The impact of caring for family members with mental illnesses on the caregiver: a scoping review

Factors influencing the mental well-being of professional guardians in Japan: The role of stress and stigma

Aim

As Japan increasingly relies on professional adult guardians, understanding their challenges and identifying support measures for their mental well-being is essential. This study explores factors influencing the mental well-being of professional guardians.

Methods

Judicial scriveners, who handle 35.9% of all guardianships, represent the largest group of professional guardians, most of whom are affiliated with the Adult Guardianship Center Legal Support. An online questionnaire survey was conducted among members of the Tokyo Branch. Of the 1627 members contacted, 227 (14.0%) responded between October 2 and 23, 2024.

Results

The prevalence of poor mental well-being (World Health Organization-Five Well-Being Index Japanese version <13) among professional guardians was 42.3%. Univariate analysis identified factors significantly associated with poor mental well-being, including low satisfaction, frequent psychological stress, inadequate job support, perceived poor physical health, loneliness, burnout, and community stigma. Multivariate analysis confirmed that frequent psychological stress (95% confidence interval [CI]: 0.08-0.37, p = 0.002) and strong community stigma (95% CI: -0.03 to 0.00, p = 0.043) were independently associated with poor mental well-being.

Conclusion

This study highlights significant challenges to the mental well-being of professional guardians in Japan, particularly due to psychological stress and community stigma. Given that 42.3% of participants reported poor mental well-being, a rate significantly higher than the general population, there is an urgent need for targeted support measures, such as stress-management programs and peer support networks.

Experiences and challenges of family caregivers of people with lower limb amputation: a qualitative study

OBJECTIVE

To explore the experiences of family caregivers transitioning to their roles of caregivers for people with dysvascular major lower limb amputation, identify the challenges they face, understand their specific needs during this transition, examine their experiences during the hospital-to-home transition, and gather insights into strategies that promote empowerment in caregiving.

METHOD

This exploratory, cross-sectional descriptive study employed a qualitative approach, conducting semi-structured interviews with 40 family caregivers of individuals with dysvascular major lower limb amputation. Data were analyzed using ATLAS.ti software and Bardin's content analysis method.

RESULTS

Content analysis identified five categories: 1) family caregiver role, 2) amputee needs/difficulties, 3) family caregiver needs/difficulties, 4) home transition, and 5) strategies to promote family caregiver empowerment, highlighting critical aspects of the caregiving experience and identifying areas for intervention.

CONCLUSION

The findings emphasize the need for family-centered empowerment programs combining hospital-based training with community support. Future research should evaluate their impact on reducing caregiver burden and improving outcomes for both caregivers and amputees.

Association Between Mental Illness and Trajectories of Social Participation Over Time in Community-Dwelling Middle-Aged and Older Couples: A Retrospective Longitudinal Study

Our study examined the association between social participation and mental illness in middle-aged and older couples, adopting a longitudinal, quantitative approach in a large sample. We analyzed the data of 3,504 middle-aged and older adults. Social participation was used as the dependent variable, and the time-varying variable was whether there was mental illness in the couple. Latent growth modeling was used to examine the association between these variables. Among the participants, 214 (6.11%) were middle-aged and older couples with at least one partner having a mental illness. An association was found between social participation and presence of a mental illness, except in the data for 2018 (estimate range =  -0.078 to - 0.032; p-value range = <.0001 to 0.035). Our findings highlight the imperative of addressing the unique needs of middle-aged and older couples with mental illness. Therefore, the findings suggest the need for interventions that can be integrated to encourage couples to participate in meaningful social activities together.

Carer Outcomes From a Residential Treatment Service for Eating Disorders

OBJECTIVE

Eating disorders often result in distress, relationship impairment, and emotional, social, and financial burden for family members and other loved ones. However, carer outcomes from eating disorder treatment are under-researched, particularly residential settings. This study aimed to examine carer outcomes from a transdiagnostic residential service for eating disorders, which included therapist-led psychoeducation and peer support for carers.

METHOD

Measures of carer burden, accommodation and enabling of eating disorder symptoms, psychological distress, and health-related quality of life were completed at pre-treatment and three months' post-treatment by 51 carers (66.7% parents).

RESULTS

Linear mixed effects modelling found significant improvement in carer burden (b = -5.80, p = 0.033), accommodation and enabling of eating disorder symptoms (b = -13.32, p = 0.003), and psychological distress (b = -3.19 p = 0.026), with medium to large effect sizes (d = -0.76-1.32). Averaged across time, women reported significantly greater carer burden than men (b = 12.42, p = 0.011).

CONCLUSIONS

Findings support the effectiveness of residential treatment for carers, including improvement in behaviours that are likely to support eating disorder recovery. Future research is needed to determine what elements in residential treatment, the caregiving relationship, and beyond contribute to these positive outcomes.

TRIAL REGISTRATION

The study was prospectively registered on the Australian and New Zealand Clinical Trials Registry in November 2021, registration number ACTRN12621001651875.

Explaining the Family-Centred Care of Young People With Depressive Disorders and Suicidal Ideations: A Grounded Theory Study

AIM

This study aimed to develop a theory to guide family members caring for young people with depressive disorders and suicidal ideations.

DESIGN

Strauss and Corbin's Grounded Theory.

METHODS

Theoretical sampling was used to recruit primary family caregivers (aged 22-60) of young people experiencing depressive disorders and suicidal ideations from hospitals and psychiatric clinics in Taiwan. Data were collected using interviews (n = 23) in 2023. Data were analysed using Corbin & Strauss' analytical framework, including open, axial and selective coding until theoretical saturation was reached.

RESULTS

A paradigm model was used to link the 13 categories and develop a substantive theory to help guide family members in the care of their young persons with depressive disorders and suicidal ideations. The core category that emerged was 'Struggling to contain the young person's life by adjusting, assisting, and protecting them from diving into depression'. Other key categories interconnected with this core category were-creating a nurturing environment, adjusting to changes, protecting the young person's safety and assisting with their medical treatment.

CONCLUSION

Family caregivers could use this theory as a guide to enhance the care of young persons experiencing depressive disorders and suicidal ideations and accompany them alongside the healing process.

IMPLICATIONS FOR THE PROFESSION

Nursing professionals could provide psychoeducation to family caregivers on how to hold the young person gently and acquire compassion for the young persons' lived experience, thoughts and emotions, by creating a nurturing environment, adjusting to changes, protecting their safety and assisting with their medical treatment.

