The experience of stigma in family caregivers of people with schizophrenia spectrum disorders: A meta-synthesis study

From Taxi Drivers to Copilots: A Reflexive Thematic Analysis with Relatives Discussing How to Enhance Person-Centeredness in Suicide Preventive Care

Previous studies on suicide prevention in healthcare settings highlight the benefits of including multiple stakeholders in the co-creation of care. However, relatives' perspectives have received little attention in this context. This study aims to elucidate the experiences of relatives of persons with healthcare contacts due to suicidal issues and to gain insights into how to enhance person-centeredness in suicide preventive healthcare. A total of 31 relatives of 27 suicidal individuals, 21 of whom had died by suicide, were included. Focus group methodology was employed; each interview was audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis by Braun and Clarke. Four themes were generated: (1) An underutilized resource, (2) Rigid, fragmented systems, (3) Copilots, not taxi drivers, and (4) Prerequisites for enhancement of person-centeredness. The analysis highlights that active involvement of relatives can provide vital collateral information, enhancing self-care initiatives during stable periods, and facilitating timely treatment during acute exacerbations. A person-centered system was described as fair, with structures that value relatives' expertise and encourage contributions from all stakeholders. Above all, trustworthiness, coherence and transparence were viewed as essential in person-centered suicide prevention.

Psychometric evaluation of the Persian version of the Family Caregiver-Specific Quality of Life Scale (FAMQOL) among family caregivers of patients with chronic psychiatric disorders

BACKGROUND

Family caregivers of psychiatric patients often experience various negative psychosocial consequences, with a decline in quality of life being the most prevalent. This study was conducted with the aim of evaluating the psychometric indices of the Persian version of the Family Caregiver-Specific Quality of Life Scale (FAMQOL).

METHODS

This cross-sectional study was conducted in 400 family caregivers of patients with chronic psychiatric diseases in Iran in 2024 using convenience sampling. Using a forward-backward translation procedure, the face and content validity of the FAMQOL were assessed through both qualitative and quantitative methods. After face and content validity, in order to determine construct validity, exploratory (n = 200) and confirmatory (n = 200) factor analysis was performed. To determine reliability, internal consistency (Cronbach's alpha coefficient and Macdonald's omega coefficient) and stability (intraclass correlation coefficient) were estimated.

RESULTS

A total of 400 participants were evaluated, comprising 184 males (46.0%) and 216 females (54.0%). In content validity, one item was removed and during exploratory factor analysis, the remaining 15 items were loaded on four factors including social, spiritual, physical and psychological, which described 61.74% of the total variance. Confirmatory factor analysis showed that the obtained model has a good fit. All obtained factors had convergent and discriminant validity. Cronbach's alpha (0.783 to 0.932), Macdonald's omega (0.817 to 0.934) and intraclass correlation coefficients (0.953 to 0.971) showed acceptable internal consistency and stability of the factors of the Persian version of FAMQOL.

CONCLUSION

Findings from this study confirm that the Persian version of the FAMQOL is a valid and reliable instrument for evaluating the quality of life among family caregivers of patients with chronic psychiatric disorders. This scale holds significant potential for both research and clinical applications, facilitating the identification of caregivers' needs and guiding the creation of targeted interventions to enhance their quality of life.

'They Don't Include Me and My Family in A Normal Picture…' Perspectives of People With Schizophrenia on Family Stigma and its Effects on Their Lives

Although combating stigma is a fundamental intervention area that should be addressed in comprehensive care, information on the effect of the family's experience of stigma on the lives of individuals diagnosed with schizophrenia is limited. This study was aimed at exploring the family's experience of stigma from the perspective of individuals diagnosed with schizophrenia and the effects of this experience on the patient's life. In this study, a descriptive qualitative approach was employed, and the participants were recruited from a university hospital in Türkiye. Semi-structured interviews were conducted with 16 individuals diagnosed with schizophrenia. Data were analysed via content analysis. The data were categorised into five themes: (1) dimensions of the stigma experience, (2) causes of family stigma, (3) confronting the effects of stigma, (4) efforts to control stigma and (5) recommendations. Family stigma is a difficulty that is accompanied by distressing emotions and social losses and restricts the lives of both patients and their families. Society's stereotypes towards the patient and the family, aggression and psychotic symptoms have been associated with the family stigma. In order to control stigma, family members limit the patient's behaviours, which puts the patient under pressure. Nurses should question the family's experience of stigmatisation, the psychosocial consequences of this experience on the patient and family and strategies coping with stigma. They should help family members be aware of coping methods that negatively affect the patient and develop adaptive coping skills through psychoeducational interventions and should create stigma-free social environments for both the patient and the family.

