Guilt, shame and expressed emotion in carers of people with long-term mental health difficulties: A systematic review

Psychosocial impacts of being nil-by-mouth as an adult: A scoping review

AIM

To map existing evidence and identify gaps in the literature concerning psychosocial impacts of being nil by mouth (NBM) as an adult.

DESIGN

A scoping review of the literature was undertaken using JBI guidance. A protocol was registered on the Open Science Framework (osf.io/43g9y). Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR).

METHODS

A comprehensive search of six databases (CINAHL, Embase, MEDLINE, PsycINFO, SCOPUS and Web of Science) was performed for studies published up to February 2023, with no restriction to study type. A scope of the grey literature was also undertaken. Two authors independently assessed eligibility and extracted data. Descriptive statistical analysis and narrative synthesis were used, and patient and public involvement included in funding discussions.

RESULTS

A total of 23 papers were included in the review, consisting of 14 primary studies (7 qualitative and 7 quantitative) and 9 grey literature. Both global psychological distress and distress specific to being NBM (thirst, missing food and drink) were reported. Caregivers also experience distress from their family member being NBM. Furthermore, social impacts were reported for both patient and caregiver, primarily social isolation and subsequent low mood.

CONCLUSION

Furthermore, research is needed to understand the prevalence of this population, how best to measure psychosocial impacts and to explore whether (and how) psychosocial impacts change over time. Advancement in this area would enable better service development to optimize care for this patient group. WHAT IS KNOWN ABOUT THIS TOPIC?: Eating and drinking provides more than nutrition and hydration. A wide range of conditions can lead to recommendations for no longer eating and drinking (nil by mouth). Being nil by mouth (NBM) for short periods such as pre-operative fasting causes distress; however, little is understood about impact on longer-term abstinence from eating and drinking. WHAT THIS PAPER ADDS?: Psychosocial consequences of being nil by mouth (NBM)have been investigated by both quantitative and qualitative studies. Being NBM impacts both patients and caregivers in various psychosocial aspects, including distress and social isolation. Several gaps remain, however, regarding ways to measure psychosocial impact of being NBM.

Investigating the association between a history of depression and biomarkers of Alzheimer's disease, cerebrovascular disease, and neurodegeneration in patients with dementia

The association between depression and dementia, particularly Alzheimer's disease (AD) and cerebrovascular disease (CVD), remains an active area of research. This study aimed to investigate the relationship between a history of depression and biomarkers of AD and CVD in patients with dementia in a clinical setting. A total of 126 patients from the University Health Network (UHN) Memory Clinic with comprehensive clinical evaluations, including neuropsychological testing and medical examinations, were included. Lumbar puncture was performed to collect cerebrospinal fluid (CSF) for biomarker analysis, and brain magnetic resonance imaging (MRI) scans were obtained to assess white matter hyperintensity (WMH) burden. The presence of depression was determined through medical records. The study findings did not reveal significant differences between participants with and without a history of depression in terms of AD biomarkers, WMH burden, neurofilament light chain levels, cognitive scores, age of symptom onset, disease duration, or vascular risk scores. Logistic regression analysis did not indicate a meaningful predictive value of these variables for depression status. This clinical study contributes to our understanding regarding the association between depression and AD/CVD biomarkers in patients with cognitive impairment. Further research is needed to elucidate the complex relationship between depression and dementia and to explore the potential mechanisms linking depression, AD, and CVD.

Barriers to Mental Illness Treatment in Saudi Arabia: A Population-Based Cross-Sectional Study

BACKGROUND

Mental illness is a disorder that can cause impairment and disability, affecting mood, thinking, and behavior; therefore, early intervention will reduce morbidity. This study aims to evaluate all the personal, family, societal, and medical barriers that prevent mental health patients from seeking consultation and treatment.

METHODS

In Saudi Arabia, a cross-sectional study was conducted on 463 individuals aged 18 and above. Data were collected by face-to-face interviews using a validated questionnaire, which consisted of two parts. The first part included sociodemographic data, while the second part contained subsections of society/family, personal, and medical barriers.

