Sleep Quality in Caregivers of Older Patients with Schizophrenia Spectrum and Bipolar Disorders: A Case-Control Study

Burdening caregivers of patients with schizophrenia at Edward Francis Small Teaching Hospital, The Gambia

PURPOSE

Deinstitutionalization of persons living with mental illness has led to many patients residing in communities with family members and shifting the burden of care and caregiving from hospitals to homes. The aim of the study was to determine the burden on caregivers of patients with schizophrenia at Edward Francis Small Teaching Hospital (EFSTH).

METHODS

This was a descriptive cross-sectional study design with a sample consisting of 161 randomly selected caregivers of patients with schizophrenia. The GHQ-12 questionnaire was used to determine the general health status of the caregivers. The caregivers' burden was assessed using the Zarit Burden Scale. The data were collected using the researcher-administered method. The collected data were analyzed with IBM SPSS Version 20 using descriptive statistics, mean differences, and the general linear model (GLM).

RESULTS

The main findings of this study were that caregivers experienced a significantly high level of burden. Most of them experienced high levels of physical (70%), psychological (93.2%), social (78.3%) and financial (55.3%) burdens. Employment status, specifically unemployment status and belonging to the Wolof ethnic group, was a significant predictor of the level of financial burden on the caregivers. Similarly, the total score for social burden was also significantly greater among unemployed caregivers. Educational level was a significant predictor of the total score on the psychological and physical burden scale.

CONCLUSION

The caregivers of patients with schizophrenia at EFSTH are experiencing a high level of burden as a result of their caregiving role, which affects their health, and this calls for urgent intervention.

Psychological well-being and family distress of Italian caregivers during the COVID-19 outbreak

The present study aimed to investigate the personal well-being and family distress of Italian caregivers during the lockdown. Five hundred sixty-five family caregivers and 638 age- and sex-matched noncaregivers completed a web-based survey. The following scales were administered to all participants: General Health Questionnaire-12 items (GHQ-12), Insomnia Severity Index (ISI), Brief Resilient Coping Scale (BRCS), and Family Distress Index (FDI). Caregivers were also asked to provide information about their family members with disabilities. Individual and family distress, as well as insomnia, were significantly higher in caregivers than controls. Contrariwise, caregivers reported lower resilience levels. Multiple linear regression showed that distress was higher in caregivers living in Central and Southern Italy. Individual well-being was negatively predicted by low independence measured by the activities of daily living (ADL). Family distress was higher in households of psychiatric patients. Finally, low resilience levels appeared as the strongest predictors of both individual and family distress. The lockdown caused severe distress among caregivers and families of people with disabilities. Support networks for people with disabilities and their families are fundamental to prevent severe consequences from a psychological, social, and economical point of view.

Correlation between Sleep Time, Sleep Quality, and Emotional and Cognitive Function in the Elderly

Background

To explore the relationship between sleep time, sleep quality, and emotional and cognitive function in the elderly.

Methods

A total of 150 elderly patients over 65 years old who were admitted to our hospital from February 2019 to April 2021 were divided into a normal cognitive function group (Mini-Mental State Examination (MMSE) score: illiteracy, >17; primary school, >20; and middle school and above, >24; N = 86) and cognitive impairment group (MMSE score: illiteracy, ≤17; primary school, ≤20; and middle school or above, ≤24; N = 64). The sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), and anxiety and depression were evaluated by Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD), respectively. The cognitive function between the two groups was compared via the Montreal Cognitive Assessment (MoCA) score, visual spatial execution, and attention. Pearson correlation analysis was used to analyze the correlation between sleep quality, sleep time, and emotional and cognitive function.

Results

In the comparison of sleep quality between the two groups, the total score of PSQI, sleep quality, falling asleep time, sleep time, and sleep efficiency of patients with cognitive impairment were higher than those of patients with normal cognitive function (P < 0.05). There was no significant difference in the scores of hypnotic use and daytime dysfunction between the two groups, but the scores of nocturnal sleep disorders and ESS in the cognitive impairment group were significantly higher than those in the normal group (P > 0.05). Compared between the two groups, the MoCA score, visual spatial execution, and attention in the cognitive impairment group were significantly lower than those in the normal group, and the difference was statistically significant (P < 0.05). The delayed recall in the cognitive impairment group was significantly higher than that in the control group (P < 0.05). There was no significant difference in orientation, naming, language, and abstract ability between the two groups (P > 0.05). The scores of HAMA and HAMD in the cognitive impairment group were significantly higher than those in the normal group. Pearson correlation analysis was used to analyze the correlation between sleep therapy, sleep time, and the score of cognitive scale. The results showed that PSQI was negatively correlated with MoCA and MMSE, and ESS was negatively correlated with MoCA and MMSE. Pearson correlation analysis results indicated that PSQI was positively correlated with HAMA and HAMD, while ESS was negatively correlated with HAMA and HAMD.

Conclusion

The sleep quality and sleep time of elderly patients are positively correlated with their cognitive function. The worse the sleep quality is, the worse their cognitive function is and the more serious their anxiety and depression are. In the course of clinical therapeutics, more attention should be paid to the sleep quality of elderly.

Sleep Quality Reports From Family Caregivers and Matched Non-caregiving Controls in a Population-Based Study

The stress of family caregiving may affect many health-related variables, including sleep. We evaluated differences in self-reported sleep quality between incident caregivers and matched non-caregiving controls from a national population-based study. Caregivers and controls were identified in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and matched on seven different demographic and health history factors. Caregivers reported significantly longer sleep onset latency than controls, before and after adjusting for covariates (ps < .05). No differences were found on measures of total sleep time or sleep efficiency. Among caregivers only, employed persons reported less total sleep time and number of care hours was a significant predictor of total sleep time. Dementia caregivers did not differ from other caregivers. This is one of the few population-based studies of sleep quality in family caregivers. Additional research is needed to examine whether sleep disturbance contributes to greater health problems among caregivers.

The Effects of Clinical Experience on Early Career Psychiatrists' Beliefs and Attitudes Towards Older Psychiatric Patients

Although literature has documented widespread negative and stereotypical attitudes held by healthcare professionals towards the older adults, there is a current paucity of research about the perspective of psychiatrists. We aimed to identify the attitudes of Tunisian early career psychiatrists towards the older adults. This was a cross-sectional study conducted among 71 early career psychiatrists. Data were collected through anonymous online surveys. A series of 4 point Likert-type questions ("strongly agree", "somewhat agree", "somewhat disagree", "strongly disagree") asked participants about their beliefs about older patients, the characteristics of the psychiatric care of an older person and emotions related to caring for older patients. Psychiatrists agreed that the older patient: is frail and vulnerable in 64.8% of cases, does not trust his psychiatrist in 28% of cases, has problems of communication in 36.6% of the cases and shows hostile or aggressive behavior in 5.6% of the cases. A multivariate binary logistic regression analysis found that clinical experience would play an independent role in predicting the following beliefs and attitudes of early career psychiatrists towards older patients: the belief that the older patient often has perceptual disorders that he is fragile and vulnerable, that he often requires polypharmacy, and that his management exposes the psychiatrist to painful emotional experiences. Given the population aging, early career psychiatrists need to be equipped with skills to fulfil significant roles in responding to future health and support needs. Integrating clinical training in psychogeriatrics into the psychiatric curriculum is strongly recommended.