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Rodell S, Parry S. Family members' experiences of seeking help for a young person with symptoms associated with the psychosis spectrum: A narrative review and synthesis. Clin Child Psychol Psychiatry 2024; 29:897-912. [PMID: 37188330 PMCID: PMC11188561 DOI: 10.1177/13591045231176701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Young people often rely on family carers to access support for their mental health. However, stigma can be a barrier to help seeking for young people and families. Little research has been undertaken with young people who experience highly stigmatised symptoms, such as psychosis spectrum symptoms, and even less research has been conducted with parents and carers, meaning barriers to help go unchallenged. Therefore, this narrative review aimed to explore stories of family experiences of seeking help for young people with symptoms associated with the psychosis spectrum. Sources searched were PsycINFO and PubMed. Reference lists of the selected papers were also cross-checked to ensure the search had not missed potential papers for inclusion. Searches returned 139 results, of which 12 were identified for inclusion. A narrative analytic approach was adopted to synthesise qualitative findings to provide a nuanced interpretation of help-seeking experiences. The narrative synthesis provided an opportunity to identify differences, similarities, and patterns across the studies to tell a cumulative emancipatory narrative of family experiences of seeking help for psychosis spectrum symptoms. Help-seeking experiences had a relational impact on families, with stress adding to conflict and anxieties inhibiting hopefulness, although families could emerge stronger and assertively with compassionate support.
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Affiliation(s)
- Sadie Rodell
- Doctorate of Clinical Psychology, Lancaster University, Lancaster, United Kingdom
| | - Sarah Parry
- Division of Health Research, Lancaster University, Lancaster, LA1 4YW, United Kingdom
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2
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Plessis L, Rexhaj S, Golay P, Wilquin H. Coping profiles of family caregivers of people with schizophrenia: differentiations between parent and sibling caregivers. J Ment Health 2024; 33:244-252. [PMID: 36545780 DOI: 10.1080/09638237.2022.2156986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 10/19/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prior research on informal caregivers of people with schizophrenia (PWS) has primarily focused on parental caregivers. However, siblings also play an important role in the recovery process of PWS. AIMS The aim of this study is to compare the coping profiles of family caregivers according to whether they are siblings or parents of the PWS. METHOD Parent and sibling caregivers (N = 181) completed the Family Coping Questionnaire (FCQ), which assessed their coping strategies. RESULTS The results reveal that parents and siblings do not use the same coping strategies and styles. Three coping profiles were identified depending on the caregiver's relationship with the PWS. Most parents displayed an undifferentiated profile (96.7%), while siblings were more heterogeneously distributed among the undifferentiated profile (58.3%), problem-focused profile (37.5%), and emotion and social support-focused profile (4.2%). CONCLUSIONS These findings suggest that the coping capacities of family caregivers to deal with the illness of their sibling or child with schizophrenia are diverse and that it is important to differentiate among them. This would enable these caregivers to benefit from support that could be tailored to their specific needs.
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Affiliation(s)
- Léa Plessis
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, Boulogne-Billancourt, France
| | - Shyhrete Rexhaj
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences Western Switzerland, Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, University Hospital Centre, Lausanne, Switzerland
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3
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Rus-Calafell M, Teismann T, Kullmann F, Alatas D, Ballero-Reque C, Holewa J, Rüsberg M, Brüne M, Paino M, Schneider S. Internet-based psychoeducation and support programme for relatives of young people with early psychosis: results of the first German-language intervention. Front Psychiatry 2024; 15:1248526. [PMID: 38292904 PMCID: PMC10824940 DOI: 10.3389/fpsyt.2024.1248526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Background International clinical guidelines recommend Family Interventions (FIs) especially for families of people at early stages of psychosis. The German S3 treatment guideline for schizophrenia gives FIs the highest level of clinical recommendation. However, some family relatives have limited access to these services due to health system constrains. Digital interventions have emerged as a solution to overcome this hindered access to evidence-based family interventions. Objective The present pilot study evaluates the feasibility and potential efficacy of the first German moderated online psychoeducation and support programme (ePSP) for relatives of people with early psychosis, with the additional purpose to improve accessibility and reduce waiting times. Methods A pre-post study was performed. A brief recruitment period was pre-established (10 weeks) to test potential improvement of regular therapy waiting times in Germany. A total of 25 relatives of people with early psychosis were recruited and received the 12-week moderated online intervention. Assessments were conducted at baseline and at post intervention. Acceptance of the intervention and the user's experience were also evaluated at post intervention. Results Recruitment, retention rates and qualitative data support the feasibility and acceptability of the ePSP. Significant positive effects of the interventions were found on key therapeutic targets, including both primary outcomes (i.e., perceived stress and beliefs about the illness). Twenty-one participants also completed the open-ended questions of the user experience questionnaire, which yielded three main themes: most important modules, difficulties in using the programme and ways to improve ePSP. Discussion These results provide preliminary efficacy estimates for a fully powered RCT to investigate superiority (or equipoise) effects of the ePSP in comparison to the routine face-to-face family therapy groups. This future RCT will also allow further exploration of ePSP to improve access to psychological therapy for relatives of young people with psychosis, also in relation to the new ground-breaking Digital Healthcare Act in Germany.
