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Hernandez M, Barrio C. Families and medication use and adherence among Latinos with schizophrenia. J Ment Health 2016; 26:14-20. [PMID: 27690706 DOI: 10.1080/09638237.2016.1222061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Medication nonadherence among Latinos with schizophrenia represents a significant treatment obstacle. Although some studies have examined patient and family perceptions of adherence, few have examined these perceptions together. However, such knowledge can provide a deeper understanding of how family processes may contribute to or impede adherence among underserved groups such as Latinos. AIMS This study explored perceptions of medication and adherence among Latinos with schizophrenia and key family members. METHOD Purposive sampling was used to collect data from 34 participants: 14 patients with schizophrenia receiving community-based mental health services in an urban public setting and 20 key family members. Informed by grounded theory, semistructured interviews were analyzed by bilingual-bicultural team members. RESULTS Salient themes emerged indicating facilitators of and obstacles to medication use. Specifically, challenges centered on medication side effects, autonomy and choice, and illness insight, whereas facilitators focused on family support and holistic views of treatment and empowerment. CONCLUSIONS Because the majority of Spanish-speaking Latinos with schizophrenia live with family, it is important to examine family factors that may influence medication use. Findings suggest that patient and family perceptions of medication should be examined as part of the treatment process, particularly regarding issues of autonomy and choice.
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Affiliation(s)
- Mercedes Hernandez
- a School of Social Work, University of Southern California , Los Angeles , CA , USA
| | - Concepción Barrio
- a School of Social Work, University of Southern California , Los Angeles , CA , USA
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Gater A, Rofail D, Marshall C, Tolley C, Abetz-Webb L, Zarit SH, Berardo CG. Assessing the Impact of Caring for a Person with Schizophrenia: Development of the Schizophrenia Caregiver Questionnaire. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:507-20. [PMID: 25680337 PMCID: PMC4662958 DOI: 10.1007/s40271-015-0114-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background The responsibilities of caring for a person with schizophrenia may significantly impact informal caregivers’ lives. The Zarit Burden
Interview (ZBI) was originally developed to assess burden among caregivers of people with Alzheimer’s disease. Objective This research was conducted to inform the development of a revised version of the ZBI, relevant to caregivers of people with schizophrenia. Methods Based on published qualitative research, the questionnaire was reviewed and modified in accordance with industry-standard guidelines. The resulting questionnaire [the Schizophrenia Caregiver Questionnaire (SCQ)] was then completed by 19 caregivers during cognitive debriefing interviews to assess understanding, relevance and comprehensiveness. Results Review of the ZBI resulted in a number of operational changes to improve face validity and potential sensitivity. Further questions were added based on key concepts identified in existing literature and minor phrasing alterations were made to improve content validity. Findings from caregiver interviews supported the content validity of the SCQ. Conclusion The SCQ provides a comprehensive view of caregivers’ subjective experiences of caregiving and demonstrated strong face and content validity. The questionnaire will be important in both clinical assessment and evaluating the efficacy of interventions designed to reduce or alleviate caregiver burden. Future research will seek to establish the psychometric validity of the questionnaire.
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Affiliation(s)
- Adam Gater
- Adelphi Values Ltd, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK.
| | - Diana Rofail
- Roche Products Ltd, Hexagon Place, 6 Falcon Way, Welwyn Garden City, Hertfordshire, UK
| | - Chris Marshall
- Adelphi Values Ltd, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Chloe Tolley
- Adelphi Values Ltd, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Linda Abetz-Webb
- Adelphi Values Ltd, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Steven H Zarit
- Department of Human Development and Family Studies, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
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Porcelli S, Bianchini O, De Girolamo G, Aguglia E, Crea L, Serretti A. Clinical factors related to schizophrenia relapse. Int J Psychiatry Clin Pract 2016; 20:54-69. [PMID: 27052109 DOI: 10.3109/13651501.2016.1149195] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Relapses represent one of the main problems of schizophrenia management. This article reviews the clinical factors associated with schizophrenia relapse. METHODS A research of the last 22 years of literature data was performed. Two-hundred nineteen studies have been included. RESULTS Three main groups of factors are related to relapse: factors associated with pharmacological treatment, add-on psychotherapeutic treatments and general risk factors. Overall, the absence of a maintenance therapy and treatment with first generation antipsychotics has been associated with higher risk of relapse. Further, psychotherapy add-on, particularly with cognitive behaviour therapy and psycho-education for both patients and relatives, has shown a good efficacy for reducing the relapse rate. Among general risk factors, some could be modified, such as the duration of untreated psychosis or the substance misuse, while others could not be modified as male gender or low pre-morbid level of functioning. CONCLUSION Several classes of risk factors have been proved to be relevant in the risk of relapse. Thus, a careful assessment of the risk factors here identified should be performed in daily clinical practice in order to individualise the relapse risk for each patient and to provide a targeted treatment in high-risk subjects.
