Determinants of burden in caregivers of patients with exacerbating schizophrenia

Unmasking the Struggle: A Scoping Review Exploring Post-Traumatic Stress Symptoms in Caregivers of Individuals with Neurodevelopmental, Psychiatric and Neurocognitive Disorders

The impact of caregiving on caregivers' mental health is typically considered within the caregiver stress and burden literature; however, more recently, research has investigated the experience of post-traumatic stress symptoms (PTSS) in caregivers. As an emerging area of research, it is timely to conduct a scoping review to map the existing literature in relation to PTSS among adult caregivers of children and adults with neurodevelopmental disorders (NDD), neurocognitive disorders, and psychiatric disorders. The scoping review was conducted using Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines and Arksey and O'Malley's five-stage methodology framework. Published and unpublished gray literature between 2005 and 2022 was included in the scoping review. Nine thousand one hundred and twenty-five studies were originally identified for screening and 22 studies were selected for inclusion in the final review. Trauma and PTSS experienced by NDD caregivers were related to news breaking, NDD diagnosis, and behavioral issues, whereas caregivers of individuals with psychosis reported aggression and violence as traumatic events. Studies showed that up to half of caregivers reported PTSS, although no conclusions could be drawn about prevalence rates. A wide variety of tools measuring PTSS were used across the 22 studies. Many symptoms of PTSS were reported by caregivers, and cognitive appraisals were associated with PTSS in caregivers. The findings highlight the importance of recognizing the impact of trauma in caregiver mental health and the potential value of using traumatic stress frameworks with these populations. Research should be expanded to establish prevalence rates and to examine the long-term impact of trauma on caregiving as caregivers and care recipients age.

An Exploration of Depression and Aggression Among Patients with Schizophrenia in China Rural Community

Purpose

In schizophrenia, aggressive conduct is frequent. And depressed mood can also contribute to the occurrence of aggressive behaviors. The aim of this study was to investigate the risk factors for the occurrence of aggression in stable schizophrenia patients in rural China, mainly to investigate the role of depressed mood in the occurrence of aggression in schizophrenia patients.

Patients and Methods

This is a cross-sectional study conducted in the townships surrounding Chaohu City, Anhui Province, China. Patients' depressive mood was evaluated using the PHQ-9 (The 9-item Patient Health Questionnaire). Patients' aggressiveness was evaluated using the Modified Overt Aggression Scale (MOAS). A score of ≥4 was used as a threshold and divided into aggressive and non-aggressive groups.

Results

This study comprised a total of 821 schizophrenia patients. Among them, the prevalence of having aggressive behavior was 18.8%. After correcting for confounders, logistic regression analysis showed that low education level (OR=0.470, 95% CI 0.254-0.870; p=0.016), living with family (OR=0.383, 95% CI 0.174-0.845; p=0.017) depressed mood (OR=1.147, 95% CI 1.112-1.184; p<0.001) was significantly associated with the risk of aggressive behavior in patients with schizophrenia. Multivariate linear regression indicated that higher levels of aggression were linked with lower levels of education and higher depressive mood.

Conclusion

This study suggests that aggression is more common in patients with stable schizophrenia, and lower levels of education and higher levels of depression are associated risk factors for its occurrence. Living alone may be helpful in reducing the likelihood of aggression.

Prevalence of violence by people living with severe mental illness against their relatives and its associated impacts: A systematic review

INTRODUCTION

Violence perpetration by adults with severe mental illness (SMI) specifically towards their relatives is a sensitive topic and a largely neglected area that has consequences and implications for different stakeholders, including healthcare providers. This paper sought to systematically review the relevant literature, to identify the types and rates of violence by people with SMI against their relatives, and to develop a detailed understanding of its reported impacts.

METHODS

A systematic review, registered with PROSPERO (registration number CRD42019150784), was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review comprised searches of Medline, Embase, PsycInfo and CINAHL databases, supplemented by manual searches. Data from 38 papers using mixed methodologies were reviewed.

RESULTS

Key findings highlighted that relatives experienced different types of violence, including physical, verbal, psychological, financial violence, and violence directed towards property. Different types often co-occurred. Mothers were the group most likely to report being victims, compared with other relatives. Reported impacts of violence on relatives included mental ill health (e.g., psychological distress, post-traumatic stress symptoms) and the deterioration, and in some cases the permanent breakdown, of family relationships and the family unit. However, relatives often continued to provide a framework of support for patients, despite risks to their own safety.

CONCLUSION

Findings speak to the importance of future research extending the focus beyond the identified victimised relative or perpetrator, to also consider the impacts of violence at the family-wide level, and to improve the outcomes of families exposed to and dealing with violence by individuals living with SMI.

The Structure of Temperament in Caregivers of Patients with Schizophrenia

The onset of schizophrenia symptoms usually occurs in early youth. As a result, the parents of these patients usually become their caregivers. The role of a caregiver for a person with schizophrenia is a considerable mental and physical burden. Therefore, an interesting issue is what motivates these people to take up this challenge. It is probable that, apart from the moral imperative or kinship, the factor determining this decision is the personality structure of the caregiver. The aim of our study was to compare the structure of temperament (according to the model of temperament as formal characteristics of behavior developed by Jan Strelau) in caregivers of young adults (age 18-25 years) with schizophrenia with the structure of temperament of parents of healthy young adults still living in the family home under their care. The study group consisted of 64 people (51 women), who were taking care of young adults (aged 18-25 years) with schizophrenia, while the control group (53 people, 42 women) consisted of parents of healthy adults still living in the family home. Both groups were asked to complete a questionnaire of the authors' own design on their demographic data as well as The Formal Characteristics of Behavior-Temperament Inventory to assess the temperament traits. The results were given in the number of points obtained on average in each dimension. Both groups did not differ in terms of size and age, with women predominating. Caregivers of young adults with schizophrenia had higher values of briskness (43.22 ± 4.45 vs. 42.90 ± 3.98, p = 0.032), emotional reactivity (46.02 ± 4.39 vs. 41.01 ± 3.12, p = 0.012) and activity level (44.01.89 ± 4.15 vs. 37.59 ± 4.77, p = 0.022) compared to the control group. The remaining dimensions of temperament: perseverance, sensory sensitivity, rhythmicity, and endurance did not differentiate between the two groups. The temperament structure of caregivers of young people with schizophrenia differs from the temperament structure of caregivers of healthy adults. Caregivers of sick people have higher values of briskness, emotional reactivity, and activity level compared to the control group.

