The role of personal loss in the caregiving experiences of well siblings of adults with serious mental illness

Filling the Void: The Role of Adult Siblings Caring for a Brother or Sister With Severe Mental Illness

Little is known about the role of adult siblings’ caregiver role within the context of mental illness. Therefore, our purpose was to explore how siblings narrate their experiences of being the main caregivers of a brother or sister with severe mental illness and how they cooperate with their ill sibling and their family of origin. We used a narrative hermeneutic approach and performed a secondary analysis of two interviews of siblings derived from a study of peoples’ experiences of hearing voices. The findings illuminate the participants’ multifaceted roles and how differently siblings might deal with the multiple challenges of caring for an ill sibling. The mediating role between their ill sibling and their family of origin to reestablish the broken family bonds was a significant aspect. Nurses’ awareness of the important and multidimensional role of caregiving siblings can improve the provision of family support and promote involvement of siblings in the treatment of an ill family member.

The experiential perspectives of siblings and partners caring for a loved one with an eating disorder in the UK

BACKGROUND

Caring for a loved one with an eating disorder typically comes with a multitude of challenges, yet siblings and partners are often overlooked. It is important to understand if current clinical guidance for supporting carers are effective and being utilised for these groups, to help meet their needs.

AIMS

To identify the experiential perspectives of siblings and partners of a loved one with an eating disorder compared with guidance for improving the adequacy of support provided to carers published by Beat and Academy for Eating Disorders.

METHOD

Three online focus groups were held for ten siblings and five partners from across the UK (12 females and three males). Carers had experience of caring for a loved one with anorexia nervosa (13 carers) or bulimia nervosa (two carers), across a range of therapeutic settings. Focus group transcriptions were analysed with thematic analysis.

RESULTS

Four key themes were identified: (a) role-specific needs, (b) challenges encountered by siblings and partners, (c) generic needs and helpful strategies or approaches, and (d) accounts of service provision and family support.

CONCLUSIONS

Overall, the majority of experiences reported by siblings and partners did not meet the published guidance. Consequently, clinical practice recommendations were identified for services, alongside the charity sector, to take a proactive approach in detecting difficulties, providing skills training and emotional/practical support, adapting/tailoring peer support groups and supporting online facilitation. Our findings part-informed the design of our national online survey on loved ones' experiences of care in eating disorders.

Non-psychopathology Related Outcomes Among Siblings of Individuals with Mental Illness: A Systematic Review

The current study consists of a systematic review of the quantitative literature on siblings of individuals with mental illness (MI). Despite the prevalence of mental illness, little is known about how siblings are specifically affected in areas of psychosocial, emotional, and behavioral outcomes. The review yielded 56 studies that examined outcomes such as behavior problems, the sibling relationship, caregiving experiences, and knowledge of mental illness among siblings. The majority of studies from the initial search were focused on siblings-as-comparison group, examining siblings for risk factors for developing mental illness. In total, the study samples covered a sibling age range of 6-81 and a patient age range of 4-84. About half (k = 27) of the included studies had samples primarily composed of siblings of individuals with schizophrenia, leaving other MI diagnoses such as depression, anxiety, and mood disorders underrepresented. However, results from comparison studies were mixed-half found that the MI-Sibs had fewer negative outcomes than the comparison group, and half found that MI-Sibs had more negative outcomes. Multiple factors, including female sibling gender, greater severity of MI symptoms, and belief in the patient's ability to control their own behavior, were all related to more negative outcomes for MI-Sibs. Future work will focus on expanding the representativeness of MI-Sibs samples and analyzing experiences of both the sibling and the individual with MI.

Siblings of Individuals With Eating Disorders: A Review of the Literature

Eating disorders (EDs) are serious psychopathologies characterized by a persistent disturbance in eating or eating-related behavior. Studies have shown EDs' detrimental consequences not only for patients, but also for their families. Nevertheless, a specific group that has so far been neglected, in both the research and clinical fields, are siblings of individuals with EDs. In an effort to identify this population's needs, and to facilitate effective prevention and treatment, this paper aims to review the existing literature on the subject, and examine siblings' personal experience, ways of coping, and levels of psychopathology. PubMed and PsycNet databases were searched with no publication date restrictions, yielding 26 relevant papers. Studies were categorized according to common themes they addressed, and subsequently summarized by highlighting common features, as well as information unique to each study. Several themes emerged, including emotional well-being, psychopathology, social consequences, family dynamics, and coping strategies. Results show that EDs experienced by one individual have significant effects on one's siblings, such as a decrease in quality of life, social isolation, and elevated familial strain. In several studies siblings were found to have elevated levels of psychopathology and EDs related symptoms. Nevertheless, findings' nature and magnitude were highly varied. The review indicates the need for further studies that will examine possible intra- and interpersonal moderating factors for EDs' impact on well-being among siblings, and take into consideration the substantial heterogeneity in studies conducted thus far. Additionally, this review highlights the need for novel and effective interventions, specifically targeting this at-risk group.