IMPACT

This theory provides valuable guidance for future intervention research aimed at improving family caregivers' ability to care for young persons with depressive disorders and suicidal ideations.

REPORTING METHOD

The COREQ guidelines were utilised.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Association Between Obesity-Related Health Factors and Patient-Reported Outcomes: Linking Patient-Reported Outcomes to PEDSnet Electronic Health Record Data

Background: While studies have described poorer health-related quality of life (HRQOL) among youth with obesity, less is known about health factors contributing to this perception. The study aims were to link patient-reported outcomes (PROs) data to electronic health record (EHR) data to describe the association between PROs and obesity-related health factors. Methods: Youth and parents of youth receiving care from weight management programs at eight PEDSnet sites completed PROMIS® measures assessing global health, fatigue, stress, and family relationships. EHR data were extracted, including demographics, anthropometrics, diagnoses, medications, and visits for the period encompassing 12 months prior to and after the date of survey. Linear regression analyses describe the association between PROMIS® scores and the diagnosis of obesity-related comorbidities, medications for obesity-related comorbidities, and health care utilization. Results: In total, 1249 youth (56% with severe obesity) of diverse backgrounds (60% public insurance, 24% non-Hispanic Black, 24% Hispanic) were included. The diagnosis of many obesity-related comorbidities and use of medications for obesity-related conditions were associated with worse global health fatigue and stress scores. The strongest associations that were consistent across many of the PROMIS® measures included number of chronic medications, number of comorbidities, having a neuropsychological diagnosis, and body mass index percentile trajectory. Conclusions: This study details the association of the health issues experienced by youth with obesity and PROs, offering targets in weight management treatment to improve youth and family perception of overall health and well-being.

The uneven triad: a qualitative study of perspectives of relatives, patients, and professionals on (not) involving relatives in mental health

INTRODUCTION

Recognition of the value of involving relatives in mental health care is growing. This study explores the ambivalence surrounding their role, including formalisation, instrumental use, burden, and potential benefits. Collaboration between relatives, patients, and professionals is essential to recovery-based approaches. Thus, despite challenges, the involvement of relatives remains crucial. This study aims to understand perspectives on involving relatives in mental health care, within the larger context of collaboration across the triad of relatives, patients, and professionals.

METHODS

We conducted a qualitative study using semi-structured interviews with relatives (n = 7), patients (n = 7), and professionals (n = 10) connected to various mental health care organizations. The study took place in The Netherlands. Data were analysed using thematic analysis.

RESULTS

For collaboration in the triad, we found five aspects to be of importance: the significance of involving relatives, changing roles from relative to caregiver, relatives' intermediary role in patient-professional relationship, negative experiences of relatives in the triad, and ambivalence about patient's autonomy. Notably, because collaboration between professionals and relatives is often challenging, it often leads to tensions.

CONCLUSION

Our study uncovers varying perspectives both on involving relatives and on collaboration within the triad. Recovery-oriented approaches do not always align with patients' and relatives' intentions and values. Although relatives want to be involved, they often feel unheard and unseen by professionals. Relatives' roles -especially the intermediary role- are surprisingly underrepresented in the recovery-oriented literature. This study reveals several tensions between the three perspectives, culminating in a so-called uneven triad. We conclude that although the concept of involving relatives is highly advocated in recovery-based approaches, actual practice is lagging behind.

Prevalence and sociodemographic configurations of anxiety and depression among caregivers of individuals with mental illness: A meta-analysis and qualitative comparative analysis

BACKGROUND

Caring for individuals with mental illness involves significant challenges from both the unique symptoms and societal stigma associated with these conditions, often leading to caregiver neglect despite the heightened risk of anxiety and depression among caregivers. This study was designed to quantify the prevalence of anxiety and depression among caregivers and to offer a detailed configurational analysis of their sociodemographic attributes.

METHODS

Random-effects meta-analyses were conducted using generalized linear mixed models to calculate the prevalence rates for each study. We explored potential sources of heterogeneity through meta-regression and subgroup analyses. Qualitative Comparative Analysis (QCA) was utilized to identify sociodemographic configurations that contribute to anxiety and depression. The study was pre-registered in PROSPERO (CRD42023478003).

RESULTS

A total of 52 studies involving 10,232 participants were included. The prevalence of depression was 43.91 % (95 % CI: 34.62 %-53.65 %), anxiety was 66.56 % (95 % CI: 48.45 %-80.82 %), and comorbidity was 37.24 % (95 % CI, 19.75 %-58.85 %). QCA identified four sociodemographic configurations contributing to depression and two contributing to anxiety. Key contributors to depression included younger, unmarried, highly educated female caregivers, as well as older, married caregivers caring for patients with schizophrenia. Anxiety was more prevalent among older, married caregivers of patients with schizophrenia and younger, highly educated female caregivers.

LIMITATIONS

Differences in the measurement tools used across studies may have impacted the results of this study.

CONCLUSIONS

The high prevalence of depression and anxiety among caregivers of individuals with mental illness underscores the need for targeted mental health services and policies.

Sociodemographic Characteristics Implicated in Severe Caregiver Burden amongst Family Caregivers of Patients with Schizophrenia: A Cross-sectional Study

BACKGROUND

Sociodemographic characteristics can influence the burden of caring for patients with mental illnesses such as schizophrenia.

AIM

The aim of this study was to ascertain the sociodemographic characteristics implicated in severe caregiver burden among family caregivers of patients with schizophrenia.

METHODS

Over 3 months, 300 caregivers of patients with schizophrenia were consecutively recruited at the psychiatry outpatient department in a tertiary hospital in Gauteng province, South Africa. The sociodemographic characteristics of the caregivers were ascertained. The 22-item Zarit Burden Interview (ZBI-22) was administered to the participants to measure the caregiver burden.

