their relatives.

Having a Sibling With Schizophrenia: A Phenomenological Study

Limited attention has been paid to experiences of individuals with siblings diagnosed with schizophrenia. The purpose of this article is to address this gap by exploring the impact of having a brother or sister with schizophrenia. The lived experience of 6 individuals with a sibling with schizophrenia was explored using van Manen’s (1997) Hermeneutic Phenomenology. Four themes were identified: struggling to understand, struggling with the system, caring for the sibling, and seeing beyond the illness. Health care providers need to re-evaluate current approaches for assisting individuals to cope with having a sibling with schizophrenia. Inclusion in the plan of care and recognition of their struggle is essential for individuals having a sibling with schizophrenia.

The impact of a family systems nursing educational program on the practice of psychiatric nurses: a pilot study

A pilot study was conducted to examine the impact of a Family Systems Nursing educational program on the practice of psychiatric nurses and to explore the nurses' perceptions of the educational program. One year after the program, six nurses were asked to complete logbooks and to participate in an individual semistructured interview based on open-ended questions and on the critical incident approach to describe their family nursing interventions and to explore their perceptions on how the educational program influenced their practice of family nursing care. Content analyses indicated that participant nurses integrated systemic family interventions in their practice and were satisfied with the program.

The factor structure of the Burden Assessment Scale and the perceived burden of caregivers for individuals with severe mental disorders

The aims of this study were to test the construct validity and the homogeneity of the Swedish version of the Burden Assessment Scale (BAS) and study perceived burden in daily life among family caregivers of individuals with severe mental disorders. A total of 256 caregivers took part in the study. The participants completed two questionnaires. One was the BAS, a brief scale that focuses on specific subjective and objective consequences of families caring for individuals with severe mental disorders. The other one was a questionnaire constructed for the study including demographic data. A principal component analysis yielded three factors: 'activity limitation', 'feelings of worry and guilt' and 'social strain'. The internal consistency calculated by Cronbach's alpha coefficients varied between 0.73 and 0.88 for the three factors. The findings indicated that the caregivers experienced more 'activity limitation' and 'social strain' in relation to the youngest and to those who had an elementary educational level than they did for comparison groups. There were no differences found between the caregivers in relation to clients' daily occupation outside home. The results confirm that family caregiver burden is complex and includes several areas such as activities in daily life, worry and social strain. Given this knowledge about caregivers' situation, it is critical that families be given opportunities to identify what support might help. Further research is needed to identify such support.

How was it for you? Families' experiences of receiving Behavioural Family Therapy

The benefits of family interventions for families having to cope with serious mental health problems are well documented but routine implementation of these interventions is often problematic. Despite a wealth of research on the clinical outcomes of such interventions, very little is known about families' subjective perceptions of receiving them. This study reports the findings of a phenomenological enquiry into the lived experience of 10 families who received Behavioural Family Therapy (BFT) as part of a training initiative in the West Midlands Health Region of the UK. The results show that families were very satisfied with the intervention. They reported reductions in the levels of stress within the family, reduction in levels of carer burden, enhanced communication skills and a positive sense of empowerment. They attributed these changes to receiving BFT. The majority of families viewed mental health professionals and services more favourably compared to their experiences before receiving BFT. This is an important finding for service providers, commissioners and mental heath workers.

Redefining parental identity: caregiving and schizophrenia

When parents try to assume responsibility for an ill adult-child with schizophrenia, the law, mental health practitioners, and often the ill person reject their right to do so. Consequently, these parents regard themselves as disenfranchised, i.e., lacking the rights required to care properly for their loved ones. Redefining Parental Identity, a grounded theory of caregiving and schizophrenia, traces changes in a parent's identity and caregiving during the erratic course of the child's mental illness. Participants were a purposive sample of 29 parent caregivers from 19 families in British Columbia, Canada, caring for 20 adult children. This understanding of their experience will be helpful to parents of people with schizophrenia, professional practitioners, and those involved in mental health care reform.

A grounded theory of families responding to mental illness

Despite decades of research documenting family burden related to mental illness of a relative, little is known about families' responses over time. A grounded theory study was designed to describe families' responses to these severe mental illnesses. Twenty-nine participants representing 17 families were interviewed 3 times over 2 years. Interviews were analyzed using constant comparison. Living with ambiguity of mental illness was the central concern. The basic social process was pursuing normalcy and included confronting the ambiguity of mental illness, seeking to control impact of the illness, and seeing possibilities for the future. Goals were managing crises, containing and controlling symptoms, and crafting a notion of "normal." Strategies were being vigilant, setting limits on patients, invoking logic, dealing with sense of loss, seeing patients' strengths, and taking on roles. The study revealed that families were profoundly affected by the social contexts of mental illnesses.

Psychological morbidity of Thai families of a person with schizophrenia

The paper presents data on families of a person with schizophrenia in rural Thailand, using the resiliency model of family stress, adjustment, and adaptation. The aim is to assess the impact of family factors on psychological morbidity of the mothers and relatives of a person with schizophrenia. One hundred and eight Thai families were interviewed based on family assessment instruments. Multiple regression analysis was performed. The findings suggest that in a stable stage of illness, other stresses of family life may have stronger impact on psychological status of family members, than the illness. Implications for clinical nurses and researchers are presented.

