Continuity of care for carers of people with severe mental illness: results of a longitudinal study

The impact of community care: Burden and quality of life of the informal caregivers of patients with severe mental disorder

This study analyzes the dimensions and consequences of the burden of caregivers of patients with SMD (Severe Mental Disorder) and the repercussions that this role has on their quality of life and health in the physical, psychic and social spheres. This is a descriptive cross-sectional study and inferential observational study which explores caregivers of patients with SMD admitted to Psychiatry Day Hospital (Huesca, Spain). The technique of consecutive cases was used as a technique for sampling and sample selection. An individualized interview was arranged, where sociodemographic data were collected and scales and instruments were administered. 52 caregivers met the inclusion criteria. The female sex predominates (67%), being the patient's mother (48%). The average age of caregivers is 60 years old. Almost 60% of the sample presents intense burden and alterations of general mental health, 77% reveal anxiety and depression, and 46% little social support. Burden is associated with hospitalization within the last year, anxiety, or total social support received. It is appreciated how the diagnosis of a chronic disease constitutes an important challenge for the patient and their family, due to the burden of the disease and the impact of the new routines imposed by the continuous treatment.

Social support network and continuity of care: an ego-network study of psychiatric service users

PURPOSE

For severely mentally ill (SMI) users, continuity of care requires consistency between the supports provided by the members of their social support network. However, we know little about their network cohesion and its association with continuity of care. We set out to investigate this association and hypothesised that it would depend on the severity of the user's situation and on his/her living arrangements.

METHODS

We conducted face-to-face interviews with 380 SMI users recruited in outpatient and inpatient mental health services in three areas in Belgium. Data regarding users' social networks were collected using an ego-network mapping technique and analysed with social network analysis. The cohesion indicators were density (frequency of connections between network members), centralisation (having a small number of central people), and egobetweenness (the user's centrality in his/her own network). Participants' perception of continuity of care was measured by the Alberta Continuity of Services Scale.

RESULTS

Results show that cohesion indicators were associated with continuity of care only for users with high-severity problems, regardless of their living arrangements. The numbers of network members, professionals, and services in the network were all negatively associated with continuity of care for all the users.

CONCLUSIONS

Satisfactory continuity of care requires fewer professionals or services in a user's network and a dense network for users with the most severe problems. This implies that those providing care must not only be able to increase cohesion within a network, but also to adapt their interventions to support the transition to a different, individualised network structure when severity decreases.

Information sharing with rural family caregivers during care transitions of hip fracture patients

Introduction

Following hip fracture surgery, patients often experience multiple transitions through different care settings, with resultant challenges to the quality and continuity of patient care. Family caregivers can play a key role in these transitions, but are often poorly engaged in the process. We aimed to: (1) examine the characteristics of the family caregivers’ experience of communication and information sharing and (2) identify facilitators and barriers of effective information sharing among patients, family caregivers and health care providers.

Methods

Using an ethnographic approach, we followed 11 post-surgical hip fracture patients through subsequent care transitions in rural Ontario; in-depth interviews were conducted with patients, family caregivers (n = 8) and health care providers (n = 24).

Results

Priority areas for improved information sharing relate to trust and respect, involvement, and information needs and expectations; facilitators and barriers included prior health care experience, trusting relationships and the rural setting.

Conclusion

As with knowledge translation, effective strategies to improve information sharing and care continuity for older patients with chronic illness may be those that involve active facilitation of an on-going partnership that respects the knowledge of all those involved.

Factors associated with the emotional distress of women family members of adults with serious mental illness

Women family members of adults with serious mental illness are at great risk for emotional distress. This study examined associations between characteristics of 60 women (age, race, and education), their relatives with mental illness (age, diagnosis, and years since diagnosis), and the family situation (relationship, living arrangements, and care provided) and symptoms of emotional distress. Depressive symptoms were greater among those with younger, non-sibling relatives. Anxiety was greater among Caucasians and those with a recently diagnosed family member, particularly bipolar disorder. Anger was associated with providing direct care. The findings are informative for tailoring interventions to minimize emotional distress in future family caregivers.