RESULTS

The range of ZBI-22 was 0-75 with a median of 19.00 (interquartile range [IQR]: 13.0-30.5). Severe burden occurred in 2.33% (7/300) of the participants. The sociodemographic characteristics that had the highest percentage amongst those with the severe burden (and their median burden score plus IQR) were increasing duration of caregiving 132.0 (72.0-264.0), residing in Northern Gauteng 17.0 (13.0-30.0), age ≥50 years 28.0 (18.0-36.0), female 23.5 (15.0-34.0), married 23.5 (17.0-31.0), parent 27.0 (16.0-36.0), living with the patient 20.0 (14.0-31.0), medical comorbidity 18.5 (14.0-31.0), secondary education 19.0 (13.0-29.0) and having another family member that requires care 27.0 (17.0-42.0).

CONCLUSION

Caregivers with the implicated characteristics require periodic evaluation of their burden of care to offer them available support including referral to appropriate socioeconomic agencies. A future research agenda is to investigate how these characteristics contribute to the burden of care in the study setting.

CONTRIBUTION

An array of sociodemographic characteristics is implicated in severe caregiver burden and their interactions in the study setting need further investigation.

The Unseen Burden: A Qualitative Investigation of Polish LGBTQ+ Caregivers' Experiences

Background/Objectives: As the world's population ages, the growing number of individuals affected by Alzheimer's disease and related dementias (ADRDs) will undoubtedly continue to impose social and economic challenges. Informal caregivers play a crucial role in providing essential support for individuals with ADRD. However, there is limited research that investigates the psychosocial functioning of caregivers (partners) from minoritized groups. Methods: This study aimed to explore the experiences of lesbian, gay, bisexual, transgender and queer (LGBTQ+) caregivers of individuals with ADRDs. Semi-structured in-depth interviews were conducted with seven caregivers of partners diagnosed with ADRDs. Three themes were identified based on reflexive thematic analysis: (i) experiencing familial alienation; (ii) fear about the future; and (iii) finding strength in the face of adversity. Results: The research highlighted difficulties reported by LGBTQ+ caregivers, while also showing how such caregivers cope. The findings provide a basis for developing targeted interventions for caregivers from minoritized groups. Conclusions: These findings have important implications for policy and intervention development concerning LGBTQ+ caregivers' mental and physical health outcomes.

Associations of Physical Activity and Sedentary Behavior With Mental Distress According to Caregiver Status: Analysis of the Health Information National Trends Survey, 2022

PURPOSE

To (1) examine how physical activity and sedentary behavior are related to mental distress and (2) identify and compare how various levels of sedentary behaviors may differentially predict mental distress after accounting for physical activity, among caregivers vs non-caregivers.

DESIGN

Cross-sectional secondary data.

SETTING

National Cancer Institute's Health Information National Trends Survey Cycle 6 fielded online from March-November 2022.

PARTICIPANTS

U.S. adults aged 18 and older.

MEASURES

The Patient Health Questionnaire-4 was administered along with caregiving status, moderate weekly physical activity, sedentary behavior, and sociodemographic characteristics.

ANALYSIS

After applying population weights, we conducted multiple adjusted logistic regression models and estimated predictive margins to understand whether a specific dose of sedentary behavior (hours/day) is associated with risk of mental distress, at different levels of physical activity.

RESULTS

Caregivers (15.41% of sample) reporting 10-hour of daily sedentary behavior were significantly more likely to experience mental distress, than those reporting lower amounts of sedentary behavior (OR = 3.372, 95%CI = 1.968, 5.776, P < 0.001). Regardless of physical activity amount, 10 hours of sedentary behavior may be a risk factor for mental distress among non-caregivers. Just 6 hours of sedentary behavior may be related to mental distress among caregivers.

CONCLUSION

Physical activity interventions tailored to caregivers' needs, responsibilities, and circumstances are required. Innovative methodologies are needed to understand caregivers' daily behaviors and the intensity of their caregiving activities.

Maintaining trust and seeking support: a qualitative study of family caregivers' experiences interacting with health care services for home-dwelling older people with mental health problems

BACKGROUND

Enhanced interactions between family caregivers and health care services can improve the care provided to older people and assist caregivers in managing their responsibilities more effectively. However, there are several barriers to involving families in care, and we need more knowledge to understand different aspects of interactions. This study with family caregivers of home-dwelling older people with mental health problems aimed to explore caregivers' experiences and perceptions of their role in interactions with health care services.

METHODS

We conducted individual in-depth interviews with ten family caregivers. Braun and Clark's thematic approach guided the analysis.

RESULTS

We identified two main themes. The first is the balancing act of managing trust: family caregivers navigating the caring role between empowering autonomy and taking responsibility. The second is the caregiver's role in a complex care context: family caregivers seeking knowledge, recognition, and support from professional caregivers.

CONCLUSIONS

Managing older people's trust is pivotal to family caregivers' interactions with health care services. These caregivers carefully balance two crucial aspects: empowering older people's autonomy and ensuring adequate health care by sharing information. To effectively involve families in the care of older people, this study highlights the need for health care services to consider the competence and time required to balance the dual responsibility of providing optimal care for older people while attending to the needs of family caregivers.

The Impact of Job Demands, Job Resources, and Organisational Justice on Global Health and Turnover Intentions in Animal Care Workers

Animal care workers in sheltering, rescue, and management are exposed to occupational stressors which negatively impact health. While the negative mental health impacts have been previously documented in this population, physical health, and its contributing factors, have not. This study investigated how job demands, job resources, and organisational justice relate to mental and physical health, and how they subsequently affect turnover intentions. Of the 285 participants, aged 19 to 94 years, who completed the online anonymous questionnaire, below average mental and physical health was reported. Mental health, but not physical health, was inversely related to intentions to leave. After controlling for age, hierarchical multiple regressions showed high emotional demands and direct euthanasia exposure significantly predicted poorer mental and physical health, while high levels of social support predicted better mental and physical health. No additional variance in either health domain was accounted for by organisational justice. It was concluded that both physical and mental health may be negatively impacted in those who work in shelter, rescue, and management environments which could lead to high turnover and poor outcomes for individuals and organisations. Monitoring through ongoing health records to enable early intervention and accommodations should be considered to promote the health of these workers.

