Families living with severe mental illness: a literature review

Quality of life and sleep, depression, family functioning, and marital adjustment in patients on hemodialysis and peritoneal dialysis

INTRODUCTION

End-stage renal disease is different from other chronic diseases that the treatment method is as difficult. Our aim in this study was to compare marital adjustment, sexual functions and family functioning between hemodialysis (HD) and peritoneal dialysis (PD) patient.

METHOD

A total of 21 HD and 27 PD patients were included. Beck Depression Inventory (BDI), Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Arizona Sexual Experiences Scale (ASEX), Golombok-Rust Inventory for Sexual Satisfaction (GRISS), Marital Adjustment Test (MAT) and Family Assessment Device (FAD) were applied.

RESULTS

BDI scores were significantly higher in HD patients (p < 0.001). According to FAD problem solving (p < 0.001), communication (p = 0.00) and general functioning scores (p = 0.04) were higher in PD. The rate of poor sleep quality was 44.4% in the PD group, and 66.7% in HD group (p = 0.12). General health (p = 0.04), vitality (p < 0.001), mental health (p = 0.00) and social functioning (p = 0.00) scores were lower in HD patients.

CONCLUSION

HD patients are at high risk for psychiatric disorders due to the treatment modality. These patients should be monitored carefully and consultation-liaison services should be increased.

Predictors of depression among caregivers of patients with severe mental illness in Northwest Ethiopia, 2023: an explanatory sequential mixed-method study

Background

Severe mental illness results in an enormous social and economic burden on affected individuals, their families, and communities, especially in developing countries, such as Ethiopia.

Objective

The aim of this study was to assess the level of depression among caregivers of patients with severe mental illness in Debre Tabor Town, Northwest Ethiopia in 2023.

Methods

This institution-based explanatory mixed study was conducted at Debre Tabor Compressive Specialized Hospitals between September 30 to October 30, 2023. A systematic random sampling technique was used to select 260 study participants, and a public health questionnaire was used to assess depression. Epicollect5 was used to collect data, which were then exported to the SPSS-25 for analysis. Variables with a p-value <0.25 were considered candidates for the multivariate logistic regression analysis. The odds ratios with a 95% confidence interval were used to determine the strength of the association. An in-depth interview was conducted with 11 participants, selected using purposive sampling.

Results

The prevalence of depression was 31.3% (95% CI = 29.7-38.6). The multivariate analysis showed that being female (AOD = 2.43, CI = 1.42-7.23), divorced/widowed (AOD = 1.8, CI = 1.32-6.34), poor social support (AOD = 2.2, CI = 1.9-5.87), and perceived stigma (AOD = 2.33, CI = 0.24-13.22) were positively associated with depression. The qualitative results suggest that being female, illiterate, severity of the illness, poor social support, and stigma were factors for depression.

Conclusions and recommendations

The prevalence of depression was high among caregivers of patients with severe mental illness. Female sex, being divorced or widowed, being illiterate, poor social support, and perceived stigma were the contributing factors. This implies that a greater focus on caregivers and the government increases mental health literacy and mental health community services.

A qualitative enquiry on the impact of mental illness stigma on caregiving role and experiences in Singapore

Introduction

Given that mental illness stigma is a common occurrence amongst people with mental illness and caregivers (CGs) can be a potential victim of stigma themselves, there is a need to examine caregivers' perspective on the phenomenon. This study is part of a larger study which aims to qualitatively examine the concept of mental illness stigma amongst different stakeholders in Singapore.

Methods

Focus group discussions (FGDs) were conducted amongst 21 informal caregivers to explore the experience of stigma encountered by them and their care recipients, and how it may implicate their caregiving experience. Both inductive and deductive thematic analyses were employed to analyze the data.

Results

Three overarching themes of stigma encounters that may have implication on caregiving experience were identified: 1) Stigma within the family; 2) Structural stigma; and 3) Stigma by association. Experience of stigma within family (e.g., social exclusion and lack of understanding) limits the caregiving supports available to CGs. CGs also took up a mediating role between their care recipients and other family who may hold stigmatizing views. Witnessing their care recipients being subjected to structural disadvantages (e.g., employment, school, and mandatory conscription) can induce emotional stresses amongst CGs and motivate them to protest and seek redress on their behalf. Furthermore, encounters of stigma themselves (e.g., being judged or blamed for their loved one's condition) also led to feelings of guilt and self-blame amongst the CGs.

Discussion

These findings can aid the formulation of interventions in informing CGs on what to expect on their caregiving journey and supporting them in dealing with issues relating to stigma and highlight the importance of anti-stigma efforts in organizational settings such as schools, corporations, and government agencies.

Effects of brief family psychoeducation on family caregiver burden of people with schizophrenia provided by psychiatric visiting nurses: a cluster randomised controlled trial

BACKGROUND

The purpose of this study was to examine the effects of a brief family psychoeducation (BFP) programme provided by psychiatric visiting nurses on caregiver burden of family caregivers of people with schizophrenia through a cluster randomised controlled trial (cRCT).

METHODS

The study was a two-arm, parallel-group cRCT. Forty-seven psychiatric visiting nurse agencies were randomly allocated to the BFP programme group (intervention group) or treatment as usual group (TAU; control group). Caregivers of people with schizophrenia were recruited by psychiatric visiting nurses using a randomly ordered list. The primary outcome was caregiver burden, measured using the Japanese version of the Zarit Burden Interview. Outcome assessments were conducted at baseline, 1-month follow-up, and 6-month follow-up. Intention-to-treat analysis was conducted to examine the effects of the BFP programme on caregiver burden.

RESULTS

Thirty-four psychiatric visiting nurse agencies and 83 family caregivers of people with schizophrenia participated in the study. The participant attrition rate was less than 20%. Adherence to the program was 100%. Compared with TAU group, the BFP programme group had decreased caregiver burden. However, this improvement was not significant at 1-month follow-up (adjusted mean difference [aMD] = 0.27, 95% CI = - 5.48 to 6.03, p = 0.93, d = 0.01) or 6-month follow-up (aMD = - 2.12, 95% CI = - 7.80 to 3.56, p = 0.45, d = 0.11).

CONCLUSIONS

The BFP programme provided by psychiatric visiting nurses did not achieve significant decreases in caregiver burden. This result may be attributed to the difficulty in continuing the research due to the COVID-19 pandemic, which prevented us from achieving the targeted sample size necessary to meet the statistical power requirements, as well as to the participation of caregivers with relatively low burden. However, the program had the advantage of high adherence to treatment plan. Further studies should be conducted with a larger sample size and a more diverse sample that includes caregivers with a higher care burden.

TRIAL REGISTRATION

The study protocol was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000038044) on 2019/09/18.

Victimisation in the life of persons with severe mental illness in Uganda: a pluralistic qualitative study

INTRODUCTION

Victimisation of persons with severe mental illness is recognised as an urgent global concern, with literature pointing to higher rates of violent victimisation of persons with severe mental illness than those of the general population. Yet, for low income countries, there is a huge gap in the literature on the risk, character and victims' in-depth experiences of victimisation of persons with severe mental illness. We explore the lived experiences and meanings of victimisation of persons with severe mental illness in Uganda, and discuss their implications for care of the mentally ill.

