Predicting schizophrenia outcome with self-report measures of family interaction

Evaluation of parent bonding style and traumatic experiences in patients with schizophrenia and bipolar disorder: A case-control study

BACKGROUND

There is no consensus about the etiology of schizophrenia (SQZ) and bipolar disorder (BD). Both hereditary and environmental factors are recognized, but the importance of variables like the role of parental attachment and trauma is still under research.

AIMS

Evaluate and compare the patient-parent bonding and the frequency and severity of various types of trauma in patients with SQZ, BD, and a control group from Primary Health Care.

METHOD

This study included 50 patients with SQZ and 50 with BD followed at a psychiatric hospital, through a convenience sample. Each participant of the clinical sample was paired with a control with no psychiatric background of the same gender and similar age, from a primary health center. Two scales were applied - Parental Bonding Instrument (PBI) and Childhood Trauma Questionnaire - Short Form (CTQ-SF).

RESULTS

Regarding PBI, there was a higher frequency of the most dysfunctional attachment style (affectionless control), in patients with SQZ and BD, with p < .001 (always), both for the father and the mother. In addition, ideal parenting style (optimal parenting) was significantly more common in control samples, with p = .002 or <.001, both for the father and for the mother. Trauma was more frequent and severe in SQZ and BD than controls, in all evaluated dimensions. Again, differences between groups are obvious, with p = .012 or <.001. Parental bonding style and scores in the care and overprotection dimensions were also correlated. The only parental bonding style in which correlations were found was in affectionless control. Correlations were more common in cases of neglect compared to abuse.

CONCLUSIONS

In this research we found important differences in terms of parental attachment and childhood trauma between patients with SQZ and BD, compared with controls of the same gender and age.

Parental bonding style and illness severity in a longitudinal study of individuals with first episode psychosis

A parenting style with high amounts of control combined with low caring or nurturing behaviour has been reported in association with mental disorders including schizophrenia. However, the association of parenting style with illness severity in individuals with schizophrenia has never been evaluated retrospectively or over a longitudinal time course. In a subset (n = 84) of the participants included in the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses)-10 study, we evaluated participants' perceptions of their own parents' bonding style at the time of their first episode of psychosis using the parental bonding instrument (PBI). We then examined the association between different bonding styles, illness course and severity, and global functioning over a 10-year follow-up. Participants who perceived that their fathers had a more caring and less controlling parenting style showed better functioning at follow-up. However, in contrast to previous research, participants who reported having been subject to uncaring and controlling parenting styles were not found to have a notably worse course of illness or symptom severity over the follow-up period. These results indicate that more optimal parental bonding styles may be associated with better overall functioning in individuals with psychosis but not with other measures of illness outcome.

The effect of family environment and psychiatric family history on psychosocial functioning in first-episode psychosis at baseline and after 2 years

The aim of the present study was to evaluate the contribution of family environment styles and psychiatric family history on functioning of patients presenting first-episode psychosis (FEP). Patients with FEP and healthy controls (HC) were assessed at baseline and after 2 years. The Functional Assessment Short Test (FAST) was used to assess functional outcome and the Family Environment Scale (FES) to evaluate family environment. Linear regressions evaluated the effect that family environment exerts on functioning at baseline and at 2-year follow-up, when FEP patients were diagnosed according to non-affective (NA-PSYCH) or affective psychoses (A-PSYCH). The influence of a positive parents' psychiatric history on functioning was evaluated through one-way between-groups analysis of covariance (ANCOVA) models, after controlling for family environmental styles. At baseline, FEP patients presented moderate functioning impairment, significantly worse than HC (28.65±16.17 versus 3.25±7.92; p<0.001, g = 1.91). At 2-year follow-up, the functioning of NA-PSYCH patients was significantly worse than in A-PSYCH (19.92±14.83 versus 12.46±14.86; p = 0.020, g = 0.50). No specific family environment style was associated with functioning in FEP patients and HC. On the contrary, a positive psychiatric father's history influenced functioning of FEP patients. After 2 years, worse functioning in NA-PSYCH patients was associated with lower rates of active-recreational and achievement orientated family environment and with higher rates of moral-religious emphasis and control. In A-PSYCH, worse functioning was associated with higher rates of conflict in the family. Both family environment and psychiatric history influence psychosocial functioning, with important implications for early interventions, that should involve both patients and caregivers.

The Role of Gender in Shame, Hostility, and Aggression Experienced by Caregivers for Patients With Dementia

The aim of this study was to investigate the differences between male and female caregivers for patients with dementia in the way they experience various psychosocial parameters such as shame, hostility, and aggression. The sample included 55 caregivers of patients with moderate and severe dementia, whereas the average age was 51 years. Female caregivers were found to experience significantly higher levels of external shame, measured by Other As Shamer scale, than male caregivers, t (53) = 2.54, P < .01. A significant difference was also found between the female and male caregivers regarding their recorded levels of internal shame, measured by Experience of Shame Scale, with female caregivers experiencing more internal shame than their male counterparts, t (53) = 2.11, P < .01. However, no significant differences were found in hostility and aggression between males and females. These results demonstrate the existence of gender differences in the levels of shame experienced by care providers for patients with dementia.