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Affiliation(s)
- Stefano Porcelli
- a Department of Biomedical and NeuroMotor Sciences , University of Bologna , Bologna , Italy
| | - Oriana Bianchini
- a Department of Biomedical and NeuroMotor Sciences , University of Bologna , Bologna , Italy ;,b Institute of Psychiatry, University of Catania , Catania , Italy
| | | | - Eugenio Aguglia
- b Institute of Psychiatry, University of Catania , Catania , Italy
| | - Luciana Crea
- b Institute of Psychiatry, University of Catania , Catania , Italy
| | - Alessandro Serretti
- a Department of Biomedical and NeuroMotor Sciences , University of Bologna , Bologna , Italy
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Hernandez M, Barrio C. Perceptions of Subjective Burden Among Latino Families Caring for a Loved One with Schizophrenia. Community Ment Health J 2015; 51:939-48. [PMID: 25952273 PMCID: PMC4619132 DOI: 10.1007/s10597-015-9881-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/02/2015] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to explore perceptions of subjective burden among Latino family members providing care for a loved one with schizophrenia. Data were collected from outpatient community mental health centers and featured 64 Latino family members who were primarily Spanish speaking and of Mexican origin. We used qualitative methods to examine subjective burden based on an open section of the Family Burden Interview Schedule. Five salient themes emerged capturing family members' subjective burden experience: (a) interpersonal family relationships, (b) emotional and physical health, (c) loss of role expectations, (d) religion and spirituality, and (e) stigma. Overall, findings illustrated that families perceived numerous challenges in their caregiving. Implications for research and practice among Latino family members are discussed.
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Affiliation(s)
- Mercedes Hernandez
- School of Social Work, University of Southern California, Montgomery Ross Fisher Building, 669 W. 34th Street, Los Angeles, CA, 90089, USA
| | - Concepción Barrio
- School of Social Work, University of Southern California, Montgomery Ross Fisher Building, 669 W. 34th Street, Los Angeles, CA, 90089, USA.
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Abstract
Coping is understood as the process of managing external or internal demands that are considered as taxing or exceeding the resources of the person. There is no formal classification of coping strategies, and these are understood as adaptive versus maladaptive and problem focuses versus emotion-focused. Understanding the commonly used coping strategies in a particular group of subjects can provide valuable insights for designing interventions to reduce the stress. In this review, we look at the literature which is available with regards to the coping strategies used by the caregivers of patients with schizophrenia. Findings suggest that caregivers of patients with schizophrenia use mixed type of coping mechanisms to deal with the stress of caregiving. The coping strategies are shown to have association with variables such as caregiver burden, caregiving experience, expressed emotions, social support, psychological morbidity in the caregivers, quality of life of caregivers and psychopathology in patients. One of the major limitations of the literature is that there is a lot of variability in the assessment instruments used across different studies to assess coping.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Pradyumna
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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Hernandez M, Barrio C, Yamada AM. Hope and burden among Latino families of adults with schizophrenia. FAMILY PROCESS 2013; 52:697-708. [PMID: 24329411 PMCID: PMC5032651 DOI: 10.1111/famp.12042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study examined hope and family burden among Latino families of individuals with schizophrenia. The sample consisted of 54 family members, one family member per outpatient adult recruited from public mental health programs in a diverse urban community. Hierarchical linear regression analyses were used to test the hypothesis that the family member's increased hope for the patient's future would be associated with decreased family burden beyond effects explained by the patient's length of illness and severity of symptoms. Results supported the study hypothesis. Family hope for the patient's future was associated with four of five types of family burden. Findings point to the prominent role of hope as a source of resilience for Latino families dealing with severe mental illness of a loved one.
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Affiliation(s)
- Mercedes Hernandez
- School of Social Work, University of Southern California, Los Angeles, CA
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Tsai HH, Tsai YF. Prevalence and factors related to depressive symptoms among family caregivers of nursing home residents in Taiwan. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1145-52. [PMID: 23340771 DOI: 10.1007/s00127-013-0652-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 01/05/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this cross-sectional study was to understand the prevalence and risk factors for depressive symptoms among nursing home residents' family caregivers in Taiwan. METHODS Family caregivers (n = 191) of nursing home residents were recruited by stratified random sampling from 16 nursing homes throughout Taiwan. Data were collected from caregivers in face-to-face interviews on depressive status (using the Center for Epidemiologic Studies Depression Scale; CES-D), on meaning ascribed to visiting nursing home residents (using the Family Meaning of Nursing-Home Visits scale), and on demographic data. Factors related to depressive symptoms were analyzed by multiple logistic regression. RESULTS The prevalence of depressive status among family caregivers was 29.8 % as determined by the CES-D cutoff score of ≥10. The non-depressed group (CES-D <10) tended to visit residents for emotional maintenance (odds = 0.54), while the depressed group (CES-D ≥10) tended to visit due to sense of responsibility for monitoring care quality (odds = 3.25). These results demonstrate that risk factors for depressive symptoms in family caregivers were their age, self-perceived health status, education level, and being the resident's main caregiver before admission. CONCLUSION These results fill a gap in knowledge by providing detailed, evidence-based data on family caregivers' priorities for visiting nursing home residents and it is related to depression. These results also provide useful information for designing intervention protocols to reduce depressive symptoms in family caregivers of nursing home residents, not only in Asian countries, but also in western countries with many Chinese/Asian immigrants.
