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McCann E, Neill F. Impact of a Family Interventions Module on Students' Knowledge, Skills and Attitudes. Issues Ment Health Nurs 2019; 40:747-753. [PMID: 31021672 DOI: 10.1080/01612840.2019.1572252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Current evidence strongly supports the implementation of family interventions as a recognised approach to working with families. The aim of this study was to evaluate postgraduate students' learning experiences and skills development whilst undertaking a Master of Science module in family interventions. Questionnaires were used to elicit students' learning and experiences in relation to their work with families. Following analysis of students' responses, the key themes that emerged in relation to family interventions included: prior learning and experiences, changes in practice, skills development, supports in practice, and course strengths and challenges. Participants particularly valued the simulated learning and reflective elements of the module. The results of the study suggest that more staff should have access to education and training to enable practitioners to work more effectively with families. However, they will need to have support mechanisms in practice to effectively implement family interventions.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, University of Dublin , Trinity College , Dublin , Ireland
| | - Freda Neill
- School of Nursing and Midwifery, University of Dublin , Trinity College , Dublin , Ireland
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102
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Sin J, Woodham LA, Henderson ,C, Williams E, Sesé Hernández A, Gillard S. Usability evaluation of an eHealth intervention for family carers of individuals affected by psychosis: A mixed-method study. Digit Health 2019; 5:2055207619871148. [PMID: 31489205 PMCID: PMC6713967 DOI: 10.1177/2055207619871148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/31/2019] [Indexed: 11/15/2022] Open
Abstract
Background Existing research suggests that eHealth interventions targeting family carers of individuals with long-term illness offer a promising approach to care delivery. In particular, digital psychoeducational interventions with interactive psychosocial support are well-received with high rates of satisfaction and acceptability. However, development of such interventions for psychosis carers is lacking. We developed a multi-component eHealth intervention specifically for carers of individuals affected by psychosis, called COPe-support (Carers fOr People with Psychosis e-support). Objective Using mixed methods to evaluate usability, system heuristics and perceived acceptability, we conducted a usability study to establish the suitability of the intervention prototype for the target user group. Methods Twenty-three carers were recruited to the study and participated in a think-aloud test or a remote online trial of the intervention. Qualitative feedback, post-use System Usability Scale (SUS) scores, and real-world usage data collected from the tests were analysed. These were also supplemented with heuristic evaluation data provided by an independent eLearning technology expert. Results Participants evaluated the intervention content as useful and helpful, and indicated that the system had satisfactory usability with a mean SUS score of 73%, above the usability quality benchmark threshold. Study results identified some minor usability issues, which were corroborated with the eLearning expert’s heuristic evaluation findings. We used these results to refine the COPe-support intervention. Conclusions The usability study with end-users and service providers identified real-life usage and usability issues. The study results helped us refine COPe-support and its delivery strategy before its launch as part of a large-scale clinical trial.
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Affiliation(s)
- Jacqueline Sin
- Population Health Research Institute, St George’s, University of London, UK
- School of Psychology & Clinical Language Sciences, University of Reading, UK
- Jacqueline Sin, Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London SW17 0RE. Twitter: @COPe_support
| | - Luke A. Woodham
- Institute of Medical and Biomedical Education, St George’s, University of London, UK
| | - , Claire Henderson
- Health Service & Population Research Department, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Elen Williams
- Independent GP*Both of the authors are first joint authors on the published paper
| | - Aurora Sesé Hernández
- Institute of Medical and Biomedical Education, St George’s, University of London, UK
| | - Steve Gillard
- Population Health Research Institute, St George’s, University of London, UK
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103
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Factors Associated with Marital Satisfaction and Quality of Life in Family Caregivers of Patients with Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162825. [PMID: 31398793 PMCID: PMC6719212 DOI: 10.3390/ijerph16162825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 01/04/2023]
Abstract
(1) Background: The aim of this research was to analyze factors associated with quality of life (QoL) and marital satisfaction in married family caregivers of patients with mental disorders. (2) Methods: A cross-sectional study was conducted in all community mental health services in Goiania municipality, Brazil, in 2016–2017. Married family caregivers of patients with severe and persistent mental disorders were recruited and their QoL and marital satisfaction was assessed by using the World Health Organization Quality of Life Instrument Abbreviated version (WHOQOL-BREF) and Marital Satisfaction Scale. Multiple linear regressions were performed to identify factors associated with QoL and marital satisfaction. (3) Results: For 163 family caregivers, the psychological and environmental QoL domains presented the best and the worst scores, respectively. Factors independently associated with better QoL for caregivers were male caregiver, the younger age of a caregiver, >8 years of schooling, ≥5 years as a caregiver who performed physical activities, caregiver without chronic disease, and no patient’s crisis in the last 30 days. Factors independently associated with marital satisfaction of the caregiver were male caregiver, caregiver with >8 years of schooling, caregiver who received support by relatives to care for the patient, caregiver who performed physical activities, no patient’s crisis in the last 30 days, and patient hospitalization in the last six months; (4) Conclusions: The main predictor for marital satisfaction was support by relatives, and for QoL it was no patient’s crisis in the last 30 days.
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104
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Sin J, Henderson C, Woodham LA, Sesé Hernández A, Gillard S. A Multicomponent eHealth Intervention for Family Carers for People Affected by Psychosis: A Coproduced Design and Build Study. J Med Internet Res 2019; 21:e14374. [PMID: 31389333 PMCID: PMC6701165 DOI: 10.2196/14374] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 01/15/2023] Open
Abstract
Background Psychosis, including schizophrenia, is the most common severe mental illness affecting 1% of the population worldwide. A large number of people provide long-term support and care for a relative with psychosis. Although psychoeducational interventions, especially those delivered through a face-to-face group format, have an established evidence base for improving the caregiving experience, well-being, and health outcomes, large-scale implementation and access remain limited. There is a demand for such provision to be made through the internet for greater flexibility and wider access. Objective This study aimed to integrate participatory research methodologies by the public, patients, and carers into the eHealth (electronic health) intervention design and build process to improve the product’s usability and acceptability. Methods We adapted a structured eHealth intervention build method to include participatory research activities involving key stakeholders and end users to co-design and coproduce our intervention. An expert advisory group (EAG) comprising public involvement members led the formative design and build work using an agile build process. Carers independent from the study were consulted on the evolving drafts of the intervention prototype through focus group meetings. These results were fed back into the intervention build work continuously to ensure end users’ input inform every stage of the process. Results An EAG comprising individuals with lived experience of psychosis, carers, health care professionals, researchers, voluntary organization workers, and eLearning experts (n=14) was established. A total of 4 coproduction workshops were held over 1 year during which the alpha and beta prototypes were designed and built through the participatory research work. Alongside this, 2 rounds of focus group study with carers (n=24, in 4 groups) were conducted to seek consultation on end users’ views and ideas to optimize the intervention design and usability. Finally, the EAG carried out a Web-based walk-through exercise on the intervention prototype and further refined it to make it ready for an online usability test. The final product contains multiple sections providing information on psychosis and related caregiving topics and interactive discussion forums with experts and peers for psychosocial support. It provides psychoeducation and psychosocial support for carers through the internet, promoting flexible access and individualized choices of information and support. Conclusions The participatory research work led to the coproduction of a eHealth intervention called COPe-support (Carers fOr People with Psychosis e-support). We believe the study methodology, results, and output have optimized the intervention design and usability, fitting the end users’ needs and usage pattern. COPe-support is currently being tested for its effectiveness in promoting carers’ health outcome through an online randomized controlled trial. Trial Registration ISRCTN Registry ISRCTN89563420; http://www.isrctn.com/ISRCTN89563420
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Affiliation(s)
- Jacqueline Sin
- Population Health Research Institute, St George's, University of London, London, United Kingdom.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Luke A Woodham
- Institute of Medical and Biomedical Education, St George's, University of London, London, United Kingdom
| | - Aurora Sesé Hernández
- Institute of Medical and Biomedical Education, St George's, University of London, London, United Kingdom
| | - Steve Gillard
- Population Health Research Institute, St George's, University of London, London, United Kingdom
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105
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Spencer L, Potterton R, Allen K, Musiat P, Schmidt U. Internet-Based Interventions for Carers of Individuals With Psychiatric Disorders, Neurological Disorders, or Brain Injuries: Systematic Review. J Med Internet Res 2019; 21:e10876. [PMID: 31290399 PMCID: PMC6647754 DOI: 10.2196/10876] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 03/15/2019] [Accepted: 03/24/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Nonprofessional carers who provide support to an individual with a psychiatric or neurological disorder will often themselves experience symptoms of stress, anxiety, or low mood, and they perceive that they receive little support. Internet-based interventions have previously been found to be effective in the prevention and treatment of a range of mental health difficulties in carers. OBJECTIVE This review seeks to establish the status of internet-based interventions for informal (nonprofessional) carers of people with psychiatric or neurological disorders by investigating (1) the number and quality of studies evaluating the efficacy or effectiveness of internet-based carer interventions and (2) the impact that such interventions have on carer mental health, as well as (3) how internet-based interventions compare with other intervention types (eg, face-to-face treatment). METHODS A systematic literature search was conducted in January 2019 using the EMBASE (1974-present), Ovid MEDLINE (1946-present), PsychARTICLES, PsychINFO (1806-present), and Global Health (1973-present) databases, via the Ovid Technologies database. Search terms included carer, caregiver, online, technology, internet-based, internet, interactive, intervention, and evaluation. Studies selected for inclusion in this review met the following predetermined criteria: (1) delivering an intervention aimed primarily at informal carers, (2) carers supporting individuals with psychiatric disorders, stroke, dementia, or brain injury, (3) the intervention delivered to the carers was primarily internet based, (4) the study reported a pre- and postquantitative measure of carer depression, anxiety, stress, burden, or quality of life, (5) appeared in a peer-reviewed journal, and (6) was accessible in English. RESULTS A total of 46 studies were identified for inclusion through the detailed search strategy. The search was conducted, and data were extracted independently by 2 researchers. The majority of studies reported that 1 or more measures relating to carer mental health improved following receipt of a relevant intervention, with interventions for carers of people with traumatic brain injury showing a consistent link with improved outcomes. CONCLUSIONS Studies investigating internet-based interventions for carers of individuals with diverse psychiatric or neurological difficulties show some evidence in support of the effectiveness of these interventions. In addition, such interventions are acceptable to carers. Available evidence is of varying quality, and more high-quality trials are needed. Further research should also establish how specific intervention components, such as structure or interactivity, contribute to their overall efficacy with regard to carer mental health.