Parental style and Cloninger's model in psychosis

Parental style and Cloninger's dimensions are associated with psychosis, but it is still unclear whether temperament, character and parenting variables are linked to specific psychotic symptoms. This study extends previous research exploring these issues. 78 patients with psychosis and 156 control subjects were recruited. Parental style was evaluated using the Measure of Parental Style. Temperament and character were evaluated using the Temperament and Character Inventory-Revised. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale. T-tests, correlations and moderation and mediation analyses were performed. Patients reported dysfunctional parenting and had higher scores for harm avoidance (HA) and self transcendence (ST), and lower scores for self directedness (SD) and cooperativeness (CO) than controls. Maternal indifference, abuse and overcontrol were correlated with positive symptoms (PS). Novelty seeking (NS), reward dependence, SD, CO were correlated with PS; HA and ST were correlated with negative symptoms. After adjusting for age, gender and family history of psychopathology lower CO partially mediated the relationship between maternal abuse and PS; the positive NS-maternal abuse interaction was associated with PS. Different parenting and personality variables may be associated with different psychotic symptoms. NS and CO may be part of a pathway between maternal abuse and PS.

Further results on the reliability of the Parental Bonding Instrument (PBI) in an Italian sample of schizophrenic patients and their parents

The reliability of the Italian version of the Parental Bonding Instrument (PBI) was assessed in a group of 26 schizophrenic patients and their parents. In both groups, internal consistency indices were satisfactory and mean PBI scores at test and retest were stable. The test-retest reliability coefficients for the PBI scales of parents ranged from .65 to .67, those of the patients from .32 (paternal-protection score) to .67 (maternal-care score). The less satisfactory test-retest reliability of patients' paternal protection score was due to minor intra-category rather than inter-category variations in their ratings. This suggests difficulties with a four-point rating scale, which might depend partly on the generally poor schooling of the sample, but it may also reflect uncertainty of schizophrenic patients concerning fathers' controlling behavior. Further studies should pay attention to this factor. Patients' PBI mean scores are compatible with an affection-less control rearing style, while those of their parents, characterized by similar poor care but less control, are consistent with a pattern of weak parental bonding.

Comparison of schizophrenic patients' families and normal families in China, using Chinese versions of FACES-II and the Family Environment Scales

The lack of measures that systematically evaluate the characteristics and functioning of Chinese families is hindering the development of appropriate family interventions for schizophrenia in China. We assessed the reliability and validity of revised and adapted Chinese versions (CV) of the Family Adaptability and Cohesion Evaluation Scales (FACES-II-CV) and the Family Environment Scales (FES-CV) and administered these instruments to 120 respondents from families with a schizophrenic member and 126 respondents from control families. The psychometric properties of the FACES-II-CV and of the FES-CV Cohesion, Conflict, Intellectual-Cultural Orientation, and Active-Recreational Orientation scales are satisfactory, so they are appropriate for use in China; the remaining six FES-CV scales require further culturally appropriate revision. Compared to control families, families with schizophrenic patients in China have higher conflict, lower cohesion, poor adaptability, and are less likely to be involved in intellectual and recreational activities. These differences remained significant after adjusting for family and respondent characteristics.

[Parental bonding as a predictive factor for the development of adult psychiatric disorders]

OBJECTIVE

To asses the capacity of the Parental Bonding Instrument (PBI) to discriminate between normal subjects and clinical samples and between with different psychiatric diagnosis.

DESIGN

The present paper analyzes the studies published between 1979 and 1995, which have used the PBI in normal subjects and clinical samples and have reported the respective means and standard deviations obtained on the two PBI dimensions: affection and control. Multiple comparisons were carried out between the mean scores of affection and control of: 1) samples with the same psychiatric diagnosis (intragroup comparison); 2) samples with different psychiatric diagnoses (intergroup comparison); 3) normal subjects and clinical samples.

RESULTS

Of the 46 studies with normal and clinical subjects, 23 studies were selected for the analysis, reporting means and standard deviations and specifying the diagnostic criteria. Samples with the same psychiatric diagnosis had similar affection and control scores. With the exception of bipolar affective disorders and avoidant personality disorders, the prevalent parental style was for all diagnostic groups the affectionless control style. Within the affectionless control style, the PBI discriminated between panic attacks, borderline personality and drug addiction but not between schizophrenia, unipolar depression and anxiety disorder. The PBI discriminated also between normal subjects samples and samples with anxiety disorder, schizophrenia, bipolar affective disorder, personality disorder and drug addiction respectively.

CONCLUSION

The results confirm previous suggestions from single studies that the perceived parental style as measured by the PBI can be considered a good predictor for the presence of psychiatric disorders excluding panic attacks, avoidant personality disorders and unipolar affective disorders. Although the different diagnostic groups do not differ in their perceived parental style (affectionless control), significant differences between some diagnostic groups within this category suggest that the PBI might have some specificity as well.

Family environment predictors of outcome in schizophrenic patients in Spain: a nine-month follow-up study

This study investigates the effects of perceived family environment on clinical outcome among patients in Spain who suffer from schizophrenia. Forty-five consecutively admitted DSM-III-R schizophrenic patients were assessed monthly with the Brief Psychiatric Rating Scale during a 9-month period. Patients and parents rated the family environment through the Family Environment Scale (FES). FES factors were considered separately for each family member, since parents' and patient's perceptions of the family environment were weakly correlated. Stepwise multiple regression analysis showed that patients' perceptions of family control and intellectual-cultural orientation predicted rehospitalization. Patients' and mothers' ratings of family control and fathers' scores of conflict and moral religious emphasis predicted psychotic relapse. However, fathers' scores of family cohesion predicted higher negative symptoms. Prior admissions, age of onset and use of depot medication tended to predict outcome in conjunction with the family variables.