How Do Shifts in Patients with Mental Health Problems' Formal and Informal Care Utilization Affect Informal Caregivers?: A COVID-19 Case Study

(1) Background: This study investigated how potential shifts in patients' formal and informal care utilization during the COVID-19 pandemic impacted their informal caregivers in terms of their subjective burden, psychological wellbeing, and happiness. (2) Methods: A retrospective cohort study design was employed for a panel of Dutch informal caregivers of persons with mental health problems (n = 219) in June 2020. Descriptive statistics and differences between means were determined for the patients' informal and care utilization and informal caregivers' subjective burden, happiness, and psychological wellbeing. Three mediation analyses were conducted using the PROCESS macro. (3) Results: Informal caregivers reported significantly worse happiness and subjective burden scores during the COVID-19 pandemic compared with before the lockdown. There were minimal shifts in patient's care utilization reported, with the exception of a decrease in significant emotional and practical support provided by the informal caregiver. In the mediation analyses, there was not a significant indirect effect of shifts in patients' formal care utilization on informal caregivers' subjective burden, psychological wellbeing, and happiness through shifts in patients' informal care utilization. (4) Discussion and conclusion: Whilst we found that shifts in patients' care utilization during the first wave of the pandemic did not affect the informal caregiver in the short term, it is unclear what the long-term impact of the pandemic might be on informal caregivers. More research should be conducted to understand the implications of short- and long-term impact of substitution on informal caregivers of persons with mental health problems, with special consideration of the COVID-19 context and uptake of e-health technology.

Disease-Related Risk Factors for Caregiver Burden among Family Caregivers of Persons with Schizophrenia: A Systematic Review and Meta-Analysis

This study aimed to conduct a quantitative synthesis of the clinical correlates of caregiver burden in schizophrenia studies published in the last two decades. Derived from eight electronic databases, this meta-analytic review revisits 34 English articles published from 2000 to 2020 relevant to family caregiver burden in the schizophrenia field. The Newcastle–Ottawa Scale (NOS) was used to assess study quality. The pooled effect sizes of the selected studies ranged from −0.390 to 0.751. The results indicated a significant association between a heavier burden and disease-related risk factors, including more severe symptoms, greater general psychopathology, greater severity of functional impairment, and longer duration of illness. The results show moderating effects of study characteristics (i.e., study quality, participants, and location) on the correlations between these disease-related risk factors and caregiver burden. This review highlights the roles of study characteristics in affecting the inconsistent results for the effects of disease-related risk factors on caregiver burden in families of patients with schizophrenia. Psychosocial interventions are essential for family caregivers of persons with schizophrenia. Future studies incorporating random samples from both high-income and low-to-middle-income countries will be crucial to understand the effects of cultural contexts on caregiver burden in families of persons with schizophrenia.

Caring for Patients with Psychosis: Mental Health Professionals' Views on Informal Caregivers' Needs

The aim of this study was to explore the views of mental health professionals regarding the needs of the informal caregivers of patients with chronic psychotic syndrome. A qualitative research design was used. The sample consisted of 12 mental health professionals selected by a purposive sampling strategy. Data were collected through semistructured, face to face interviews. Framework analysis was used to analyze qualitative data and establish main themes and subthemes. Three main themes emerged namely, (i) impact of caring on caregivers’ lives, (ii) caregivers’ needs, and (iii) recommendations for better care. Informal caregivers’ needs were conceptualized into subthemes within the main themes. Caregivers’ increased responsibilities of caring for their relatives, the impact on their mental and physical health status and the restrictions in their social and professional life were revealed. Targeted health interventions and social policy planning are recommended for supporting informal caregivers and improving patient care.

An Integrative Review of Measuring Caregiver Burden in Substance Use Disorder

BACKGROUND

Family caregivers contribute to engagement in treatment and adherence, reduced substance misuse and relapse, and increased well-being of recipients with substance use disorder. However, providing care has also been associated with negative emotional and physical health outcomes for caregivers. The purpose of this integrative review was to determine what instruments are used to measure caregiver burden in informal caregivers of individuals with substance use disorder.

METHODS

An integrative review framework was applied to examine empirical and theoretical literature to answer the guiding research question, "How is caregiver burden measured in caregivers of individuals with substance use disorder?" PubMed, CINAHL, and APA PsychINFO were searched using a combination of search terms. The initial 1,198 articles were narrowed to 32 that fit the search criteria and purpose of the review.

RESULTS

A variety of scales have been used to measure caregiver burden. Caregiver burden is operationalized as objective or subjective burden. Objective burden refers to changes in the home, finances, employment, social life, and leisure, whereas subjective burden refers to the emotional reaction of the caregiver in coping with providing care. Caregiver burden was most often reported as moderate to severe in populations with substance use disorder. Attributes measured included anxiety, depression, stress, worry, displeasure, care recipient behavioral problems and substance abuse, stigma, relationship strain, financial expenses, social support, family disruption, and the effect on caregiver physical and emotional health.

CONCLUSIONS

Specific instruments that can accurately evaluate objective and subjective caregiver burden are needed to measure the quality of caregiver health. More research is necessary to better understand the physical and emotional health of caregivers of persons with substance use disorder and the factors that contribute to increased quality of life. Understanding the relationship between outcomes and protective factors could help nurses to develop prevention strategies and treatment interventions aimed at decreasing the psychosocial trauma and stress associated with caregiver burden.

Observed Outcomes: An Approach to Calculate the Optimum Number of Psychiatric Beds

The number of psychiatric beds, in most developed countries, has decreased progressively since the late 1950s. Many clinicians believe that this reduction has gone too far. But how can we determine the number of psychiatric beds a mental health system needs? While the population health approach has advantages over the normative approach, it makes assumptions about optimal and minimum duration of hospitalization required for various psychiatric disorders. In this paper, we describe a naturalistic approach that estimates the required number of psychiatric beds by comparing the bed levels at which negative outcomes develop in different jurisdictions. We hypothesize that there will be a threshold below which negative outcomes will be seen across jurisdictions. We predict that hospital key performance indices will be more sensitive to bed reductions than the clinical and social outcomes of patients. The observed outcome approach can complement other approaches to determining bed numbers at the national and local levels, and should be a priority for future health services research.

What about psychiatrists' attitude to mentally ill people?

Objective

Firstly, to assess and, secondly, to compare experts' and lay attitudes towards community psychiatry and the respective social distance towards mentally ill people.

Method

Comparison of two representative Swiss samples, one comprising of 90 psychiatrists, the other including 786 individuals of the general population.

Results

The psychiatrists' attitude was significantly more positive than that of the general population although both samples have a positive attitude to community psychiatry. The statement that mental health facilities devalue a residential area has revealed most agreement. Psychiatrists and the public do not differ in their social distance to mentally ill people. Among both samples, the level of social distance increases the more the situation described implies ‘social closeness’.

Conclusion

The strategy to use psychiatrists as role models or opinion leaders in anti-stigma campaigns cannot be realised without accompanying actions. Psychiatrists must be aware that their attitudes do not differ from the general public and, thus, they should improve their knowledge about stigma and discrimination towards people with mental illnesses.

The experience of carers of patients with severe mental illness: a comparison between London and Bologna

Purpose.

The experience of care giving inventory (ECI) is a self-reported measure of the caregiving experience as seen by the carer of a person with a serious mental illness. It comprises eight negative subscales and two positive subscales; positive and negative scores are obtained from these (ECI total positive and ECI total negative). This study aims to assess the validity and the reliability of the Italian version of the ECI and to compare the experience of carers in London and Bologna as measured by the ECI.