'Did I Make the Right Choice': A Qualitative Exploration of Decision Regret Among Family Caregivers After Hospitalising a Patient With Schizophrenia

Committing a family member with schizophrenia to a psychiatric ward is a coping mechanism often employed under challenging circumstances. This decision entails significant emotional repercussions and ethical dilemmas, potentially undermining the psychological well-being of the family and eroding public trust in mental health services and professionals. This study investigates the experiences of regret among family members after deciding to commit a relative to a locked ward, adhering to the COREQ guidelines. Employing a descriptive qualitative methodology, we conducted in-depth interviews with 14 family members in Heilongjiang Province, China, who faced this difficult choice. Data were analysed using reflexive thematic analysis, which identified seven themes within three stages: Decision antecedent (limited comprehension of schizophrenia and treatment, deficiencies in supportive environment), decision process (suboptimal communication, hospitalisation and weighing of alternative options) and decision outcome (emotional burden of a loved one's hospital life, the indelible mark of schizophrenia, impact on family dynamics). The study highlights the need for targeted interventions, including addressing biased social media portrayals, enhancing the accuracy of medical information, ensuring transparency in psychiatric practices and improving support for families during hospitalisation.

Multi-scale multimodal deep learning framework for Alzheimer's disease diagnosis

Multimodal neuroimaging data, including magnetic resonance imaging (MRI) and positron emission tomography (PET), provides complementary information about the brain that can aid in Alzheimer's disease (AD) diagnosis. However, most existing deep learning methods still rely on patch-based extraction from neuroimaging data, which typically yields suboptimal performance due to its isolation from the subsequent network and does not effectively capture the varying scales of structural changes in the cerebrum. Moreover, these methods often simply concatenate multimodal data, ignoring the interactions between them that can highlight discriminative regions and thereby improve the diagnosis of AD. To tackle these issues, we develop a multimodal and multi-scale deep learning model that effectively leverages the interaction between the multimodal and multiscale of the neuroimaging data. First, we employ a convolutional neural network to embed each scale of the multimodal images. Second, we propose multimodal scale fusion mechanisms that utilize both multi-head self-attention and multi-head cross-attention, which capture global relations among the embedded features and weigh each modality's contribution to another, and hence enhancing feature extraction and interaction between each scale of MRI and PET images. Third, we introduce a cross-modality fusion module that includes a multi-head cross-attention to fuse MRI and PET data at different scales and promote global features from the previous attention layers. Finally, all the features from every scale are fused to discriminate between the different stages of AD. We evaluated our proposed method on the ADNI dataset, and the results show that our model achieves better performance than the state-of-the-art methods.

Assessing the quality of life of schizophrenia patients and their family caregivers in a Romanian sample: the role of clinical, sociocultural, and demographic factors

Background

Schizophrenia is a chronic mental health disorder significantly impacting the Quality of Life (QOL) of both patients and their family caregivers. In Romania, approximately 193,000 individuals are affected by schizophrenia, with most relying on non-professional family caregivers. These caregivers face substantial psychological, physical, financial, and social challenges, which remain understudied and often overlooked by health policymakers. This research employs a biopsychosocial framework to explore the interconnected clinical, cognitive, and sociocultural factors influencing the QOL of schizophrenia patients and their caregivers.

Objectives

This study aims to assess the QOL of schizophrenia patients and their family caregivers in a Romanian sample, focusing on key determinants such as social support, financial stressors, and caregiving burden, to provide insights for interventions and possibly policy development.

Methods

This cross-sectional study included 156 individuals: 52 schizophrenia patient-family caregiver pairs (n = 104) and a control group of 52 participants recruited from an occupational health clinic. The control group was matched with the patient-caregiver pairs on demographic characteristics, including age, gender, education, and socioeconomic status. Controls were selected to reflect similar socioeconomic and health-related challenges but excluded individuals with a history of mental health disorders. Schizophrenia diagnoses were established using ICD-10 criteria (F20.0-9). QOL was assessed using the Heinrichs-Carpenter Quality of Life Scale (QLS) exclusively for schizophrenia patients, while the WHOQOL-BREF was administered to all participants to ensure comparability. Additional assessments included the Beck Depression Inventory (BDI) for depressive symptoms, the Montreal Cognitive Assessment (MoCA) for cognitive functioning, the Eppendorf Schizophrenia Inventory (ESI) for caregiver psychopathology, and the Global Assessment of Functioning (GAF) scale to measure functional status.