Benefit Finding and Growth Among Family Caregivers of Individuals With Mental Illness: A Scoping Review

Benefit finding is a concept that represents finding positive changes or benefits through difficult experiences. To map the currently available studies on benefit finding and growth among family caregivers of individuals with mental illness, we conducted a scoping review based on methodological frameworks. A systematic search for studies published in English was conducted using MEDLINE, PsycINFO, PsycARTICLES, CINAHL, and PTSDpubs from inception to August 2023. After screening, 21 articles were included in the review. Of these, 11 studies were cross-sectional studies, 7 were qualitative studies, 2 were mixed-methods studies, and a randomized controlled trial (RCT). Family caregivers experienced various positive psychological changes, such as becoming compassionate/tolerant and resilient, stronger family bonds, change in perspective on life and hope, acquisition of knowledge and coping strategies, and leveraging their experiences and appreciation by others, following various struggles and negative changes. Some indicators of benefit finding and growth, such as positive personal traits, positive reappraisal, good relationships with patients, and social support, were also revealed. The quality assessment demonstrated an acceptable level of quality in most studies, with a few outliers. Future longitudinal studies would reveal the mechanism of benefit finding and growth among family caregivers of individuals with mental illness.

The role of informal caregivers in suicide prevention for men- findings from a psychological autopsy study

BACKGROUND

Men have a significantly higher risk of dying by suicide than women and at the same time are less likely to make use of psychosocial support services. Therefore, informal caregivers who care for a person at risk play a significant role. This study aims to highlight the distress and support needs of informal caregivers for men in suicidal crises.

METHODS

N = 15 participants who lost a man to suicide in the last 3-12 months were interviewed using psychological autopsy interviews. The interviews were analyzed using a comprehensive category system while following a deductive-inductive approach.

RESULTS

The majority of participants reported experiencing significant stress as well as anxiety about leaving the affected men unsupervised. Only four participants indicated that they openly discussed their stress with their social environment, and just two sought professional support. Notably, only two caregivers anticipated the possibility of suicide. There was also little professional support for caregivers, resulting in participants using internet resources to inform themselves about suicidal ideation and behavior.

CONCLUSION

These findings highlight the significant stress and burden experienced by informal caregivers in suicide prevention for men. Lack of open communication and insufficient access to support exacerbate the emotional burden on caregivers. These results highlight the need for accessible resources and assistance to better support both caregivers and the individuals they care for.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00030758, Registered on 11.11.2022.

Poor sleep quality and associated factors among HIV-positive and negative postpartum women in Addis Ababa, Ethiopia: a comparative cross-sectional study

Background

Poor sleep quality is common during the postpartum period due to nighttime feeding and frequent nocturnal awakenings of infants. In addition, the condition may worsen among postpartum women living with human immunodeficiency virus (HIV), affecting their capacity to care for their child. Therefore, this study will provide baseline information by assessing the burden of poor sleep quality and associated factors among HIV-positive and negative postpartum women in Addis Ababa, Ethiopia.

Objective

The aim of this study was to assess poor sleep quality and its associated factors among HIV-positive and negative postpartum women in Addis Ababa, Ethiopia in 2023.

Methods

A comparative cross-sectional study was conducted from 20 March to 20 May 2023, and a systematic random sampling technique was employed to obtain a total of 535 study subjects. An interviewer-administered questionnaire and chart review were used to collect the data. The Pittsburgh Sleep Quality Index was used to assess the outcome variable with a cutoff point ≥5. Binary logistic regression was employed to check the association of each independent variable with the outcome variable. Variables having a p-value of less than 0.05 in multivariable analysis were considered statistically significant and an adjusted odds ratio with a 95% confidence interval (CI) was computed.

Results

In this study, the overall prevalence of poor sleep quality among postpartum women was 56.3% [95% CI (51.9, 60.6)]. Poor sleep quality prevalence among HIV-positive and -negative women was 80% and 50.5%, respectively. Being HIV-positive [AOR = 2.38, 95% CI (1.31, 4.32)], being divorced [AOR = 4.5, 95% CI (1.55, 13)], and having a family history of mental illness [AOR = 1.89, 95% CI (1.16, 3.1)], depression [AOR = 1.93 (1.11, 3.3)], and anxiety [AOR = 2.76, 95% CI (1.8, 4.2)] among postpartum women and poor social support [AOR = 6, 95% CI (1.63, 22.4)] among HIV-positive women were significantly associated with poor sleep quality.

Conclusion and recommendation

This study revealed that the prevalence of poor sleep quality was higher among HIV-positive postpartum women compared to HIV-negative women. It would be better if professionals routinely assess postpartum women for sleep quality and focus on HIV-positive women.

Associations of mental disorders in children with parents' subsequent mental disorders: nationwide cohort study from Finland and Denmark

BACKGROUND

Intergenerational transmission of mental disorders has been well established, but it is unclear whether exposure to a child's mental disorder increases parents' subsequent risk of mental disorders.

AIMS

We examined the association of mental disorders in children with their parents' subsequent mental disorders.

METHOD

In this population-based cohort study, we included all individuals with children born in Finland or Denmark in 1990-2010. Information about mental disorders was acquired from national registers. The follow-up period began when the parent's eldest child was 5 years old (for ICD-10 codes F10-F60) or 1 year old (for codes F70-F98) and ended on 31 December 2019 or when the parent received a mental disorder diagnosis, died, or emigrated from Finland or Denmark. The associations of mental disorders in children with their parents' subsequent mental disorders were examined using Cox proportional hazards models.

RESULTS

The study cohort included 1 651 723 parents. In total, 248 328 women and 250 763 men had at least one child who had been diagnosed with a mental disorder. The risk of a parent receiving a mental disorder diagnosis was higher among those who had a child with a mental disorder compared with those who did not. For both parents, the hazard ratios were greatest in the first 6 months after the child's diagnosis (hazard ratio 2.04-2.54), followed by a subtle decline in the risk (after 2 years, the hazard ratio was 1.33-1.77).

CONCLUSION

Mental disorders in children are associated with a greater risk of subsequent mental disorders among their parents. Additional support is needed for parents whose children have been recently diagnosed with a mental disorder.