Method.

The sample consisted of 95 Bologna carers and 69 London carers of patients suffering from a functional psychotic disorder. The internal consistency of the Italian ECI and correlation between the Italian ECI total negative and the GHQ-12 (external validity) were estimated. Independent t-tests and chi-squared tests were used to compare sample characteristics and mean ECI scores. Regression analyses were used to control for confounders.

Results.

Internal consistency and validity of the Italian ECI were similar to these previously found. The Bologna caregivers had a higher ECI total negative than London carers; this difference was partially explained by worse patients' functioning and by a higher proportion of parents in Bologna. Bologna carers scored significantly lower on ECI total positive after controlling for relationship and patient functioning.

Conclusions.

The Italian ECI is a well-accepted and valid instrument to describe caregiving experiences. The similar scores in ECI total negative between London and Bologna underline a cross-cultural consistency of negative experience of caregiving and re-emphasise the importance of patients functioning in different cultural contexts. The differences found for ECI total positive suggest area for further research.

The economic burden of schizophrenia in Germany: A population-based retrospective cohort study using genetic matching

Objective

Prior studies to determine the economic consequences of schizophrenia have largely been undertaken in clinical settings with a small number of cases and have been unable to analyze effects across different age cohorts. The aim of this study is to investigate the burden of schizophrenia in Germany.

Methods

Costs, service utilization, and premature mortality attributable to schizophrenia were estimated for the year 2008 using a retrospective matched cohort design. Therefore, 26,977 control subjects as well as 9411 individuals with a confirmed diagnosis of schizophrenia were drawn from a sickness fund claims database. To reduce conditional bias, the non-parametric genetic matching method was employed.

Results

The final study population comprised 8224 matched pairs. The annual cost attributable to schizophrenia was €11,304 per patient from the payers’ perspective and €20,609 from the societal perspective with substantial variations among age groups: direct medical expenses were highest among patients aged > 65 years, whereas younger individuals (< 25 years) incurred the greatest non-medical costs. The annual burden of schizophrenia from the perspective of German society ranges between €9.63 billion and €13.52 billion.

Conclusion

There are considerable differences in the distribution of costs and service utilization for schizophrenia. Because schizophrenia is characterized by an early age of onset and a long duration, research efforts should be targeted at particular populations to obtain the most beneficial outcomes, both clinically and economically.

Societal Costs of Schizophrenia in Denmark: A Nationwide Matched Controlled Study of Patients and Spouses Before and After Initial Diagnosis

BACKGROUND

Information on welfare cost of patients with schizophrenia and spouses is limited.

AIM

The main aim of this study to investigate factual societal mean annual costs per individual during 5 years before and after the initial diagnosis of schizophrenia.

METHOD

A register-based cohort study of 12 227 patients with incident schizophrenia (International Classification of Diseases, Tenth Revision F20-F20.99) with spouses and 48 907 matched controls in Denmark during 2002-2016.

RESULTS

The total annual costs of health care and lost productivity were Euro 43 561 higher for patients with schizophrenia and health care costs and costs of lost productivity were increased during 5 years before the initial diagnosis. The total annual direct health care and indirect costs of lost productivity were Euro 21 888 higher for spouses to patients with schizophrenia than spouses of individuals with no diagnosis of schizophrenia. Also before initial diagnosis, health care costs and lost productivity were increased among spouses of patients with schizophrenia.

CONCLUSION

Patients with schizophrenia differed from the general population with respect to all included costs. The study documented a significant burden on spouses. The excess health care costs of schizophrenia are further increased by psychiatric and somatic comorbidity, and the societal costs are 4-10 times higher than chronic neurological disorders such as epilepsy and multiple sclerosis. Early onset of schizophrenia implies that patients are affected before finishing school and before entrance to labor market. Cost savings could be achieved by investments in preventive interventions reaching young people's needs; in initiatives to reduce hospital admissions caused by medication side effects, substance misuse, and lifestyle factors; and in occupational training.

Disease-related stressors of caregiving burden among different types of family caregivers of persons with schizophrenia in rural China

BACKGROUND

Little is known about the impacts of schizophrenia on different types of caregiving burden.

AIM

This study aims to examine how the severity of schizophrenia, social functioning and aggressive behavior are associated with caregiving burden across different kinship types.

METHOD

The analytic sample included 300 dyads of persons with schizophrenia and their family caregivers in Xinjin, Chengdu, China. The 10th edition of the International Classification of Diseases (ICD-10) was utilized to identify the patients, whose symptom severity, social functioning and aggressive behavior were measured. Caregiving burden was estimated using the Burden Scale for Family Caregivers-short (BSFC-s).

RESULTS

A higher level of burden was significantly associated with female caregivers, larger family size, lower income, worse symptoms, poorer functional status and more aggressive behaviors. Parent caregivers showed greater burden if the patients had better functioning of social interest and concern or more aggression toward property. Mother caregivers showed greater burden than fathers. Spouses tended to perceive greater burden if the patients had better marital functioning, poorer occupational functioning or more aggressive behaviors toward property. Patients attacking others or a father with schizophrenia was related to a higher burden of child caregivers. A heavier burden of other relatives was correlated with patients' more verbal aggression and self-harm.

CONCLUSION

This study shows the distinct impacts of disease-related factors on the caregiving burden across different kinship types. Our findings have implications for health-care professionals and practitioners in terms of developing more targeted family-based or individualized intervention to ameliorate burden according to kinship types and deal with behavioral and functional problems in schizophrenia.

Costs and outcomes for individuals with psychosis prior to hospital admission and following discharge in Bulgaria

PURPOSE

To examine the cost of psychotic disorders in Bulgaria prior to hospital admission and following discharge from two perspectives: healthcare and societal; and to evaluate the association between the costs and the patient's characteristics.

METHODS

96 individuals with psychosis experiencing psychotic exacerbation and their primary caregivers were evaluated upon the patients' hospital admission. The participants were followed up after 12 months. The costs were evaluated from healthcare and societal perspective using the Client's Sociodemographic and Service Receipt Inventory (CSSRI-EU). The psychopathology, functioning, quality of life and caregiver's burden were measured using standardized instruments. The mean differences in the costs and the associations with the clinical and socio-demographic characteristics of the patients were evaluated.

RESULTS

The healthcare costs increase from EUR 120.66 (SD = 163.85) at baseline to EUR 177.54 (SD = 136.98) at follow-up. The total cost from societal perspective are up to sixfold higher than the healthcare costs at both assessments [EUR 717.41 (SD = 402.33) and 880.40 (SD = 1592.00), respectively] and do not change significantly. A major shift in the subtypes of costs, and significant associations of the costs with the socio-demographic and clinical characteristics, were found.

