Recovery and serious brain disorders: the central role of families in nurturing roots and wings

Recovery From Schizophrenia: The Case of Mexican-Origin Consumers and Family Caregivers

This study examined the views about the future of persons with schizophrenia and their caregivers to understand what is at stake in engaging in recovery. The views of 60 Mexican-origin consumer-caregiver dyads were coded by three independent raters using a recovery literature-based coding system of recovery components: social relations, caregiving burden relief, independence, self-responsibility, and empowerment. General recovery expectations were also rated. Interrater reliability, component frequency, and congruence between the consumers and caregivers' expectations were statistically examined. Dominant recovery components for consumers and caregivers were independence (72.5%), general expectations for recovery (51%), and social relations (43%). Relatives differed in two important ways. Consumers held significantly greater expectations for independence (p < 0.01), whereas caregivers focused more on general recovery (p < 0.001). What matters for recovery for this sample of Mexican-origin consumers and caregivers differs. Addressing differences in views may facilitate person-centered treatment that considers the views of consumers and caregivers.

Carers' hope, wellbeing and attitudes regarding recovery

Carers are important to the recovery of their relatives with serious mental disorder however, it is unclear whether they are aware of, or endorse recent conceptualisations of recovery. This study compared carers' and mental health workers' recovery attitudes, and undertook multivariate predictions of carers' wellbeing, hopefulness and recovery attitudes. Participants were 82 Australian family members caring for a relative with psychosis. Carers' average recovery attitudes were less optimistic than for previously surveyed staff. Carers' recovery attitudes were predicted by perceptions that their relative's negative symptoms were more severe. Hopefulness and wellbeing was predicted by more positive and less negative caregiving experiences. Hopefulness was also predicted by less frequent contacts with their affected relative, and unexpectedly, by perceptions of more severe psychotic symptoms. Carers' wellbeing was further predicted by having a partner and having no lifetime history of a mental disorder. Hope and wellbeing are affected by everyday challenges and positive experiences of caregiving.

Measuring Family Caregiver Perceptions of Support in Caring for Children and Youth With Mental Health Concerns

This correlational study assessed how families of children with mental illness perceived the levels of support they received from informal and formal resource providers and the associations between perceived support and child outcomes. Adult caregivers (N = 904) of youth receiving public mental health care services were administered the Family Caregiver Perceptions of Support Scale developed by the authors to assess family caregiver perceptions of support prior to and at termination of services. Factor analysis identified three types of caregiver anticipated supports: informal support resources, support for treatment plan influence, and health care resources. The domains were significantly and positively associated with one another but did not uniformly correlate with youth mental health outcomes. The study provides preliminary evidence that treatment gains in youth mental health outcomes are observed when caregivers perceive support in treatment processes. Suggestions for future research are made, stressing the importance of caregivers and providers working together and describing needs related to future scale improvements.

Expressed emotion, human agency, and schizophrenia: toward a new model for the EE-relapse association

Although there is a clear statistical association between expressed emotion (EE) and schizophrenic relapse, our understanding of the mechanisms underlying this relationship is underdeveloped. This study tested a theoretical model in which caregivers' perceptions of their ill relative's agency underlie the EE-relapse association. To evaluate this model, we completed qualitative and quantitative analyses of narratives provided by individuals caring for a relative with schizophrenia. The results indicate that high-EE caregivers perceive the expression of symptoms as stemming from their ill relative's agency more frequently than low-EE caregivers. This was true for both high-EE-criticism and high-EE-emotional overinvolvement caregivers. High-EE and low-EE caregivers did not differ in their perceptions of the role of their ill relative's agency with regard to the control of symptoms. The findings suggest that EE may be a proxy risk factor for caregivers' perceptions of their ill relative's agency.

Caregiving and illness beliefs in the course of psychotic illness

OBJECTIVE

Informal caregivers play a central role in patient care, and caregiving can provide positive and negative experiences. Negative caregiving experiences are associated with distress. This study investigates associations between caregiving appraisals in psychosis, distress, and 3 key illness beliefs (consequences, cure-control, and timeline), and whether illness beliefs makes a contribution to the relation between negative caregiving appraisal and distress.

METHOD

We employed a cross-sectional study design. Caregivers (n = 146), including Early Psychosis Services caregivers (n = 60), completed self-report measures of the impact of care and illness beliefs.

RESULTS

Negative caregiving appraisals and distress were strongly associated. Caregivers appraised caregiving negatively and reported greater distress when they perceived the illness as having severe consequences for themselves and the patient, and when they perceived it as a long-term illness. In contrast, they appraised caregiving positively when they perceived that both they and the patient could exert some control over the illness. Illness beliefs did not account for the strong relation between negative caregiving appraisals and distress. Caregivers of patients with longer illness histories reported higher levels of positive caregiving appraisals.

CONCLUSION

Caregivers' cognitive representation of psychosis may play an important role in positive and negative appraisals about caregiving, even at an early stage of the illness. Implications for interventions with early psychosis caregivers are discussed.

Sibling perspectives on severe mental illness: reflections on self and family

Through focus group interviews, participants were asked to describe the impact over time of having a sibling with severe mental illness. Transcript content was then organized into categories and overarching themes using grounded-theory analysis. Respondents' personal and interpersonal experiences are presented, along with suggestions for professional outreach and further research.