Operational Mechanisms of Peer Support Groups and Support for Caregivers of People Living with Serious Mental Illness

The challenges faced by caregivers of people living with serious mental illness in Canada are well documented in the literature including emotional distress, financial strain, social isolation, and concerns about their physical health following the impact of caregiving. Peer support programs (including peer support groups) emerged as a promising method to attempt to address these challenges. While there is evidence on the positive impacts of peer support groups in providing support for caregivers, the mechanisms by which peer support groups operate and influence support for caregivers of people living with serious mental illness are less understood. This qualitative study took on a co-designed participatory research approach. Fifteen adult caregivers of people living with serious mental illness across Canada were engaged through key informant interviews that lasted for 45 - 60 min each. A thematic analysis was carried out to help understand the operational mechanisms of peer support groups in influencing support for caregivers. The key informant interviews allowed for the identification and description of the following operational mechanisms that influenced the support caregivers received from peer support groups: (1) Group dynamics; (2) Messaging/content; (3) Equity and inclusion, (4) Group philosophy; and (5) Privacy concerns. Findings from this study showed that caregivers identified a number of operational mechanisms of peer support groups that explained how they felt supported when they participated in peer support groups. Among other operational mechanisms, group dynamics in terms of the gathering of caregivers of different age brackets and varying caregiving experience negatively influenced the peer support experience of caregivers. This pointed to the need for group dynamics that consider close age ranges and similar caregiving experience during group meetings to enhance support for caregivers. Caregivers also identified a gap in equity and inclusion in peer support groups that could have otherwise enriched their experience and enhanced the support they looked to receive from the group. Practical examples to enhance equity and inclusion include promoting active listening, using inclusive language, encouraging diverse representation and asking for feedback from peer support group members. While peer support groups in Canada exist independently of one another, it may help to consolidate evidence-based recommendations in the operational mechanisms of these groups, for the benefit of caregivers who turn to these groups for support, having been left on their own by an otherwise fractured mental health system.

Review of community-based interventions for people with serious mental illness, focusing on learning instrumental activities of daily living and enhancing wellbeing

This review synthesises evidence on community-based interventions designed to support individuals with serious mental illness (SMI) in learning instrumental activities of daily living (IADLs). Given the increasing prevalence of SMI affecting over 500 million people worldwide, and associated functional impairments, effective interventions are critically needed. This review of thirty studies represented a range of global contexts and intervention types, which were categorised into simple IADLs (e.g. household chores), complex IADLs (e.g. financial management), and recreational IADLs (e.g. leisure activities). Findings demonstrated that community-based interventions significantly improved IADLs, promoting functional independence and overall well-being. Thematic analysis identified five key mechanisms for success: individualised goal-setting, structured programs with practical learning, engagement of support systems, integration into daily life, and use of innovative technologies. The review highlighted that personalised and practical IADL interventions, supported by robust community and technological resources, were most effective. When effective, interventions enhance practical skills of individuals while also contributing to emotional well-being, social connections, and personal fulfilment. Despite promising results, the review notes variability in study designs and outcomes, suggesting a need for consistent and long-term evaluations. Nonetheless, review insights offer valuable guidance for designing future interventions to better support autonomy and community integration of individuals with SMI.

Long-Term Caregiving Impact and Self-Care Strategies in Family Caregivers of People with Neuropsychiatric Disorders: A Mixed-Method Study

Family caregivers of people with neuropsychiatric conditions are at risk of caregiver burden and declining health. The aims of this study were to identify the impact of caring on long-term family caregivers and their unmet needs and to explore their self-care strategies for achieving a successful caregiving experience. A mixed-method study was conducted using semi-structured interviews and a questionnaire in which standardized, self-reported measures of burden, health behaviors, sleep, and mental well-being were administered. Participants were family caregivers of people with neuropsychiatric disorders. Convenience sampling of 28 caregivers: 13 of people with mental health disorders (schizophrenia and bipolar disorder) and 15 with Alzheimer's disease. Based on the analysis of the semi-structured interviews, data saturation was reached. Analysis of self-reported measures indicated that 32.1% of long-term caregivers had high caregiver burden, 64.3% had reduced quality of life, 39.3% had low sleep quality, 21.4% had low adherence to the Mediterranean diet, 50.0% had a physical activity below the recommendation, 42.9% had high anxiety symptoms, 35.7% had high depressive symptoms, and 71.4% had reduced self-care agency. Content analysis and statistical analysis were conducted. Two themes were identified: (1) the impact of long-term caregiving and unmet needs and (2) successful self-care strategies. Caregivers of people with Alzheimer's disease spent less time doing physical activity, had higher caregiver burden, and poorer health-related quality of life. The negative impact of caregiving could be prevented/managed by assessing the individual's circumstances for the development of cross-sectional self-care strategies involving physical, emotional, and social spheres.

Healthcare needs and expectations of family members caring for mental healthcare users in South Africa

BACKGROUND

 In South Africa, many mental healthcare users reside in rural areas and 91% of them live with their family members. Exploring and describing the needs of family members caring for mental healthcare users is important to determine their expectations of the healthcare system.

OBJECTIVES

 The study aimed to explore and describe the healthcare needs and expectations of family members caring for mental healthcare users in Vhembe district, Limpopo province, South AfricaMethod: A qualitative, descriptive and contextual design was used to collect data from 16 purposively selected family members caring for mental healthcare users. Data were collected through semi-structured face-to-face interviews, and analysed using thematic data analysis to develop themes and categories.

RESULTS

 The results of the interviews yielded two themes, healthcare needs and expectations of family members. The needs included physical healthcare, psychological healthcare, and social, financial, educational and spiritual needs. The healthcare expectations were divided into two sub-themes: (1) expectations from the healthcare systems, and (2) expectations from healthcare professionals.

CONCLUSION

 The study showed that support from community members and healthcare providers could reduce the burden of care perceived by family members. Results confirmed the need for developing a family psychoeducational programme adapted to the South African context to meet the family members' needs. Quantitative research on healthcare needs with a larger sample of family members is recommended.Contribution: The study may contribute to mental health nursing practice and education. Nursing support based on the needs of family members may enhance their well-being and caregiving abilities. The importance of tailor-made psychoeducational family support should be emphasised in nursing education.