CONCLUSIONS

Psychotic disorders and psychotic exacerbations have high societal costs. The underfunding of mental healthcare in Bulgaria is at the expense of high caregivers' and societal cost. The treatment of psychotic exacerbation is effective and investment in mental healthcare for the improvement of the psychopathology, social functioning, quality of life and the burden of informal care should be viewed as a sustainable investment.

Understanding caregiver burden from a long-term perspective: The Banyan model of caregiver experiences

PURPOSE

A multiphase model for experiences of family members of persons with mental illness that considers both positive and negative aspects is proposed.

DESIGN AND METHODS

Mixed methods (semistructured interviews, life history timelines, focus group discussions, and the Experience of Caregiving Inventory) were used with caregivers accessing outpatient services of a nongovernmental organization in urban and rural locations around Chennai, India.

FINDINGS

Based on our results, we constructed a multiphase model, which we named The Banyan model of caregiver experiences. The phases are (1) manifestation of symptoms, (2) seeking help, (3) helplessness and attribution, (4) relative control and insight, (5) loss and worries, and (6) finding new meaning.

PRACTICAL IMPLICATIONS

Our multiphase model allows us to identify in more detail the needs of caregivers at various stages.

Informal Caregiving Relationships in Psychosis: Reviewing the Impact of Patient Violence on Caregivers

A modest association can be found between people with a schizophrenia spectrum diagnosis (psychosis) and perpetrating acts of violence. When a person with psychosis does engage in violence, it is their informal carers, when compared to those from the general population, who are more likely to be the targets, and violence will often occur within the family home. Despite the importance of carer support for improving patient outcomes, our understanding of how carers are impacted by patient initiated violence in psychosis remains limited. This paper reviews literature documenting the effects of patient-initiated violence in psychosis on carer functioning. The review comprised searches of Medline, PsychInfo, Embase, and Web of Science databases and the hand searches of reference lists from relevant published papers. The review was limited to English language publications from inception to 11th September 2017, and where carer experiences following reports of violence from patients with psychosis were specifically recorded. Data from 20 papers using mixed methodologies were reviewed. Patient violence in psychosis was linked to poorer carer outcomes, including carer reports of burden, trauma, fear, and helplessness. There is, however, a significant need for further studies to systematically quantify the impact and correlates of patient initiated violence on psychosis caregivers, and improve prevention.

Novel technology as platform for interventions for caregivers and individuals with severe mental health illnesses: A systematic review

BACKGROUND

Severe mental illnesses (SMIs) have been found to be associated with both increases in morbidity-mortality, need for treatment care in patients themselves, and burden for relatives as caregivers. A growing number of web-based and mobile software applications have appeared that aim to address various barriers with respect to access to care. Our objective was to review and summarize recent advancements in such interventions for caregivers of individuals with a SMI.

METHODS

We conducted a systematic search for papers evaluating interactive mobile or web-based software (using no or only minimal support from a professional) specifically aimed at supporting informal caregivers. We also searched for those supporting patients with SMI so as to not to miss any which might include relatives.

RESULTS

Out of a total of 1673 initial hits, we identified 11 articles reporting on 9 different mobile or web-based software programs. The main result is that none of those studies focused on caregivers, and the ones we identified using mobile or web-based applications were just for patients and not their relatives.

LIMITATIONS

Differentiating between online and offline available software might not always have been totally reliable, and we might have therefore missed some studies.

CONCLUSIONS

In summary, the studies provided evidence that remotely accessible interventions for patients with SMI are feasible and acceptable to patients. No such empirically evaluated program was available for informal caregivers such as relatives. Keeping in mind the influential role of those informal caregivers in the process of treatment and self-management, this is highly relevant for public health. Supporting informal caregivers can improve well-being of both caregivers and patients.

Experiences of caring for a sibling with schizophrenia in a Chinese context: A neglected issue

Adult clients with schizophrenia are primarily cared for by their ageing parents. When the parents become ill or die, siblings are considered to be responsible for taking over the caregiving role. However, little is known about caregiving for a sibling with schizophrenia, and no studies have explored this phenomenon in an Asian context. The aim of the present descriptive, qualitative study was to understand the experiences of being the primary caregiver of a sibling with schizophrenia. Data were collected from 10 siblings of currently-hospitalized patients diagnosed with schizophrenia using semistructured, in-depth interviews. Recorded interviews were transcribed and analysed by qualitative content analysis. This analysis identified four themes: (i) stepping forward to become caregiver; (ii) challenges of caregiving; (iii) need for support; and (iv) worries about future care. Our findings suggest that mental health-care professionals should involve all family members, including siblings, in the care plan for the person with schizophrenia, and provide appropriate psychoeducation for all family members to reduce not only the tension and stress of current caregiving, but also anxieties about future care.

Relationship Between Caregiving Burden and Anger Level in Primary Caregivers of Individuals With Chronic Mental Illness

OBJECTIVES

The objective of this study was answer to the question: to what extent are the anger of the caregivers of patients diagnosed with schizophrenia and their perceived level of burden are related?

METHOD

The study is a descriptive and correlational study. The information form prepared by the researchers which questions the socio-demographic information of the individuals along with the "Caregiving Burden Inventory" which examines the burden of the caregiver as well as "Trait Anger and Anger Expression Style Scale (TAAES)" which determines the anger levels of the caregivers were used.

RESULTS

The caregiving burdens of the caregivers according to the score averages were determined as 11.88±9.78 for time and dependency burden, 11.93±8.46 for developmental burden, 8.47±6.63 for physical burden, 5.61±5.26 for social burden, 6.29±5.25 for emotional burden and the total burden score was determined as 44.19±26.75. According to the trait anger and anger expression style scale score averages; trait anger was determined as 15.12±5.95, anger expression as 9.70±3.43, anger-in as 15.22±4.02, anger control as 28.05±5.57 and anger total score average as 68.11±9.97.

CONCLUSION

According to the results obtained from this study, caregivers of schizophrenia patients experience developmental, physical, social and emotional burdens in addition to trait anger. The caregivers of schizophrenia patients need knowledge and support in order to control the burden and the anger they experience during the caregiving process.

Role of 3-monthly long-acting injectable paliperidone in the maintenance of schizophrenia

AIMS

Paliperidone palmitate 3-month (PP3M) represents a new long-acting injectable antipsychotic therapeutic option. This review aims: 1) to summarize available data relating to efficacy, safety, tolerability and costs of PP3M; 2) to describe hospitalization rate, occupational status, treatment preference, satisfaction, adherence and caregiver burden of patients with schizophrenia who participate in PP3M clinical trials; 3) to examine ethical implications, pros and cons of PP3M use and 4) to propose study designs to further assess PP3M.

METHODS

On August 21, 2017, a search on PubMed about PPM3, without any filter restriction, was conducted and all available records were analyzed. Records written in a language other than English were excluded.

RESULTS

Twenty-two records were included in this review: 6 reviews, 1 report, 4 pharmacokinetic studies, 2 cost-effectiveness analyses, 1 open-label clinical trial, 2 randomized controlled trials (RCTs), 5 studies based on these 2 RCTs and 1 observational study.