Being a parent of an adult son or daughter with severe mental illness receiving professional care: parents' narratives

The aim of this study was to illuminate the meaning of parental care-giving with reference to having an adult son or daughter with severe mental illness living in a care setting. The parents were asked to narrate their relationship to offspring in the past, in the present, and their thoughts and feelings concerning the future. The study was guided by a phenomenological hermeneutic perspective. The meaning of parental care was illuminated in the themes 'living with sorrow, anguish and constant worry', 'living with guilt and shame', 'relating with carer/care; comfort and hardships' 'coming to terms with difficulties' and 'hoping for a better life for the adult child'. Parental care-giving emerged as a life-long effort. The narratives revealed ongoing grief, sorrow and losses interpreted as chronic sorrow. The narratives disclosed a cultural conflict between the family system and the care system, which was interpreted as a threat to the parental role, but also experiences of receiving comfort and having confidence in the care given. Experiences of stigma were interpreted from the way of labelling illness, narrated experiences of shame and relations with the public and mental health professionals. Parents' persisting in the care-giving role, striving to look after themselves and expressing hopes for the future were interpreted as a process of coming to terms with difficulties. Results suggest that mental health professionals need to be aware of their own attitudes and treatment of families, improve their cooperation with, and support to families, and provide opportunities for family members to meet one another.

Male caregivers of mentally ill relatives

TOPIC

To describe the lived experiences of male caregivers of severely mentally ill relatives and their perceptions of this nontraditional role.

METHODS

A qualitative study of informal interviews with purposively selected male caregivers (N = 10), using an informal interview guide that addressed psychosocial, physical, financial, and crisis-management categories.

FINDINGS

The data yielded three themes of caregiving: expressions of burden, duration and depth of commitment, and role affirmation.

CONCLUSIONS

The results can help health professionals develop needed education and support services for men in this emerging role and contribute to family health in the community.

Environmental context of caregiving for severely mentally ill adults: an African American experience

Most people with severe mental illness depend on family to provide care. Although an increasing amount of research has examined caregiving, there is much to be discovered about the caregiving experience of African American families. This ethnographic study reports findings from 16 African American caregivers, presenting a picture of how they navigate through their environment to meet the needs of caregiving. Formal resource selection and use, and perceived barriers to and facilitators of care within an urban environment, are discussed. The impact of the African American community's perception of mental illness on caregiving and involvement in policy change also is discussed.

The experience of fathers of adult children with schizophrenia

The purpose of this study was to describe the lived experience of fathers of adult children with schizophrenia by exploring the extent to which they engaged in caregiving. Cross-sectional data were gathered from 12 fathers over a 2-year period using naturalistic inquiry. Two instruments guided in-depth explorations of caregiving experiences, theme extrapolation, and theme refinement. Data were collected during taped interviews using the constant-comparative method. Findings indicated that the caregiving event was prolonged. Three themes explained the extent to which these fathers engaged in caregiving: involvement in care, unresolved issues, and severity of the event. Recommendations include similar studies with ethnic groups and use of chronic sorrow as a framework for studies about parental care for adult children with severe mental illness. practice implications include immediate assessment of fathers, supportive listening, and brief therapy.

Objective burden among primary caregivers of persons with chronic schizophrenia

A better understanding of the burden on the family has become increasingly important because many families assume a major role in the care of their relatives who have schizophrenia. The purpose of this study was to provide descriptive information about the negative consequences on the family (e.g. physical problems, restrictions in social life, tense relationships in the family) reported by the primary caregivers of persons with schizophrenia. Two types of objective burden were studied: general and attributable objective burden. The former refers to the general consequences on the family while the latter corresponds to those consequences specifically attributed to the presence of mental illness. Seventy primary caregivers completed a self-report instrument. The general negative consequences identified most frequently were tense relationships in the household, and the physical and emotional problems of the primary caregiver. The most common negative consequences directly related to the ill relative were the primary caregiver's emotional problems, the disturbance in the primary caregiver's performance of work, and the disruption in the lives of other adults in the household. The clinical implications and future directions of research are discussed.

Families of psychiatric patients: a critical review and future research directions

It is generally acknowledged that mental illness creates burdens for family caregivers. Since the 1950s, medical literature has identified the type and extent of those burdens, especially for families of patients with schizophrenia. Whereas the imperative to identify interventions for these families is clear, there has been a lack of systematic research of families' responses to and management of mental illness, resulting in significant gaps in knowledge. The rapidly changing health-care environment suggests that our understanding of families' responses to mental illness need to be reexamined for current relevance and new insights. This article critically examines the research to date and identifies gaps in knowledge related to family experience of mental illness. It argues the need to continue studies of caregiver burden and the stress resulting from that burden. Future directions for research are suggested.

Grounded theory: overview and application in pediatric nursing

The grounded theory approach is a valuable research method in pediatric nursing for understanding and explaining human experience. In the first part of this article the steps involved in the grounded theory method are described, with illustrations from published grounded theory in pediatric nursing. The application of grounded theory in pediatric nursing is the focus of the second section of this article. The results of a CD-ROM data base search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1983 to 1995 are summarized to identify grounded theory research in pediatric nursing conducted during those years.