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Affiliation(s)
- Lucy Spencer
- Section of Eating Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Rachel Potterton
- Section of Eating Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Karina Allen
- Section of Eating Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,The Eating Disorders Service, Maudsley Hospital, South London & Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Peter Musiat
- Section of Eating Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Ulrike Schmidt
- Section of Eating Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,The Eating Disorders Service, Maudsley Hospital, South London & Maudsley National Health Service Foundation Trust, London, United Kingdom
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106
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Nuttall AK, Thakkar KN, Luo X, Mueser KT, Glynn SM, Achtyes ED, Kane JM. Longitudinal associations of family burden and patient quality of life in the context of first-episode schizophrenia in the RAISE-ETP study. Psychiatry Res 2019; 276:60-68. [PMID: 31026764 PMCID: PMC6538431 DOI: 10.1016/j.psychres.2019.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 10/27/2022]
Abstract
The present study examined longitudinal associations between family member perceived burden and clinical correlates to understand potential covariation in change over time in the context of first-episode schizophrenia in the RAISE-ETP study (N = 282). Across 24 months, family burden, patient quality of life, and positive symptoms improved. Findings from the present study suggest covariation in change over time in quality of life and family burden. As patient quality of life improved, family burden decreased. However, initial levels of quality of life were not significantly associated with changes in family burden and vice versa. Initial levels of positive symptoms were significantly associated with initial levels of family burden. These findings have treatment implications by suggesting the potential for interventions aimed at improving quality of life to have a spillover effect on family burden, or alternatively, that reducing perceived family burden may improve patient quality of life.
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Affiliation(s)
- Amy K. Nuttall
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI,Center for Research in Autism, Intellectual and Other Neurodevelopmental Disabilities, Michigan State University, East Lansing, MI, USA,Corresponding Author: Amy K. Nuttall, phone +1 517 884-9443;
| | - Katharine N. Thakkar
- Center for Research in Autism, Intellectual and Other Neurodevelopmental Disabilities, Michigan State University, East Lansing, MI, USA,Department of Psychology, Michigan State University, East Lansing, MI, USA,Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Xiaochen Luo
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Kim T. Mueser
- Center for Psychiatric Rehabilitation and Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston, MA, USA,Departments of Psychological and Brain Sciences and Psychiatry, Boston University, Boston, MA, USA
| | | | - Eric D. Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, USA,Cherry Health, Grand Rapids, MI, USA
| | - John M. Kane
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA,Feinstein Institute for Medical Research, NY, USA,The Zucker Hillside Hospital, Glen Oaks, NY, USA
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107
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Smith LM, Onwumere J, Craig T, Kuipers E. Role of poor sleep in determining distress in caregivers of individuals with early psychosis. Early Interv Psychiatry 2019; 13:613-618. [PMID: 29417730 DOI: 10.1111/eip.12538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/18/2017] [Accepted: 12/17/2017] [Indexed: 01/04/2023]
Abstract
AIM Looking after someone in the early stages of psychosis can have a negative impact on caregivers, but there is little clarity about which interventions, if any, caregivers should be offered. This study investigated sleep disturbances in early psychosis caregivers and the relationship between their sleep quality and distress. METHOD In all, 79 caregivers of patients with a recent first episode of psychosis completed self-report measures including the Pittsburgh Sleep Quality Index (PSQI), the RAND 36-item Health Survey 1.0 (SF-36) and the Experiences of Caregiving Inventory (ECI). RESULTS All caregivers were living with their relatives with psychosis and had been providing support since the onset of illness (mean duration = 92.5 weeks, SD = 84.0); 60% (47/79) obtained a global PSQI score that exceeded the established cut-off score for clinically significant sleep problems (>5). Low "sleep duration" and "sleep disturbances" contributed the most to elevated PSQI scores, with 17.7% of participants reporting regular wakening at night due to "stress" or "worries." When predicting psychological distress (SF-36) from negative appraisals of caregiving (ECI) and poor sleep (PSQI), a significant unadjusted regression model was obtained, F(2,73) = 29.440, P = .000, R2 of .447. An estimation of the indirect effect of negative thoughts about caregiving on mental distress through poor sleep was also significant (ab = -.05, 95% CI [-.09, -.02], PM = .39). CONCLUSION Caregivers of people with psychosis may have significant problems with sleep, which relates to distress and negative appraisals about caregiving. Health services need to ask caregivers directly about such issues and consider offering brief interventions to improve sleep quality.
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Affiliation(s)
- Lindsay M Smith
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Juliana Onwumere
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Thomas Craig
- King's College London, Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Elizabeth Kuipers
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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108
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Abstract
PURPOSE OF REVIEW To better understand the overall burden of schizophrenia, we aimed to explore informal caregivers' experiences by evaluating the current evidence on caregiver and patient characteristics, the type of care provided by caregivers, and the impacts of caregiving on caregivers' lives. RECENT FINDINGS Caregivers provide direct care, assistance with activities of daily living, and emotional, social, and financial support to individuals with schizophrenia. Increased duration of illness and of care, severe or persistent schizophrenia symptoms, criticism of the care recipient, financial burden, and patient disability intensify caregiver burden. Caregivers of individuals with persistent symptoms often feel overwhelmed, stressed, drained, burdened, frustrated, or angry. Financial impacts of caregiving include treatment costs for care recipients, providing financial support, and lost productivity and income. Depression and anxiety are common health impacts for caregivers, who also have increased physical healthcare resource use relative to healthy controls. Caregiver burden is reduced by formal support programs to improve caregivers' stress management and coping skills and informal sources of social support. SUMMARY Targeted efforts to improve access to care and provide additional support for caregivers are needed to alleviate caregiver burden and improve outcomes for individuals with schizophrenia.
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109
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Byrom NC. Supporting a friend, housemate or partner with mental health difficulties: The student experience. Early Interv Psychiatry 2019; 13:202-207. [PMID: 28707357 DOI: 10.1111/eip.12462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 05/02/2017] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
AIMS When experiencing mental health difficulties, university students turn to their friends for support. This study assessed the consequences of caregiving among a university sample, identifying predictors of caregiving burden among students. METHODS A total of 79 students with experience of supporting a friend with mental health difficulties were recruited through a UK student mental health charity to complete an online survey. Alongside qualitative data, the online survey used the Experience of Caregiving Inventory and the Involvement Evaluation Questionnaire as measures of the consequences of caregiving. RESULTS Students supporting friends, housemates or partners were found to experience significant consequences of caregiving. Frequency of face-to-face contact and duration of illness predicted more negative consequences of caregiving, but these relationships were not straightforward. The presence and intensity of professional support did not influence the experience of caregiving. CONCLUSIONS The study suggests that the impact of supporting friends with mental health difficulties is not insubstantial for students. Broadening the network of informal social support may help improve the experience for students supporting a friend, but currently, contact with professional services appears to have a limited effect.
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Affiliation(s)
- Nicola C Byrom
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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110
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Lo HHM, Ho WC, Lau ENS, Lo CW, Mak WWS, Ng SM, Wong SYS, Wong JOY, Lui SSY, Lo CSL, Lin ECL, Poon MF, Choi K, Leung CWC. A Brief Mindfulness-Based Family Psychoeducation Intervention for Chinese Young Adults With First Episode Psychosis: A Study Protocol. Front Psychol 2019; 10:516. [PMID: 30915004 PMCID: PMC6421292 DOI: 10.3389/fpsyg.2019.00516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/21/2019] [Indexed: 12/21/2022] Open
Abstract
Family psychoeducation (FPE) has been recommended as a major component in the treatment of psychosis. Many previous studies have implemented an intensive program design that often only emphasized improvements in patients' illness outcomes but the benefits for caregivers were limited. There have been calls for a time-limited but cost-effective FPE program to mitigate the looming reality of the suffering of people with psychosis and their families. A Brief Mindfulness-Based Family Psychoeducation for psychosis program is developed to reduce caregivers' burden and promote young adult's recovery. A randomized controlled trial will be conducted to compare this intervention with an ordinary FPE intervention. Both arms will involve six sessions, with a total contact time of 12 h. 300 caregivers of young adults who have experienced first episode psychosis within last 3 years will be recruited. Program effectiveness will be assessed by comparing outcomes measuring the caregivers' burden, mental health symptoms, positive well-being, and the young adult's mental health symptoms during the study and at 9-month post-randomization. The role of expressed emotions, interpersonal mindfulness, and non-attachment in mediating these outcomes will be explored. An additional qualitative approach Photovoice is selected to explore the complex family experiences and the benefits of mindfulness from the caregivers' personal perspectives. Trial Registration: The trial is registered with the United States Clinical Trials Registry (ClinicalTrials.gov): NCT03688009.
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Affiliation(s)
- Herman Hay-Ming Lo
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Wing-Chung Ho
- Department of Social and Behavioural Sciences, The City University of Hong Kong, Kowloon, Hong Kong
| | - Elsa Ngar-Sze Lau
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Chun-Wai Lo
- Specialist in Psychiatry, Private Practice, Hong Kong, Hong Kong
| | - Winnie W. S. Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, China
| | - Siu-Man Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Simon S. Y. Lui
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, Hong Kong
| | - Cola Siu-Lin Lo
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, Hong Kong
| | | | - Man-Fai Poon
- Integrative Community Centre for Mental Wellness, Baptist Oi Kwan Social Service, Hong Kong, Hong Kong
| | - Kong Choi
- Integrative Community Centre for Mental Wellness, Richmond Fellowship of Hong Kong, Hong Kong, Hong Kong
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111
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Sedgwick R, Duff A, Lines S, Akenzua A, Jones F. Family-inclusive practice in a psychiatric intensive care unit. BJPsych Bull 2019; 43:259-263. [PMID: 30855003 DOI: 10.1192/bjb.2019.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and MethodThe National Institute for Health and Care Excellence recommends involving the families of patients admitted to psychiatric hospital care, without specific guidance on how to do it. To improve family involvement in a National Health Service psychiatric intensive care unit, a relatives' and carers' clinic was set up. Fifty family members attended and completed questionnaires. Nine went on to take part in interviews, the results of which were analysed using thematic analysis. RESULTS: Families felt more informed and found the increased access to information useful. They felt that the process showed respect for them and their family member, and that their contribution was valued. Running throughout the interviews was the contrast with previous experiences; families reported feeling heard and understood and attributed this in part to timing and environment.Clinical implicationsThe clinic was viewed positively by families and met the trust's commitment to including carers, as well as national guidance which suggests it should be part of routine practice.Declaration of interestNone.