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Affiliation(s)
- Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- German Center of Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- German Center of Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Germany
| | - Fine Kullmann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Dilara Alatas
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Cristina Ballero-Reque
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Julia Holewa
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Marilena Rüsberg
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Martin Brüne
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University Bochum, Bochum, Germany
| | - Mercedes Paino
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- German Center of Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Germany
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4
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Buck B, Wingerson M, Whiting E, Snyder J, Monroe-DeVita M, Ben-Zeev D. User-Centered Development of Bolster, an mHealth Intervention for Early Psychosis Caregivers: Needs Assessment, Prototyping, and Field Trial. JMIR Ment Health 2023; 10:e50522. [PMID: 38032692 PMCID: PMC10722359 DOI: 10.2196/50522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/09/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Caregivers play a critical role in the treatment and recovery of youth and young adults at risk for psychosis. Caregivers often report feeling isolated, overwhelmed, and lacking in resources. Mobile health (mHealth) has the potential to provide scalable, accessible, and in-the-moment support to caregivers. To date, few if any mHealth resources have been developed specifically for this population. OBJECTIVE The aim of this study was to conduct user-centered design and testing of an mHealth intervention to support early psychosis caregivers. METHODS We conducted a multiphase user-centered development process to develop the Bolster mobile app. In phase 1, a total of 21 caregivers were recruited to participate in a qualitative needs assessment and respond to an initial prototype of the Bolster platform. Content analysis was used to identify key needs and design objectives, which guided the development of the Bolster mobile app. In phase 2, a total of 11 caregivers were recruited to participate in a 1-week field trial wherein they provided qualitative and quantitative feedback regarding the usability and acceptability of Bolster; in addition, they provided baseline and posttest assessments of the measures of distress, illness appraisals, and family communication. RESULTS In phase 1, participants identified psychoeducation, communication coaching, a guide to seeking services, and support for coping as areas to address. Live prototype interaction sessions led to multiple design objectives, including ensuring that messages from the platform were actionable and tailored to the caregiver experience, delivering messages in multiple modalities (eg, video and text), and eliminating a messaging-style interface. These conclusions were used to develop the final version of Bolster tested in the field trial. In phase 2, of the 11 caregivers, 10 (91%) reported that they would use Bolster if they had access to it and would recommend it to another caregiver. They also reported marked changes in their appraisals of illness (Cohen d=0.55-0.68), distress (Cohen d=1.77), and expressed emotion (Cohen d=0.52). CONCLUSIONS To our knowledge, this study is the first to design an mHealth intervention specifically for early psychosis caregivers. Preliminary data suggest that Bolster is usable, acceptable, and promising to improve key targets and outcomes. A future fully powered clinical trial will help determine whether mHealth can reduce caregiver burdens and increase engagement in services among individuals affected by psychosis.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Mary Wingerson
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Erica Whiting
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jaime Snyder
- Information School, University of Washington, Seattle, WA, United States
| | - Maria Monroe-DeVita
- Supporting Psychosis Innovation through Research Implementation and Training (SPIRIT) Lab, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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5
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Sanjuán-Quiles Á, Alcañiz-Garrán MDM, Montejano-Lozoya R, Ramos-Pichardo JD, García-Sanjuán S. [The perspective of caregivers from a gender analysis.]. Rev Esp Salud Publica 2023; 97:e202307062. [PMID: 37415488 PMCID: PMC10541258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/23/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE Gender influences the provision of family caregiving, identifying inequalities in the distribution of care-related tasks. The aim of this study was to analyze the gender influence in family caregiving, provided by elderly while, identifying the sociodemographic characteristics of caregivers. METHODS Mixed, descriptive and phenomenological study was made. Eight women and five men aged seventy and over participated who cared for dependent people at home, selected by intentional sampling in Valencia. The analysis of the in-depth interviews was carried out in three stages: reading to the participants of the transcripts for their verification; discrimination of units of meaning; eidetic and phenomenological reduction to obtain the statements of meaning. Frequencies and percentages were calculated. RESULTS The mean age, educational level and years dedicated to care were higher in caregivers. Caregivers had a greater burden related to caregiving. Three categories influenced by androcentric culture were idenfied: vital perspective; reasons that support care; coping strategies. 90% of female caregivers cared out of moral obligation, compassion, reciprocity, and love; and 80% of male caregivers by responsibility and reciprocity, obtaining a satisfactory achievement and learning. Both developed resilience skills, reaching higher levels of adaptation. Male caregivers used more protective coping mechanisms and 50% of female caregivers obtained the most comforting support from religion. CONCLUSIONS Gender determines the meaning given to the experience of caring. The reasons and coping strategies in men and women are different.