METHODS

A pluralistic qualitative study was undertaken to explore victimisation among patients with severe mental illness. Patients who had suffered victimisation were purposively sampled from Butabika National Referral Mental Clinic and Masaka Regional Referral Hospital, following confirmation of symptom remission. In-depth interviews were held with 18 participants, comprising 13 females and 5 males from low to moderate socioeconomic status. Interpretative phenomenological analysis and thematic content analysis were conducted.

RESULTS

Victimisation was exhibited in three main forms: (a) psychological, expressed in attitudes towards mentally ill family members as valueless and dispensable, and stigmatisation, (b) physical, as manifested in beatings, indoor confinement and tethering mostly by family members and (c) sexual victimisation, particularly rape. Also observed were victim's various responses that pointed to the negative impact of victimisation, including a heightened risk of suicide, social withdrawal, a sense of hatefulness and a predisposition to more victimisation.

CONCLUSION

The family environment plays a predominant role in perpetrating victimisation of the mentally ill in some sub-Saharan African contexts such as Uganda. We propose a holistic framework for mental health interventions, incorporating biomedical but notably also social determinants of mental health, and targeted at improving familial relationships, social support and a sense of belongingness both within the family and the broader community.

Preliminary investigation of objective and subjective experiences of relatives of individuals with hoarding behaviors

OBJECTIVE

Families of individuals with hoarding symptoms report substantial burden; however, there has been no investigation of potential positive experiences. The objective of this study was to examine the experiences reported by individuals with a relative with elevated hoarding symptoms using a cross-sectional design. The current investigation expands on the literature in this area by incorporating a detailed interview of experiences in conjunction with validated measures of hoarding symptomology.

METHODS

Twenty-nine adults with relatives with elevated hoarding symptoms completed self-report measures of hoarding severity for themselves and their relative and a clinician-administered assessment of their experiences with their family member with hoarding symptoms.

RESULTS

Participants endorsed significant burden across a range of areas, including permanent changes in their daily routine. The majority (93%) of participants reported at least one positive experience, with 69% endorsing companionship as a benefit of the relationship. Greater symptom severity of the relative with hoarding symptoms was associated with greater subjective burden and decreased positive experiences.

CONCLUSION

Our results add further evidence to the potential for interpersonal psychotherapy to lead to a reduction in hoarding symptomology.

Reframing Mental Health Ethics

Mental health ethics has been classically focused on ethical concepts and problems in clinical mental health spaces. Psychiatric and psychotherapeutic ethics are main threads of analysis in this subfield of bioethics. However, ethical issues emerge around mental health and illness both within and beyond clinical settings. In particular, ethical quandaries arise in employment, education, family caregiving, and incarceration of people with mental health conditions outside of the clinical setting. Likewise, ethics are an important consideration within alternative care systems where mentally ill people seek support beyond biomedicine, psychotherapy, and case management. In this article, we argue that our understanding of "mental health ethics" should expand to be more inclusive of value questions and conflicts that arise in all areas of the lives of people with mental health conditions, rather than focusing more narrowly on how clinical practitioners and researchers should best respond to ethical quandaries in the delivery of mental healthcare. Community mental health is an ideal space in which to think about such ethical issues, as scholars and practitioners in the field strive to meet not only medical needs but the broader social needs of people with mental health conditions. We begin by providing an overview of psychiatric and psychotherapeutic ethics, and then describe broader applications of ethics in the lives of people experiencing mental illness. We encourage community mental health practitioners and researchers to reconceptualize disciplinary boundaries to consider the vast scope of ethical issues related to mental health in and out of the clinic.

Determinants of Quality of Life (QoL) in Female Caregivers in Elderly Care Facilities in Korea

BACKGROUND

The purpose of this study was to analyze the effects of general characteristics, fatigue, depression, self-efficacy, job stress and interpersonal relationships on the quality of life (QoL) of caregivers in nursing hospitals and use them as basic data for intervention programs to improve the quality of life of caregivers.

METHODS

The participants in the study were 137 caregivers, aged 52-76, who were actively working in nursing hospitals. Data were collected from caregivers by visiting 9 hospitals in 6 cities, with a questionnaire of fatigue, depression, self-efficacy, job stress, interpersonal relationship, quality of life.

RESULTS

Age, marriage, marital satisfaction, education, education experience of QoL, monthly income, perceived economic status, hobby or leisure activity, and number of disease showed differences in the degree of QoL at a statistically significant level. In stage 1, economic status (β = -0.18, p = 0.033) and hobby or leisure activity (β = 0.19, p = 0.025) were influencing factors (F = 4.58, p < 0.001). In stage 2, monthly income (β = -0.19, p = 0.034) and perceived economic status (β = -0.18, p = 0.035) were influencing factors. In stage 3, age (β = -2.80, p = 0.006), perceived economic status (β = -2.41, p = 0.017), self-efficacy (β = 3.19, p = 0.002) and interpersonal relationship (β = 7.12, p < 0.001) were influencing factors which showed 61.5% explanatory power (F = 12.88, p < 0.001). Since the subject's fatigue, depression, and stress did not affect the quality of life, further research is needed.

CONCLUSIONS

In order to improve the quality of life of caregivers, it would be necessary to develop interventions for raising their self-efficacy and interpersonal relationship by considering their degree of economic status, hobby or leisure activity, monthly income, and age.

Talking and making meaning about parental mental health problems: The role of children's family caregivers

When a parent is less able to meet their children's needs due to a severe and enduring mental health problem (MHP), other adult family members often help with childcare. We present a Grounded Theory of how children's family caregivers construct meaning about the parental MHP and communicate about it with children. Nineteen caregivers participated in qualitative interviews. Each supported at least one related child aged 4-17 years with a parent with MHPs. We found that caregivers engaged in a Core Social Process of providing protection in uncertainty. This comprised three categories as follows: shaping the interactional space, communicating through the developmental process, and engendering a sense of safety. Caregivers appeared to act from a Key Social Positioning of developing a caregiver identity. The findings implicate family-focused provision of mental health and social care. Clinical recommendations are made for whole-family interventions and the role of marital and family therapists.

Distress, burden, and wellbeing in siblings of people with mental illness: a mixed studies systematic review and meta-analysis

BACKGROUND

Family members of people with mental illness (MI) may experience a host of psychological adversities such as increased stress, burden, and reduced wellbeing. However, relatively little is known about siblings. This study aimed to characterise the experience of distress (viz. depressive and anxiety symptoms), burden, and wellbeing in siblings of people with MI.

METHODS

Studies reporting on quantitative measures of depression, anxiety, burden, or wellbeing in siblings; and/or qualitative findings on siblings' experience were eligible. The literature search was conducted up until 20th October 2022.

RESULTS

Sixty-two studies comprising data from 3744 siblings were included. The pooled mean percentage of depressive symptoms fell in the mild range at 15.71 (k = 28, N = 2187, 95% CI 12.99-18.43) and anxiety symptoms fell in the minimal range at 22.45 (k = 16, N = 1122, 95% CI 17.09-27.80). Moderator analyses indicate that siblings of people with a schizophrenia spectrum disorder experience greater depressive symptoms than siblings of people with other types of MI (β = -16.38, p < 0.001). Qualitative findings suggest that individuals may be particularly vulnerable during their siblings' illness onset and times of relapse. Limited communication, confusion about MI, and the need to compensate may contribute to siblings' distress and/or burden. Siblings' experience of wellbeing and caregiving were closely related.