Family Caregivers of Persons with Bipolar Disorder: Caregiver Demographics and Need and Preference for Intervention

The unpredictability of bipolar disorder is highly distressing for family caregivers, who differ in their needs and preferences for stress-reducing or educational interventions. Applying Ryan and Sawin's model, this study examined associations between caregiver demographics (age, gender, and race) as contextual factors and caregiver needs and preferences for three interventions as process factors within a preliminary descriptive analysis of 306 family caregivers from a randomized clinical trial. Caregiver needs for education about bipolar disorder, biofeedback, and Resourcefulness Training© were determined by established cut scores on validated measures of bipolar knowledge, heart rate variability, and resourcefulness. Frequencies for need and preference for intervention were compared by caregiver age, gender, and race. Discrepancies between caregiver need and preference for interventions were analyzed. Non-White caregivers showed greater need for education (X2=33.68, p < 0.001). Middle-aged caregivers showed greatest need for biofeedback (X2=19.58, p < 0.001). Need for Resourcefulness Training© was similar across age, gender, and race. We found 58% needed biofeedback, 34% education, and 18% Resourcefulness Training©; 46% of those in the preference group chose Resourcefulness Training©. Further caregiver intervention research should consider the effect of caregiver needs and preferences on their health. The findings support the essentiality of assessing caregiver demographics, needs, and preferences before implementing interventions.

The impact of religious spiritual care training on the spiritual health and care burden of elderly family caregivers during the COVID-19 pandemic: a field trial study

BACKGROUND

Family caregiving is associated with many physical and psychological problems for caregivers, but the effect of spiritual support on reducing their issues during a crisis is also the subject of research. The study aims to examine the impact of religious spiritual care training on the spiritual health and care burdens of elderly family caregivers during the COVID-19 pandemic.

METHODS

The randomized controlled field trial involved 80 Iranian family caregivers in Bushehr City, who were selected by convenience sampling based on the inclusion criteria and divided into experimental (40 people) and control (40 people) groups by simple random sampling in 2021 and 2022. Data collection was conducted using spiritual health and care burden questionnaires using the Porsline software. The virtual intervention included spiritual and religious education. Four virtual sessions were held offline over two weeks. The first session was to get to know the participants and explain the purpose, The second session focused on the burden of care, the third on empowerment, and the fourth on mental health and related issues. In the control group, daily life continued as usual during the study.

RESULTS

Mean changes in existential health (3.40 ± 6.25) and total spiritual health (5.05 ± 11.12) increased in the intervention group and decreased in the control group. There were statistically significant differences between the two groups for existential health (t = 3.78, p = 0.001) and spiritual health (t = 3.13, p = 0.002). Cohen's d-effect sizes for spiritual health and caregiving burden were 0.415 and 0.366, respectively. There was no statistically significant difference in mean changes in religious health (p = 0.067) or caregiving burden (p = 0.638) between the two intervention and control groups.

CONCLUSION

Given that the religious-spiritual intervention had a positive effect on existential health and no impact on religious health or care burden, it is recommended that comprehensive planning be undertaken to improve the spiritual health of family caregivers to enable them to better cope with critical situations such as a COVID-19 pandemic.

TRIAL REGISTRATION

IRCT code number IRCT20150529022466N16 and trial ID number 48,021. (Registration Date2020/06/28).

A qualitative enquiry on the impact of mental illness stigma on caregiving role and experiences in Singapore

Introduction

Given that mental illness stigma is a common occurrence amongst people with mental illness and caregivers (CGs) can be a potential victim of stigma themselves, there is a need to examine caregivers' perspective on the phenomenon. This study is part of a larger study which aims to qualitatively examine the concept of mental illness stigma amongst different stakeholders in Singapore.

Methods

Focus group discussions (FGDs) were conducted amongst 21 informal caregivers to explore the experience of stigma encountered by them and their care recipients, and how it may implicate their caregiving experience. Both inductive and deductive thematic analyses were employed to analyze the data.

Results

Three overarching themes of stigma encounters that may have implication on caregiving experience were identified: 1) Stigma within the family; 2) Structural stigma; and 3) Stigma by association. Experience of stigma within family (e.g., social exclusion and lack of understanding) limits the caregiving supports available to CGs. CGs also took up a mediating role between their care recipients and other family who may hold stigmatizing views. Witnessing their care recipients being subjected to structural disadvantages (e.g., employment, school, and mandatory conscription) can induce emotional stresses amongst CGs and motivate them to protest and seek redress on their behalf. Furthermore, encounters of stigma themselves (e.g., being judged or blamed for their loved one's condition) also led to feelings of guilt and self-blame amongst the CGs.

Discussion

These findings can aid the formulation of interventions in informing CGs on what to expect on their caregiving journey and supporting them in dealing with issues relating to stigma and highlight the importance of anti-stigma efforts in organizational settings such as schools, corporations, and government agencies.

The Lived Experience of Informal Caregivers of People Who Have Severe Mental Illness and Coexisting Long-Term Conditions: A Qualitative Study

BACKGROUND

People with severe mental illness (SMI) experience higher rates and poorer outcomes of physical long-term conditions (LTCs). The management of SMI and LTCs is highly complex and many people with SMI rely on informal carers for support, which may lead to high levels of caregiver burden, and caregiver burnout. Caregiver burnout can result in poor health outcomes for informal carers and a reduction in the quality of care they are able to provide. Therefore, it is important to understand the caring experience to identify and address factors that contribute to burden and burnout.

METHODS

This paper reports a secondary qualitative analysis of semistructured interviews and focus groups conducted with informal carers of people who have coexisting SMI and LTCs. We recruited 12 informal carers in England between December 2018 and April 2019. The transcripts were coded and analysed thematically.

RESULTS

We identified two overarching themes and five subthemes. The themes included 'Fighting on all fronts: Mounting strain between demands and resources', which described the challenge of providing care in the context of coexisting SMI and LTCs, and 'Safekeeping: The necessity of chronic hypervigilance', which captured how informal carers' roles were defined by managing high-risk situations, leading to hypervigilance and paternalistic approaches to care.

CONCLUSION

The experience of informal carers for people with SMI and coexisting LTCs is marked by limited access to support and the management of significant risk, which could contribute to high caregiver burden. Further primary research is needed to understand how the experiences of the caregiver role for people with SMI and LTCs influence caregiver burden.

PATIENT OR PUBLIC CONTRIBUTION

Our PPI panel DIAMONDS Voice provided guidance on this study from conception, design and development of interview guides and recruitment materials to final write-up. DIAMONDS Voice consists of service users and carers who have experience of SMI and LTCs. Three carer members reviewed the final manuscript, and two are credited as authors.