RESULTS

The results showed that 379 (81.9%) indicated that society and family barriers impacted them, whereas 325 (70.3%) believed that personal barriers hindered seeking help. However, 294 (63.5%) opted for medical barriers as a hindrance. Regarding the highest barriers, 120 of the total respondents (25.9%) saw psychiatric illness as a source of shame and stigma, 166 respondents (35.9%) said that the psychiatric patient is seen as crazy, 159 of them (34.3%) believed it is tough for anyone to talk about their feelings and emotions and 183 respondent (39.5%) feared that psychiatric illness would decrease the chance of marriage to the appropriate person. Our findings also indicated a low trust in hospital treatment, hence a loss of confidence in using medications.

CONCLUSION

The findings of this study indicate that societal stigma is the most common barrier preventing people from seeking mental health consultation. Many barriers differ significantly between males and females.

How Do Care Partners of People with Rare Dementia Use Language in Online Peer Support Groups? A Quantitative Text Analysis Study

We used quantitative text analysis to examine conversations in a series of online support groups attended by care partners of people living with rare dementias (PLWRD). We used transcripts of 14 sessions (>100,000 words) to explore patterns of communication in trained facilitators' (n = 2) and participants' (n = 11) speech and to investigate the impact of session agenda on language use. We investigated the features of their communication via Poisson regression and a clustering algorithm. We also compared their speech with a natural speech corpus. We found that differences to natural speech emerged, notably in emotional tone (d = -3.2, p < 0.001) and cognitive processes (d = 2.8, p < 0.001). We observed further differences between facilitators and participants and between sessions based on agenda. The clustering algorithm categorised participants' contributions into three groups: sharing experience, self-reflection, and group processes. We discuss the findings in the context of Social Comparison Theory. We argue that dedicated online spaces have a positive impact on care partners in combatting isolation and stress via affiliation with peers. We then discuss the linguistic mechanisms by which social support was experienced in the group. The present paper has implications for any services seeking insight into how peer support is designed, delivered, and experienced by participants.

"I wanted to hide but also to be found": the high school experiences of young adults who grew up in the same home as a sibling with depression

BACKGROUND

Depression is a mental health condition that can have far-reaching consequences for the entire family, not just for the affected individual. Siblings are particularly vulnerable in that the unremitting stress and guilt at home can affect multiple aspects of their lives, including relationships, added responsibilities, and health. This pressure may affect siblings' own emotional well-being and academic success. Most studies in this field have examined the impact of depression on the affected adolescents or their parents, whereas few have examined the impact on siblings. Sibling studies have been limited by lack of sample homogeneity, especially in the context of coping in high school. This study sought to examine the retrospective experiences of young adults who lived in the same house as a sibling with depression while they were in high school.

METHODS

This qualitative study examined 21 young adults (aged 18-29) who grew up with a sibling with depression. In-depth, semi-structured interviews were conducted from May to September 2022. The interviews were recorded and transcribed and underwent thematic analysis.

RESULTS

Three main themes emerged from the interviews: (1) "School as a place of refuge": The perspective of participants who grew up with a sibling with depression regarding their high school experience. (2) "I wanted the adults at school to see me": Relations between research participants and the school educational staff. (3) "I was afraid people would relate to me as the sibling of a crazy person": Participants' relationships with their peers.

CONCLUSIONS

This study sheds light on the experiences of adolescents who grew up with a sibling with depression. The findings point to feelings of being invisible, self-nullification, avoiding sharing with others, and transparency. The participants were afraid that if their peers found out about their sibling they would also be stigmatized and alienated. The study shows that adolescents living with a sibling with depression need support at school.

Ashamed or afraid? Traumatic symptom severity and emotional activations of Covid-19-related events

This study investigates the role of shame, guilt, and fear activations related to Covid-19 stressful experiences in predicting traumatic symptoms. We focused on 72 Italian adults recruited in Italy. The primary outcome was to explore the traumatic symptoms severity and negative emotions associated with COVID-19-related experiences. The presence of traumatic symptoms was met by a total of 36%. Shame and fear activations predicted traumatic scales. Qualitative content analysis identified Self-centered, and Externally-centered counterfactual thoughts and five relevant subcategories were also identified. The present findings suggest the importance of shame in the maintenance of traumatic symptoms related to COVID-19 experiences.