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Affiliation(s)
- Ángela Sanjuán-Quiles
- Departamento de Enfermería; Facultad de Ciencias de la Salud; Universidad de Alicante.Universidad de AlicanteAlicanteSpain
| | - María del Mar Alcañiz-Garrán
- Escuela de Enfermería La Fe; Universidad de Valencia. Universidad de ValenciaGrupo de investigación en Arte y Ciencia en Cuidados; Instituto de Investigación Sanitaria La Fe (IISLAFE).Instituto de Investigación Sanitaria La Fe (IISLAFE)ValenciaSpain
| | - Raimunda Montejano-Lozoya
- Escuela de Enfermería La Fe; Universidad de Valencia. Universidad de ValenciaGrupo de investigación en Arte y Ciencia en Cuidados; Instituto de Investigación Sanitaria La Fe (IISLAFE).Instituto de Investigación Sanitaria La Fe (IISLAFE)ValenciaSpain
| | - Juan Diego Ramos-Pichardo
- Departamento de Enfermería; Facultad de Ciencias de la Salud; Universidad de Huelva.Universidad de HuelvaHuelvaSpain
| | - Sofía García-Sanjuán
- Departamento de Enfermería; Facultad de Ciencias de la Salud; Universidad de Alicante.Universidad de AlicanteAlicanteSpain
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Wildman EK, MacManus D, Harvey J, Kuipers E, Onwumere J. Prevalence of violence by people living with severe mental illness against their relatives and its associated impacts: A systematic review. Acta Psychiatr Scand 2023; 147:155-174. [PMID: 36316292 PMCID: PMC10107449 DOI: 10.1111/acps.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Violence perpetration by adults with severe mental illness (SMI) specifically towards their relatives is a sensitive topic and a largely neglected area that has consequences and implications for different stakeholders, including healthcare providers. This paper sought to systematically review the relevant literature, to identify the types and rates of violence by people with SMI against their relatives, and to develop a detailed understanding of its reported impacts. METHODS A systematic review, registered with PROSPERO (registration number CRD42019150784), was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review comprised searches of Medline, Embase, PsycInfo and CINAHL databases, supplemented by manual searches. Data from 38 papers using mixed methodologies were reviewed. RESULTS Key findings highlighted that relatives experienced different types of violence, including physical, verbal, psychological, financial violence, and violence directed towards property. Different types often co-occurred. Mothers were the group most likely to report being victims, compared with other relatives. Reported impacts of violence on relatives included mental ill health (e.g., psychological distress, post-traumatic stress symptoms) and the deterioration, and in some cases the permanent breakdown, of family relationships and the family unit. However, relatives often continued to provide a framework of support for patients, despite risks to their own safety. CONCLUSION Findings speak to the importance of future research extending the focus beyond the identified victimised relative or perpetrator, to also consider the impacts of violence at the family-wide level, and to improve the outcomes of families exposed to and dealing with violence by individuals living with SMI.