Experiencing the relationship with a sibling coping with mental health problems: Dilemmas of connection, communication, and role

Prolonged mental health problems of one family member influences the whole family system, including sibling relationships. The current research focuses on the way siblings of persons with mental health problems experience the relationship. The findings identify the challenges and difficulties these siblings face and can help mental health practitioners support siblings as well as their brothers and sisters with mental health problems. This qualitative research employs the Interpretative Phenomenological Analysis method. Data were collected through in-depth semi-structured interviews with 14 adult siblings of persons coping with prolonged mental health problems. The sample included seven men and seven women, between the ages of 20-55. Three main themes were identified: (a) Connection: Between involvement and distance; (b) Communication: Controlled confrontation or cautious vagueness; (c) Role: Positioning in the sibling relationship. The discussion introduces the Relational Dialectics Theory in order to understand contradictory statements that arise from the interviewees' experience of dialectal tensions between: involvement versus distancing; direct confrontation versus cautious vagueness; and opposing positions in relation to the sibling coping with mental health problems. A multi-voiced discourse allows for dialogue that incorporates the contradictory poles of the dialectic, thus enabling the siblings to balance the tension in the relationship. In addition, the concept of ambiguous loss is used to interpret the findings. The study is limited by the small homogeneous sample. The results highlight the need for practitioners to give special attention to siblings of persons with mental health problems in order to help them process and cope with the challenges in the relationship, thus providing an opportunity for growth and empowerment.

Aggressive Children With Mental Illness: A Conceptual Model of Family-Level Outcomes

The purpose of this research was to examine how families adapt and respond to an aggressive child with mental illness. This article presents findings from a qualitative study of four families, which were selected as typifying the experiences of a larger sample of 14 families; each family included a child with mental illness and a history of violent behavior. The analysis revealed a five-stage pattern in how families perceived and responded to victimization and their child or sibling's mental illness. The study suggests that families with a violent child with mental illness and other healthy children cannot live through episodes of violence without removing the child with mental illness from the home or suffering considerable damage to the family. The article concludes with recommendations for mental health practitioners and family intervention specialists.

Factors of caregiver burden and family functioning among Taiwanese family caregivers living with schizophrenia

AIMS AND OBJECTIVES

To assess the degree of caregiver burden and family functioning among Taiwanese primary family caregivers of people with schizophrenia and to test its association with demographic characteristics, family demands, sense of coherence and family hardiness.

BACKGROUND

Family caregiving is a great concern in mental illness. Yet, the correlates of caregiver burden and family functioning in primary family caregivers of individuals with schizophrenia still remain unclear.

DESIGN

A cross-sectional descriptive study.

METHODS

A convenience sample of 137 primary family caregivers was recruited from two psychiatric outpatient clinics in Taiwan. Measures included a demographic information sheet and the Chinese versions of the Family Stressors Index, Family Strains Index, 13-item Sense of Coherence Scale, 18-item Caregiver Burden Scale, Family Hardiness Index and Family Adaptability, Partnership, Growth, Affection, and Resolve Index. Data analysis included descriptive statistics, Pearson's product-moment correlation coefficients, t-test, one-way analysis of variance and a stepwise multiple linear regression.

3 RESULTS

Female caregivers, additional dependent relatives, increased family demands and decreased sense of coherence significantly increased caregiver burden, whereas siblings as caregivers reported lower degrees of burden than parental caregivers. Family caregivers with lower family demands, increased family hardiness and higher educational level had significantly enhanced family functioning. Sense of coherence was significantly correlated with family hardiness.

CONCLUSIONS

Our findings highlighted the importance of sense of coherence and family hardiness in individual and family adaptation. Special attention needs to focus on therapeutic interventions that enhance sense of coherence and family hardiness, thereby improving the perception of burden of care and family functioning.

RELEVANCE TO CLINICAL PRACTICE

Given the nature of family caregiving in schizophrenia, understanding of correlates of caregiver burden and family functioning would help provide useful avenues for the development of family-focused intervention in psychiatric mental health nursing practice.