Experiences of family caregivers in forensic mental health care-A qualitative evidence synthesis

WHAT IS KNOWN ON THE SUBJECT

Internationally, research and policy agendas recommend that family caregivers of service users in mental health care be involved in care and treatment, to support the service user's recovery process. Family caregivers of service users in mental health care are often highly burdened. There is a lack of research-based knowledge about the experiences of family caregivers of service users in forensic mental health care (FMHC) and their involvement in care and treatment.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

This study indicates a persistent caregiver presence and/or caregiver advocacy in regard to care and treatment of the service user in FMHC. This study indicates that health care professionals (HCPs) might play a role in eliciting a persistent caregiver presence and/or caregiver advocacy.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

HCPs need to develop their collaborative skills and be more willing to listen to and understand caregivers' persistent presence and/or advocacy. HCPs need to be more skilled to understand caregivers' and families' living with the complexities of mental illness and offence. HCPs are encouraged to adjust the involvement of family caregivers in care and treatment to FMHC.

ABSTRACT

Introduction There is a lack of research about experiences of family caregivers of service users in forensic mental health care (FMHC) and their involvement in care and treatment. Research shows that caregivers are burdened. Further knowledge is required, to provide a foundation for improving clinical practice. Aim To review research literature, to investigate existing knowledge about caregiver experiences and, secondly, caregivers' experiences of facilitators and barriers related to their involvement in care and treatment. Method Qualitative evidence synthesis undertaken in a thematic synthesis of thirteen peer-reviewed studies. Results The analysis identified three descriptive themes: violence against family; a great burden of responsibility; and difficult collaboration, together with an additional three analytical themes: bearing witness; persistent presence; and advocacy becomes necessary. Discussion Persistent caregiver presence and/or caregiver advocacy may be elicited by health care professionals' (HCPs') exclusion of caregivers from care and treatment. Caregivers' feelings of guilt in relation to the service user's offence may play an additional role in persistent presence and advocacy and, therefore, in HCPs' exclusion of them. Implications for Practice HCPs need to develop their collaboration with caregivers by their willingness to listen to caregivers to understand emotional complexities within families experiencing mental illness and offence.

Status and influencing factors of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury: a quantitative and qualitative study

BACKGROUND

Disease uncertainty widely exists among family caregivers of patients with moderate and severe craniocerebral injury. This negative emotional reaction will reduce the ability of family caregivers to make decisions during the critical stage of the patient, causing serious effects on the rescue and prognosis of patients with moderate and severe craniocerebral injury. Therefore, this article aims to understand the state of the uncertainty of the disease of family caregivers of patients with moderate and severe craniocerebral injury in China, to analyze the influencing factors, and to explore the specific resource of the uncertainty of the disease combined with qualitative study. The outcomes will provide a theoretical basis for formulating an accurate clinical nursing intervention strategy.

METHODS

This study was conducted in the neurosurgery ward. A total of 214 family caregivers were evaluated using five previously validated scales: (i) Mishel Uncertainty in Illness Scale for family member, (ii) Simplified Coping Style Questionnaire, (iii) Social Support Rating Scale, and (iv) Self-Rating Anxiety Scale, (v) Zarit Caregiver Burden Interview. Kolmogorov-Smirnov was used to test the normality of the data distribution. The potential determinants of disease uncertainty were evaluated using the univariate statistical analysis. A multivariate linear regression model was adopted to assess the predictors of disease uncertainty in family caregivers of patients with moderate and severe craniocerebral injury. Objective sampling method was used to conduct semi-structured interviews with 17 family caregivers of patients with moderate and severe craniocerebral injury, and Colaizzi 7-step analysis method was used to analyze and summarize the interview data.

RESULTS

The evaluated participants exhibited critically high levels of perceived uncertainty. The results of multiple linear regression showed that the influencing factors of family caregivers' disease uncertainty were anxiety, number of other caregivers, GOS, negative coping style, and caregiver burden. The qualitative research focuses on two main topics: the sources of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury and experience to cope with the situation.