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Affiliation(s)
- Rosemary Sedgwick
- South London and Maudsley NHS Foundation Trust/King's College London
| | - Alexa Duff
- St George's University Hospitals NHS Foundation Trust
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112
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Zanetti ACG, Vedana KGG, Pereira CCM, de Azevedo Marques JM, da Silva AHS, Martin IDS, Dantas RAS, de Souza J, Galera SAF, Gherardi-Donato ECDS. Expressed emotion and socio-demographic and clinical factors in families of Brazilian patients with schizophrenia. Int J Soc Psychiatry 2019; 65:56-63. [PMID: 30488742 DOI: 10.1177/0020764018815207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Families are the main caregivers of people with schizophrenia. Family dynamic and expressed emotion (EE) of relatives are fundamental determinants on the course of schizophrenia. METHOD This study analyzed socio-demographic and clinical factors related to EE components. A total of 94 dyads (patients with schizophrenia and their relatives) were recruited from three mental health clinics. A form containing socio-demographic and clinical variables and the Brazilian version of Family Questionnaire were used and the data were analyzed through regression model. RESULTS Results showed that factors such as patients' occupation status and patients' age, as well as relatives' gender and the degree of relatedness, were related to emotional overinvolvement and critical comments levels. CONCLUSION This is the first study in the Brazilian cultural context that evaluates EE components and related factors on families of patients with schizophrenia. Other studies concerning EE on different cultural contexts and possible interventions must be carried out to help health professionals to improve patient and family care.
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Affiliation(s)
- Ana Carolina Guidorizzi Zanetti
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Kelly Graziani Giacchero Vedana
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Camila Corrêa Matias Pereira
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | | | - Amanda Heloisa Santana da Silva
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Isabela Dos Santos Martin
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Rosana Aparecida Spadoti Dantas
- 3 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Jacqueline de Souza
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Sueli Aparecida Frari Galera
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Edilaine Cristina da Silva Gherardi-Donato
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
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Turkington D, Gega L, Lebert L, Douglas-Bailey M, Rustom N, Alberti M, Deighton S, Naeem F. A training model for relatives and friends in cognitive behaviour therapy (CBT) informed care for psychosis. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1497749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Douglas Turkington
- Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle-upon-Tyne, UK
| | - Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, Alcuin Research Resource Centre, York, Heslington, UK
| | - Latoyah Lebert
- Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle-upon-Tyne, UK
| | - Maggie Douglas-Bailey
- Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle-upon-Tyne, UK
| | | | - Mary Alberti
- Schizophrenia Society of Ontario, Toronto, Canada
| | | | - Farooq Naeem
- Department of Psychiatry, Queen’s University, Kingston, Canada
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Schess J, Diminic S, Hielscher E, Harris MG, Lee YY, Kealton J, Whiteford HA. Investment in Australian mental health carer services: how much and does it reflect evidence of effectiveness? AUST HEALTH REV 2018; 44:104-113. [PMID: 30558709 DOI: 10.1071/ah18065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/05/2018] [Indexed: 11/23/2022]
Abstract
Objective The aims of this study were to quantify Australian federal and state government expenditure on mental health carer services for 2014-15, map the types of services being provided and explore how funded service types compare with the evidence base for the outcomes of these carer services. Methods Web searches were conducted to identify in-scope mental health carer services in Australia funded by federal and state and territory governments. Funding estimates were confirmed where possible with available government and carer organisation contacts. A literature search was conducted for reviews of studies investigating mental health carer service outcomes. Results In 2014-15, the estimated Australian national, state and territory government expenditure on mental health carer services was approximately A$90.6million. This comprised A$65.6million in federal expenditure and A$25.0million in state and territory expenditure. Most funding streams provided respite and psychoeducation. The literature showed positive carer outcomes for psychoeducation and intensive family interventions. Evidence was lacking for the effectiveness of respite services. Conclusions These findings suggest a mismatch between what is known about the extent to which different service types deliver positive carer outcomes and the current allocation of funds across Australia's mental health system. This study also highlights the fragmentation of the mental health carer services system, supporting the need to streamline access. What is known about this topic? Informal carers of people with mental disorders provide a critical role to the significant number of individuals with mental illness in Australia, and provide an unpaid workforce to the Australian mental health system. This role comes with significant physical, emotional and financial burden, which government-funded services can assist with to allow mental health carers to continue to serve in their caring role while improving their quality of life. What does this paper add? Using both published data and communication with health and non-government officials, we have estimated federal and state expenditure on mental health carer services at A$90.6million in 2014-15 fiscal year and have provided a mapping of the services this expenditure funds. In addition, through analysis of the literature on outcomes of carer services provided, we have seen a mismatch of expenditure and the evidence base. What are the implications for practitioners? There is a necessity for both more research into service outcomes aimed particularly at mental health carers and thinking critically about whether the current prioritisation of funds can be increased and/or reallocated to create better outcomes for mental health carers.
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Affiliation(s)
- Jaclyn Schess
- Department of Economics, Yale University, New Haven, Connecticut, USA. Email
| | - Sandra Diminic
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Qld 4076, Australia. Email
| | - Emily Hielscher
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Qld 4076, Australia. Email
| | - Meredith G Harris
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Qld 4076, Australia. Email
| | - Yong Yi Lee
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Qld 4076, Australia. Email
| | | | - Harvey A Whiteford
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Qld 4076, Australia. Email
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Smith LM, Onwumere J, Craig T, Kuipers E. Caregiver correlates of patient-initiated violence in early psychosis. Psychiatry Res 2018; 270:412-417. [PMID: 30308465 DOI: 10.1016/j.psychres.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 08/29/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022]
Abstract
Patient-initiated violence may pose a significant risk to the strength and longevity of informal caregiving relationships in psychosis. We aimed to assess caregiver reports of patient-initiated violence in early psychosis and to examine the relationship between violent incidents and appraisals of caregiving, perceived mental wellbeing in caregivers and Expressed Emotion (EE) in the caregiving relationship. Eighty psychosis caregivers were recruited via Early Intervention (EI) psychosis services in London, United Kingdom. Caregivers were questioned about their experiences of patient-initiated violence during the semi-structured Camberwell Family Interview, and completed the Experience of Caregiving Inventory and the RAND SF-36 health survey in a cross-sectional experimental design. One third of the sample reported at least one incident of patient-initiated violence. Reports of violence were associated with poorer mental wellbeing scores amongst caregivers and more negative appraisals of caregiving. Patient-initiated violence also correlated with greater criticism and hostility expressed towards patients, and a rating of high EE in caregiver reports. The results underscore the need to ask explicitly and routinely about the physical safety of caregivers looking after someone with psychosis. Families should be directed towards appropriate interventions to help manage any risk of violence and the likely negative impact on the caregiving relationship.
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Affiliation(s)
- Lindsay M Smith
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Juliana Onwumere
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK.
| | - Thomas Craig
- King's College London, Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Elizabeth Kuipers
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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Haider II, Tiwana F, Zohra N, Rehaman KU. Development and validation of assessment of psycho-education of carers questionnaire: An early experience. Pak J Med Sci 2018; 34:1237-1241. [PMID: 30344583 PMCID: PMC6191818 DOI: 10.12669/pjms.345.15710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective Psycho-education is an intervention integrating psychotherapeutic and educational strategies. Whilst carer psycho-education is known to aid in psychiatric disorders, at present there is no known tool to assess the degree to which this is routinely provided by mental health professionals. Our objective was to develop and validate a tool, in English, which assesses psycho-education of carers of psychiatric patients in Pakistan. Methods A questionnaire was generated in English. It was pretested on twenty male and female carers and was refined to attain a more reliable version. Sixty bilingual male and female primary carers, who were fluent in English, and had been in a care-giving role for more than three months were requested to complete the developed Questionnaire for the Assessment of Psycho-Education of Carers (APEC) at Fatima Memorial Hospital Psychiatry Out-patient department within a period of four months from December, 2017 to April, 2018. Carers were identified via patients presenting to a psychiatric OPD. Responses were analyzed for reliability and test retest consistency using Cronbach's alpha analysis, Intraclass correlation coefficients, factor analysis and Paired t-test. Results APEC was found to be easily understandable and capable of adequately assessing aspects of psycho-education. A high degree of internal consistency was demonstrated on cronbach's alpha analysis. Cronbach's α coefficient for various domains was sufficiently high ranging from0.76 to 0.960. Similarly, domains of (APEC) were highly correlated. Test-retest reliability was assessed by computing the correlation between Visits 1 and 2 scores. Conclusion The developed questionnaire can adequately assess psycho-education of primary carers in mental health settings.
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Affiliation(s)
- Imran Ijaz Haider
- Prof. Dr. Imran Ijaz Haider, FRCPsych (London) Department of Psychiatry and Behavioral Sciences, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
| | - Farah Tiwana
- Ms. Farah Tiwana, MSc Mental Health Studies. Department of Psychiatry and Behavioral Sciences, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
| | - Noor Zohra
- Ms. Noor Zohra, PhD Scholar. Department of Human Development and Family Studies, Govt. College of Home Economics, Lahore, Pakistan
| | - Khaleeq Ur Rehaman
- Prof. Dr. Khaleeq ur Rehaman, FECSM (European Joint Committee). Department of Urology and Andrology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
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Stomski NJ, Morrison P, Sealey M, Skeffington P, O'Brien G. The association between gratitude and burden in Australian mental health carers: a cross-sectional study. Scand J Caring Sci 2018; 33:215-221. [PMID: 30311247 DOI: 10.1111/scs.12623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 09/17/2018] [Indexed: 01/29/2023]
Abstract
The level of carer burden has increased as carers take on more responsibility for mental health consumers as a result of the contemporary shift in the delivery of services from institutional to community settings. Interventions are required to mitigate mental health carer burden. Therefore, we examined the association between dispositional gratitude and burden in a cross-sectional survey of 231 Australian mental health carers. Dispositional gratitude was assessed by the S-GRAT, and carer burden was measured using the Involvement Evaluation Questionnaire. The results of a general linear model demonstrated that higher levels of a lack of sense of deprivation were significantly associated with lower levels of tension, worrying and urging. In contrast, higher levels of simple appreciation were significantly associated with higher levels of supervision, worrying and urging. Our findings highlight that gratitude interventions should focus on promoting a lack of sense of deprivation and appreciation of others in order to reduce mental health carer burden.