DISCUSSION

According to these last 9 studies, when compared with placebo, PP3M showed a longer time to relapse and good safety and tolerability profiles. Furthermore, when compared with paliperidone palmitate 1 month (PP1M), PP3M treatment showed: 1) non-inferiority in terms of efficacy, safety, tolerability, rate of hospitalization, symptomatic and functional remission, treatment preference and variations of the occupational status; 2) a longer time to relapse after treatment discontinuation and 3) a similar reduction of the caregiver burden.

CONCLUSION

PP3M is the only 3-monthly long-acting injectable antipsychotic available on the market. This makes it a unique option of treatment, which could be chosen both in early and advanced phases of illness. Nonetheless, longer naturalistic follow-up studies, two-arm head-to-head superiority trials and mirror studies, based on real-world samples of patients, are needed to further assess long-term safety and advantages of this new option of treatment and to define patients' sub-populations that would most beneficiate from it.

Schizophrenia: Impact on Family Dynamics

In many societies, family members are now the primary caregivers of mental health patients, taking on responsibilities traditionally under the purview of hospitals and medical professionals. The impact of this shift on the family is high, having both an emotional and economic toll. The aim of this paper is to review the main changes that occur in family dynamics for patients with schizophrenia. The article addresses three central themes: (i) changes in the family at the onset of the disorder, (ii) consequences for family members because of their caregiver role, and (iii) family interventions aimed at improving the complex dynamics within the family. After analyzing and discussing these themes, it is observed that despite advances in the field, the viability of taking care of a patient with schizophrenia by the family remains a challenge. Improving care will require commitments from the family, the mental health service system, and local and national governments for greater investments to improve the quality of life of society in general and individuals with schizophrenia in particular.

Six-session caregiver psychoeducation on bipolar disorder: Does it bring benefits to caregivers?

AIM

To evaluate the impact of psychoeducational intervention on the levels of burden, of self-esteem and quality of life in caregivers of patients diagnosed with Bipolar Disorders.

METHOD

In this randomized clinical trial, changes in degree of burden, levels of self-esteem and quality of life were evaluated. Caregivers could participate in the group of psychoeducation (six sessions) or usual treatment (without psychoeducation following a manual).

RESULTS

There were no significant differences regarding levels of objective burden between groups. Both groups presented improvement in subjective burden scores throughout the interventions. Objective burden scores showed significant reduction in the usual treatment group (p = .003) and a trend toward decrease in the psychoeducational intervention (p = .081). There are no differences regarding improvement in perceived self-esteem and quality of life when comparing means between the groups with and without intervention.

CONCLUSION

A six-session caregiver psychoeducational intervention on bipolar disorder did not bring benefits to caregiver's health. A longer longitudinal follow-up study would be crucial to see whether there were differences in degree of burden, perceived self-esteem and quality of life over time in caregivers.

Pattern and Type of Aggressive Behavior in Patients with Severe Mental Illness as Perceived by the Caregivers and the Coping Strategies Used by Them in a Tertiary Care Hospital

Aggressive behavior by patients with severe mental illness is a major problem needing intervention. This descriptive cross sectional study examined the perception and coping strategies of caregivers with a sample of 100 toward aggressive behavior by patients with severe mental illness in the outpatient and inpatient unit of the department of psychiatry in a tertiary care hospital. The data were collected by a semistructured interview using Revised Overt Aggression Scale-modified, Aggressive Behavior and Intervention Checklist, Ways of Coping Checklist-Hindi Adaptation and Impact of Patient Aggression on Carers Scale-Adapted. The caregivers perceived aggression in varying extent from the patients. Majority used problem-focused coping to deal with aggressive behavior. Most of the caregivers perceived insisting to take medicines and talking about patient's illness as the triggers for aggressive behavior which was managed by talking to the patient calmly, lovingly and by leaving the patient alone. The findings strongly suggest aggressive behavior as a frequent problem faced by family members of patient with severe mental illness. Nursing interventions should focus on counseling and psycho education for empowering caregivers to utilize strategies to reduce occurrence of aggressive behavior from patient and ways to effectively cope with the situation.

Determinants of subjective and objective burden of informal caregiving of patients with psychotic disorders

BACKGROUND

In a previous study, the objective burden of informal caregiving to patients with psychotic disorders amounted to 22 hours/week, and the subjective burden was huge with predominately anxiety and depression as main symptoms. In this study, determinants of the informal caregiving burden are analyzed to find foci for interventions to ease the size of burden.

METHODS

Patients with psychotic disorders (n = 107) and their informal caregivers (n = 118) were included. They were assessed with a comprehensive battery of rating scales including patient and caregiver characteristics as well as the amount and quality of health-care provision.

RESULTS

A multiple linear regression analysis showed that the subjective burden was significantly lower when patients had higher levels of functioning and when the health status of the informal caregivers was good. No significant determinants were found for the objective burden, but an association was found between a higher socioeconomic status of the caregivers and the amount of money provided for the patient. An association was also found between a positive perception of caregiving and more hours spent on caregiving.

CONCLUSION

The functioning level of the patients was the main determinant of the subjective burden of informal care. For the objective burden, no main determinant was found.

Impact of patients' psychiatric hospitalization on caregivers: a systematic review

OBJECTIVE

A systematic literature review was conducted to assess the impact of patients' psychiatric hospitalizations on caregivers.

METHODS

A systematic search of the Web of Knowledge, PsycINFO, and MEDLINE (PubMed) was conducted for peer-reviewed articles published in English before August 31, 2013. Qualitative, quantitative, and mixed-methods studies were included if they focused on the outcomes of caregivers of either adult or youth patients and presented data collected directly from caregivers of patients who had been psychiatrically hospitalized.

RESULTS

Twenty-nine articles met the inclusion criteria. The review found that caregivers are heterogeneous in their reaction to patients' psychiatric hospitalization; however, many report distress. Many caregivers have reported experiencing stigma, disruptions in daily life, worse general medical health, economic strain, and changes in relationships after hospitalization. Negative reactions to the hospitalization may decrease over time, but distress can remain elevated compared with the general population. Nonetheless, many caregivers have also reported experiencing positive changes as a result of the hospitalization. The reaction of caregivers may be influenced by the severity of the patient's psychiatric problems as well as the caregiver's demographic characteristics and style of coping.

CONCLUSIONS

Caregivers experience a range of reactions to psychiatric hospitalizations. Providing caregivers with psychoeducation about their possible reaction to hospitalization and teaching them coping techniques may improve clinical outcomes for patients. Future research is needed to understand the heterogeneity in caregivers' reactions to patients' psychiatric hospitalization.