CONCLUSION

This review highlights the complex psychological experience of siblings and the need for greater research and clinical support for this important yet often overlooked cohort.

Flourishing, psychological distress and internalized stigma among parents of an adult son or daughter with schizophrenia

BACKGROUND

Parents of adults diagnosed with schizophrenia, have been reported to have higher levels of psychological distress than the general population, and parents whose offspring have other mental or physical illnesses.

AIM

This study examines the comparatively new construct of flourishing, and its relationship to internalized stigma and psychological distress.

METHOD

A cross-sectional survey was conducted between July 2021 and March 2022, with an international sample of 200 parents of adult sons or daughters diagnosed with schizophrenia. Participants completed a demographic questionnaire and three standardized inventories. These were the PERMA Profiler, which measures flourishing, the CORE-10, which measures psychological distress, and a new parental Internalized Stigma Scale. Sample characteristics of individuals of schizophrenia and their parents were examined using descriptive statistics, and the contributing factors affecting stigma were assessed through regression analysis.

RESULTS

The initial hypothesis that parents scoring high on internalized stigma, would have significantly higher levels of psychological distress and lower levels of flourishing, than parents with low-level internalized stigma, was confirmed. Overall, the flourishing levels were lower and psychological distress higher in these parents, than those of the general population. Regression analysis identified psychological distress and hopefulness as the two major predictors of flourishing, though in different directions. Interestingly, stigma did not determine flourishing, in spite of their close relationship.

CONCLUSIONS

Researchers have long been aware of internalized stigma in persons with schizophrenia. Yet this study is one of the few that linked it with parents of adults with schizophrenia and flourishing and psychological distress. Implications were discussed in the light of the findings.

Unraveling Reactionary Care: The Experience of Mother-Caregivers of Adults with Severe Mental Disorders in Catalonia

In most Mediterranean countries, people diagnosed with severe mental disorders (SMDs) are typically cared for by the mother, causing a significant burden on people in this family role. Based on a broader mental health participatory action and qualitative research carried out in Catalonia (Spain) of 12 in-depth interviews and 3 focus groups, this article analyses the mother-caregivers' experience in the domestic space. The results show that patients and caregivers are engaged in a relationship of "nested dependencies", which create social isolation. This produces the conditions of "reactionary care", practices that limit the autonomy of those affected and that reproduce forms of disciplinary psychiatric institutions. We conclude that both institutional violence derived from economic rationality and that which stems from the gender mandate feed off each other into the domestic sphere. This research argues for placing care at the center of clinical practice and shows the need to consider the structural forces shaping it.

Experiences of helplessness and fear among caregivers diagnosed with severe mental illness and co-caregivers: The Danish High Risk and Resilience Study - VIA 7

This study investigates indicators of disorganized caregiving among caregivers of children who have a familial predisposition of schizophrenia spectrum psychosis (SZ) or bipolar disorder (BP), and whether indicators of disorganized caregiving are associated with the caregivers' and children's level of functioning as well as the children's internalizing and externalizing behavior problems. Indicators of disorganized caregiving were assessed with the Caregiving Helplessness Questionnaire (CHQ). Level of functioning was evaluated using the Children's Global Assessment Scale and the Personal and Social Performance Scale, while dimensional psychopathology were measured with the Child Behavior Checklist. 185 caregivers belonging to a SZ combined group (i.e., SZ-I + SZ co-caregiver), 110 caregivers to a BP combined group (i.e., BP-I + BP co-caregiver), and 184 caregivers to a population-based control group provided data on CHQ. Having a history of SZ or BP or being a co-caregiver to a parent with SZ or BP was associated with higher levels of experiences of helplessness and fear. Higher scores on helplessness were associated with lower level of functioning among caregivers and children and with children having externalizing/internalizing behavior problems. These results emphasize the need for interventions addressing indicators of disorganized caregiving in families with SZ or BP.

The association between social class and the impact of treatment for mental health problems: a systematic review and narrative synthesis

PURPOSE

This systematic review aimed to synthesise all quantitative literature on the association between social class and the effectiveness of interventions for mental health disorders.

METHODS

Systematic literature searches (inception-March 2021) were conducted across 7 databases, and all quantitative studies meeting inclusion criteria, examining the impact of social class on access to treatment, or intervention effectiveness, or the impact of treatment on social mobility, were synthesised narratively.

RESULTS

Evidence suggests that lower social class may be associated with reduced access to primary and secondary mental health care and increased likelihood of access via crisis services, and patients of lower social class may not benefit from all mental health interventions, with reduced effectiveness. While limited, there was some indication that psychosocial interventions could encourage increased employment rates.

CONCLUSION

Social class is associated with the effectiveness of psychological interventions, and should be considered when designing new interventions to prevent barriers to access and improve effectiveness.

An Analysis of Six Month Follow-Up Data from a Peer Parent Support Study

The current study examines trajectories of treatment outcomes 6 months after completion of a peer parent program, NAMI Basics. Fifty-two caregivers who were part of a larger trial completed questionnaires prior to, immediately after, and 6 months after completing NAMI Basics. Growth curve models were used to examine trajectories of caregiver ratings of parent activation and engagement, parent help-seeking intentions, child symptoms, outpatient service use, and parent stress at 6 months after completion of the program. Prior improvements to the outcomes of parent activation and engagement (β = 2.31, p < .001, d = 1.35), parent help-seeking intentions (β = 1.94, p = .017, d = 0.69), and child intrapersonal distress (β = - 3.93, p = 0.046, d = 0.58) were maintained at 6 months, while help-seeking intentions was not (β = 1.31, p = .222, d = 0.47). Though no changes were observed immediately post-class, caregivers reported significant increases in outpatient services use (β = - 1.51, p = .030, d = 0.68) and reductions in parenting stress (β = - 4.99, p = 0.009, d = 0.75) and overall child symptoms (β = - 19.67, p = 0.001, d = 0.90) at 6 month follow-up. These results suggest that many of the positive impacts of the NAMI Basics program are sustained 6 months after the intervention. Additionally, these results suggest that some positive outcomes of the program may not emerge until several months after taking the class. Implications and future directions are discussed.

Using Photovoice in a Mindfulness-Based Program to Understand the Experiences of Caregivers of Young Adults with Psychosis

Studies have consistently shown that family caregivers experience caregiver burden and depression when they provide care for family members with psychosis. Photovoice is a participatory action research method of fostering dialogues about personal experiences by sharing and discussing photographs that may improve our understanding about how a mindfulness-based family psychoeducation program (MBFPE) can reduce the caregiver burden and improve their caregiving experience. We explored the experiences of the participants in their use of photovoice in a MBFPE. We investigated whether the MBFPE program generated positive changes for caregivers of young adults with psychosis. Using photovoice, we collected qualitative data to help develop a unique contextual understanding of MBFPE program outcomes and generate novel ideas, insights, suggestions, and questions on the basis of participant's perceptions. Participants in our pilot study and randomized controlled study of MBFPE were invited to participate in this photovoice activity. On the basis of a procedure developed for MBFPE, caregivers were invited to use photographs to express how mindfulness contributed to caregivers' management of their caregiving stress and burden. Caregiver's inquiry with the MBFPE instructors were transcribed for analysis together with the photographs. A grounded theory approach was adopted to analyze the photovoice images, participants' reflections, and inquiries of photographs. Six themes were developed in understanding the lived experience of caregivers in participation of MBFPE: (1) I pay attention to the present moment; (2) I care about my family; (3) I trust my children; (4) I appreciate the connection with and support from nature and the universe; (5) I observe my worries and guilt and learn not to be reactive; and (6) I find space in offering care and exercising self-care. The application of photovoice can offer an additional approach to enhance the awareness and insights of participants in a mindfulness-based program. Specific guidelines may be developed to enhance the learning of participants.

