The Relationship Between the Burden of Caregiving, Submissive Behaviors and Depressive Symptoms in Primary Caregivers of Patients With Schizophrenia

Depression in caregivers of patients with schizophrenia: a scoping review

PURPOSE

Caregivers play a vitally important role in the lives of people with schizophrenia. However, their mental health can often be overlooked. In recent years, with increasing attention to mental health and wellness, common mental illness such as depression in caregivers of people with schizophrenia has received renewed attention. The purpose of this review was to consolidate and synthesize recent literature on (1) the prevalence of depression in caregivers of people with schizophrenia, (2) factors associated with depression in caregivers of people with schizophrenia, and (3) interventions that target depression in caregivers of people with schizophrenia.

METHODS

A systematic search focusing on literature published between 2010 and 2022 was done to retrieve relevant articles from the following databases: Ovid MEDLINE, Ovid EMBASE, and Ovid Psych INFO.

RESULTS

Twenty-four studies met inclusion criteria and were included in the review. Nine evaluated the prevalence of depression, 18 evaluated factors associated with depression in caregivers, and 6 examined interventions targeting depression. The prevalence of depression and depressive symptoms in samples of caregivers ranged between 12 and 40% across the studies. Females, especially mothers of people with schizophrenia, were more likely to experience depression, followed by younger caregivers. Several factors, including gender, interpersonal relationships, social support, stigma, literacy, and financial constraints, were identified as factors associated with depression in caregivers. Several interventions like yoga, emotional training, and psychoeducation were evaluated, and they showed a significant reduction in the level of depression and depressive symptoms experienced by the caregiver population.

CONCLUSIONS

Depression in caregivers in this clinical population may be widespread and warrants further study. There are promising interventions that can target depression in caregivers. Well-designed longitudinal studies may help identify caregivers at risk of developing depression and further inform targets for intervention.

The effect of a physical activity intervention on burden and healthy lifestyle behavior in family caregivers of patients with schizophrenia: A randomized controlled trial

AIM

The aim of this study is to investigate the efficacy of a physical activity intervention on burden and healthy lifestyle behavior in family caregivers of schizophrenia.

METHOD

A randomized, controlled trial was conducted to evaluate the effect of physical activity program on burden and healthy lifestyle behavior in family caregivers of patients with schizophrenia. The "Physical Activity Program" consisted of 5 min of warm-up activities as the initial segment, 20 min of rhythmic exercises as the activity segment, 5 min of cool down exercises as the final segment and 30 min of free walking. The program consisted of 8 sessions. The Zarit Caregiver Burden Scale and the Healthy Lifestyle Behavior Scale were applied to the physical activity and control groups ahead of the program's implementation. A total of 60 caregivers were randomly distributed to the intervention (n = 30) and control groups (n = 30). Post-intervention measurement was completed by 60 caregivers and all the caregivers completed the intervention.

RESULTS

Significant differences were found on the Zarit Caregiver Burden Scale score and Healthy Lifestyle Behavior score between the groups.

CONCLUSION

Future research should examine with larger sample groups, carry out interventions, and apply the physical activity intervention by targeting caregivers, along with different interventions.

Effects of a psychoeducation program on disease burden, depression, and anxiety levels in relatives of psychotic patients in a community mental health center

PURPOSE

This study evaluates the effect of a 10-week psychoeducation program (PP) on disease burden, depression, and anxiety levels in relatives of psychotic patients.

DESIGN AND METHODS

The participants were 43 relatives of patients attending a community mental health center. The Zarit Caregiver Burden Scale (ZCBS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) were used to collect psychometric data.

FINDINGS

Administering the PP to caregivers significantly reduced their ZCBS, BAI, and BDI scores.

PRACTICE IMPLICATIONS

We recommend integrating the PP into treatment and rehabilitation programs within the scope of psychiatric-care services.

Abusive supervision, supervisor undermining, and turnover intentions: mediation of quiescent silence and desire to seek revenge among Thai banking frontliners

Purpose

Drawing on the social exchange theory, this study aims to investigate the destructive impact of abusive supervision and supervisor undermining on quiescent silence and turnover intentions among frontline employees. Whether quiescent silence and the desire to seek revenge mediate the path from aggressive supervisory behaviors to turnover intentions is explored.

Design/methodology/approach

Following a time-lagged design, the authors collected data from 350 frontline banking officers in Thailand by a survey. For data analysis purposes, structural equation modeling procedures are used through Smart partial least square version 3.2.0.

Findings

Uniquely, findings suggest that abusive supervision does not result in any form of retaliation. Supervisor undermining has a trickle-down effect on the desire to revenge, quiescent silence and turnover intentions. For supervisor undermining, the direct path, as well as mediating roles are supported by data.

Practical implications

The findings of this study suggests organizational systems should discourage supervisors from undermining the subordinates. There is a need to offer regular training to supervisors. Furthermore, employees should be provided some platforms and the freedom to positively speak at work. Above all, supervisors should be more inspiring which can dilute negative perceptions of abuse.