The role of family therapy in the management of schizophrenia: challenges and solutions

Family interventions for schizophrenia have been amply demonstrated to be effective and are recommended by most of the international clinical guidelines. However, their implementation in the clinical setting as well as in treatment protocols of patients with psychosis has not been fully achieved yet. With the increasing deinstitutionalization of patients, family has begun to assume the role of care performed by psychiatric hospitals, with a high emotional cost for caregivers as well as the recognition of burden experiences. Families have been the substitute in the face of the scarcity of therapeutic, occupational, and residential resources. For this reason, the viability of patients' care by their families has become a challenge. This article aims to discuss the most important aspects of family interventions, their impact on families, and the most important challenges that need to be overcome in order to achieve well-being and recovery in both patients and caregivers.

Sobrecarga de familiares cuidadores de pacientes psiquiátricos: relação com assertividade

Foi avaliada a sobrecarga de familiares cuidadores de pacientes psiquiátricos e sua relação com as habilidades sociais e assertividade. Participaram 53 familiares, atendidos em um CAPS tipo I. Utilizou-se a Escala de Sobrecarga BI, o Inventário de Habilidades Sociais IHS-Del-Prette, a Escala de Assertividade RAS e um Questionário Sociodemográfico e Clínico. Os resultados mostraram que os familiares com maior grau de inibição e timidez (RAS) apresentaram escores significativamente mais elevados de sobrecarga. A análise de regressão múltipla mostrou que a timidez foi o principal fator preditivo da sobrecarga. Não foi encontrada relação da sobrecarga com os escores do IHS-Del-Prette. Os dados apontam para a necessidade de implementar ações psicoeducacionais nos serviços de saúde mental, envolvendo o treinamento de assertividade dos familiares cuidadores, contribuindo, assim, para um melhor relacionamento com os pacientes e uma busca mais eficiente de suporte social, para o desempenho do papel de cuidador com menor sobrecarga.

Le rôle des familles au sein du système de santé mentale au Québec

Cet article vise à résumer l’état des lieux quant au rôle des familles de personnes atteintes de troubles mentaux au sein du système de santé mentale au Québec. À cet effet, un rappel historique permet de mettre en perspective les différents rôles occupés par les familles, d’agent causal, tant au point de vue de la générique que des émotions exprimées, à prestataire de soins qui peut vivre du fardeau et finalement partenaire. Un modèle élaboré par la FFAPAMM et qui identifie trois rôles principaux permet de contextualiser le rôle actuel dans le système. Ce modèle, intitulé CAP, regroupe et décrit trois rôles des familles qui, s’ils sont tributaires du passé, continuent de se côtoyer à notre époque : celui de client, d’accompagnateur et finalement de partenaire. Des recommandations provenant d’un projet de recherche québécois et d’un rapport de la Commission de santé mentale du Canada permettront d’envisager un avenir où les besoins et les aspirations des familles seront pris en compte.

Measuring perceived rehabilitation needs of Caregivers of People with Schizophrenia in mainland China

This paper reports the development and validation of the Wuxi version of the Rehabilitation Needs Questionnaire for Caregivers of People with Schizophrenia (PRNQ-C-WX) based on the original Hong Kong version (PRNQ-C-HK). PRNQ-C-WX was validated by exploratory factor analysis (EFA) using a convenience sample consisting of 200 caregivers of people with schizophrenia. EFA yielded an eight-factor solution accounting for 63.8 % of the total variance which resulted in a 50-item PRNQ-C-WX. The questionnaire has excellent internal consistencies. Its factor structure is similar to the Hong Kong version. Some suggestions for policy, service and research development in mental health in mainland China are made.

Quality of life of key caregivers of schizophrenia patients and association with kinship

INTRODUCTION

Reports on the quality of life (QOL) of family caregivers of schizophrenia patients are uncommon. Relations of different degree of kinship to caregivers' QOL are unexplored, but may be relevant. The purpose of this study was to assess the subjective QOL of caregivers of stable outpatients with diagnosis of schizophrenia compared with controls, and to assess factors associated with QOL in this population.

METHODS

Responses of 138 schizophrenia outpatient' family caregivers to the Quality of Life, Enjoyment and Satisfaction Questionnaire (QLESQSF) were compared with those of a sex- and age-matched control group. Patients were assessed with the Positive and Negative Symptom Scale (PANSS) and the Global Assessment of Functioning (GAF) and data were collected for kinship relationship and hospitalization.

RESULTS

Group of caregivers had significantly lower QOL compared with controls (t=11.347; df=271; p=0.0001). Caregivers' QOL correlated significantly with their age and differed according to the degree of kinship and marriage status. ANCOVA, with age as covariate, performed to asses the differences in QOL according to kinship, showed that parents and own children had significantly lower QOL than patients' siblings who were also caregivers.

CONCLUSION

QOL of the schizophrenia patients' caregivers is lower in comparisons to controls. It depends on the degree of kinship and caregivers' age. Parents and own children have lower QOL than siblings. Psycho-educational intervention programmes should target specific needs of the family as a whole, depending also on their age and kinship relationship.

Predictors of family caregiver burden in schizophrenia: Study from an in-patient tertiary care hospital in India

BACKGROUND

Family caregivers experience significant burden in taking care of their patients with schizophrenia. Research on predictors of caregiver burden in India, where families are the primary caregivers of schizophrenia patients, is lacking.

AIM

To study the predictors of burden experienced by the family caregivers of first admission in-patient schizophrenia patients in India.

METHODS AND MATERIALS

Family caregivers of 137 schizophrenia patients admitted to an in-patient facility of a hospital in south India were interviewed using the Burden Assessment Schedule. The coping, knowledge about schizophrenia, perceived social support of the caregivers and illness severity, psychopathology and disability experienced by the patients were also assessed.

STATISTICAL ANALYSIS

Bivariate correlation and multivariate regression analysis were used to study the association of different factors on burden.

RESULTS

Duration of illness and levels of psychopathology and disability had significant direct correlation with total burden score; perceived social support had significant inverse correlation with total burden score. There was a high correlation between psychopathology and disability (p<0.001). Two separate regression analyses, each including total PANSS score (psychopathology) or total IDEAS score (disability) showed that duration of illness and perceived social support were significant predictors of burden in addition to psychopathology and disability.

CONCLUSION

During the first hospitalization, in addition to symptom reduction and disability limitation, focus should be on enhancing social support in order to reduce caregiver burden among family members of schizophrenia patients.

Rede de apoio social de pacientes com diagnóstico de esquizofrenia: estudo exploratório

Este artigo objetivou descrever e analisar a rede de apoio social de pacientes com diagnóstico de esquizofrenia de um Centro de Atenção Psicossocial II (CAPS II) do Distrito Federal, Brasil, por meio da Análise de Redes Sociais (ARS). Observou-se que a maioria consegue retribuir o apoio recebido, especialmente para os membros da família. Estender essa reciprocidade poderia ser uma proposta a ser desenvolvida, a fim de fortalecer as relações para além do âmbito familiar e incentivar melhorias na rede de apoio social. Uma cultura participativa em todos os contextos, nos quais se encontram inseridos os portadores de esquizofrenia, pode contribuir, sobremaneira, para o aumento da autonomia e da autoestima dos mesmos. Verifica-se que é viável, por meio deste estudo, reconhecer as limitações dos pacientes em questão, assim como identificar suas potencialidades.