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Affiliation(s)
| | - Paul Morrison
- School of Health Professions, Murdoch University, Perth, WA, Australia
| | - Margaret Sealey
- School of Health Professions, Murdoch University, Perth, WA, Australia
| | - Petra Skeffington
- School of Health Professions, Murdoch University, Perth, WA, Australia
| | - Geraldine O'Brien
- School of Psychology and Exercise Science, Murdoch University, Perth, WA, Australia
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Sinha Deb K, Tuli A, Sood M, Chadda R, Verma R, Kumar S, Ganesh R, Singh P. Is India ready for mental health apps (MHApps)? A quantitative-qualitative exploration of caregivers' perspective on smartphone-based solutions for managing severe mental illnesses in low resource settings. PLoS One 2018; 13:e0203353. [PMID: 30231056 PMCID: PMC6145572 DOI: 10.1371/journal.pone.0203353] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023] Open
Abstract
Background Mobile application based delivery of psycho-social interventions may help reduce the treatment gap for severe mental illnesses (SMIs) and decrease the burden on caregivers. Apps developed in high income settings show effectiveness, but they suffer from lack of applicability in low resource scenarios due to the difference in technology penetration, affordability, and acceptance. Objective This study aimed to understand health technology usage, perceived needs, and acceptability of app based interventions in patients with SMIs to improve illness management and reduce caregiver burden. Methods The study was conducted in inpatient and outpatient settings of a tertiary care center in North India. A cross-sectional survey assessed smartphone and health app usage. Further, three focus group discussions evaluated the needs and apprehensions in using apps in management of SMIs. Results A total of 176 participants including 88 patients and 88 caregivers completed the survey. Smartphone ownership was similar to the national average (30%) in both caregivers (38.6%) and in patients (31.8%). Although subjects regularly used a third party app, health app usage was very low. Cost, unfamiliarity, and language were significant barriers to adoption. The focus group discussions provided insight into the various apprehensions of caregivers in using and in allowing patients to use smartphones and such apps. Caregivers wanted mobile apps for accessing information regarding services and resources available for people with SMI, and they felt such apps can be helpful if they could automate some of their routine caregiving activities. However, the significant difficulty was perceived in regards to the cost of the device, language of the medium, and unfamiliarity in using technology. Apprehensions that SMI patients might misuse technology, or damage the device were also prevalent. Conclusions The study systematically looks into the scope, design considerations and limitations of implementing a mobile technology based intervention for low resource settings. With only one-third of the patients and caregivers having access to smartphones and internet, parallel outreach strategies like IVRS should be actively considered while designing interventions. The difficulty of understanding and searching in a non-native language needs to be addressed. Hand holding of caregivers and frequent encouragement from treating doctors might significantly help in technology adoption and in surmounting the apprehensions related to using technology. To make the solution acceptable and useful to the already over-burdened caregivers, developers need to work closely with patients’ family members and follow a ground-up collaborative approach to app development. The scope of delivering mental health services through technology is immense in resource constrained settings like India, provided we, researchers, appreciate and accept the fact that in the varied landscape of a divergent economic, educational, and cultural milieu, a single solution will never suffice for all, and intervention modality matching with end user capacity will be of paramount importance in determining the success of the endeavor.
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Affiliation(s)
| | - Anupriya Tuli
- Department of Computer Science, IIIT-Delhi, Delhi, India
| | - Mamta Sood
- Department of Psychiatry, AIIMS, New Delhi, India
| | | | - Rohit Verma
- Department of Psychiatry, AIIMS, New Delhi, India
| | | | - Ragul Ganesh
- Department of Psychiatry, AIIMS, New Delhi, India
| | - Pushpendra Singh
- Department of Computer Science, IIIT-Delhi, Delhi, India
- * E-mail:
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Baruch E, Pistrang N, Barker C. Psychological interventions for caregivers of people with bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2018; 236:187-198. [PMID: 29747136 DOI: 10.1016/j.jad.2018.04.077] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/10/2018] [Accepted: 04/14/2018] [Indexed: 01/28/2023]
Abstract
AIMS Clinical guidelines recommend that psychological interventions be offered to caregivers of people with bipolar disorder. However, there is little clarity about the efficacy of such interventions. This review examined the efficacy of psychological interventions in improving caregiver-focused outcomes, including burden, psychological symptoms and knowledge. METHOD A systematic search for controlled trials was conducted using a combination of electronic database searches (PsycINFO, MEDLINE, and CENTRAL), and hand searches. Risk of bias was assessed using the Cochrane Collaboration tool. Outcomes were meta-analysed using Review Manager (RevMan). RESULTS Nine studies met inclusion criteria. All meta-analyses compared psychoeducation to a control. At post-treatment there was a large effect of psychoeducation on burden (g = -0.8, 95% CI: -1.32, -0.27). However, there was high heterogeneity, confidence intervals were wide, and the effect was not maintained at follow-up. The apparent effect of psychoeducation on psychological symptoms was driven by a single outlying study. There was a very large effect on knowledge at post-treatment (g = 2.60, 95% CI: 1.39, 3.82) and follow-up (g = 2.41, 95% CI: 0.85, 3.98). LIMITATIONS There was considerable diversity in study methodology and quality. The number of included studies and sample sizes were small. CONCLUSIONS This review provides tentative meta-analytic evidence for the efficacy of psychoeducation in improving caregiver burden at post-treatment, and knowledge at post-treatment and follow-up. Services could consider offering psychoeducation as part of a multi-disciplinary package of care. However, more methodologically rigorous research is needed before clinical recommendations can be made with confidence.
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Affiliation(s)
- Ella Baruch
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
| | - Nancy Pistrang
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Chris Barker
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
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120
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The coping process of Japanese parents who experience violence from adult children with schizophrenia. Arch Psychiatr Nurs 2018; 32:549-554. [PMID: 30029746 DOI: 10.1016/j.apnu.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 03/06/2018] [Indexed: 11/21/2022]
Abstract
With the acceleration of deinstitutionalization might increase families' chances of suffering violence by patients. This study clarified parents' coping processes with violence experienced from patients with schizophrenia. The grounded theory approach was used, and 26 parents were interviewed. We identified a four-stage coping process: (1) hope for treatment, (2) living with violence, (3) trying to solve violence, and (4) last solution for violence. This coping process had two illness-related characteristics: (1) a process of coping with two main stressful events (the illness and violence), and (2) the need for long-term appraisal of violence because of its unclear causes.
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121
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Skärsäter I, Keogh B, Doyle L, Ellilä H, Jormfeldt H, Lahti M, Higgins A, Meade O, Sitvast J, Stickley T, Kilkku N. Advancing the knowledge, skills and attitudes of mental health nurses working with families and caregivers: A critical review of the literature. Nurse Educ Pract 2018; 32:138-146. [PMID: 30007849 DOI: 10.1016/j.nepr.2018.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 01/21/2023]
Abstract
Involving and supporting the family members and caregivers of people with mental illness is essential to high-quality mental health services. However, literature suggests that there is a lack of engagement between family members and mental health nurses (MHNs). Lack of knowledge among MHNs is often cited as one of the main reasons for this lack of engagement. The aim of this review was to explore the knowledge, skills and attitudes that are required by MHNs to enable to them to work more effectively with families affected by mental illness. A literature based critical review was used to access and review 35 papers in order to extract concepts that could inform the design of eLearning materials to assist MHNs advance their knowledge in this area. Two overarching themes were identified; 'Mental health problems and the family' and 'Working with the family'. From these themes, the knowledge, skills and attitudes required to work more effectively with families are described. The findings from this review provide a descriptive account of the knowledge skills and attitudes that are required for effective family work. In addition, the review provides an empirical foundation for education programmes in the area.
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Affiliation(s)
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Heikki Ellilä
- University of Applied Science Turku, Ruiskatu 8, 20810, Turku, Finland
| | | | - Mari Lahti
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Institute of Mental Health Building, Triumph Road, Innovation Park, UK
| | - Agnes Higgins
- Halmstad University, Box 823, SE 301 18, Halmstad, Sweden
| | - Oonagh Meade
- School of Psychology, National University of Ireland, Galway, Ireland.
| | - Jan Sitvast
- University of Applied Sciences HU, Bolognalaan 101, 3584CJ, Utrecht, The Netherlands
| | - Theodore Stickley
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Institute of Mental Health Building, Triumph Road, Innovation Park, UK
| | - Nina Kilkku
- Tampere University of Applied Sciences, Kuntokatu 3, 33520, Tampere, Finland
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Quinlan E, Deane FP, Crowe T. Pilot of an acceptance and commitment therapy and schema group intervention for mental health carer's interpersonal problems. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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123
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Shepherd-Banigan ME, Shapiro A, McDuffie JR, Brancu M, Sperber NR, Van Houtven CH, Kosinski AS, Mehta NN, Nagi A, Williams JW. Interventions That Support or Involve Caregivers or Families of Patients with Traumatic Injury: a Systematic Review. J Gen Intern Med 2018; 33:1177-1186. [PMID: 29736752 PMCID: PMC6025684 DOI: 10.1007/s11606-018-4417-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/17/2018] [Accepted: 03/21/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Almost 40 million family caregivers care for a loved one with severe physical or cognitive impairments. The purpose of this review is to summarize evidence about the benefits of interventions to support or involve family members/caregivers of patients with trauma-related injury on caregiver, patient, and household outcomes. METHODS English-language peer-reviewed publications in MEDLINE, CINAHL, and PsycINFO from 1995 through December 2016 were identified. Eligible studies included RCT or quasi-experimental studies evaluating interventions designed to support or involve caregivers or family members of patients with TBI, PTSD, or polytrauma. Abstractions were completed by one reviewer and checked by a second; two reviewers independently assessed risk of bias using the Cochrane Effective Practice and Organization of Care Review Criteria. RESULTS Thirteen studies (n = 9 TBI; n = 4 PTSD, n = 0 polytrauma) evaluated psychological or rehabilitation interventions involving caregivers. Interventions did not improve TBI patients' functional status (standardized mean difference [SMD], 0.29 [95% confidence interval [CI], - 0.51 to 1.08]) or psychological symptoms (SMD - 0.25, CI - 0.62 to 0.12). Qualitative analysis shows potential intervention benefit for TBI symptoms. Interventions did not improve TBI caregiver psychological symptoms (SMD - 0.26, CI - 0.57 to 0.05); however, qualitative analysis suggests mixed effects for caregiver burden and quality of life. Positive intervention effects on patients' PTSD symptoms, mental health service use, and PTSD caregivers' psychological symptoms were identified with certain interventions. Strength of evidence ranged from moderate to very low. DISCUSSION Studies showed mixed patterns of intervention effects on caregiver and patient outcomes; evidence about intervention impact is inconclusive. This review is the first to identify caregiving interventions for patients with TBI and polytrauma and extends past reviews about patients with PTSD. Limitations include a small evidence base, low study quality, disparate methods, varied outcome measures, and high heterogeneity. PROSPERO Registration CRD42017053516.
