Quality of life and its social determinants for patients with schizophrenia and family caregivers in Cambodia

Quality of Life in Caregivers of Patients with Schizophrenia: A Systematic Review of the Impact of Sociodemographic, Clinical, and Psychological Factors

Caregiving for a patient with schizophrenia (PwS) imposes a high burden on caregivers and often affects their quality of life. This systematic review aims to synthesize the current evidence on the sociodemographic and psychological factors of caregivers, as well as patient-related sociodemographic and clinical factors, that may influence caregivers' QoL. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed in three major databases-PubMed/Medline, SCOPUS, and Web of Science-to identify original studies examining informal caregivers of PwS and assessing the relationship between caregivers' QoL and various sociodemographic, psychological, or clinical factors. Methodological quality appraisal was performed using the Joanna Briggs Institute checklist. In total, 31 studies were included in the review and discussed at length. Lower QoL was associated with unemployment, older age, female gender, financial difficulties, being unmarried, and lower education. Additionally, increased schizophrenia symptom severity, higher caregiver burden, and elevated levels of depression and anxiety may negatively influence caregivers' QoL. Given these findings, future research should focus on developing tailored interventions to improve caregivers' QoL. Addressing these modifiable risk factors through targeted support programs and policies could significantly enhance caregivers' QoL.

Causal beliefs regarding schizophrenia and help-seeking behaviors among patients with schizophrenia and family caregivers attending psychiatric clinics in Cambodia

Schizophrenia often follows a chronic or recurrent course, placing an immense burden on patients and their families. Mental health services in Cambodia are still highly limited, thus there is a major treatment gap. It is common that people consult traditional healers (Kru Khmer) and monks. In this culture, people who receive psychiatric medical treatment are expected to exhibit higher mental health literacy, but little is known about this factor. In this study, we interviewed 59 patients with schizophrenia and 59 family caregivers attending psychiatric clinics in Cambodia. Through qualitative analysis using a thematic analysis approach, we extracted eight themes of causal beliefs regarding schizophrenia: (1) spiritual beliefs, (2) cultural symptoms, (3) physical problems, (4) heredity, (5) substance abuse, (6) traumatic events, (7) stress in human relationships or in one's social environment, and (8) socioeconomic position. We found that "thinking too much" (kit chroeun) and "worrying too much" (prouy / barom chroeun), cultural idioms of distress, were recognized as causal factors of schizophrenia by both parents and family caregivers. Some participants were aware of the possible causal factors in light of the latest psychiatry findings, such as genetic factors and childhood trauma. Our data show that causal beliefs are not a decisive factor in shortening the duration of untreated psychosis (DUP). In Cambodia, where the treatment for schizophrenia is pluralistic, we suggest that it is crucial to embed the meaning of psychiatric treatment into local meaning worlds for better help-seeking behaviors.

Canonical correlation analysis of family burden of disease and quality of life in caregivers of people living with schizophrenia: evidence from Schizophrenia-specific cohort in the less-developed multi-ethnic region of Southwest China

BACKGROUND

Health-related quality of life is a multi-dimensional concept that involves individual's perceived physical and mental health, social relationships, and environment. Family members are the primary caregivers of people living with schizophrenia in China, the quality of life of caregiver of people living with schizophrenia is generally poorer, which may indirectly affect the quality of life of the people with schizophrenia.

METHODS

We conducted a comprehensive survey on quality of life in caregivers of people living with schizophrenia based on the Schizophrenia-specific cohort in the Less-developed Multi-ethnic Region of Southwest China to validate the accessibility and effectiveness of the schizophrenia family care model at the family level, caregivers of people living with schizophrenia were selected as participants in Baoshan City, Yunnan Province from September 2022 to March 2023, quality of life, family burden of disease, sociodemographic and behavioral information of participants were collected.

RESULTS

Domain scores for physical, psychological, social relationships, and environment of quality of life were 13.50 ± 2.61, 12.67 ± 2.40, 13.64 ± 2.32, and 12.46 ± 1.76 respectively. In our study, we found that gender, age, education level, personal monthly income, history of smoking and alcohol consumption, subjective sleep quality, relation to the patient, degree of self-care and the number of relapses in patient all influence 1 to 4 domains of quality of life for caregivers, stratified analysis was conducted to minimize the effect of gender on the results, we still found that history of smoking could positively predict the score of psychological domain and history of alcohol consumption could positively predict the score of social relationships domain. Canonical correlation analysis showed that the 'impact on family interaction' in family burden of disease was most closely related to quality of life.

CONCLUSION

Building harmonious family relationships can help improve the quality of life for caregivers of People living with schizophrenia.

Caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a psychiatric tertiary hospital in South Africa

Background

Chronic mental illnesses such as schizophrenia affect patients' functioning, making caregiving necessary although burdensome.

Aim

This study aimed to determine caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a Psychiatric Outpatient Department (POD).

Setting

Tertiary hospital in Northern Pretoria, South Africa.

Methods

In this cross-sectional study conducted over 3 months, 300 consecutive family caregivers who attended the POD were administered a 22-item Zarit Burden Interview (ZBI-22), which has a score of 0-88, with higher values indicating more burden. Their sociodemographic characteristics were ascertained. Linear and ordinal logistic regression analyses were performed to identify determinants or predictors of total and severe burdens, respectively.