CONCLUSION

The main cause of disease uncertainty of family caregivers of patients with moderate and severe craniocerebral injury is that patients' disease progression and prognosis as well as caregivers' own pressure of responsibility and negative mental status. Furthermore, caregivers' own pressure of responsibility and negative mental status are not clear. Therefore, helping family caregivers adopt positive coping approaches, guiding them to actively seek support from family and society, improving their nursing skills, and understanding of disease progression and prognosis all play an important role in alleviating the uncertainty of the disease.

Factors of Parental Preparation of Children with Mental Illnesses for Their Independent Living after Their Own Death

Families of children with mental illnesses are often concerned about living in the community after their parents' death. The cross-sectional study aimed to examine the association between how parents prepare adult children with mental illnesses to live independently after the death of the parent(s). The participants were 1112 members of 46 family support groups for mental illnesses in Tokyo, Japan. The age of the people with mental illness was 40s, and that of their parents was 70s. Logistic regression analysis showed that mothers' support in daily living, no income or pension for disabled people, staying at home during free time, and parental livelihood being the same as the person with mental illness were factors that were negatively associated with the independent living of people with mental illness. In contrast, parental participation in the family group and creating a system for securing regular living expenses of the person with mental illness were positively associated with independent living. The results suggest that parents need to promote their children's recovery and prepare them financially by forecasting their independent living after their own death.

A systematic review comparing caregiver burden and psychological functioning in caregivers of individuals with schizophrenia spectrum disorders and bipolar disorders

BACKGROUND

Informal primary caregivers provide crucial supports to loved ones experiencing serious mental illnesses with profound outcomes for the caregivers themselves. A comprehensive understanding of how different serious mental illnesses change the caregiving experience may provide important insight into the ways in which caregivers can be better supported in their role. The aim of this review was to synthesize the comparative literature examining caregiver burden and psychological functioning (anxiety, depression, distress, and psychological wellbeing) between caregivers of people with schizophrenia spectrum disorders and bipolar disorder.

METHODS

Studies were included if they compared caregivers across both diagnostic groups and used measures assessing either caregiver burden or psychological functioning of caregivers. Databases searched up until 11th of January 2022 included: Medline COMPLETE, Embase, PsycINFO and CINAHL. Reference list scans and grey literature searches across government, organisational and dissertation databases were also conducted.

RESULTS

Twenty-eight studies comprising 6166 caregivers were included. Fourteen studies suggested that caregiving burden was comparable across both groups. The effects of caring on caregiver mental health and stress were comparable across both groups. However, methodological limitations were noted, including a reliance on cross-sectional studies, multiple and sometimes competing definitions of caregiving burden, variable sample sizes, and variation in measures used.

CONCLUSION AND IMPLICATIONS

The experience of providing care is multidimensional and complex. Symptoms and functional difficulties experienced by people being cared for may affect caregivers more so than diagnosis. Caregivers play a vital role in helping people with serious mental illness. Supporting caregivers by reducing their burden and improving their psychological functioning may help them to continue to provide support, and cope with, the challenges of providing care.

Perceived Caregiver Strain, 3- and 18-Month Poststroke, in a Cohort of Caregivers from the Life after Stroke Trial (LAST)

Aim

To gain more knowledge of caregiver strain in the Life After Stroke Trial (LAST) population.

Methods

This is a substudy of the LAST study, including all caregivers' reports of perceived Caregiver Strain Index (CSI) at inclusion and 18-month follow-up irrespective of group allocation. The checklist “STROBE Statement—Checklist of items that should be included in reports of cohort studies” was used. Caregivers to adults (age ≥18 years), here defined as the person living with, a patient with a first-ever or recurrent stroke, community dwelling, with modified Rankin Scale (mRS) <5 and no serious comorbidities, was invited to fill out the Caregiver Strain Index at three months (10–16 weeks) poststroke. Domains indicating differences of change in perceived strain in the total sample were analyzed in a linear regression analysis.

Results

Caregiver strain (n = 147) varying from 5% to 27% was reported by the caregivers at baseline and between 2% to18% at 18-month follow-up. The items indicating the highest level of strain at baseline and 18 months were as follows: “Care giving is confining,” “There have been changes in personal plans,” “There have been emotional adjustments,” and “I feel completely overwhelmed.” The samples were divided into age groups 0–79 years and 80–100 years, indicating a higher strain on the caregiver for persons 80–100 years at 18 months.