Originality/value

The proposed mediation of desire to revenge and quiescent silence is unique to this study. Moreover, the challenge to the traditional trickle-down effects of abusive supervision is a unique intervention in the organizational behavior literature.

Social support and quality of life among rural family caregivers of persons with severe mental illness in Sichuan Province, China: mediating roles of care burden and loneliness

OBJECTIVE

To explore the relationship between social support and quality of life (QoL) among family caregivers of persons with severe mental illness (SMI) and examine the mediating roles of care burden and loneliness.

METHODS

A cross-sectional study was carried out between December 2017 and May 2018. A random sample of 256 family caregivers of persons with SMI in rural areas of Sichuan Province, China was recruited for participation. Survey data on socio-demographics, social support, care burden, loneliness, and QoL were collected via in-person interviews. Multiple linear regression analysis and structural equation modeling (SEM) were used to test the hypothesized relationships.

RESULTS

The majority (72.7%) of family caregivers of persons with SMI in this study reported having low QoL. Social support was positively associated with QoL and negatively associated with care burden and loneliness. The findings suggested the mediating roles of care burden and loneliness on the association between social support and QoL.

CONCLUSION

The hypothesized model was found to be a suitable model for predicting QoL among family caregivers of persons with SMI. The findings can help inform the design of future interventions aimed at enhancing social support, reducing care burden and loneliness, which may be helpful to improve caregivers' QoL. Future study is required to find a causal path to promote QoL among family caregivers of persons with SMI.

Validation of the distress thermometer for caregivers of children and adolescents with schizophrenia

AIM

To develop and psychometrically test the distress thermometer for caregivers (DT-C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia.

DESIGN

A validation diagnostic accuracy study and descriptive cross-sectional survey.

METHODS

DT-C was adopted based on Harverman's distress thermometer for parents. The cut-off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale-21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018.

RESULTS

One-item DT of DT-C indicated a good retest reliability (r = 0.86) and one-item DT and the Problem List (PL) indicated good convergent validity (r = 0.67-0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70-0.90). Setting seven as the cut-off score, the values of sensitivity (0.72-0.81), specificity (0.86-0.90), Youden's index (0.61-0.70), positive predictive value (0.67-0.74), and negative predictive value (0.84-0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88-0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut-off. Caregivers above the cut-off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains.

CONCLUSION

The DT-C, with six domains containing 35 items in Problem List and with the cut-off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers' distress.

IMPACT

This study adapted a reliable DT-C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals.

Feelings, thoughts and experiences of caregivers of patients with schizophrenia

BACKGROUND

Caregivers have different experiences in the patient care process during which the role of providing care is fulfilled.

AIM

The aim of this study was to provide data on the feelings, thoughts and experiences of the caregivers of patients with schizophrenia.

METHOD

In this study, the phenomenological method was used.

RESULTS

The results of this study revealed the following themes: meaning of schizophrenia, the meaning of being caregiver, life before being caregiver, feeling of patients' relatives, difficult areas while providing care, coping situations and metaphors produced by the caregivers.

CONCLUSION

The results obtained from the study revealed that the caregivers of patients with schizophrenia need information about the mental illness and have a higher emotional burden.

PRACTICE IMPLICATIONS

Nurses should listen to caregivers' experiences, inquire about the experience of caregivers regarding patient care and advise caregivers on how to take care of their patients.

Mitigating distress and promoting positive aspects of caring in caregivers of children and adolescents with schizophrenia: Mediation effects of resilience, hope, and social support

Assistance for distressed caregivers can indirectly facilitate recovery of the people being cared for, yet how resilience, hope, and social support mediate between caregiving burden and adjustment outcomes is unclear. A structural equation model was constructed based on data from a cross-sectional survey of 324 caregivers of children and adolescents with schizophrenia using multidimensional caregiver burden inventory, Connor-Davidson resilience scale, Herth hope index, perceived social support scale, distress management screening measure, and positive aspects of caregiving instruments. On distress, caregiving burden had a relatively large direct effect, and an indirect effect, mainly mediated by resilience. Resilience had a greater effect than social support or hope on distress. On positive aspects of caregiving (PAC), caregiving burden had only an indirect effect, primarily via the processes from social support and resilience to hope. Hope had a significant direct effect, while resilience and support had moderate indirect effects on PAC via hope. Resilience is an important mediator between caregiving burden and distress, with a greatest effect. Resilience, hope, and social support all mediated between caregiving burden and PAC, with hope having a greatest effect. Reducing the care burden may greatly help to relieve caregiver distress. Providing needed social support, encouraging caregivers to proactively utilize the support, and enhancing resilient coping skills will be helpful in developing resilience and mitigating distress. Health professionals should assess and ameliorate burden, be particularly aware of caregiver hopes, provide formal support, and encourage informal support to promote PAC.

Caregivers of individuals with schizophrenia: who are they and what are their challenges?

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.