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Affiliation(s)
- Megan E Shepherd-Banigan
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Abigail Shapiro
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer R McDuffie
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Mira Brancu
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nina R Sperber
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Courtney H Van Houtven
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Andrzej S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Neha N Mehta
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Avishek Nagi
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - John W Williams
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
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Families in Assertive Community Treatment (ACT) Teams in Norway: A Cross-Sectional Study on Relatives' Experiences of Involvement and Alienation. Community Ment Health J 2018; 54:686-697. [PMID: 29127565 DOI: 10.1007/s10597-017-0207-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
International research shows that relatives of people with mental illness are rarely involved by mental health services. Assertive Community Treatment (ACT) has been recently implemented in Norway. The experience of relatives of ACT users is largely unknown. The aim of this study was to explore relatives' experience with ACT-teams in Norway. Data were collected using the family involvement and alienation questionnaire, consisting of experiences of approach, and alienation from the provision of professional care. 38 Relatives participated in this study. A majority experienced a positive approach (openness, confirmation, and cooperation) from the ACT teams, which also was considered better compared to previous services. They considered openness and cooperation as essential aspects from the professionals. Almost half did not feel alienated (powerlessness and social isolation). Higher level of being approached positively was significantly associated with lower level of feeling alienated. The knowledge of what constituted relatives' positive experiences with the ACT teams should be transferred into practice regarding how to form a positive alliance with relatives.
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125
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Dalton J, Thomas S, Harden M, Eastwood A, Parker G. Updated meta-review of evidence on support for carers. J Health Serv Res Policy 2018; 23:196-207. [PMID: 29768942 DOI: 10.1177/1355819618766559] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To update a 2010 meta-review of systematic reviews of effective interventions to support carers of ill, disabled, or older adults. In this article, we report the most promising interventions based on the best available evidence. Methods Rapid meta-review of systematic reviews published from January 2009 to 2016. Results Sixty-one systematic reviews were included (27 high quality, 25 medium quality, and nine low quality). The quality of reviews has improved since the original review, but primary studies remain limited in quality and quantity. Fourteen high quality reviews focused on carers of people with dementia, four on carers of those with cancer, four on carers of people with stroke, three on carers of those at the end of life with various conditions, and two on carers of people with mental health problems. Multicomponent interventions featured prominently, emphasizing psychosocial or psychoeducational content, education and training. Improved outcomes for carers were reported for mental health, burden and stress, and wellbeing or quality of life. Negative effects were reported in reviews of respite care. As with earlier work, we found little robust evidence on the cost-effectiveness of reviewed interventions. Conclusions There is no 'one size fits all' intervention to support carers. There is potential for effective support in specific groups of carers, such as shared learning, cognitive reframing, meditation, and computer-delivered psychosocial support for carers of people with dementia. For carers of people with cancer, effective support may include psychosocial interventions, art therapy, and counselling. Carers of people with stroke may also benefit from counselling. More good quality, theory-based, primary research is needed.
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Affiliation(s)
- Jane Dalton
- 1 Research Fellow, Centre for Reviews and Dissemination, University of York, UK
| | - Sian Thomas
- 1 Research Fellow, Centre for Reviews and Dissemination, University of York, UK
| | - Melissa Harden
- 2 Information Specialist, Centre for Reviews and Dissemination, University of York, UK
| | - Alison Eastwood
- 3 Professor of Research, Centre for Reviews and Dissemination, University of York, UK
| | - Gillian Parker
- 4 Professor of Social Policy Research, Social Policy Research Unit, University of York, UK
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Hunger C, Hilzinger R, Bergmann NL, Mander J, Bents H, Ditzen B, Schweitzer J. Bezugspersonenbelastung erwachsener Patienten mit sozialer Angststörung. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0281-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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127
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Perry A, Gardener C, Dove J, Eiger Y, Loewenthal K. Improving mental health knowledge of the Charedi Orthodox Jewish Community in North London: A partnership project. Int J Soc Psychiatry 2018; 64:235-247. [PMID: 29460690 DOI: 10.1177/0020764018756935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This article describes a successful community-based partnership project between statutory and third-sector services targeting the strictly Orthodox Jewish community (OJC). METHODS The City and Hackney Black and Minority Ethnic (BME) Access Service (East London NHS Foundation Trust (ELFT)) collaborated with Bikur Cholim, a local third-sector organisation based in the heart of a north London Charedi OJC, to develop a brief culturally tailored psychoeducational group intervention focusing on mental health promotion and prevention. In total, 34 carers in the Charedi OJC were provided with general information on mental health, the availability of support services and self-care. RESULTS Overall improvements in well-being, increased intentions to access services, particularly talking therapies, and qualitative feedback indicated that the group was very well received. CONCLUSION The project endorses the value of culturally relevant psychoeducation, enabling suggestions for culturally appropriate service development.
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Affiliation(s)
| | | | - Jonathan Dove
- 1 East London NHS Foundation Trust, London, UK.,3 Bikur Cholim, London, UK
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Zhang T, Xu L, Tang Y, Cui H, Li H, Wei Y, Xu Y, Jiang L, Zhu Y, Li C, Jiang K, Xiao Z, Wang J. Using 'WeChat' online social networking in a real-world needs analysis of family members of youths at clinical high risk of psychosis. Aust N Z J Psychiatry 2018; 52:375-382. [PMID: 28587479 DOI: 10.1177/0004867417712460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The argument surrounding the safety and effectiveness of interventions for the population of individuals at a clinical high risk of developing psychosis has been ongoing for the past 30 years. However, few studies have assessed the needs of this special young population, who are struggling with the recent onset of psychotic symptoms. METHOD The sample consisted of 171 family members of 108 clinical high-risk individuals included from the ShangHai at Risk for Psychosis research programme. A 'WeChat' group was established to provide mutual support. There were 22,007 valid messages sent within the group between 1 April 2015 and 27 June 2016. Chat records were subsequently analysed to determine the needs of families during intervention at the early stages of psychosis. RESULTS Families of clinical high-risk individuals were highly involved in the entire medical process, and the major concerns of the families of clinical high-risk individuals focused on both functional recovery and medication. The themes of 'take medication', 'go to school' and 'study in school' were often discussed within the group. CONCLUSION A family-focused intervention targeting functional recovery and real-time professional explanations of medication would meet the major needs of families of Chinese clinical high-risk individuals.
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Affiliation(s)
- TianHong Zhang
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - LiHua Xu
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - YingYing Tang
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - HuiRu Cui
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - HuiJun Li
- 2 Department of Psychology, Florida Agricultural & Mechanical University, Tallahassee, FL, USA
| | - YanYan Wei
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - YangYang Xu
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - LiJuan Jiang
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - YiKang Zhu
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - ChunBo Li
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - KaiDa Jiang
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - ZePing Xiao
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - JiJun Wang
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- 3 Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, P.R. China
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Sin J, Henderson C, Spain D, Cornelius V, Chen T, Gillard S. eHealth interventions for family carers of people with long term illness: A promising approach? Clin Psychol Rev 2018; 60:109-125. [PMID: 29429856 DOI: 10.1016/j.cpr.2018.01.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 11/29/2017] [Accepted: 01/31/2018] [Indexed: 12/22/2022]
Abstract
Family carers of people who have long term illness often experience physical and mental health morbidities, and burden. While there is good evidence to suggest that carers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group-formats. eHealth interventions offer a novel, accessible and self-paced approach to care delivery. Whether these are effective for carers' wellbeing has been little explored. This paper reports the first comprehensive systematic review in this area. A total of 78 studies, describing 62 discrete interventions, were identified. Interventions commonly aimed to promote carers' knowledge, self-efficacy, caregiving appraisal, and reduce global health morbidities. Interventions were offered to carers of people with a wide range of long term illness; dementia has been the most researched area, as reported in 40% of studies. Clinical and methodological heterogeneity in interventions precluded meta-analyses, and so data were analysed narratively. The most popular approach has comprised psychoeducational interventions delivered via an enriched online environment with supplementary modes of communication, such as network support with professionals and peers. Overall, carers appreciate the flexibility and self-paced nature of eHealth interventions, with high rates of satisfaction and acceptability. More studies using robust designs are needed to extend the evidence base.
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Affiliation(s)
- Jacqueline Sin
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, England, UK; School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, Reading RG6 6AL, England, UK.
| | - Claire Henderson
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, England, UK.
| | - Debbie Spain
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, England, UK.
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, England, UK.
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, England, UK.
| | - Steve Gillard
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, England, UK.
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Rodríguez-Meirinhos A, Antolín-Suárez L, Oliva A. Support Needs of Families of Adolescents With Mental Illness: A Systematic Mixed Studies Review. Arch Psychiatr Nurs 2018; 32:152-163. [PMID: 29413065 DOI: 10.1016/j.apnu.2017.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ana Rodríguez-Meirinhos
- Department of Developmental and Educational Psychology, Universidad de Sevilla, Camilo José Cela, s/n, 41018 Seville, Spain.
| | - Lucía Antolín-Suárez
- Department of Developmental and Educational Psychology, Universidad de Sevilla, Camilo José Cela, s/n, 41018 Seville, Spain
| | - Alfredo Oliva
- Department of Developmental and Educational Psychology, Universidad de Sevilla, Camilo José Cela, s/n, 41018 Seville, Spain
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131
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Mirsepassi Z, Tabatabaee M, Sharifi V, Mottaghipour Y. Patient and family psychoeducation: Service development and implementation in a center in Iran. Int J Soc Psychiatry 2018; 64:73-79. [PMID: 29334847 DOI: 10.1177/0020764017747910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family and patient psychoeducation have demonstrated significant improvement in clinical and social outcomes for patients suffering from severe mental disorders and their families. However, these evidence-based practices are not widely implemented at service delivery level and into routine clinical practice, especially in less developed countries. AIM The aim of this article is to report the processes of development and implementation of a psychoeducational service for patients with severe mental illnesses and their families in Iran. METHOD The program was developed at Roozbeh Hospital in Tehran, Iran. A group of clinicians worked on the development phase of the program and drafting the manuals. Then, a series of workshops and supervision sessions were held to train group leaders for implementation of the group psychoeducation for patients and families. In the pilot phase, the services were delivered to two groups of patients and families, and then the manual was revised based on the feedback from group leaders and participants. RESULTS The program consisted of eight 90-minute weekly patient group sessions and 6 weekly multiple family group sessions. Two manuals for patient education (schizophrenia and bipolar disorder) were developed. Several information sheets were developed and distributed during different sessions of family and patient psychoeducation related to the content of each session. Despite providing the hospital clinicians with the information regarding these new services, less than 10% of the admitted patients were referred by their clinicians. CONCLUSION Feasibility and sustainability of the program are affected by a number of factors. Low referral rate of clinicians, limited resources of the hospital, issues related to stigma and logistic issues are barriers in implementation of these services. Administrators' and clinicians' understanding of the importance of patient and family psychoeducation seems to be crucial in sustainability of such programs in routine service delivery.
