Needs of the families of people with schizophrenia

Burdens experienced and perceived needs of relatives of persons with SMI - a systematic meta-synthesis

Background: Close relatives of people with severe mental illness (SMI) experience problems known as family burdens. In addition, they may have their own needs for support, something often overlooked by the healthcare system. Meta-syntheses in this area may help explore the meaning of the experience of living with someone who has a SMI.Aim: Our aim was to describe the burdens experienced and needs perceived on a daily basis by relatives to someone who has a SMI.Methods: The databases PubMed, CINAHL, and PsychInfo were searched using a systematic search strategy. Studies were screened for relevance and quality was appraised. A meta-synthesis of nine qualitative studies was then conducted.Results: The nine studies discerned the following themes. Burden themes; Forced to carry a sometimes unbearable burden; Burdened by own ill-health and disrupted relationships; Distressed and stigmatized by society. Needs themes; strengthening protective factors; Skills and practical support greatly appreciated.Conclusions: The burdens and needs of relatives of persons with SMI strongly influence their lives. They require relief from both practical and emotional burdens. Family interventions and other programs to support relatives should be encouraged with this knowledge in mind.

Parents' experience of living with and caring for an adult son or daughter with schizophrenia at home in Ireland: a qualitative study

This study explored the experience of parents living with, and caring for, an adult son or daughter with schizophrenia. There is increasing emphasis on the involvement of carers and users in the care for people with schizophrenia. 'A Vision for Change' highlights the need for a partnership approach and emphasizes that carers are an integral part in the planning and delivery of mental health services. In order to meet such requests, it was necessary to explore the meaning of caregiving for Irish families. A descriptive qualitative design was used to enable parents to describe their experiences. Semi-structured, in-depth interviews with a convenience sample of six parents in Ireland were carried out in 2007. The study encompassed four major themes: psychological tsunami, caring activities, coping with enduring illness and an uncertain pathway. Parents reported severe psychological distress when their son or daughter was diagnosed with schizophrenia. Their deep sense of loss was followed by acceptance of the situation. Feelings of love and a sense of responsibility helped to give meaning to their caring role. This study gave a voice to some parents of a son or daughter with schizophrenia. A family-centred approach should be at the core of care planning for this vulnerable population.

The predictive validity of expressed emotions (EE) in schizophrenia. A 20-year prospective study

BACKGROUND

The level of expressed emotions in the family (EE) and components thereof (emotional over-involvement EOI, and critical comments CC) have been found to be related to treatment outcomes in psychotic patients. One point of interest is the dynamic of various outcomes in relation to initial EE, CC and EOI levels.

METHOD

43 individuals with diagnosis of schizophrenia were assessed at 1, 3, 7, 12 and 20-year follow-ups. The EE indicator was evaluated during the index hospitalization. Outcome indicators included: number of relapses, number and duration of in-patient rehospitalizations, and severity of psychopathological symptoms.

RESULTS

1) A high EE indicator was associated with a higher number of relapses in every follow-up and differences between the groups with low and high EE indicators proved significant after 3, 7, 12 and 20 years of the illness. 2) A high EE indicator was associated with a higher number of rehospitalizations after 3 and 7 years, and showed as a clear trend after 12 and 20 years. 3) A high level of CC was associated with a higher number of relapses. 4) The severity of positive symptoms increased only in the group with high CC. 5) The negative syndrome was not associated with EE, EOI or CC.

CONCLUSIONS

The EE indicator may be considered a valid prolonged predictor of relapses and rehospitalizations. A high level of CC was associated with a higher number of relapses and intensification of the positive syndrome in both the short-term and long-term course of the illness.