Results

Most caregivers were aged 46.0 ± 14 years, females (62%), parents (39%), of low-income status (93.7%), had secondary education (70%), resided with the patient (87%), and helped with all troublesome activities (95.3%). The median ZBI-22 score was 19.0 (interquartile range: 13.0-30.5). The determinants of both total and severe burdens were: caregiver age ≥ 50 years adjusted odds ratio (aOR): 2.55, confidence interval (CI): 1.49-4.36; residential area farther away from the hospital aOR: 1.76, CI: 1.3-2.99; increasing months of caregiving aOR: 1.0, CI: 1.001-1.009, p = 0.006; and not having another family member that needs care aOR: 0.43, CI: 0.24-0.78.

Conclusion

Having mental healthcare facilities close to residential areas and assisting caregivers aged ≥ 50 years who have multiple family members who need care may alleviate the burden.

Contribution

Predicting total and severe caregiver burdens contemporaneously is effective for identifying potential burden interventions.

Mental health recovery for people with schizophrenia in Southeast Asia: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: Mental health recovery has become a more prevalent approach to empowering people with schizophrenia (PWS), especially in western countries. However, despite the benefits, there is a lack of evidence regarding its practice in developing countries such as Southeast Asian Countries. The optimal treatment for PWS has not yet been identified, since most mental health care is provided in hospital-based settings in Southeast Asia. Mental health treatment in Southeast Asia is highly influenced by cultural norms, values, and practices. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The findings highlight the importance of integrating cultural aspects into the treatment of people with schizophrenia. The sample of unique elements in Southeast Asian mental health recovery include using a close neighbour/cadre as social support and using religious activity to increase hope. Lack of government support, high level of employment, and stigma are the biggest barriers in the PWS recovery process. WHAT IS THE IMPLICATION FOR PRACTICE?: There is a research gap regarding the awareness and implementation of mental health recovery in psychiatric programs across the Southeast Asian region which likely impacts the effectiveness of the treatment. The review shows that little research has explored the concept of personal recovery in Southeast Asian Countries.

ABSTRACT

INTRODUCTION: Recovery has become an important approach used by mental health services around the world. Many mental health systems have taken steps to move towards more recovery-oriented practices and service delivery. Therefore, establishing recovery-oriented services in developing countries like those in the Southeast Asian region requires a detailed understanding of the cultural norms, values, and current mental health practices.

AIMS

To investigate the mental health practices that promote recovery, its barrier in Southeast Asia, and to determine if they align with the CHIME recovery model.

METHOD

Electronic databases MEDLINE, EMBASE, CINAHL, PsycINFO and SCOPUS, were searched [PROSPERO] (CRD42021227962). Peer-reviewed English language articles from 2004 to January 2021 were included. Methodological quality was assessed using the CASP checklist, and thematic synthesis of included studies was conducted.

RESULTS

Thirty-one studies met inclusion criteria. Several themes illustrated mental health recovery services and the current obstacles identified in South-east Asian studies. Connection includes peer support and support groups, relationship status, and limited opportunities to become involved in the community. Hope is found in cultural concepts of hope, stimulating recovery through mental health programs, whilst lack of knowledge and education are the main barriers. Ethnicity is linked to a high level of stigma, but ethnicity also builds identity. Meaning and spirituality manifest in religious activities as the catalyst for recovery. Finally, the opposite of Empowerment is seen in the tendency of people with schizophrenia to remain in a passive position. Further barriers to empowerment are unemployment and a lack of social support.

DISCUSSION

In Southeast Asia, the elements of culture, religiosity, and communality are essential to mental health recovery. The obstacles to recovery are relate to human rights, social support, family involvement, and continuity of care.

IMPLICATIONS FOR PRACTICE

This review explores the concept of mental health recovery for people who are experiencing psychosis and living in Southeast Asian countries. The evidence may contribute to the further development of mental health programs in this region.

Development of mental healthcare in Cambodia: barriers and opportunities

BACKGROUND

Despite the increasing recognition globally of the importance of mental health for sustainable development, significant barriers remain to developing mental health services in low- and middle-income countries. This study explored the particular barriers and opportunities for developing mental health services in Cambodia and how these compared with those described in other low- and middle-income countries.

METHODS

For this qualitative study, 18 experienced mental health professionals from different disciplines were selected using purposive sampling. Semi-structured interviews were carried out in Phnom Penh and thematic analysis of the data was completed.

RESULTS

Five key themes were identified: (1) Prioritising mental health in Cambodia, (2) Strengthening collaborations between mental health stakeholders, (3) Developing a mental healthcare model appropriate for the Cambodian culture and context, (4) Increasing the quantity and (5) Improving the quality of mental healthcare. All five themes were referred to by all 18 participants and the two most repeated themes were (2) Strengthening collaborations and (5) Improving the quality of mental healthcare.

CONCLUSIONS

The themes identified in this study both corroborate previous barriers identified to developing mental health services in low- and middle-income countries and shed new light on opportunities of particular importance in Cambodia. Strengthening collaborations between key stakeholders in mental health and prioritising the quality of mental health education, training and service provision were both cited as being significant opportunities for enhancing the development of mental health services in Cambodia. These have not been widely described before as being important factors.

Correction: Quality of life and its social determinants for patients with schizophrenia and family caregivers in Cambodia

[This corrects the article DOI: 10.1371/journal.pone.0229643.].