Conclusion

Caregiver strain was relatively low both at baseline and at 18-month follow-up. Main caregiver strains were reported in terms of a sense of confinement, a tendency of emotional strain, and the altering of plans at both time points. Depression was one of the main explanatory factors for the perceived caregiver strain. The perception of caregiver strain was higher in age groups 80–100 years than age groups 0–79 years.

[Involuntary admission to psychiatry at the request of caregivers: The point of view of caregivers]

OBJECTIVES

In France, the family and friends of a patient with a psychiatric disorder can legally be involved in the decision to involuntary admission to psychiatry through care at the request of a third party. This involvement has been questioned in recent years, notably to protect this third party. The main objective of this work was to assess whether providing the third party with information on care without consent when providing care at the request of a third party (SDT) had an impact on the third party's experience. The secondary objectives were to identify other factors that might impact the third party's experience of the SDT, and to assess the impact of the SDT on the relationship between the third party and his or her hospitalized relative, as well as the factors that might influence it.

METHODS

The study was based on a questionnaire, constructed after meeting several members of an association of relatives of patients with psychiatric disorders : UNAFAM. This questionnaire questioned the context of hospitalization, the information provided concerning care without consent, the experience of the third party at the time of hospitalization and at a distance, and the impact of hospitalization on the relationship between the third party and his or her hospitalized relative, both at the time of hospitalization and at a distance. This questionnaire was then sent to UNAFAM members in three randomly selected regions. It was specified that it was only intended for people who had already been a third party during SDT. The results were received anonymously.

RESULTS

Among the 166 respondents, 85 (51.2 %) had received information about involuntary admission, and there was more frequent relief at the time of hospitalization (P<0.01) and at a distance (P<0.01), and less frequent feelings of violence towards their loved one at a distance from hospitalization (P=0.02) compared to those who had not received information. The negative impact of hospitalization on the relationship between the third party and their hospitalized relative was lower (P=0.04) among third parties who received information. The fact that the doctor was perceived as being mainly responsible for the decision to hospitalize also preserved the third party's experience and relationship with his or her relative. However, third parties who understood their involvement as an administrative necessity reported less frequent relief (P=0.01), and the negative impact of hospitalization on their relationship with their relative was higher (P=0.01). Conversely, the fact that they felt integrated into the care and listened to by the health care team was correlated with a better experience of the situation by the third party, and a lesser negative impact of hospitalization on the relationship between the third party and their relative.

CONCLUSIONS

Providing information to the third party about involuntary admission at the time of an SDT could improve his or her experience of the situation and limit the negative impact of hospitalization on his or her relationship with his or her loved one. Although it seems important for the third party to feel that the majority of the decision to hospitalize is made by the physician, including him/her in this decision could improve his/her experience of the situation and limit the negative impact of hospitalization on the relationship between the third party and his/her family member.

Family environment and depressive episode are associated with relapse after first-episode psychosis