Effectiveness of a community-based peer support service among persons suffering severe mental illness in China

Background

Community-based peer support service is widely and effectively deployed for persons suffering severe mental illness (SMI) in countries with well-developed outpatient mental health systems. The objective of this study is to evaluate the effectiveness of a 1-year peer service project among persons with SMI implemented in China.

Methods

A total of 101 consumers (service recipients) and 66 family caregivers were recruited at baseline from communities located in Beijing and Chengdu. Severity of psychiatric symptoms, personal and social functioning, self-esteem, life satisfaction, and medication adherence were evaluated among consumers. Self-esteem, life satisfaction, anxiety, and depressive symptoms were assessed among family caregivers. Participants were reevaluated at 1 year with the same measures. Changes in outcomes from baseline to 1-year follow-up were examined using paired sample t tests or Stuart-Maxwell tests.

Results

Consumers' psychiatric symptoms were decreased at 1 year (p < 0.001). Their personal and social functioning (p = 0.003) and life satisfaction (p < 0.001) were increased. There were no improvements in self-esteem (p = 0.108) and medication adherence (ps ≥ 0.827) among consumers. For caregivers, no increases were presented in outcomes at the 1-year assessment (ps ≥ 0.164).

Conclusions

The findings suggest that peer support services could be sustainably implemented across China, with positive impacts on the psychiatric symptoms, social functioning, and life satisfaction of participants suffering SMI.

Psychological distress in siblings of people with mental illness: A systematic review and meta-analysis

OBJECTIVE

The objective of this study was to characterise the prevalence and/or severity of psychological distress (namely, depression and anxiety symptoms) in siblings of people with mental illness (MI) and to examine correlates of distress in siblings of people with MI.

METHOD

Studies comparing distress in individuals with and without a sibling with MI were eligible. Studies reporting on correlates of distress in siblings were also eligible. A search of MEDLINE Complete, PsycINFO and Embase was conducted up until 17 March 2022.

RESULTS

Fifteen studies comprising 2304 siblings and 2263 comparison individuals were included. Meta-analyses indicated individuals with a sibling with MI experience significantly greater depressive symptoms (Hedges's g = 0.53, 95% CI = [0.32, 0.73], siblings n = 1962, comparison individuals n = 2248) and anxiety symptoms (Hedges's g = 0.40, 95% CI = [0.19, 0.61], siblings n = 653, comparison individuals n = 533) than those without. The sibling relationship, siblings' locus of control, interpersonal functioning and their appraisal of the impacts of MI were identified as important and potentially modifiable correlates.

CONCLUSION

Individuals with a sibling with MI experience greater depressive and anxiety symptoms than those without and would likely benefit from support. Future studies are required to elucidate the mechanisms underlying distress in siblings.

Effect of emotional awareness skills training on emotional awareness and communication skills in patients with schizophrenia: A Randomized Controlled Trial

PURPOSE

This study was conducted to examine the effect of emotional awareness skills training on emotional awareness and communication skills in patients with schizophrenia.

METHODS

This randomized controlled trial was conducted with 44 patients with schizophrenia (22 in the intervention group and 22 in the control group) registered at a community mental health center. The personal information form, Toronto Alexithymia Scale (TAS-20), and communication skills scale-adult form were used to collect patient data. The emotional awareness skills training was implemented once a week for 8 weeks.

RESULTS

After the training, the mean scores of the "Difficulty Identifying Feelings" and "Difficulty Describing Feelings" subscales of TAS-20 decreased and the mean scores of the communication skills scale-adult form increased in the intervention group; the difference between the groups was statistically significant. While there was no difference between the groups in the initial measurements, a significant difference was found between the mean scores of "Difficulty Identifying Feelings" and "Difficulty Describing Feelings" in the intervention group and a significant difference was found in both groups between the subscales of "Basic Skills and Personal (Self) Expression", "Willingness to Communicate", "Caring Communication" and "Active Listening and Non-Verbal Communication" and the total mean score after the intervention.

CONCLUSION

Based on the study results, it can be concluded that emotional awareness skills training is an effective psychiatric nursing intervention that improves emotional awareness and communication skills. NCT05038927.

Psychosocial inventory for caregivers (PIC) of persons with mental illness: Content validity and cognitive interviewing process

BACKGROUND

Content validity and cognitive interview plays a vital role in tool construction and contributes significantly in determining the psychometric properties of a tool.

AIM

The study aimed to present the content validation process, using expert judgment and to illustrate the use of a cognitive interviewing method for gathering validity evidence on the response process of psychosocial inventory for caregivers (PIC) of persons with mental illness.

METHODOLOGY

This is a descriptive, psychometric study on content validity through expert judgment which was conducted at the LGB Regional Institute of mental health, Assam, India. Convenience and intentional sampling were used for the selection of the field expert. In this study, the psychosocial inventory for caregivers (PIC) of persons with mental illness was validated by 10 mental health professionals from India. The present study proceeded in three phases. Phase-1, an item pool (150 items) was generated. Phase-2, content validity was calculated based on the content validity index (CVI) and content validity ratio (CVR). Phase-3, cognitive interview (CI) was done. The study was approved by the institute ethics committee (IEC) of LGBRIMH, Tezpur.

RESULTS

Through content validity procedure, 39 items out of 150 were discarded, whereas, through cognitive interview 27 out of 111 items were deleted. So, altogether 84 items were retained for the final scale 'psychosocial inventory for caregivers (PIC) of persons with mental illness. Universal agreement (UA) was 0.6.

CONCLUSION

In present study, content validity was found to be satisfactory. Yet, further studies are needed to evaluate its reliability and validity.