Correlational study: illness representations and coping styles in caregivers for individuals with schizophrenia

BACKGROUND

Caring for individuals with schizophrenia can create distress for caregivers which can, in turn, have a harmful impact on patient progress. There could be a better understanding of the connections between caregivers' representations of schizophrenia and coping styles. This study aims at exploring those connections.

METHODS

This correlational descriptive study was conducted with 92 caregivers of individuals suffering from schizophrenia. The participants completed three questionnaires translated and validated in French: (a) a socio-demographic questionnaire, (b) the Illness Perception Questionnaire for Schizophrenia and (c) the Family Coping Questionnaire.

RESULTS

Our results show that illness representations are slightly correlated with coping styles. More specifically, emotional representations are correlated to an emotion-focused coping style centred on coercion, avoidance and resignation.

CONCLUSION

Our results are coherent with the Commonsense Model of Self-Regulation of Health and Illness and should enable to develop new interventions for caregivers.

Caregiving and coping in carers of people with anorexia nervosa admitted for intensive hospital care

OBJECTIVE

The aim of the study was to examine how carers cope practically and emotionally with caring for individuals with anorexia nervosa who require intensive hospital care.

METHOD

This study explores objective burden (time spent with caregiving and number of tasks), subjective burden (psychological distress), and social support in a sample of parents (n = 224) and partners (n = 28) from a consecutive series of patients (n = 178) admitted to inpatient units within the United Kingdom.

RESULTS

Most time was spent providing emotional support and less with practical tasks. Time spent with caregiving was associated with carer distress and was fully mediated by carer burden. This was ameliorated by social support. Partners received minimal support from others, and we found similar levels of burden and distress for mothers and partners.

DISCUSSION

The data indicate that professional and social support alleviates carer distress and may be of particular value for partners who are more isolated than parents. The data also suggest that time spent with practical support may be of more value than emotional support.

Sources of parental burden in a UK sample of first-generation North Indian Punjabi Sikhs and their white British counterparts

OBJECTIVE

The correlates of parental burden in schizophrenia may differ between ethnic groups, but few studies have examined this in a UK setting. Our aim was to identify the correlates of burden in a UK sample of first-generation North Indian Punjabi Sikh parents and their white British counterparts.

METHOD

Test the association of burden with a series of clinical, social and service use variables and control for potential confounding factors in a model predicting drivers of burden in a combined sample of the above.

RESULTS

The strongest correlates of burden were patient symptoms and parental distress. Differences in correlates of burden between the groups emerged when individual components of service use and parental social network were tested. The group comparisons also revealed differences in expressed emotion (EE) and social networks.

CONCLUSION

The similarities in sources of burden between the groups could be explained by a commonality of sociocultural and economic experience, resulting from the successful acculturation and affluence of this British Sikh group. The differences between the groups may be related to enduring cultural factors such as kin support, since larger family groups were associated with low burden in the British Sikh group. The nature of EE in this British Sikh group may explain why it was not associated with burden in this sample.

Factors associated with caregiver psychological distress in chronic schizophrenia

BACKGROUND AND AIMS

Caregivers of patients with schizophrenia experience increased levels of psychological distress. This study investigated the impact of caring for patients with chronic schizophrenia on the mental health status of the caregivers and described the relationship between various socio-demographic and clinical characteristics and caregiving psychological distress.

METHODS

The study was carried out at the Psychiatric Hospital of Athens. The Symptom Check List Revised (SCL-90-R) was administered to 87 caregivers of chronic schizophrenia patients and 90 healthy controls. The Positive and Negative Syndrome Scale (PANSS) was administered to schizophrenia patients in order to assess illness severity.

RESULTS

The group of caregivers scored higher on the majority of symptom dimensions of the SCL-90-R than the control group. Clinical features of schizophrenia, i.e. duration of illness and PANSS positive and negative symptoms significantly predicted caregiving psychological distress. Caregivers' and patients' socio-demographic characteristics were not associated with caregivers' distress, with the exception of caregivers' sex: female caregivers experienced significantly higher levels of psychological distress than males.

CONCLUSIONS

The study suggests that clinical features of schizophrenia influence distress levels in caregivers of patients with chronic schizophrenia. The stronger predictors of distress appear to be female caregiver's gender, duration of illness as well as positive and negative symptomatology.

O cuidador e a sobrecarga do cuidado à saúde de pacientes egressos de internação psiquiátrica

OBJETIVO: Identificar as características sóciodemográficas e o grau de sobrecarga dos familiares cuidadores de pacientes egressos de internação psiquiátrica. MÉTODOS: Estudo quantitativo exploratório realizado em um ambulatório de saúde mental utilizando um questionário e a Escala de Avaliação da Sobrecarga dos Familiares. A amostra compôs se de 21 cuidadores de pacientes egressos de internação psiquiátrica. RESULTADOS: Todos os cuidadores tinham vínculo familiar, média de idade de 46 anos, sendo a maioria mulheres. As mães foram as principais cuidadoras em 38% dos casos. Todos apresentaram grau de sobrecarga, sendo a objetiva predominantemente maior. Os maiores escores médios relacionaram se às preocupações com a segurança física e futuro do paciente. CONCLUSÃO: foi identificada considerável sobrecarga familiar entre os cuidadores o que evidencia a importância de uma relação colaborativa entre os serviços de saúde mental, pacientes, seus cuidadores e suas famílias para melhor manutenção dos tratamentos psiquiátricos.

The right of caregivers to access health information of relatives with mental illness

This article reviews the legal, ethical and practical challenges of complying with the Ontario Personal Health Information Protection Act (PHIPA) within the context of a Canadian mental health system that is overburdened and under resourced. The advent of deinstitutionalization has placed significantly increased responsibilities on the families of mentally ill individuals. While research evidences that involving family members in the care of their mentally ill relatives improves treatment outcomes, mental health practitioners constantly face the challenge of engaging family caregivers while also complying with privacy laws. The authors propose an Ontario Caregiver Recognition Act (OCRA) to formally recognize family caregivers as informal health information custodians based on the practice of other jurisdictions which incorporate the rights of family members actively engaged in providing care to their mentally ill relatives.

Burdens and difficulties experienced by caregivers of children and adolescents with schizophrenia-spectrum disorders: a qualitative study

AIM

The purpose of this qualitative study was to investigate the burdens and difficulties associated with the experience of caring for youth with schizophrenia-spectrum disorders.

METHODS

Ten caregivers participated in a modified version of the Knowledge about Schizophrenia Illness interview.

RESULTS

The most common areas of general difficulties reported by caregivers were emotional burdens and the everyday practical demands and sacrifices required in caring for their dependents. RESULTS also suggested high levels of burden for caregivers concerning difficulties with mental health services.

CONCLUSION

Additional work is needed to learn more about the challenges that caregivers of youth with schizophrenia-spectrum disorders are facing, as well as to develop empirically based strategies for helping these caregivers and their dependents.