WHAT IS KNOWN ON THE SUBJECT?: Relapse rates are high among patients who have experienced first-episode psychosis (FEP). Psychotic relapses are associated with worse quality of life and poorer functionality of the FEP patient. The use of psychoactive substances, non-adherence to drug treatment, and high expressed emotion (EE) are notable predictors of relapse after the FEP. Although some studies have suggested that psychotic relapse may be associated with a family environment with high levels of emotional over-involvement (EOI), this finding is still inconsistent across different cultures. EE specific components must be evaluated and interpreted according to the context of cultural norms. There is a scarcity of studies on the role of depression in the occurrence of relapses after the FEP, and the results remain uncertain. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study explored the predictors of psychotic relapses in Brazilian patients who experienced FEP. Our results indicate that 29.2% of the patients relapsed after the FEP. Patients diagnosed with depression and high-EOI in the family environment were predictors of psychotic relapses in this population. This study expands knowledge about the cultural specificity of EOI and the role of depression in psychotic relapse. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nursing professionals must consider the implications of the family environment and depression in the course of psychosis. Family interventions and the appropriate treatment of depression are important for improving the prognosis of FEP patients. ABSTRACT: Introduction Psychotic relapse may be associated with relatives' high emotional over-involvement (EOI) and with a diagnosis of major depressive episode (MDE) among first-episode psychosis (FEP) patients, but the results are still inconsistent across different cultures. Aim Evaluate the predictors of relapse in FEP patients. Method Prospective cohort study with 6-month follow-up conducted with 65 dyads of patients and relatives from an early intervention unit in Brazil. At the baseline interview, relatives answered to a sociodemographic data form and to the Family Questionnaire. Patients provided sociodemographic and clinical data and answered the Measurement of Treatment Adherence; the Alcohol, Smoking and Substance Involvement Screening Test; the Severity of Dependence Scale to assess cannabis dependence, and the MDE module of the Mini-International Neuropsychiatric Interview. Psychotic relapses were evaluated using items from the Brief Psychiatric Rating Scale. The data were analysed using multiple logistic regression. Results 29.2% of the patients presented at least one psychotic relapse. High-EOI and MDE were predictors of psychotic relapses. Discussion Our findings expand the knowledge about the cultural specificity of EOI and the role of depression in psychotic relapse. Implications for practice Family nursing interventions and the appropriate treatment of MDE must be considered in the care of FEP patients.

Family caregivers' experiences of providing care for family members from minority ethnic groups living with dementia: A qualitative systematic review

AIMS AND OBJECTIVES

To review the literature on family caregivers' experiences of providing care for a family member from an ethnic minority group living with dementia within the European context.

BACKGROUND

Due to labour migration during the late 1960s and early 1970s, many European countries are now encountering an increasing number of older people from diverse ethnic minority groups who have been diagnosed with dementia. Although family care is predominantly used as a care pathway among families with immigrant backgrounds, little is known about family caregivers' experiences of providing care for a family member with dementia.

DESIGN

A systematic review of qualitative literature.

METHODS

Eight databases (CINAHL, EMBASE, MEDLINE, PsychINFO, SCOPUS, Social Care Online, SocIndex and Epistemonikos) were searched for original, peer-reviewed papers, published in English between 2010 and 2021. The literature review was conducted and reported in accordance with PRISMA 2020 checklist for reporting systematic reviews.

RESULTS

After identifying, screening and assessing articles for eligibility, 14 articles were critically appraised using the standardised assessment tool Mixed methods Appraisal Tool (MMAT, version 2018) and included in the review. The data synthesis process identified four themes across the qualitative studies: controversies and challenges; a lack of health literacy; barriers to seeking support from the healthcare or social services; and models of care.

CONCLUSIONS

Most of the family caregivers highlighted the value of being able to care for a family member living with dementia. However, the findings also reveal that they experience controversies and challenges due to their lack of dementia health literacy and perceived barriers to seeking healthcare support.

RELEVANCE TO CLINICAL PRACTICE

The findings from the current review can inform healthcare and social services in relation to implementing models of care that facilitate and complement family caregivers' role in caring for family members living with dementia from minority ethnic groups.

Barriers to Family Resilience in Caregivers of People Who Have Schizophrenia

PURPOSE

To explore the barriers to family resilience in caregivers of people who have schizophrenia.

DESIGN

A qualitative descriptive approach was used.

METHODS

Semistructured interviews were conducted with family caregivers of patients with schizophrenia registered at the psychiatry outpatient unit of a hospital center. Content analysis was performed on audio-recorded and verbatim-transcribed interviews. The consolidated criteria for reporting qualitative research (COREQ) checklist was applied to this study.

RESULTS

A total of 31 family caregivers participated, the majority of whom were female (71%) with an average age of 57.5 years. Most participants lived with and cared for their relative (90.3%). The caregiver role was assumed mostly by mothers (54.8%) and fathers (22.6%). Barriers to family resilience in caregivers of people experiencing schizophrenia broadly fall under five categories: lack of knowledge about the disease, social stigma, expressed emotion, involvement in the relationship, and blame.

CONCLUSIONS

In view of the paucity of studies exploring and understanding the barriers to family resilience, this study presents itself as one of the first in this area. There are different barriers to family resilience. This research provides an overview and an understanding of key barriers to family resilience in caregivers of people experiencing schizophrenia.