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Affiliation(s)
- Zahra Mirsepassi
- 1 Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tabatabaee
- 1 Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- 1 Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Mottaghipour
- 2 Department of Psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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132
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Amaresha AC, Kalmady SV, Joseph B, Agarwal SM, Narayanaswamy JC, Venkatasubramanian G, Muralidhar D, Subbakrishna DK. Short term effects of brief need based psychoeducation on knowledge, self-stigma, and burden among siblings of persons with schizophrenia: A prospective controlled trial. Asian J Psychiatr 2018; 32:59-66. [PMID: 29216608 DOI: 10.1016/j.ajp.2017.11.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022]
Abstract
Siblings of persons with schizophrenia are important in providing long-term social support to the patients. Interventions addressing their needs are very sparse. Hence, this study aimed at testing the short-term effects of brief need based psychoeducation on knowledge, self-stigma, and burden among siblings of persons with schizophrenia. In this prospective controlled open label trial, 80 siblings of persons with schizophrenia were allocated in equal numbers to the brief need based psychoeducation group and the treatment-as-usual group. The outcomes were measured at baseline, and after the first and third month post-intervention. RM-ANCOVA was conducted to test the effect of the brief psychoeducation on outcome scores. The groups were similar with respect to socio-demographic, clinical, and outcome scores at the baseline. There was a significant group×time interaction effect on knowledge (F=8.71; p<0.01; ηp2=0.14) and self-stigma scores (F=14.47; p<0.001; ηp2=0.21), wherein the brief psychoeducation group showed a significant increase in knowledge and reduction in self-stigma with medium effect size through baseline to the third month follow-up as compared to the treatment as usual group. We also observed a significant main effect of time; irrespective of the group allocation, there was a significant increase in the knowledge through baseline to third month follow-up (F=5.69; p=0.02; ηp2=0.09). No main or interaction effects of group and time were observed on burden. The findings suggest that brief need based psychoeducation may increase knowledge about the illness and reduce self-stigma. Further systematic studies are warranted to test this intervention for long-term effects.
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Affiliation(s)
- Anekal C Amaresha
- Department of Social Work, Christ University, Bengaluru, 560029, India.
| | - Sunil Vasu Kalmady
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, T6G 2E8 Canada
| | - Boban Joseph
- Department of Psychiatric Social Work and the Schizophrenia Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Sri Mahavir Agarwal
- Department of Psychiatry and the Schizophrenia Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry and the Schizophrenia Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry and the Schizophrenia Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Daliboina Muralidhar
- Department of Psychiatric Social Work and the Schizophrenia Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Doddaballapura K Subbakrishna
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
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Reupert A, Ward B, McCormick F, Ward C, Waller S, Kidd S. Developing a model of family focused practice with consumers, families, practitioners and managers: a community based participatory research approach. BMC Health Serv Res 2018; 18:66. [PMID: 29382350 PMCID: PMC5791189 DOI: 10.1186/s12913-018-2844-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/16/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND While governments are urging adult mental health services to support consumers in the context of their family, there is little information about what family focused practice is, nor how it might be enacted. METHODS Informed by the principles of Community Based Participatory Research, workshops were held in three rural Australian communities in 2015 to discuss the meaning of family focused practice and how such practices might be promoted. RESULTS Participants described the need to raise community awareness about mental illness and provide practical support to the family. Participants emphasized the importance of practitioners genuinely communicating with consumers and their families about mental illness and the need for collaborative care and treatment planning. They also highlighted the challenges of living in rural places and posed some solutions. CONCLUSION On the basis of the results and previous literature, we developed a model of family focused practice that outlined various stakeholders and their enactments. The model has the potential to inform policy, professional development and practice guidelines.
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Affiliation(s)
- Andrea Reupert
- Faculty of Education, Krongold, Monash University, Clayton, VIC 3800 Australia
| | - Bernadette Ward
- School of Rural Health, Monash University, PO Box 666, Bendigo, VIC 3552 Australia
| | - Francis McCormick
- Psychiatric Services, Bendigo Health, PO Box 126, Bendigo, VIC 3552 Australia
| | - Cathy Ward
- Murray City Coast Country GP Training, Bendigo, VIC 3550 Australia
| | - Susan Waller
- Monash Rural Health, Monash University, PO Box 397, Moe, VIC 3825 Australia
| | - Susan Kidd
- Psychiatric Services, Bendigo Health, PO Box 126, Bendigo, VIC 3552 Australia
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Allison S, Bastiampillai T, Castle D. Victoria's low availability of public psychiatric beds and the impact on patients, carers and staff. Aust N Z J Psychiatry 2018; 52:91-92. [PMID: 28742977 DOI: 10.1177/0004867417721019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephen Allison
- 1 Discipline of Psychiatry, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- 1 Discipline of Psychiatry, Flinders University, Adelaide, SA, Australia.,2 South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - David Castle
- 3 St. Vincent's Health, The University of Melbourne, Melbourne, VIC, Australia
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135
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Quinlan E, Deane FP, Crowe T, Caputi P. Do attachment anxiety and hostility mediate the relationship between experiential avoidance and interpersonal problems in mental health carers? JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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136
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Blanthorn-Hazell S, Gracia A, Roberts J, Boldeanu A, Judge D. A survey of caregiver burden in those providing informal care for patients with schizophrenia or bipolar disorder with agitation: results from a European study. Ann Gen Psychiatry 2018; 17:8. [PMID: 29456588 PMCID: PMC5810188 DOI: 10.1186/s12991-018-0178-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Agitation is a common feature of bipolar disorder and schizophrenia. Previous research indicates that specific symptoms impact caregiver burden in these conditions, but the impact of agitation on caregiver experience is poorly understood. The aim of this study was to characterise caregiver burden in providers of informal care for patients with bipolar disorder and schizophrenia who experience agitation. METHODS In total, 297 matched patient and caregiver surveys were collected across the UK, Germany and Spain between October 2016 and January 2017. To be eligible, caregivers needed to provide informal care to a patient with a diagnosis of bipolar disorder or schizophrenia with agitation managed in a community setting and participating in the patient survey. The caregiver survey captured information on demographics and their role in managing the patient's agitation. Caregiver burden was assessed using the Involvement Evaluation Questionnaire. Descriptive analysis was conducted. RESULTS Caregivers provided 38.3 h (SD ± 40.34) a week of support to the patient with 20% providing 50 h or more. Most caregivers reported that they recognised an episode of agitation all of the time (44%, n = 130) or sometimes (40%, n = 119). Verbal de-escalation techniques (talking (80%, n = 239) and soothing (73%, n = 218) were the most commonly reported strategies used by caregivers during an episode of agitation; 14% (n = 43) reported resorting to physically restraining the patient. Caregivers supervised rescue medication administration regularly (41%, n = 69) or occasionally (49%, n = 82). Mean Involvement Evaluation Questionnaire score was 32.2 (± 15.27), equivalent to 28.4 (± 13.56) in Germany, 35.6 (± 16.55) in Spain and 33.3 (± 15.15) in the UK. Involvement Evaluation Questionnaire scores were higher for caregivers who reported hostile (41.7 ± 17.07) lack of control (40.3 ± 16.35) and violent (39.5 ± 16.40) patient behaviours when agitated. Over excitement (31.8 ± 15.05), restless (32.6 ± 14.77) and tense (32.9 ± 15.64) behaviours were associated with a lower Involvement Evaluation Questionnaire score. CONCLUSIONS Caregivers are active participants in the recognition and management of agitation episodes. The substantial burden reported by these caregivers is impacted by factors including the number of hours of care provided, patient behaviours and country. These may be viable targets for effective interventions to reduce caregiver burden.
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Berger S, Chen T, Eldridge J, Thomas CA, Habermann B, Tickle-Degnen L. The self-management balancing act of spousal care partners in the case of Parkinson's disease. Disabil Rehabil 2017; 41:887-895. [PMID: 29228835 DOI: 10.1080/09638288.2017.1413427] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Living with and caring for someone with chronic illness can lead to limitations in activity and social participation for the care partner. Past research emphasizes the importance of care partners taking care of themselves physically and emotionally so they can stay healthy to support the care recipient. There is little information regarding how the care partner takes care of their own social lives. The purpose of this study was to explore the concept of social self-management from the perspective of spousal care partners of people with Parkinson's disease. METHOD Twenty spousal care partners of people with Parkinson's disease were interviewed three times. A grounded theory approach informed data analysis. RESULTS Findings that emerged from the data focused on balance in activities, support, and emotions and were summarized into three main themes: (1) Activities: Caregiving and beyond; (2) Strategies to support self and spouse; and (3) Emotional impact: Burden and compassion. CONCLUSION This research shows that care partners want to retain social participation and provides support for the importance of addressing the socio-emotional needs of care partners of people with a chronic disease. Interventions that guide care partners to take care of their spectrum of needs may lead to healthier, positive relationships. Implications for rehabilitation The focus of rehabilitation is often on the person diagnosed with the chronic condition. Living with and caring for someone with a chronic illness, such as Parkinson's disease, can lead to limitations in activity and social participation for the care partner. Including care partners in the rehabilitation process is key to helping maintain their health and well-being. Learning caregiving and self-management strategies may help care partners support their loved ones while staying socially engaged.