Caregivers' experience of caring for family members with complex health needs in Latvia

The article examines the experiences of family caregivers engaged in the provision of long-term care for their relatives with complex health needs within the Latvian context. Semi-structured interviews were conducted with seven caregivers who provide care in cases of dementia, depression, schizophrenia, opioid use, Down syndrome and mild cognitive impairment. A thematic analysis of interview transcripts revealed common themes, such as the initial experiences when encountering a family member's disorder and the subsequent reactions, as well as the quest for support and resources. Variations mainly centered around differences in formal aspects and childhood experiences of care. Caregivers reported risk factors such as guilt, lack of support from family and friends, financial difficulties, deficiency of professional care and ignoring the caregiver's own needs. Awareness of personal resources, values and limits, coping with personal stigma and improved overall quality of life were identified as protective factors. The findings underscore several preventive measures that social and mental health services could implement to mitigate the adverse effects of caregiving on caregivers' lives.

Caregiving experiences of family caregivers of patients with schizophrenia in a community: a qualitative study in Beijing

OBJECTIVES

This study aims to understand the caregiving experiences of family caregivers of people with schizophrenia in a community.

DESIGN

A qualitative study based on phenomenological analysis was conducted through in-depth interviews.

SETTING

This study was carried out from May to June 2023 in two community health service centres in urban Beijing, China.

PARTICIPANTS

We selected 16 family caregivers for interviews using purposive sampling method.

RESULTS

Four themes and 10 subthemes were identified: (1) psychosocial distress of family caregivers (feeling unprepared and helpless at the beginning, confronting negative emotions in long-term care and straying away from social life); (2) adverse impacts on the whole family (poor cooperation within the family, insufficient family involvement in professional care); (3) coping with family caregiving (accepting the reality of the patients' illness, struggling with family life balance and having realistic expectations); (4) concerns about future care (daily living support, physical health management).

CONCLUSION

Family caregivers experienced psychosocial distress and family stress in the process of caregiving. They had to cope with caregiving stress and were concerned about the long-term care of people with schizophrenia. These findings provide implications for intervention programmes to strengthen social support, family involvement, and active coping for caregivers and develop long-term care mechanisms for people with schizophrenia.

Health effects of caregiving and coping with severe mental disorders: A caregivers' experience

Background

Informal caregivers are an essential health resource in the care of persons with severe mental disorders, particularly in South Africa where access to mental healthcare services is limited.

Aim

The study aimed to explore and describe the coping strategies used by informal caregivers and the specific health impacts they face in the context of severe mental disorders in South Africa.

Setting

The study was conducted in Bushbuckridge municipality situated in the northeastern parts of Mpumalanga province, South Africa.

Methods

A descriptive qualitative methodology was used to conduct semi-structured interviews with 12 purposefully selected participants. Audio-recorded interviews were translated, transcribed and analysed inductively on NVivo12 using reflexive thematic analysis.

Results

The themes identified were caregivers' experience of consequences of caregiving and caregivers' experience of coping with their caregiving role. Participants experienced negative consequences on their emotional, mental and physical health. The participants use internal and external resources to cope with the challenges they face, and many highlighted using emotion-focused coping strategies.

Conclusion

The findings revealed an urgent need to develop support strategies to strengthen informal caregivers' coping and promote good health particularly in rural South Africa where informal caregivers play a crucial role in the management of severe mental disorders.

Contribution

The finding demands that policymakers and healthcare providers prioritise the health and well-being of the informal caregivers. There should be policies targeted specifically at developing and implementing caregiver-orientated healthcare services.

Associations between employment and mental health of older workers with disparate conditions: Evidence from China

PURPOSE

This study aimed to examine associations between the employment of older people and mental health across demographic characteristics, socioeconomic conditions, and health status, with a focus on pensions.

METHODS

This study included 4,512 participants aged 60-69 from the CLASS in 2014. A multiple linear regression was conducted to investigate the association between employment and mental health. A causal forest model was applied to estimate the heterogeneous treatment effects.

RESULTS

Employed individuals (n = 1,295) reported better mental health than their non-employed counterparts. This association displayed significant heterogeneity, primarily attributed to pensions. Those with lower pensions may be compelled to work due to financial reasons, thus offsetting the health-promotion effect of employment.

CONCLUSION

Employment may benefit the mental health of older adults, which has a more significant marginal effect on those who are men, older, urban residents, without a spouse, below primary education, receiving more pensions, and less family and friend support.

The impact of informal care provision on the quality of life of adults caring for persons with mental health problems: A cross-sectional assessment of caregiver quality of life

This study assessed the quality of life of informal caregivers for individuals with mental health problems in the Netherlands. An online survey was administered to a panel of informal caregivers in June 2020 (n = 261). Informal caregivers of persons with mental problems were found to have an exceptionally low quality of life. A high subjective burden (p < .001), lower perseverance time (p = .016), low caregiver overall health status (p = .004) and psychological wellbeing (p = .008), younger caregiver age (p = .011), child caregiving responsibilities (p = .025), and no social support network (p = .038) were associated with worse quality of life scores. These findings shed light on the significant challenges faced by informal caregivers of persons with mental health problem. This raises concerns about the long-term sustainability of informal care and mental healthcare reform.

A randomized controlled trial of a targeted support program for informal caregivers in adult psychiatry

Background

The importance of informal caregivers for persons with severe mental illness has been demonstrated. However, this role may cause a high care burden that considerably affects caregiver health. The Ensemble program is a five-session brief individual intervention designed to support informal caregivers. This trial aimed to assess the efficacy of the program versus SAU (support as usual) for participants with a high care burden.

Methods

A single-center randomized controlled trial including 149 participants was conducted. Caregivers in the intervention arm participated in the Ensemble program. The effects of the intervention were assessed using mixed models for repeated measures analysis of variance on improvements in informal caregivers' psychological health status, optimism levels, burden scores, and quality of life at three time points (T0 = pretest; T1 = posttest at 2 months, and T2 = follow-up at 4 months).

Results

Analysis of the Global Psychological Index showed no significant effect at the two endpoints in favor of the Ensemble group. However, the Brief Symptom Inventory-Positive Symptom Distress Index was significantly lower at the two-month follow-up. A significant reduction in burden on the Zarit Burden Interview was observed post-intervention, along with an increase in optimism levels on the Life Orientation Test-Revised at follow-up in the Ensemble group. No significant differences were observed in quality of life. Clinical improvements in both psychological health status and burden levels were also identified.