Quality of Life among Caregivers of Patients Diagnosed with Major Chronic Disease during COVID-19 in Saudi Arabia

Quality of life (QoL) is considered one of the measures of health outcomes. Limited research studies have assessed family caregivers’ QoL, especially among patients diagnosed with chronic disease. This study measures the QoL of caregivers who guardian patients diagnosed with cardiovascular disease, diabetes, cancer, and/or other diseases during the COVID-19 pandemic. Participants were primary caregivers who were supporting, in the last six months, individuals diagnosed with one of the previously mentioned chronic diseases. This included caregivers of patients admitted to a tertiary hospital from January 2021 to July of the same year (n = 1081); all participants completed the World Health Organization Quality of Life Assessment tool (WHOQOL-BREF) questionnaire. Caregivers of patients with cancer reported the highest mean level of QoL, followed by diabetes, cardiovascular diseases, then other different diseases (M = 3.80; M = 3.38; M = 3.37; and M = 2.51, respectively). A chi-square test of independence was performed to examine the relationship between the QoL of the four groups and their behaviors (i.e., caregivers’ psychological onuses and physical actions/reactions). The relation between these variables was significant, X² (3, n = 1081) = 8.9, p = 0.001. The Kruskal–Wallis test indicated significant differences among the four groups (p ≤ 0.001). While the overall results of the QoL level of participants were low, a major recommendation of this study was to incorporate a QoL assessment to caregivers of chronically ill patients. Regular psychological and physical health check-ups of caregivers should be mandated in the healthcare system. Research studies should consider investigating and identifying the factors affecting health outcomes and positive developments which have a great impact on the wellbeing of both caregivers and patients on personal, organizational, and national levels.

Intra-household Variation in Pathways to Care for Epilepsy and Mental Disorders in Eastern Uganda

Integrating mental, neurological, and substance use (MNS) health care into the public health system has become a global priority, with mental health, and well-being now being part of the Sustainable Development Goals. In the aim to provide good quality care for MNS disorders, understanding patients' pathways to care is key. This qualitative study explores the pathways to care of patients attending an outpatient mental health clinic of a district hospital in eastern rural Uganda, from the perspectives of their caregivers. Twenty seven in-depth interviews were conducted with caregivers of MNS patients visiting the clinic, with a focus on four case-presentations. Data analysis consisted of thematic and emergent content analyses using NVivo 11. Results across all interviews highlight that chosen help-seeking itineraries were largely pluralistic, combining and alternating between traditional healing practices, and biomedical care, regardless of the specific MNS disorder. Intra-household differences in care seeking pathways—e.g., where one patient received traditional help or no care at all, while the other received biomedical care—depended on caregivers' perceived contextual illness narrative for each patient, in combination with a variety of other factors. If interpreted as a form of bewitchment, traditional medicine and healing was often the first form of care sought, while the mental health clinic was seen as a recourse to “free” care. Patients, especially younger children, who showed visible improvements once stabilized on psychotropic medication was a source of motivation for caregivers to continue with biomedical care at the mental health clinic. However, stock-outs of the free psychotropic medication at the clinic led to dissatisfaction with services due to out-of-pocket expenses and precipitated returning to alternative therapy choices. This article showcases the importance of understanding the complex and varied combinations of individual, cultural, socioeconomic and structural factors that may affect caregivers' choices of pathways to care for patients with MNS disorders in eastern rural Uganda. These cumulative complex processes and context-specific help-seeking behaviors, which ultimately impact patient treatment and MNS health outcomes, need to be first acknowledged, understood and taken into account if we are to promote more inclusive, effective and integrated public mental health systems globally.

Family Recovery Interventions with Families of Mental Health Service Users: A Systematic Review of the Literature

INTRODUCTION

Recovery has become a catalyst for much organisational and cultural change within mental health services. Recovery involves the service user living the best life of their choice despite the presence of mental health challenges. In contrast, recovery of families remains under-developed with minimal attention given to the unique support families may require in their own recovery journeys. This paper aims to place focus on the topic through a systematic review of the literature into family recovery interventions in mental health; Method and Analysis: A PRISMA compliant systematic review was initiated. It included how the reviewers retrieved and selected studies for the systematic review. It outlined the inclusion/exclusion criteria and how these were further developed through the PICO framework. It also outlined how the reviewers assessed issues of bias and quality, as well as the process of data synthesis; Results: Three studies were included in this review. Each focusing on family recovery interventions across the lifespan: Kidstime to family toolkits to family psychoeducation. The benefits and challenges of each intervention to the family were synthesised along with a list of four family recovery enablers that are vital for the implementation of such family recovery interventions; Discussion/Implications for Practice: The results highlight the paucity of quality literature available for family recovery interventions. All three studies scored poorly in terms of quality, with one particular study (Nagi and Davies 2015) lacking quotations from participants to back up their claims. From this study, a number of actions need to be implemented, specifically around the enablers needed to allow for family recovery interventions to be fully implemented.

The effect of the virtual social network-based psycho-education on the hope of family caregivers of clients with severe mental disorders

Psycho-education may have a positive effect on family caregivers of clients with mental disorders, and promote positive psychological states such as hope. The present study aims to investigate the effect of virtual social network-based psycho-education on the hope of family caregivers of clients with severe mental disorders. This study is a quasi-experimental research with a control and experimental groups. The participants of the study were 72 family caregivers of clients with severe mental disorders (36 in each group). Data were collected using demographic questionnaire and Adult Hope Scale before the study, immediately after the end of the training (first post-test), and 4 weeks afterwards (second post-test). The experimental group received psycho-education through Telegram App for four weeks. The results of the demographic questionnaire showed that both groups were homogeneous. The results of the Adult Hope Scale indicated that the mean score of both control and experimental groups were statistically significant and increased in the experimental group (P < 0.001). In addition, the changes of hope score in the experimental group were statistically significant in the first post-test than the pre-test, and in the second post-test than the first post-test and pre-test (P < 0.001). The findings of this study suggested that virtual social network-based psycho-education promotes the hopes of the family caregivers of clients with severe mental disorders. Due to the low cost and fast access of people to virtual networks, the content of this educational program can be widely used for family caregivers.

The impact of parenting a child with serious mental illness: Accounting for the parent's genetic vulnerability to mental illness

Parents of adults with serious mental illness (SMI) often are primary caregivers for their affected relative. Prior work has suggested that the toll of caregiving is associated with poorer well-being in family caregivers, particularly parents of affected adults. However, due to methodological limitations, it has not been possible to assess these family caregivers' own genetic vulnerability to mental and physical health problems, and thus the impact of caregivers' genetic risk on well-being may not have been accounted for. With the addition of genetic data to large survey samples, family caregivers' genetic vulnerability to mental and physical health problems can now be estimated. Parents from the Wisconsin Longitudinal Study who have an adult child with an SMI (n = 265) and a comparison group of parents with a child without disabilities (n = 5,036) reported their psychological well-being and mental and physical health across 4 measures. Genetic vulnerability was assessed using polygenic risk scores of neuroticism, bipolar disorder, schizophrenia, and depression. Results indicate that the effect of having a child with an SMI still had significant effects for all 4 parental health outcomes even after controlling for these measures of genetic vulnerability. This study's results affirm the negative health impact of parenting a child with SMI, above and beyond genetic vulnerability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Economic Distress in Families with a Member Suffering from Severe Mental Illness: Illness Burden or Financial Crisis? Evidence from Greece

The present study aims to explore the economic distress and pertinent coping strategies in families with a member suffering from a severe mental illness. Furthermore it endeavors to gauge the impact of illness burden and that of the Greek recession on economic distress, while disentangling their contribution. In total, 190 key relatives of people with severe mental illness were recruited from community mental health services in the region of Attica. Relatives completed a self-reported questionnaire consisting of the Index of Personal Economic Distress, the Family Burden scale and the Family Rituals scale. Information on financial strategies for tackling recession and income loss due to the recession was also gleaned. Regarding economic distress, only 15% had frequent difficulty meeting routine financial demands in their household. The preponderant strategy was spending savings (56.8%). Income category and spending less on basic needs were the main predictors of economic distress. Objective poverty indices rather than burden predicted economic distress to a greater extent.