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Affiliation(s)
- Sue Berger
- a Department of Occupational Therapy , Boston University , Boston , MA , USA
| | - Tiffany Chen
- b Department of Occupational Therapy , Whittier Rehabilitation Hospital , Westborough , MA , USA
| | - Jenna Eldridge
- c Department of Occupational Therapy , Tufts University , Medford , MA , USA
| | - Cathi A Thomas
- d Department of Neurology , Boston University Medical Center , Boston , MA , USA
| | | | - Linda Tickle-Degnen
- c Department of Occupational Therapy , Tufts University , Medford , MA , USA
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Joy DS, Manoranjitham SD, Samuel P, Jacob KS. Explanatory models and distress in primary caregivers of patients with acute psychotic presentations: A study from South India. Int J Soc Psychiatry 2017; 63:563-568. [PMID: 28758522 DOI: 10.1177/0020764017722575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Emotional distress among caregivers of people with mental illness is common, changes overtime and requires appropriate coping strategies to prevent long-term disability. Explanatory models, which underpin understanding of disease and illness, are crucial to coping. AIM To study the association of explanatory models and distress among caregivers of people with acute psychotic illness. METHOD A total of 60 consecutive patients and their primary caregivers who presented to the Department of Psychiatry, Christian Medical College, Vellore, were recruited for the study. Positive and Negative Syndrome Scale (PANSS), Short Explanatory Model Interview (SEMI) and the General Health Questionnaire-12 (GHQ-12) were used to assess severity of psychosis, explanatory models of illness and emotional distress. Standard bivariate and multivariable statistics were employed. RESULTS Majority of the caregivers simultaneously held multiple models of illness, which included medical and non-medical perspectives. The GHQ-12 score were significantly lower in people who held multiple explanatory models of illness when compared to the caregivers who believed single explanations. CONCLUSION Explanatory models affect coping in caregivers of patients with acute psychotic presentations. There is a need to have a broad-based approach to recovery and care.
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Affiliation(s)
- Deepa S Joy
- 1 Department of Psychiatric Nursing, College of Nursing, Christian Medical College, Vellore, Vellore, India
| | - S D Manoranjitham
- 1 Department of Psychiatric Nursing, College of Nursing, Christian Medical College, Vellore, Vellore, India
| | - P Samuel
- 2 Department of Biostatistics, Christian Medical College, Vellore, Vellore, India
| | - K S Jacob
- 3 Department of Psychiatry, Christian Medical College, Vellore, Vellore, India
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Dirik A, Sandhu S, Giacco D, Barrett K, Bennison G, Collinson S, Priebe S. Why involve families in acute mental healthcare? A collaborative conceptual review. BMJ Open 2017; 7:e017680. [PMID: 28963308 PMCID: PMC5623469 DOI: 10.1136/bmjopen-2017-017680] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/29/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Family involvement is strongly recommended in clinical guidelines but suffers from poor implementation. To explore this topic at a conceptual level, a multidisciplinary review team including academics, clinicians and individuals with lived experience undertook a review to explore the theoretical background of family involvement models in acute mental health treatment and how this relates to their delivery. DESIGN A conceptual review was undertaken, including a systematic search and narrative synthesis. Included family models were mapped onto the most commonly referenced underlying theories: the diathesis-stress model, systems theories and postmodern theories of mental health. Common components of the models were summarised and compared. Lastly, a thematic analysis was undertaken to explore the role of patients and families in the delivery of the approaches. SETTING General adult acute mental health treatment. RESULTS Six distinct family involvement models were identified: Calgary Family Assessment and Intervention Models, ERIC (Equipe Rapide d'Intervention de Crise), Family Psychoeducation Models, Family Systems Approach, Open Dialogue and the Somerset Model. Findings indicated that despite wide variation in the theoretical models underlying family involvement models, there were many commonalities in their components, such as a focus on communication, language use and joint decision-making. Thematic analysis of the role of patients and families identified several issues for implementation. This included potential harms that could emerge during delivery of the models, such as imposing linear 'patient-carer' relationships and the risk of perceived coercion. CONCLUSIONS We conclude that future staff training may benefit from discussing the chosen family involvement model within the context of other theories of mental health. This may help to clarify the underlying purpose of family involvement and address the diverse needs and world views of patients, families and professionals in acute settings.
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Affiliation(s)
- Aysegul Dirik
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Sima Sandhu
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Katherine Barrett
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Gerry Bennison
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Sue Collinson
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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140
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Hsiao CY, Lee CT, Lu HL, Tsai YF. Living with schizophrenia: Health-related quality of life among primary family caregivers. J Clin Nurs 2017; 26:5151-5159. [PMID: 28881102 DOI: 10.1111/jocn.14063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To examine influencing factors of health-related quality of life in primary family caregivers of people with schizophrenia receiving inpatient psychiatric rehabilitation services. BACKGROUND Families, particularly primary family caregivers, have become more important than ever in mental health care. Yet, research on health-related quality of life among primarily family caregivers is limited. DESIGN A correlational study design was used. METHODS A convenience sample of 122 primary family caregivers participated in the study. Data were analysed with descriptive statistics, Pearson's product-moment correlation, t test, one-way analysis of variance and a hierarchical multiple regression analysis. RESULTS Primary family caregivers who were parents, older, less educated, and had a lower monthly household income, increased affiliate stigma and decreased quality of family-centred care experienced poor health-related quality of life. Particularly, monthly household income, affiliate stigma and quality of family-centred care appeared to be the most critical determinants of health-related quality of life. CONCLUSIONS Efforts to enhance satisfaction of life should focus on reducing affiliate stigma as well as increasing monthly household income and strengthening the quality of family-centred care. RELEVANCE TO CLINICAL PRACTICE Findings may assist in the development of culturally integrated rehabilitation programmes to decrease affiliate stigma and increase family engagement as a means of promoting quality of life for primary family caregivers living with people who have schizophrenia.
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Affiliation(s)
- Chiu-Yueh Hsiao
- Department of Nursing, College of Medical and Health Science, Asia University, Wufeng, Taichung, Taiwan, Republic of China
| | - Chun-Te Lee
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Huei-Lan Lu
- Jianan Psychiatric Center, Ministry of Health and Welfare, Rende, Tainan, Taiwan, Republic of China
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan, Republic of China.,Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan, Republic of China.,Department of Psychiatry, Chang Gung Memorial Hospital in Keelung, Keelung City, Taiwan, Republic of China
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141
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Wirsén E, Åkerlund S, Ingvarsdotter K, Hjärthag F, Östman M, Persson K. Burdens experienced and perceived needs of relatives of persons with SMI - a systematic meta-synthesis. J Ment Health 2017; 29:712-721. [PMID: 28853618 DOI: 10.1080/09638237.2017.1370632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Erik Wirsén
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Simon Åkerlund
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Karin Ingvarsdotter
- Department of Social Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | | | - Margareta Östman
- Department of Social Science, Faculty of Health and Society, Malmö University, Malmö, Sweden, and
| | - Karin Persson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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142
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Camilleri I, Ward M, Scerri J. Existing But Not Living: Experiences of Long-Term Caregivers of Individuals With Unipolar Depression. J Psychosoc Nurs Ment Health Serv 2017; 55:16-21. [PMID: 28840932 DOI: 10.3928/02793695-20170818-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/26/2017] [Indexed: 02/03/2023]
Abstract
The shift in care from long-term hospitalization of individuals with mental illness to the community places a greater onus of responsibility on informal caregivers. The purpose of the current study was to explore the lived experiences of long-term caregivers of individuals with unipolar depression. A qualitative phenomenological methodology was used and two sets of semi-structured interviews were conducted with nine informal caregivers. Data were transcribed following Giorgi's phenomenological method. The following three themes were identified: Flooded by Emotions, Personal Growth and Satisfaction, and Psychosocial Effects and Challenges. Caregivers described adapting by adjusting their behavior to avoid conflict with care recipients. These adjustments had a detrimental effect on their well-being, where they described that they were "existing but not living." These findings highlight the need for ongoing support, which should be tailored to the unique needs and concerns of individuals who are providing long-term care to individuals with depression. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 16-21.].
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143
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Jenkins PE, Bues S, Cottrell J, Hawkins J, Pinder L, Price S, Stewart A. A collaborative care skills workshop for carers: Can it be delivered in 1 day? Clin Psychol Psychother 2017; 25:130-137. [DOI: 10.1002/cpp.2119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Paul E. Jenkins
- Oxford Health NHS Foundation Trust; Warneford Hospital; Oxford UK
- University of Birmingham; Birmingham UK
| | - Sonia Bues
- Oxford Health NHS Foundation Trust; Warneford Hospital; Oxford UK
| | - Julie Cottrell
- Oxford Health NHS Foundation Trust; Warneford Hospital; Oxford UK
| | - Joel Hawkins
- Oxford Health NHS Foundation Trust; Warneford Hospital; Oxford UK
| | - Laura Pinder
- Oxford Health NHS Foundation Trust; Warneford Hospital; Oxford UK
| | - Susan Price
- Oxford Health NHS Foundation Trust; Warneford Hospital; Oxford UK
| | - Anne Stewart
- Oxford Health NHS Foundation Trust; Warneford Hospital; Oxford UK
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144
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McCann TV, Cotton SM, Lubman DI. Social problem solving in carers of young people with a first episode of psychosis: a randomized controlled trial. Early Interv Psychiatry 2017; 11:346-350. [PMID: 26592195 PMCID: PMC5573962 DOI: 10.1111/eip.12301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022]
Abstract
AIM Caring for young people with first-episode psychosis is difficult and demanding, and has detrimental effects on carers' well-being, with few evidence-based resources available to assist carers to deal with the problems they are confronted with in this situation. We aimed to examine if completion of a self-directed problem-solving bibliotherapy by first-time carers of young people with first-episode psychosis improved their social problem solving compared with carers who only received treatment as usual. METHODS A randomized controlled trial was carried out through two early intervention psychosis services in Melbourne, Australia. A sample of 124 carers were randomized to problem-solving bibliotherapy or treatment as usual. Participants were assessed at baseline, 6- and 16-week follow-up. RESULTS Intent-to-treat analyses were used and showed that recipients of bibliotherapy had greater social problem-solving abilities than those receiving treatment as usual, and these effects were maintained at both follow-up time points. CONCLUSIONS Our findings affirm that bibliotherapy, as a low-cost complement to treatment as usual for carers, had some effects in improving their problem-solving skills when addressing problems related to the care and support of young people with first-episode psychosis.