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Affiliation(s)
- Emilie K Wildman
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Science, King's College London, London, UK
| | - Joel Harvey
- Department of Law and Criminology, Royal Holloway, University of London, Surrey, UK
| | - Elizabeth Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Juliana Onwumere
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
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7
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Estradé A, Onwumere J, Venables J, Gilardi L, Cabrera A, Rico J, Hoque A, Otaiku J, Hunter N, Kéri P, Kpodo L, Sunkel C, Bao J, Shiers D, Bonoldi I, Kuipers E, Fusar-Poli P. The Lived Experiences of Family Members and Carers of People with Psychosis: A Bottom-Up Review Co-Written by Experts by Experience and Academics. Psychopathology 2023; 56:371-382. [PMID: 36689938 PMCID: PMC10568611 DOI: 10.1159/000528513] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/20/2022] [Indexed: 01/24/2023]
Abstract
Informal caregivers of individuals affected by psychotic disorder can play a key role in the recovery process. However, little research has been conducted on the lived experiences of carers and family members. We conducted a bottom-up (from lived experience to theory) review of first-person accounts, co-written between academics and experts by experience, to identify key experiential themes. First-person accounts of carers, relatives, and individuals with psychosis were screened and discussed in collaborative workshops involving individuals with lived experiences of psychosis, family members, and carers, representing various organizations. The lived experiences of family members and carers were characterized by experiential themes related to dealing with the unexpected news, the search for a reason behind the disorder, living with difficult and negative emotions, dealing with loss, feeling lost in fragmented healthcare systems, feeling invisible and wanting to be active partners in care, struggling to communicate with the affected person, fighting stigma and isolation, dealing with an uncertain future, and learning from one's mistakes and building resilience and hope. Our findings bring forth the voices of relatives and informal carers of people with psychosis, by highlighting some of the common themes of their lived experiences from the time of the initial diagnosis and throughout the different clinical stages of the disorder. Informal carers are key stakeholders who can play a strategic role, and their contributions in the recovery process merit recognition and active support by mental health professionals.
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Affiliation(s)
- Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Juliana Onwumere
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Jemma Venables
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Ana Cabrera
- Asociación Madrileña de Amigos y Familiares de Personas con Esquizofrenia (AMAFE), Madrid, Spain
| | - Joseba Rico
- Asociación Madrileña de Amigos y Familiares de Personas con Esquizofrenia (AMAFE), Madrid, Spain
| | - Arif Hoque
- Young Person’s Mental Health Advisory Group (YPMHAG), King’s College London, London, UK
| | - Jummy Otaiku
- Young Person’s Mental Health Advisory Group (YPMHAG), King’s College London, London, UK
| | - Nicholas Hunter
- National Health System (NHS) South London and Maudsley (SLaM) Recovery College, London, UK
| | - Péter Kéri
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe), Brussels, Belgium
| | - Lily Kpodo
- South London and Maudsley (SLaM) NHS Foundation Trust, London, UK
| | - Charlene Sunkel
- Global Mental Health Peer Network (GMHPN), Johannesburg, South Africa
| | - Jianan Bao
- Department of Forensic and Neurodevelopment Sciences, King’s College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- School of Medicine, Keele University, Staffordshire, Newcastle, UK
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Elizabeth Kuipers
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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8
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Wilson E, Onwumere J, Hirsch C. Psychological Processes Associated With Resilience in UK-Based Unpaid Caregivers During the COVID-19 Pandemic. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e10313. [PMID: 36762350 PMCID: PMC9881121 DOI: 10.32872/cpe.10313] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Unpaid caregivers have faced and dealt with additional challenges during the COVID-19 pandemic. Understanding the psychological processes associated with their resilience is warranted. The objective of this study was to examine the associations between resilience with mental distress, emotion regulation strategies (i.e., reappraisal and suppression) and interpretation bias in adult caregivers. Method Participants were living in the UK, aged 18+, and consisted of 182 unpaid caregivers of an adult aged 18+ living with a long-term health condition, and 120 non-caregivers. Data were collected in an online study during the first national UK COVID-19 lockdown (May and September 2020). Hierarchical multiple regression analyses explored whether emotion regulation strategies and interpretation bias explained unique variance in levels of resilience in caregivers whilst controlling for anxiety and depression. Results Compared to non-caregivers, caregivers reported higher levels of anxiety, depression, negative interpretation bias and lower levels of resilience. Emotion regulation strategies did not differ between groups. Within caregivers, greater resilience was associated with lower mood disturbance, a positive interpretation bias, and greater use of cognitive reappraisal and lower use of suppression strategies to regulate emotions. Emotion regulation and interpretation bias together predicted an additional 15% of variance in current levels of resilience. Conclusion Our findings indicate that psychological mechanisms such as emotion regulation strategies, particularly reappraisal, and interpretation bias are associated with resilience in caregivers. Although preliminary, our findings speak to exciting clinical possibilities that could form the target of interventions to improve resilience and lower mental distress in unpaid caregivers.