Global perspective of burden of family caregivers for persons with schizophrenia

Schizophrenia is a severe form of mental illness that affects about 7 per 1,000 of the adult population. It is estimated that globally about 29 million people have schizophrenia. With the advent of deinstitutionalization, most persons with schizophrenia are now being cared for in the community by their families. Living with a relative with severe mental illness is stressful. Burden of care is a global issue affecting family caregivers in both developed and developing countries. This article aims to examine the burden of family caregivers for persons with schizophrenia and the socioeconomic factors that influence the caregivers' perception of burden. There is a general agreement that family interventions are beneficial to family caregivers. Therefore, this article examines two of the most commonly investigated interventions: psychoeducation and support groups, for family caregivers of persons with schizophrenia.

[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.

Stigma and discrimination against people with mental illness: a critical appraisal

This editorial gives an overview of the different roots and forms of discrimination and stigmatisation towards people with mental illness. It explains the differences between stereotype, prejudice and discrimination. It further highlights some research foci of stigma research in the last decade. The emphasis was mostly on investigating the attitudes of the general population, but barely addressed other groups that have probably more intensive and more crucial contact with people with mental illness. Furthermore, only very few intervention programs were evaluated. This editorial concludes that other groups than the general population, e.g., mental health professionals, should be investigated about their attitudes to people with mental illness. Moreover, intervention campaigns should be additionally evaluated after a given period as it is not well known whether effects of interventions are long-lasting. It might be that anti-stigma campaigns, as every public health campaign, must be repeated if sustainability is the goal. Furthermore, the message must be carefully chosen. One option is to replace the “traditional” messages by focussing, e.g., on symptoms of mental illness, for instance anxiety, affective symptoms or suicidal ideations. Finally, a plea for more stigma-related research is given as research in stigma-related issues is also stigmatised.

Mental disorder in Polish families: is diagnosis a predictor of caregiver's burden?

OBJECTIVE

To test whether a caregiver's burden is associated with the patient's psychiatric diagnosis and to find other predictors of family burden; to provide Polish data on the issue to international literature.

METHOD

Of 377 eligible subjects, 141 were interviewed on admission to the mental hospital using Brief Psychiatric Rating Scale, Manchester Short Assessment of Quality of Life, Groningen Social Disability Schedule and Client's Sociodemographic and Clinical History Inventory. Their caregivers completed the Involvement Evaluation Questionnaire (IEQ). Subjects were grouped according to ICD-10 diagnoses: schizophrenia (n = 55), depression (n = 61), and anxiety and personality disorders (n = 25). Highly aggressive, suicidal and somatically unstable patients were excluded along with patients below 18 and over 65 years. Statistics included multiple regression analysis, ANOVA, Kruskal-Wallis and chi-square tests.

RESULTS

Diagnostic groups differed with respect to sociodemographics, psychopathology and quality of life, but not with respect to mean level of social functioning. Despite between-group differences, the caregiver's burden did not differ according to the diagnostic group. Of the four dimensions of burden, "worrying" and "urging" scored the highest. Majority of caregivers worried about their relative's general health (82%), future (74%) and financial status (66%). Caregivers' characteristics and not patients' explained the largest proportion of the family burden variance (almost 23% for IEQ Tension). Higher burden seemed to be associated with the carer's age, being a parent and number of hours spent weekly on caring for the ill relative. Lower burden was associated with the carers' subjective feelings of being able to cope with problems and to pursue their own activities. Longer history of patient's illness led to higher IEQ Tension. Polish caregivers were affected by their role in the same way as their counterparts abroad, but more of them were worried.

CONCLUSIONS

The caregiver's burden seems to be independent of the patient's diagnosis, but other factors contribute to the perceived burden, many of which are on the caregiver's part. In Poland, the overall family burden may be attributed mostly to worrying about a mentally ill relative and his future. All caregivers may benefit from psychoeducation and family interventions usually planned for those caring for relatives with schizophrenia.

An exploratory factor analysis of the Burden Assessment Scale with a sample of African-American families

It remains unclear if the factor structures of commonly used caregiver burden scales normed on white samples are similar with samples from different ethnic communities. Our study tests the factor structure of the Burden Assessment Scale (BAS) using Exploratory Factor Analysis (EFA) with data from low-income, African American families caring for a family member with schizophrenia. The EFA solution included a 2 factor structure of subjective burden and objective burden with strong loadings demonstrating a clear differentiation between the factors. Our results suggest that low income, African American families appear to experience caregiving burden as one major or broad component in their lives similar to other areas that demand ongoing coping and adaptation. Likewise, the factor structure found with this sample as compared to the factor structure found with white samples suggests differences in the perception of and/or the reporting of burden. Study limitations as well as implications for practice are provided.

Apoio social na experiência do familiar cuidador

Estudo qualitativo, do tipo descritivo, objetivando conhecer a experiência de cuidar de pessoas doentes no contexto dos lares, analisando as implicações do apoio social na saúde física e emocional do familiar cuidador. Os dados foram coletados por meio da entrevista semi-estruturada junto a dezoito familiares cuidadores de pessoas com doenças crônicas. A técnica do discurso do sujeito coletivo foi utilizada para a organização dos dados. Constatou-se que todos os informantes eram do sexo feminino, com idade média de cinquenta anos, possuiam até o nível médio de escolaridade, cuidavam ininterruptamente de pessoa doente, predominando as mães com sequela de acidente vascular cerebral. Relatavam comprometimento da sua saúde relacionado ao cuidado realizado: dor na coluna, hipertensão, enxaqueca e depressão. Os discursos coletivos são sugestivos da quebra das redes sociais e da escassez de apoio, levando a pessoa a rejeitar a condição de cuidador. A sobrecarga ficou caracterizada pelo familiar cuidador perceber-se diante de inúmeras situações de enfrentamento, muitas das quais não conseguia administrar.

Cognitive model of caregiving in psychosis

BACKGROUND

There is a long history of research into the attributes of carers of people with psychosis, but few interventions target their distress or their difficulties.

AIMS

To describe an empirically based model of the relationships of those caring for people with psychosis to inform clinical and theoretical advances.

METHOD

We developed a model of informal carer relationships in psychosis, based on an integration of the literature elaborating the concept of expressed emotion. The model accounts for divergent outcomes of three relationship types: positive, overinvolved and critical/hostile relationships.

RESULTS

Good evidence supports a number of hypotheses concerning the origin and maintenance of these relationship outcomes, which relate to specific differences in carer attributions, illness perceptions, coping behaviour, social support, distress, depression and low self-esteem predicted by our model. We propose that interventions aimed at modifying the specific maintenance factors involved in the different styles of relationships will optimise therapeutic change both for service users with psychosis and for their carers.

CONCLUSIONS

Family work in psychosis, which improves relationships through problem-solving, reduces service user relapse. It is now time to consider theory-based interventions focused on improving carer outcomes.