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Affiliation(s)
- Terence V McCann
- Centre for Chronic Disease, College of Health and Biomedicine (Discipline of Nursing), Victoria University, Melbourne, Victoria, Australia
| | - Sue M Cotton
- Orygen Youth Health Research Centre, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health and Monash University, Melbourne, Victoria, Australia
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145
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Effectiveness of psychoeducational interventions for family carers of people with psychosis: A systematic review and meta-analysis. Clin Psychol Rev 2017; 56:13-24. [DOI: 10.1016/j.cpr.2017.05.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/25/2016] [Accepted: 05/23/2017] [Indexed: 02/03/2023]
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146
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A pilot randomized controlled trial of E-care for caregivers: An internet intervention for caregivers of depressed patients. Internet Interv 2017; 9:88-99. [PMID: 30135842 PMCID: PMC6096299 DOI: 10.1016/j.invent.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/15/2017] [Accepted: 06/23/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression has a high impact on both patients and the people around them. These non-professional caregivers often experience overburdening and are at risk for developing psychological symptoms themselves. Internet interventions have the potential to be accessible and (cost)-effective in terms of reducing and preventing psychological symptoms. Less is known about their potential to decrease psychological distress among caregivers. The primary aim of this study is to evaluate (1) the user-friendliness and (2) the initial short-term effects on psychological distress of 'E-care for caregivers', an internet based guided self-management intervention for non-professional caregivers of depressed patients. METHODS A pilot randomized controlled trial (RCT: n = 80) comparing 'E-care for caregivers' (n = 41) with a waitlist-control group (n = 39). The primary outcome measure (user-friendliness) was assessed with the System Usability Scale (SUS) and semi-structured telephone interviews among participants. Interviews were qualitatively analyzed with thematic content analysis. Secondary outcomes were assessed through online questionnaires administered at baseline and post-intervention at six weeks among caregivers. Statistical analyses were conducted according to the intention-to-treat principle using regression techniques for the secondary outcomes. RESULTS All participants were recruited within six weeks through online advertising. Two-thirds of participants experienced higher levels of psychological distress (K10 > 20). The internet intervention was evaluated as user-friendly by caregivers (average score of 81.5, range [0-100]). Results did not show a reduction in psychological distress or other secondary outcome measures. Sensitivity analyses showed a decreased quality of life in the control condition compared to the intervention condition (p = 0.02, Cohen's d = 0.44) and higher levels of mastery (p = 0.02, Cohen's d = 0.48) in the intervention condition compared to controls. DISCUSSION The internet intervention was evaluated positively for usability and was considered as easy to use. The study did not show a reduction in symptoms of psychological distress. However, there were some indications that those completing the internet intervention perceived higher levels of mastery and a protective effect in quality of life post-intervention. STRENGTHS AND LIMITATIONS As far as we know, this study is the first to examine the user-friendliness and initial effects of an internet intervention specifically designed for non-professional caregivers of depressed patients. As this was a pilot study, the findings should be interpreted with caution. We recommend investigating the possibilities of providing a (partially) sequential design as well as incorporating themes like stigma and expressed emotion in the online course and subsequent evaluation of the internet intervention in a full-scale RCT, with a six-month follow-up. TRIAL REGISTRATION Netherlands Trial Register: NTR5268. Registered on 30 June 2015.
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147
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Bademli K, Lök N, Kılıc AK. Relationship Between Caregiving Burden and Anger Level in Primary Caregivers of Individuals With Chronic Mental Illness. Arch Psychiatr Nurs 2017; 31:263-268. [PMID: 28499565 DOI: 10.1016/j.apnu.2016.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/14/2016] [Accepted: 12/01/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objective of this study was answer to the question: to what extent are the anger of the caregivers of patients diagnosed with schizophrenia and their perceived level of burden are related? METHOD The study is a descriptive and correlational study. The information form prepared by the researchers which questions the socio-demographic information of the individuals along with the "Caregiving Burden Inventory" which examines the burden of the caregiver as well as "Trait Anger and Anger Expression Style Scale (TAAES)" which determines the anger levels of the caregivers were used. RESULTS The caregiving burdens of the caregivers according to the score averages were determined as 11.88±9.78 for time and dependency burden, 11.93±8.46 for developmental burden, 8.47±6.63 for physical burden, 5.61±5.26 for social burden, 6.29±5.25 for emotional burden and the total burden score was determined as 44.19±26.75. According to the trait anger and anger expression style scale score averages; trait anger was determined as 15.12±5.95, anger expression as 9.70±3.43, anger-in as 15.22±4.02, anger control as 28.05±5.57 and anger total score average as 68.11±9.97. CONCLUSION According to the results obtained from this study, caregivers of schizophrenia patients experience developmental, physical, social and emotional burdens in addition to trait anger. The caregivers of schizophrenia patients need knowledge and support in order to control the burden and the anger they experience during the caregiving process.
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Affiliation(s)
- Kerime Bademli
- Akdeniz University Faculty of Nursing, 07050 Antalya, Turkey.
| | - Neslihan Lök
- Selçuk University Faculty of Health Science, Konya, Turkey
| | - Ayten Kaya Kılıc
- Antalya Kamu Hastaneleri Birliği Antalya Eğitim Araştırma Hastanesi, Toplum Ruh Sağlığı Merkezi, Turkey
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148
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Abstract
AIMS Few studies have examined the experiences of carers of people with psychosis using a representative sample. Aiming to obtain generalisable results concerning carers in the context of increased emphasis on involving carers in Australian mental health service delivery and policy frameworks, this study recruited carers within the second Australian national survey of psychotic disorders (Survey of High Impact Psychosis, SHIP). Given that most SHIP participants had long-term illness and extended relationships with carers, the health and wellbeing of carers as a group were expected to be relatively stable. However, since it is unknown whether carers' health and wellbeing would change, our main aim was to explore change and stability in carers' health and wellbeing and the relationship between any changes experienced by individual carers and corresponding SHIP participants' functioning over time. METHODS Ninety-eight caregivers of SHIP participants were recruited at baseline and completed validated instruments assessing their health and wellbeing. Seventy-eight carers were re-interviewed at 1-year follow-up. Clinical factors were extracted from the SHIP database. Wilcoxon matched-pairs signed-rank test and t-test were used to analyse changes in variables over time. Cross-lagged analyses were conducted to identify possible causative relationships in changes in SHIP participant and carer variables. RESULTS A substantial percentage of carers experienced social isolation (28.6%), psychological distress (37.7%) and poorer quality of life than population norms. There were no statistically significant changes between baseline and follow-up scores for almost all carers' health and wellbeing variables, other than a poorer perception of their quality of life in relation to their physical health after 1 year. Cross-lagged analyses suggested that poorer functioning of people with psychosis influenced carers' social isolation, grief and psychological distress. CONCLUSIONS Findings show that carers' perception of their health and wellbeing did not improve within current mental health service delivery frameworks over time. Carer's persistently poor health and wellbeing suggests a pressing need to enhance services that improve carers' health and wellbeing especially their physical health and the functioning of people with psychosis whom they support.
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149
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Ruggeri M, Lasalvia A, Santonastaso P, Pileggi F, Leuci E, Miceli M, Scarone S, Torresani S, Tosato S, De Santi K, Cristofalo D, Comacchio C, Tomassi S, Cremonese C, Fioritti A, Patelli G, Bonetto C. Family Burden, Emotional Distress and Service Satisfaction in First Episode Psychosis. Data from the GET UP Trial. Front Psychol 2017; 8:721. [PMID: 28559862 PMCID: PMC5432637 DOI: 10.3389/fpsyg.2017.00721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/21/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Literature has documented the role of family in the outcome of chronic schizophrenia. In the light of this, family interventions (FIs) are becoming an integral component of treatment for psychosis. The First Episode of Psychosis (FEP) is the period when most of the changes in family atmosphere are observed; unfortunately, few studies on the relatives are available. Objective: To explore burden of care and emotional distress at baseline and at 9-month follow-up and the levels of service satisfaction at follow-up in the two groups of relatives (experimental treatment EXP vs. treatment as usual TAU) recruited in the cluster-randomized controlled GET UP PIANO trial. Methods: The experimental treatment was provided by routine public Community Mental Health Centers (Italian National Health Service) and consisted of Treatment as Usual plus evidence-based additional treatment (Cognitive Behavioral Therapy for psychosis for patients, Family Intervention for psychosis, and Case Management). TAU consisted of personalized outpatient psychopharmacological treatment, combined with non-specific supportive clinical management and informal support/educational sessions for families. The outcomes on relatives were assessed by the Involvement Evaluation Questionnaire (IEQ-EU), the General Health Questionnaire (GHQ-12), and the Verona Service Satisfaction Scale (VSSS-EU). Differences within and between groups were evaluated. Results: At baseline, 75 TAU and 185 EXP caregivers were assessed. In the experimental group 92% of relatives participated in at least 1 family session. At follow-up both groups experienced improvement in all IEQ and GHQ items, but caregivers belonging to the EXP arm experienced a significantly greater change in 10 IEQ items (mainly pertaining to the “Tension” dimension) and in GHQ items. Due to the low sample size, a significant effectiveness was only observed for 2 IEQ items and 1 GHQ-12 item. With respect to VSSS data at follow-up, caregivers in the EXP arm experienced significantly greater satisfaction in 8 items, almost all pertaining to the dimensions “Relatives' Involvement” and “Professionals' Skills and Behavior.” Conclusions: The Family intervention for psychosis delivered in the GET UP PIANO trial reduced family burden of illness and improved emotional distress and satisfaction with services. These results should encourage to promote FIs on caregivers of first-episode psychosis patients.
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Affiliation(s)
- Mirella Ruggeri
- UOC Psichiatria, Azienda Ospedaliera Universitaria IntegrataVerona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Antonio Lasalvia
- UOC Psichiatria, Azienda Ospedaliera Universitaria IntegrataVerona, Italy
| | - Paolo Santonastaso
- Department of Neurosciences, University of Padova and Azienda OspedalieraPadova, Italy
| | | | - Emanuela Leuci
- Department of Mental Health, Azienda USL ParmaParma, Italy
| | - Maurizio Miceli
- Department of Mental Health, Azienda USL FirenzeFirenze, Italy
| | - Silvio Scarone
- Department of Psychiatry, University of MilanoMilan, Italy
| | | | - Sarah Tosato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Katia De Santi
- UOC Psichiatria, Azienda Ospedaliera Universitaria IntegrataVerona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Carla Comacchio
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Simona Tomassi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Carla Cremonese
- Department of Neurosciences, University of Padova and Azienda OspedalieraPadova, Italy
| | - Angelo Fioritti
- Department of Mental Health, Azienda USL BolognaBologna, Italy
| | - Giovanni Patelli
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma2000Milan, Italy
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
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Onwumere J, Kuipers E. Caregiving roles: when will they be routinely recognized and supported? J Ment Health 2017; 26:95-97. [DOI: 10.1080/09638237.2017.1301649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Juliana Onwumere
- Psychology Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Elizabeth Kuipers
- Psychology Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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