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Affiliation(s)
- Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Saunders J. "At wits' end!": perspectives of Hispanic caregivers of a family member with schizophrenia. Issues Ment Health Nurs 2013; 34:451-8. [PMID: 23805930 DOI: 10.3109/01612840.2012.741659] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this qualitative exploratory study was to explore the perspectives of Hispanic caregivers as they provide the day-to-day care for their family member with schizophrenia. Interviews were conducted by a promotora (a Spanish speaking trained community health worker) with ten Hispanic caregivers at a large community center in a southwest border city over a six month period. Sixty interviews were audio recorded, translated into English, transcribed, and then interpreted using content analysis. One main overarching perspective emerged: "at wits' end." The following four supportive themes emerged: feeling marginalized, seeking answers, relying on God, and lacking support.
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Affiliation(s)
- Jana Saunders
- Texas Tech University, Health Sciences Center, 3601 4th St., Lubbock, TX 79430, USA.
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Family caregivers' monitoring of medication usage: a qualitative study of Mexican-origin families with serious mental illness. Cult Med Psychiatry 2011; 35:63-82. [PMID: 21153047 DOI: 10.1007/s11013-010-9198-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the high level of involvement of many family caregivers of adults with serious mental illness such as schizophrenia, little is known about their experiences with and beliefs about monitoring the psychiatric medication usage of their relatives. We used consensual qualitative research methods to analyze narratives on this topic by 12 Mexican-descent caregivers (160 pages of transcripts). The caregivers predominantly represented parent (mother) caregivers with levels of psychological distress and burden that were similar to those of larger samples of Mexican-descent caregivers. They represented equally high and low Expressed Emotion. We found that (a) caregivers' high knowledge (awareness) of medication usage was either tied to a hands-on monitoring approach or inferred by either the absence or the presence of their relatives' symptoms, (b) caregivers struggled with reconciling the symptom stabilization benefits of medication with the medications' side effects and limitations, and (c) most caregivers received little to no assistance from other available family members. Theory development and possible interventions involving family-assisted support of psychiatric medication usage should assess and possibly address caregivers' struggles with medications' side effects and low levels of support from available family.
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Abstract
PURPOSE OF REVIEW Caregivers play a fundamental role in the lives of mental patients with whom they have an interdependent relationship. The current review provides evidence supporting the association between providing care for a mentally ill person and an often unrecognized burden on the life of the caregiver. RECENT FINDINGS Caregivers often sustain a significant physical, emotional, social, and financial stress related to providing care for a loved one with a mental disease. Caregiver-oriented psychoeducational programs and caregiver participation in mutual support groups are among interventions that could assist in relief from this burden. SUMMARY Further work needs to be done regarding the burden experienced by caregivers who are responsible for mental patients with somatic symptoms. Participation of the caregiver in programs that target this burden should be encouraged. Physicians should take into consideration caregivers' needs and worries and incorporate them in the healing process.
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Ganguly KK, Chadda RK, Singh TB. Caregiver Burden and Coping in Schizophrenia and Bipolar Disorder: A Qualitative Study. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2010. [DOI: 10.1080/15487761003757009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schmid R, Schielein T, Binder H, Hajak G, Spiessl H. The forgotten caregivers: Siblings of schizophrenic patients. Int J Psychiatry Clin Pract 2009; 13:326-37. [PMID: 24916945 DOI: 10.3109/13651500903141400] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective. The situation of caregivers of psychiatric patients is mostly focussed on burdens of parents or spouses of patients. The burden of siblings due to the illness, however, is mostly underestimated and disregarded. Methods. Thirty-seven narrative interviews with siblings of schizophrenia inpatients were analysed by using a summarizing content analysis. The founded global statements were quantitatively analysed. Regression-analysis as well as regression trees were used to evaluate the data linked with sociodemographic and disease-related variables of the patient and siblings. Results. The results showed a high proportion of siblings engaged in caregiving activities. A total of 492 individual statements were summarized in 26 global types of statements. The three most often reported burdens by the healthy siblings are: "Handling the symptoms of illness" (100%), "Emotional burden due to the illness of the sibling" (100%) and "Uncertainty in judging what amount of stress the patient can cope with" (81.1%). Linear regression and regression tree analysis show predictors for higher burdened siblings. Conclusion. Siblings of schizophrenia patients are burdened in various aspects and in a specific matter. Their special needs will therefore have to be recognised before they can receive appropriate intervention.
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Affiliation(s)
- Rita Schmid
- Department of Psychiatry and Psychotherapy, University Medical Center Regensburg, Regensburg, Germany
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