Caring for Patients with Psychosis: Mental Health Professionals' Views on Informal Caregivers' Needs

The aim of this study was to explore the views of mental health professionals regarding the needs of the informal caregivers of patients with chronic psychotic syndrome. A qualitative research design was used. The sample consisted of 12 mental health professionals selected by a purposive sampling strategy. Data were collected through semistructured, face to face interviews. Framework analysis was used to analyze qualitative data and establish main themes and subthemes. Three main themes emerged namely, (i) impact of caring on caregivers’ lives, (ii) caregivers’ needs, and (iii) recommendations for better care. Informal caregivers’ needs were conceptualized into subthemes within the main themes. Caregivers’ increased responsibilities of caring for their relatives, the impact on their mental and physical health status and the restrictions in their social and professional life were revealed. Targeted health interventions and social policy planning are recommended for supporting informal caregivers and improving patient care.

Ethnographic Insights into the Quality of Life and Experiences of People Living with Schizophrenia in Harare, Zimbabwe

Schizophrenia is a complex and severe mental disorder affecting more than 20 million people worldwide. This study used focused ethnography to explore the everyday lives of 18 people living with schizophrenia in Zimbabwe and its impact on their quality of life (QOL). Data were collected using semi-structured interviews, observational fieldwork, and the short form of the World Health Organization QOL-BREF questionnaire. Those aged 20-40 years experienced poorer QOL than older people. Family dislocation, living with stigma and discrimination, cost of medications and limited and variable access to treatment and support disrupted participants' ability to enjoy life and function socially.

'Family centric rehabilitation' for persons with mental illness in India: Conceptual framework using evidence-based case studies'

PURPOSE OF THE STUDY

In India, people live in a collective society wherein family members are the primary caregivers for the person suffering from mental illness (PMI). Psychiatric rehabilitative models are individual-centric, focusing on individual level skills (emotional, social, self-management and vocational) and development to enhance successful community reintegration. If the entire family is considered to be a unit for rehabilitation, i.e. family centric rehabilitation, the possibility of empowering the family to function effectively is higher despite the illness. The objective of the case study is to conceptualize the framework 'Family centric Rehabilitation'.

METHODS

Case study design.

RESULTS

Family centric rehabilitation can be conceptualized as 'a process that facilitates families, dysfunctional due to PMI, to reach their optimal level of independent functioning by harnessing resources available within the community'. Family centric rehabilitation focuses on enhancing global functioning of the "family unit", in essence all members, rather than just the PMI. Strategies deployed include concurrently addressing and minimizing anticipated challenges across domains including medical, psychosocial, vocational as well as economic, thereby aiding in recovery of the family unit as a whole.

CONCLUSIONS

Family centric rehabilitation is an important culture specific concept that aims to provide optimal level of functioning of all family members and can contribute to the family achieving self-sustenance, a sense of autonomy and empowerment.

Family understanding and communication about an adult relative's mental health problem: A systematic narrative review

WHAT IS KNOWN ON THE SUBJECT?: Adults who support an adult family member with a severe and enduring mental health problem often experience carer burden. Over time, this often negatively affects their mental and physical health and social well-being. Understanding and communicating about mental health problems in families can help to improve resilience and coping among both adults and children. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: We conducted a review of studies looking at how adult relatives understand and communicate about an adult family member's mental health problem. The findings highlight that how relatives make sense of MHP is related to historical family relationships, their mental health literacy and whether they see themselves as a "carer" or not. The findings also show that little research to date has explored how adult relatives talk with children about their parent's difficulties, and how the adults' understanding might affect what children learn about the MHP. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a research gap to be addressed regarding family communication with children about parental mental health problems. This knowledge gap likely impacts family-focused mental health nursing and therapy provision. Mental health nursing, therapeutic and support workers and advocates are ideally positioned to assist relatives with improving their mental health literacy and confidence communicating about mental health, and to promote inclusion of relatives and children in interventions. ABSTRACT: Introduction Relatives are profoundly affected by an adult family member's severe and enduring mental health problem (MHP). The burdens of caring impact on adult relatives' emotional, physical and social well-being. How relatives make meaning and communicate about the MHP is thought to affect family talk about mental health, and this can impact family coping and well-being. Aim No review has yet drawn together research about how adult relatives of people with severe and enduring MHP make meaning and communicate about their relatives' difficulties. We aimed to address this gap. Method We conducted a systematic review of peer-reviewed primary research. SCOPUS, PubMed, Psychnet, SCIE, Cochrane and CINAHL+ databases were searched. Results Nineteen papers qualified for inclusion. Findings are organized under four themes: making meaning about the MHP and affected individual; conceptualizing the self in the presence of the MHP; meaning-making processes underlying relatives' well-being outcomes; and relatives' perspectives on family talk about the MHP. Discussion Historical relationships, caregiver identity and mental health literacy moderate relatives' understanding and talk about the MHP. Implications for practice Psychoeducation and communication support for relatives should be provided by mental health practitioners. Future research should address familial communication about MHP, including with children.

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.

Caring for a violent relative with severe mental illness: a qualitative study

Background

According to the literature reviewed, although families living with a mentally ill relative often face violence, this issue has been little studied in nursing.

Methods

We conducted a qualitative research study to explore the experience of families dealing with this complex reality. We adopted Jacques Donzelot's theory of the government of family as our theoretical framework and used grounded theory as our research methodology. In total, 14 participants who had been victims of violence perpetrated by relatives with severe mental illness were interviewed.

Findings

Qualitative analysis led to the identification of five themes: (a) medico-legal apparatus; (b) experience of violence; (c) the family's responsibility toward the violent relative; (d) exclusion and stigmatisation; and (e) suffering and resilience. The present paper focuses on the study's central theme: the family's responsibility toward the violent relative.

“Their pain is our pain”: The lived experience of intimate partners in Veteran recovery from PTSD

Introduction: Social support, particularly support from an intimate partner, is both a significant protective factor for trauma-exposed Veterans and critical for recovery in mental health, yet we know little about the experiences and support needs of their partners, particularly in the Australian context. This study examined the multidimensional nature of experiences of being an intimate partner of a contemporary Veteran with posttraumatic stress disorder (PTSD). Methods: The authors used a qualitative phenomenological approach to conduct an inductive thematic analysis of data collected through individual interviews with a purposive sample of 10 partners of contemporary Veterans living in Australia. Interviewees were recruited through a range of community support organizations. Results: Analysis revealed intimate partners are crucial participants in supporting the recovery journey for traumatized Veterans, effectively managing day-to-day care, encouraging autonomy and instilling hope. However, descriptions highlighted that lack of understanding of partners’ daily lives, and particularly their commitment to maintaining their intimate relationship, by health care providers and government results in a sense of invisibility and is the key barrier to receiving the support they need in order to support recovery in their Veteran partners. Discussion: The findings underscore the importance of recognizing the role of intimate relationships in trauma recovery and of responding to the support needs of intimate partners. In particular, the findings have clear implications for improving the engagement by health care providers of partners of Veterans with PTSD in Veteran clinical treatment. More formal recognition of the indirect impact of PTSD on partners of Veterans is also needed within organizational policies and procedures. Finally, there is clearly a need for continuing education of health care providers, government staff and the general community about the nature of PTSD and its impacts on relationships, particularly the intimate type.