CLINICAL RELEVANCE

There is a need for nurses to help families to be resilient. By understanding the barriers to resilience, nurses are able to focus on these factors and help families to remove or reduce their influence.

Trauma and Social Pathways to Psychosis, and Where the Two Paths Meet

The pathways from trauma-via dissociation-to psychosis have been thoroughly tested and evidenced, but what has received less attention has been the social pathways-via dissociation-to psychosis. Often social factors are more commonly linked to other influences, e.g., to appraisals and the creation of negative schema in cognitive models, or to unsupportive caregiving experiences where there is high "expressed emotion." However, evidence is now emerging that negative social rank experiences, such as being excluded or shamed, may themselves have dissociative properties, which poses intriguing questions as to how trauma pathways and social pathways might interact. This article reviews the state of knowledge in trauma and social pathways to psychosis and then considers the potential mechanisms and the relationships between them, specifically (i) dissociation, (ii) attachment, and (iii) social rank. Recommendations are suggested for future modeling and testing of three-way interactions (dissociation × attachment × social rank) in the pathway from trauma to psychosis.

Predictors of Expressed Emotion in First Episode Psychosis

This article evaluated the predictors of EE and its components, EOI and CC, in relatives of first episode psychosis patients (FEP) in Brazil. Cross-sectional observational study conducted with 82 dyads of FEP patients and their relatives. Data collection instruments: sociodemographic and clinical data questionnaire, Family Questionnaire, Zarit Burden Interview and Morisky Medication Adherence Scale. Logistic and linear regression models were used. Our results indicate that patient's age, relative's sex, daily time spent together, and family burden were predictors of EE and its components. Our findings may be helpful in planning nursing interventions to reduce EE and prevent psychotic relapses.

Female Pakistani carers' views on future formal and informal care for their older relatives in Norway

Background

The aging of Pakistani immigrants in Norway raises questions related to their increased need for care and help from relatives, as well as those concerning what future formal and informal care and healthcare accessibility for older immigrants may look like. The hidden nature of family caregiving means that the circumstances of carers, their views and their dilemmas related to future care are largely invisible. In this study, we explored female Pakistani carers’ views of future care and healthcare accessibility for their older relatives in Norway.

Methods

Our data included interviews with family carers between the ages of 23 and 40 years old, living in Oslo, Norway. We recruited ten family carers, out of which eight were daughters and two were daughters-in-law. Interviews were conducted by the first author in Urdu or English and were recorded and transcribed verbatim.

Results

Our findings revealed several factors that influenced participants’ perceptions about formal and informal caregiving, which can be organised into the following themes: 1) caring for family in Norway as in Pakistan, 2) worries about being ‘dropped off’ at a care home, 3) concerns about being cared for by outsiders, 4) questions about what other people might say and 5) adhering to society’s expectations of a ‘good’ carer.

Conclusion

Family carers’ traditional views of filial piety do not entirely determine the use of or access to healthcare services of their older relatives. There is a need to develop culturally sensitive healthcare systems so that immigrant families and their carers have more options in choosing care in old age, which in turn will ease their families’ care burden. Healthcare professionals and policymakers should not assume that immigrant families will take care of their own older members but should instead secure adequate support for older immigrants and their family carers.

Outcomes and change processes of an established family education program for carers of adults diagnosed with a serious mental health condition

BACKGROUND

Family education programs (FEPs) target caregiving-related psychological distress for carers of relatives/friends diagnosed with serious mental health conditions. While FEPs are efficacious in reducing distress, the mechanisms are not fully known. Peer group support and greater mental health knowledge are proposed to reduce carers' psychological distress by reducing stigmatising attitudes and self-blame, and strengthening carers' relationship with their relative.

METHODS

Adult carers (n = 1016) who participated in Wellways Australia's FEP from 2009 to 2016 completed self-report questionnaires at the core program's start and end, during the consolidation period, and at a 6-month follow-up. Those who enrolled early completed questionnaires prior to a wait-list period. We used linear mixed-effects modelling to assess the program's effectiveness using a naturalistic wait-list control longitudinal design, and multivariate latent growth modelling to test a theory-based process change model.