Conclusion

The Ensemble program offers an inclusive approach based on a recovery perspective that significantly reduces symptom distress and burden and increases optimism among informal caregivers.Clinical trial registration: https://clinicaltrials.gov/, NCT04020497.

[The impact of caregiving on the emotional well-being and health of family caregivers.]

INTRODUCTION

Family caregivers, who take care of older relatives, bear a heavy burden that can detrimentally affect their physical health and emotional well-being.

OBJECTIVE

This study aims to explore the subjective perceptions of family caregiving's impact on physical health and emotional well-being, the experience of feeling overburdened by caregiving responsibilities, and the subjective perceptions of health among caregivers of older relatives. Data from three waves of online questionnaire surveys conducted in 2018, 2020, and 2022 were analyzed.

METHOD

The COPE Index items were used to measure subjective perceptions of the impact of caregiving on physical health and emotional well-being and perceptions of being overburdened by caregiving. We present descriptive statistics and chi-square test analyses.

RESULTS

In all three waves, the majority of respondents frequently or always perceived a negative impact of caregiving on their emotional well-being and physical health, with more than half always or often experiencing caregiver overburdening. A significant correlation was observed between the perceived impact of caregiving on physical health and emotional well-being, over 70% of respondents provided similar responses to both questions. Furthermore, a significant relationship is between the prevalence of caregiver overburden and subjective perceptions of health, with those experiencing caregiver overload being more likely to report poor or very poor health. Over 60% of participants indicated frequent or constant overburden of care, with this subgroup exhibiting a higher likelihood of perceiving their health as poor or very poor.

DISCUSSION

Our results demonstrate that the caregiving burden affects both physical and emotional well-being. A significant proportion of family caregivers experience detrimental effects on their physical health and emotional well-being due to caregiving responsibilities. These negative effects were reported simultaneously by the majority of respondents.

CONCLUSION

Caregiving can have negative consequences on the health of family caregivers. Our research underscores the importance of preventive measures. Orv Hetil. 2023; 164(40): 1583-1591.

Consumers' longitudinal health information needs and seeking: a scoping review

Needing and seeking health information often is a longitudinal everyday life information behavior that involves the use of technology. However, no reviews of consumers' longitudinal health information needs (HIN) and health information-seeking (HIS) behavior have been conducted. We performed a scoping review to address this gap. Specifically, we surveyed the characteristics, timeline construction and research findings of studies investigating consumers' longitudinal HIN and HIS. Initial searches were conducted in November 2019 and updated in July 2022. A total of 128 papers were identified, reviewed and analyzed using content and thematic analyses. Results showed that most papers were quantitative, conducted in the USA, related to cancer, conducted during the diagnosis and treatment phases, and followed preset time intervals. Findings concerning the development patterns of consumers' HIN degrees and HIS effort were mixed (i.e. increasing, decreasing or being consistent over time). They seemed to be shaped by factors such as health conditions, data collection methods and the length of data collection. Consumers' use of sources changes depending on health status and source accessibility; their medical terminologies seem to expand over time. HIS has a strong emotional dimension which may lead to adaptive or maladaptive information behaviors (e.g. information avoidance). Overall, the results revealed a lack of understanding of HIN and HIS from a longitudinal perspective, particularly along health condition progression and coping trajectories. There is also a lack of understanding of the role of technologies in the longitudinal HIS process.

Interaction between the Participation in and the Impact on Mental Health Service Users and Their Relatives of a Multicomponent Empowerment-Based Psychosocial Intervention

Relatives play an important role in the recovery journey of mental health service users. Interventions directed either at service users or their relatives may influence the other person as well. The project 'Activa't per la salut mental' (Get active for mental health) consisted of a series of four interventions addressed at people diagnosed with mental disorders and their relatives to help them in their recovery process, increasing their agency and quality of life. The main objective of the present study is to evaluate the interaction of the participation of service users on their relatives' outcomes and vice versa. The impact of the project was evaluated within a randomised controlled trial. The treatment group had access to all the circuit interventions, while the control group received treatment as usual and could only access one of the interventions. All participants were evaluated at baseline, six months, and twelve months after the end of the first intervention. Service users were evaluated with the Stages of Recovery Instrument, and relatives with the Family Burden Interview Schedule II and the Duke-UNC-11 questionnaires. The interaction of participation and impact between service users and their relatives was analysed by means of correlational analyses within the intervention group (n = 111, service users mean age = 40.6, 40% women; relatives mean age = 56.7, 72% women). Service users' baseline characteristics (being in a relationship, educational level, employment, and younger age) influenced in the level of participation of relatives and vice versa (lower educational level). The results also indicated correlations between participation and outcomes at various points as well as the evolution of service users' recovery and the care burden of relatives. Service users' participation levels interacted with the decrease of relatives' frequency of burden and the first steps of their own recovery journey (moratorium, awareness, and preparation) while relative's participation just interacted with the evolution of two stages of service users' recovery levels (preparation and growth). These results can be extremely helpful in fostering interactive benefits in future projects addressing the wellbeing of mental health service users and their relatives. Future studies could use specific designs to explore the directionality of the causality of these effects.

Family Perspectives Related to Caring for Mental Health Care Users: A Case Study in the Long-Term Mental Health Institutions of Limpopo Province, South Africa

Family involvement in long-term mental health care is a significant therapeutic aspect in managing mentally ill patients. This study aimed to determine the perspectives of family members about caring for mental health care users at selected long-term mental health institutions in Limpopo Province. A qualitative explorative and contextual descriptive design was used. Purposive sampling was used to select family members with mental health care users admitted in long-term health institutions in Limpopo Province. Data were collected with in-depth individual interviews aided by an audio recorder and field notes. Data were qualitatively analysed. Trustworthiness and ethical considerations were ensured. Two themes yielded from the interviews: Perspectives of family members about their involvement in the care of mental health care users and difficulties in caring for mental health care users at home when granted leave of absence or discharged. Sub-themes: Caring for mental health care users leads to an understanding of mental illness; Lack of skill and inability to monitor mental health care users at home; Mental health care users abuse substances during leave of absence which makes family reluctant to request them for visit; Caring for mental health care users at home viewed as a difficult task and stigma from the community. The challenges experienced by family members contribute to poor interaction with mentally ill patients. We recommend that family members of mental health care users be educated about mental illnesses and encouraged to participate in the care of the patients.