Rehabilitation needs of patients with schizophrenia attending the general hospital psychiatric unit of a tertiary care hospital in South India

CONTEXT

Schizophrenia is a major psychiatric illness that is stressful for both patients and their families. Along with clinical improvement with medications, psychosocial rehabilitation is an essential part of treatment to improve functioning and quality of life.

AIMS

This study aims to assess the rehabilitation needs of patients with schizophrenia and to identify the association of these needs with demographic and clinical variables.

SETTINGS AND DESIGN

A cross-sectional descriptive design was used. The study was conducted in a general hospital psychiatric unit (GHPU) of a tertiary care teaching hospital.

SUBJECTS AND METHODS

The sample included 770 subjects (385 patients and 385 caregivers). A standardized self-administered questionnaire, the Rehabilitation Needs Assessment Schedule was used to assess the patients' rehabilitation needs.

STATISTICAL ANALYSIS USED

Categorical variables were expressed as frequencies and percentages. Continuous variables were expressed in terms of mean with standard deviation or median with an interquartile range. The association between different rehabilitation needs was analyzed using the Chi-square test or Fisher's exact test.

RESULTS

The most common requirement was skill training rehabilitation needs (93.8%), followed by psychosocial modification rehabilitation needs (88%) and help for family members (87%). There were significant associations (P < 0.05) between age at onset of illness with employment, current living status with overall needs, and help needed by the family.

CONCLUSION

The study found that 76.9% of the patients required help in at least one rehabilitation domain. The findings of the study have implications in planning and implementing rehabilitation programs.

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.

The caregivers' dilemma: Care burden, rejection, and caregiving behaviors among the caregivers of patients with depressive disorders

Taking care of depressed patients significantly impacts caregivers' lives, both objectively and subjectively. The effects of caregivers' burden on their responses to their patients has yet to be investigated. The aim of this study is to explore the relationships among caregivers' subjective and objective burden, depression, frequency of caregiving behaviors, and rejective attitude. A cross-sectional study was conducted among 134 caregivers of patients diagnosed with depressive disorders. We administered questionnaire to assess caregivers' demographics, care burden, reassurance seeking, depression, rejective attitude and caring behaviors. Both caregivers' objective and subjective burdens were associated with their depressive symptoms. Rejection towards patients was determined by the caregivers' level of depressive symptoms, subjective feeling of sadness, and anger, rather than by their objective burden. On the other hand, the frequency of caregiving behavior was determined by perceived reassurance seeking and anger, rather than by caregivers' depression or objective burden. These findings suggest that caregivers' subjective burden plays a more salient role in predicting their rejection and frequency of caregiving behaviors toward the patients than objective burden. The caregivers in this study could recognize their rejective attitude toward depressed patients but still had difficulty withdrawing their care when they were already in distress.

Effects of brief family psychoeducation for caregivers of people with schizophrenia in Japan provided by visiting nurses: protocol for a cluster randomised controlled trial

INTRODUCTION

Development of a support system for families caring for people with schizophrenia in routine psychiatric care settings is an important issue worldwide. Regional mental health systems are inadequate for delivering effective services to such family members. Despite evidence that family psychoeducation (FPE) alleviates the burden of schizophrenia on families, its dissemination in routine clinical practice remains insufficient, suggesting the need for developing an effective and implementable intervention for family caregivers in the existing mental health system setting. In Japan, the visiting nurse service system would be a practical way of providing family services. Visiting nurses in local communities are involved in the everyday lives of people with schizophrenia and their families. Accordingly, visiting nurses understand their needs and are able to provide family support as a service covered by national health insurance. The purpose of this study is to discover whether a brief FPE programme provided by visiting nurses caring for people with schizophrenia will alleviate family burden through a cluster randomised controlled trial (cRCT).

METHODS AND ANALYSIS

The study will be a two-arm, parallel-group (visiting nurse agency) cRCT. Forty-seven visiting nurse agencies will be randomly allocated to the brief FPE group (intervention group) or treatment as usual group (control group). Caregivers of people with schizophrenia will be recruited by visiting nurses using a randomly ordered list. The primary outcome will be caregiver burden, measured using the Japanese version of Zarit Burden Interview. Outcome assessments will be conducted at baseline, 1-month follow-up and 6-month follow-up. Multiple levels of three-way interactions in mixed models will be used to examine whether the brief FPE programme will alleviate the burden on caregivers relative to treatment as usual.

ETHICS AND DISSEMINATION

The Research Ethics Committee of the Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Japan (No 2019065NI) approved this study. The results will be published in a scientific peer-reviewed journal.

TRIAL REGISTRATION NUMBER

UMIN000038044.

Strategies used by families to cope with chronic mental illnesses: Psychometric properties of the family crisis oriented personal evaluation scale

PURPOSE

This study was aimed at investigating the psychometric properties of the Family Crisis Oriented Personal Evaluation Scale (F-COPES) for Turkish society, which assesses the coping skills of caregivers of individuals with chronic mental illnesses.

DESIGN AND METHODS

The study was conducted with 153 family caregivers of patients with a chronic mental illness admitted to the inpatient and outpatient units of two university hospitals and İzmir Schizophrenia Solidarity Association. For the language validity, the translation-back translation method was performed, for the content validity, expert opinions were obtained, for the construct validity, exploratory and confirmatory factor analysis was performed. For the reliability analysis, Cronbach α reliability coefficient was calculated and the test-retest reliability analysis was performed.

FINDINGS

The content validity index of the scale was 0.96. The Cronbach's α reliability coefficient for the overall scale was .80. Factor loadings of the subscales ranged between 0.56 and 0.69 for the Acquiring Social Support subscale, between 0.43 and 0.74 for the Reframing subscale, between 0.53 and 0.74 for the Seeking Spiritual Support subscale. The model fit indexes were as follows: χ² = 176.369, df = 116, χ² /df = 1.52, RMSEA = 0.059, CFI = 0.90, IFI = 0.91, GFI = 0.88.

PRACTICE IMPLICATIONS

The results of the present study show that the levels of psychometric properties of F-COPES in Turkish society are acceptable. It is thought that it would be useful to use the F-COPES in the assessment of coping behaviors of individuals who give care to patients with a chronic mental illness and that it can be used as measurement tool in studies to be conducted with caregivers of patients with a chronic mental illness to assess their coping skills.

Impact of brief psychosocial intervention on key relatives of patients with schizophrenia: A randomized controlled trial

BACKGROUND

Caregivers of patients with schizophrenia often experience high burden of care and have deterioration in the quality of their life. This study attempted to assess the efficacy of a brief psychosocial intervention (BPI) on the burden of care and quality of life (QOL) of key relatives of patients with schizophrenia and its subsequent effect on QOL of their patients (if any).

METHODS

A total of 66 patients and their key relatives were included in the study. Patients were assessed for psychopathology (by applying Positive and Negative Syndrome Scale and World Health Organization QOL scale [WHOQOL-BREF]) and relatives were assessed on Burden Assessment Schedule and WHOQOL scale (WHOQOL-100). Thirty-three patients and their key relatives were randomly allocated to BPI group and nonspecific control intervention group.