RESULTS

While there was no significant change over the wait-list period, psychological distress, self-blame and stigmatising attitudes significantly decreased, and communication and relationship quality/feelings increased from the core program's start to its end. Changes were maintained throughout the consolidation period and follow-up. Peer group support significantly predicted the declining trajectory of distress. Peer group support and greater knowledge significantly predicted declining levels of self-blame and stigmatising attitudes, and increasing levels of communication.

CONCLUSIONS

This is the first study to quantitatively validate the mechanisms underlying the effect of FEPs on carers' psychological distress. Peer group support is key in modifying carers' appraisals of their friend/relatives' condition. Continued implementation of FEPs within mental health service systems is warranted.

Assessment of Different Dimensions of Shame Proneness: Validation of the SHAME

A large body of research revealed that shame is associated with adaptive and maladaptive correlates. The aim of this work was to validate a new dimensional instrument (SHAME), which was developed to disentangle adaptive and maladaptive dimensions of shame proneness. Confirmatory factor analyses supported the three-factorial structure (bodily, cognitive, and existential shame) in American (n = 502) and German (n = 496) community samples, using invariance testing. Bifactor model analyses exhibited distinct associations of adaptive (bodily and cognitive shame) and maladaptive (existential shame) dimensions of shame with psychopathology and social functioning. Network analyses highlighted the role of existential shame in psychopathology, especially for a clinical sample of patients with Borderline Personality Disorder (n = 92). By placing shame pronenesss into a network of similar and dissimilar constructs, the current findings serve as a foundation for drawing conclusions about the adaptive and maladaptive nature of shame.

Characteristics of Parents With High Expressed Emotion and Related Factors: A Study of Parents of Adults With Schizophrenia

This study aimed to clarify characteristics of parents with high expressed emotion (EE) and related factors among parents of adults with schizophrenia. In total, 73 (25.3%) of the 289 parents had high EE (Family Attitude Scale [FAS] score ≥60), and 216 (74.7%) had low EE (FAS score <60). A multiple logistic regression analysis showed that high EE parents were more distressed (odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.16-1.39) and experienced more physical violence from their adult children with schizophrenia (OR = 2.86; 95% CI = 1.28-6.43); the children with schizophrenia had been hospitalized at time of survey (OR = 6.54; 95% CI = 1.10-38.89) and were less likely to attend rehabilitation services (OR = 2.56; 95% CI = 1.06-6.17). Practitioners need to provide crisis intervention, home-visiting services, and support services for parents during hospitalization of their children with schizophrenia.

Attachment, mentalisation and expressed emotion in carers of people with long-term mental health difficulties

BACKGROUND

Expressed emotion (EE) is a global index of familial emotional climate, which is comprised of emotional over-involvement (EOI) and critical comments (CC)/hostility. Although EE is an established predictor of negative outcomes for both people with long-term mental health difficulties and their family carers, its psychological underpinnings remain relatively poorly understood. This paper examined associations between attachment, mentalisation ability and aspects of EE.

METHODS

Carers of people with long-term mental health difficulties (n = 106) completed measures of adult attachment (the Experiences in Close Relationships-Short Form questionnaire), mentalisation (the Reading the Mind in the Eyes Test and the Emotional Self-Efficacy Scale) and EE (the Family Questionnaire). Data were analysed using hierarchical multiple regression.

RESULTS

Attachment avoidance and facets of mentalisation were directly and uniquely positively associated with CC/hostility, with attachment avoidance and other-directed emotional self-efficacy (one facet of mentalisation) each significantly predicting CC/hostility scores after controlling for the effects of EOI and demographic variables. However, no associations were observed between EOI, attachment anxiety and mentalisation. Furthermore, no indirect effects from attachment to EE via mentalisation was found.

CONCLUSIONS

Although it would be premature to propose firm clinical implications based on these findings, data indicate that it may be beneficial for clinicians to consider attachment and mentalisation in their conceptualisation of carers' criticism and hostility. However, further research is needed to clarify the magnitude of these associations and their direction of effect before firm conclusions can be drawn.