Results

Caregivers exhibited elevated depressive symptoms, with a mean Beck Depression Inventory (BDI) score of 25 (≥20 indicates moderate depression), highlighting the significant psychological burden associated with caregiving. In contrast, the control group had a mean BDI score of 15, below the clinical threshold. Additionally, caregivers demonstrated reduced cognitive functioning, with a mean Montreal Cognitive Assessment (MoCA) score of 24, compared to 28 in the control group (<26 suggests mild cognitive impairment). These findings underscore the biopsychosocial stressors faced by caregivers.

Conclusions

This study highlights the significant cognitive, psychological, and sociocultural burdens associated with schizophrenia for patients and caregivers, advancing understanding of these challenges in a Romanian context. By emphasizing the need for integrated, culturally sensitive care models, our findings offer actionable insights to inform national and international mental health policies and future research on caregiver support and QOL enhancement.

Investigation the effect of Acceptance and Commitment Therapy (ACT) training on stigma and family functioning in family members of patients with psychiatric disorders: a randomized controlled clinical trial

BACKGROUND

Regarding the prevalence and pervasiveness of psychiatric disorders, which significantly affect not only the patients themselves, but also their families, family therapy has emerged as a promising intervention. This research examined the effects of Acceptance and Commitment Therapy (ACT) on stigma and family functioning in family members of patients with psychiatric illnesses, demonstrating effectiveness in improving family functioning and coping strategies in the face of mental illness.

METHODS

This randomized controlled clinical trial without blinding. Forty family members of patients with psychiatric disorders were randomly assigned to an intervention group (N = 20) or a control group (N = 20). The intervention group received ACT in eight weekly sessions, each lasting 90 min, while control group remained on a waiting list. Both groups were assessed at three time points: pre-intervention, post-intervention, and at a one-month follow-up. Data collection instruments included a demographic information questionnaire, a stigma assessment, and a family functioning measure. Data were analyzed using SPSS software version 23.

RESULTS

A statistically significant difference was observed between the mean post-test and follow-up stigma scores of the intervention and control groups (P < 0.05). The intervention group's mean scores showed a rising trend, whereas the control group's mean scores showed a declining trend. This was evident from within-group comparisons of the mean post-test and follow-up stigma scores. Repeated measures ANOVA indicated that the pattern of change in stigma for the intervention group was significant, in contrast to control group, suggesting a reduction in stigma (P < 0.001).

CONCLUSION

In light of the findings presented in this study, ACT emerges as a promising intervention for mitigating stigma, and enhancing the family functioning of individuals afflicted with mental disorders. To improve the generalizability of the study results, comparable studies using this therapy method should be undertaken on family caregivers of patients with mental illnesses.

IRANIAN REGISTRY OF CLINICAL TRIALS

IRCT registration number: IRCT20190917044802N10.

REGISTRATION DATE

14/9/2023.

Neglect of Psychological Care for Children with Cerebral Palsy and Their Families and Its Impact on Their Occupational Engagement in Saudi Arabia

Background and Objectives: Many children with (CP) and their families in Saudi Arabia struggle emotionally. Unfortunately, there have not been many studies conducted on how to help them with these challenges. This research aims to bring attention to this gap and to explore how a lack of proper mental health care might affect these children's ability to participate in everyday activities. Materials and Methods: In this cross-sectional descriptive study, a survey was conducted between August and October 2023. A total of 300 parents of CP children from Saudi Arabia participated in the study. The impact of psychological care negligence on the occupational engagement of CP children and their families was assessed by designing a valid questionnaire. Results: A total of 300 parents of children with CP participated in this study. The majority of the sample, 71% of parents, said that their children did not receive any psychological care, and 59.7% of the participants said that their children did not even receive a referral to a psychologist. However, 60.3% of parents of children noticed a significant decline in the occupational performance of their children, and 65.7% predicted an improvement in their children's performance with future psychological care. Conclusions: It is clear that there is a lack of awareness about the importance of mental health care for children with CP in Saudi Arabia. This lack of care hinders these children and their families' occupational engagement and social participation.

A Vicious Circle of Hope and Despair: Stigma Experienced by Relatives of Persons with Severe Mental Illness

Not only people suffering from severe mental illness (SMI) but also their family members experience stigma. Relatives are met with negative attitudes from healthcare professionals, which adds to the problem. This Swedish study employed a qualitative inductive explorative design in the analysis of written free-text responses from 65 persons who completed a questionnaire for relatives of persons with SMI. The overarching theme, "A vicious circle of hope and despair", was elaborated by four categories which formed a vicious circle: "Wanting openness, understanding and acknowledgement"; "Facing a lack of understanding from others"; "Seeking understanding from mental healthcare professionals but experiencing the opposite"; and "Keeping family experiences private." If this vicious circle of family stigma is to be broken, measures are needed for both relatives and health care professionals.