RESULTS

There was a statistically significant reduction in burden of care (P = 0.004) and improvement in QOL of relatives (P = 0.024) as well as in QOL scores of patients (P = 0.0028) in the BPI group.

CONCLUSION

BPI is associated with a significant improvement in QOL as well as burden of care of key relatives of patients with schizophrenia, which, in turn, results in improvement in QOL of their patients.

Understanding family perspectives on supported employment

BACKGROUND

One integral way by which individuals in recovery pursue meaning and productivity in their lives is via employment. Unfortunately, the vast majority of individuals with serious mental illness (SMI) who express the desire to work remain unemployed. Families have the potential to play an important role in the domain of supported employment (SE), though may not have the knowledge or skills to do so.

AIMS

This quantitative study aimed to better understand the perspectives of family members on the role of employment in recovery and the barriers faced by their loved ones in pursuing work.

METHOD

Participants included 86 family members of individuals with SMI who were affiliated with their state NAMI Chapter and agreed to take part in an online survey. Wilcoxon signed-rank tests were used to determine meaningful differences between the highest and lowest ranked statements for each main research question.

RESULTS

Family members recognize that employment is important to recovery and offers individuals with SMI a valued social role. Relative to other factors, financial independence and being employed in a competitive job were viewed as less important to recovery. The most salient barriers to employment included stable housing, need for transportation, concerns about losing benefits, low self-esteem, and medication side effects.

CONCLUSIONS

While family members can appreciate the importance of SE and their loved ones' desire to work, they still tend to rank other factors as more integral to recovery. This underscores the need for additional education about the potential for employment to facilitate these other factors in recovery.

Experiences of Family Violence Committed by Relatives With Severe Mental Illness: A Grounded Theory

In forensic psychiatry, family violence perpetrated by a loved one suffering from severe mental illness is a significant problem thought to affect nearly half of families. To examine this poorly documented issue, a qualitative study using a grounded theory research strategy was conducted with family members who have experienced violence committed by a relative with severe mental illness. Semistructured interviews were conducted with 14 participants who had experienced this type of violence. The works of poststructuralist thinkers Jacques Donzelot and Michel Foucault inform the theoretical framework. Qualitative analysis of the data led to the emergence of five major themes: medicolegal apparatus, experience of violence, family's responsibility toward the violent relative, exclusion and stigmatization, and suffering and resilience. The main results of this qualitative study indicate that families are governed through specific mechanisms, including instrumentalization of the family's role and transfer of the violent person's care to the family. Obstacles preventing families from being included in their relative's care were also raised. This research contributes to nursing by shedding light on clinical interventions and health policy in family care. It also offers insight into the provision of appropriate quality care in particularly complicated family situations.

Joining forces to improve psychosocial care for people with cognitive deficits across diagnoses: social health as a common framework

Cognitive deficits such as memory problems have a major impact on independence in daily life and participation in society in several populations, such as people with dementia, brain injury (i.e. stroke) or a severe mental illness such as schizophrenia. Similarities in the impact on participation and well-being have resulted in the development of comparable psychosocial interventions across populations, aiming to support people to adapt to cognitive deficits or by adapting the environment. These interventions are developed separately, without using the expertise in other fields. We argue that each of the fields and the field of psychosocial care in general would benefit from closer collaboration on development and evaluation of innovative psychosocial interventions. Collaboration has been complicated by the use of different care models and theoretical frameworks, each with their own terminology. The concept of social health - the ability to participate in work or other meaningful activities and to feel healthy despite a condition - translates to the leading care models within the fields of dementia, brain injury and severe mental illness. The concept of social health provides a common language and framework. In this paper, we elaborate on strategies for collaboration using examples of interventions to improve social health.

The Paths to Negative and Positive Experiences of Informal Caregiving in Severe Mental Illness: A Study of Explanatory Models

The experience of caregiving in severe mental illness is a valuable concept for research and clinical practice as it can provide access to the idiosyncratic assessment of negative and positive dimensions of informal caregiving, thus allowing the design of interventions focused on reducing risk factors and promoting protective factors. This study was aimed at testing explanatory models of negative and positive experiences of caregiving considering the role of the caregiver’s perceptions of difficulties, satisfaction, and coping. A convenience sample of 159 informal caregivers of patients with schizophrenia was used in this study. Different variables were considered: (1) perception of difficulties (Caregiver’s Assessment of Difficulties Index); (2) perception of satisfaction (Caregiver’s Assessment of Satisfaction Index); (3) perception of coping (Caregiver’s Assessment of Managing Index); and (4) the experience of caregiving (Experience of Caregiving Inventory). Using structural equation modeling, the results revealed the following: (1) the perception of difficulties and of satisfaction coexist; (2) the negative experiences of caregiving are predominantly explained by the perception of difficulties and of coping with stress; and (3) the positive experiences of caregiving are mainly explained by the perception of sources of intrapersonal satisfaction, while the perception of coping does not have robust predictive value.

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.

Depression and associated factors among primary caregivers of children and adolescents with mental illness in Addis Ababa, Ethiopia

BACKGROUND

Mental illnesses among children and adolescents are under-recognized and under-treated problems. Depression is one of today's all-too-silent health crises in caregivers. Although primary caregivers of children and adolescents with mental illness are more frequently depressed, little attention is being given to the problem in Ethiopia. Thus, this study aimed to assess prevalence of depression and associated factors among primary caregivers of children and adolescents with mental illness in Ethiopia.

METHODS

Institution-based cross-sectional study was conducted among primary caregivers of children and adolescents with mental illness in Ethiopia. Systematic random sampling was used to recruit a total of 416 study participants. Patient Health Questionnaire-9 was used to measure depression. After descriptive statistics was conducted, binary logistic regression was employed to carry out bivariate and multivariate analysis.

RESULT

The overall prevalence of depression was 57.6% with 95% CI (53, 62.7). The prevalence of depression among female primary caregivers was 64.6% (n = 181). Female sex (AOR = 2.4, 95% CI: 1.18,4.89), duration of care > 5 years (AOR = 4.2, 95% CI: 2.02,8.70), absence of other caregiver (AOR = 2.7, 95% CI: 1.41,5.34), being mother (AOR = 3.9, 95% CI: 1.90,8.04), autistic spectrum disorder (ASD) (AOR = 4.7, 95% CI: 2.06,10.54) and attention deficit /hyperactivity disorder (ADHD) (AOR = 5.3, 95% CI: 2.14,13.23) diagnosis of children and adolescents and poor social support (AOR = 5.5, 95% CI: 2.04,15.02) were associated with depression.

CONCLUSION

The prevalence of depression among primary caregivers of children and adolescents with mental illness attending treatment in St. Paul's hospital millennium medical college (SPMMC) and Yekatit-12 hospital medical college (Y12HMC) was high. Therefore, it needs to screen and treat depression in primary caregivers of children and adolescents having follow-up at child and adolescent clinics especially for those primary caregivers who are female, mother, gave care for > five years, have no other caregiver, have children diagnosed with ASD and ADHD and have poor social support.