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Affiliation(s)
- Emma Wilson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Colette Hirsch
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
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McKenna A, Hazell CM, Souray R, Cai W, Man LC, Brown L, Floyd C, Lyons N, Widuch K, James G, Keay D, Souray J, Afsharzadegan R, Raune D. Do carers of adolescents at first episode psychosis have distinctive psychological needs? A pilot exploration. Int J Soc Psychiatry 2022; 68:600-609. [PMID: 33554710 DOI: 10.1177/0020764021992828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Carers of patients experiencing first episode psychosis (FEP) are at an increased risk of mental and physical health problems themselves. However, little is known about how the psychological needs of carers may differ between those caring for an adolescent versus an adult who has FEP. AIMS This pilot study aimed to explore any differences in the psychological needs of carers caring for adolescents versus adults with FEP. METHODS We surveyed 254 carers of 198 FEP patients (34 carers of adolescents of 24 FEP adolescent patients). Carers completed self-report measures of anxiety, depression, burnout, subjective burden, coping, and key illness beliefs. The sample was divided according to whether the patient was under (adolescent) or over (adult) age 18, and analysed using mixed model logistic regressions. RESULTS Compared to the carers of adult patients, carers of adolescents were more than twice as likely (12% vs. 30%) to experience overall burnout syndrome (all three domains), and to develop it much quicker (19.4 vs. 10.1 months). They were also more likely to adopt behavioural disengagement avoidance as a form of coping. However, there was no difference between carers in terms of anxiety, depression, beliefs and subjective burden. For carers of adolescents, burnout was independently predicted by: a negative belief about the consequences of psychosis for the adolescent patient and an incoherent understanding of the patient's mental health. CONCLUSIONS If our findings can be replicated in a larger sample, then Rapid-Onset-Burnout-Syndrome (ROBS) is a particular problem in carers of adolescents at FEP, suggesting a need for routine screening and possible prophylactic intervention. Carers of adolescent's use of behavioural escape coping maybe also require early intervention. Theoretically, consideration could be given to the development of an adolescent sub-branch to the cognitive model of caregiving.
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Affiliation(s)
- Alice McKenna
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK.,Community Transformation Project, East London NHS Foundation Trust, London, UK
| | - Cassie M Hazell
- Department of Social Sciences, University of Westminster, London, UK
| | - Rowan Souray
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Wenyi Cai
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Lai Chu Man
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Lucy Brown
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Caroline Floyd
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Natasha Lyons
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Kaja Widuch
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Gareth James
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Debra Keay
- CAHMS Ash Tree, Central and North West London NHS Foundation Trust, London, UK
| | - Jonathan Souray
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Roya Afsharzadegan
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - David Raune
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
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10
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Khalil SA, Elbatrawy AN, Saleh NM, Mahmoud DAM. The burden of care and burn out syndrome in caregivers of an Egyptian sample of schizophrenia patients. Int J Soc Psychiatry 2022; 68:619-627. [PMID: 33567951 DOI: 10.1177/0020764021993155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The role of caregivers of schizophrenia patients in management and prognosis is crucial, caregivers are considered cornerstones in getting better outcome and quality of life. AIM To assess the burden of care and burn out syndrome in the caregivers of schizophrenia patients and its sociodemographic and clinical correlates. METHODS Recruiting all schizophrenia patients and their caregivers who sought help at El Mamoura hospital, Alexandria, Egypt, for assessment of burn out syndrome and burden of care and its sociodemographic and clinical correlates over full 6 months period. RESULTS The study included 120 schizophrenia patient and their 120 caregivers, Zarit Caregiver Burden Interview score was 25.758 ± 7.382, which indicates high burden level. Regarding the Maslach Burnout Inventory results, the mean score of Emotional Exhaustion was 50% of the caregivers have high Emotional Exhaustion scores, 35% have moderate scores; followed by 15% with low scores. The mean score of Depersonalization 46.67% of the caregivers have high (DP) scores, 30.83% have moderate scores; while 22.50% low scores. The mean score of Personal Accomplishment was 62.50% of the caregivers have low scores; 36.67% have moderate scores, while only 0.83% have high scores. Most important correlates were, male patient, positive symptoms, continuous course of illness, noncompliance, living in rural areas, and low family income. CONCLUSIONS Levels of Burn out syndrome and burden of care is high in caregivers of schizophrenia patients, caring for caregivers is very important for providing better mental health services, more research is still needed in this field.
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Kopelovich SL, Stiles B, Monroe-DeVita M, Hardy K, Hallgren K, Turkington D. Psychosis REACH: Effects of a Brief CBT-Informed Training for Family and Caregivers of Individuals With Psychosis. Psychiatr Serv 2021; 72:1254-1260. [PMID: 34015942 DOI: 10.1176/appi.ps.202000740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychosis Recovery by Enabling Adult Carers at Home (Psychosis REACH) is a training for families of individuals with psychosis that consists of recovery-oriented psychosis psychoeducation, caregiver self-care, and skills training informed by cognitive-behavioral therapy for psychosis (CBTp). The authors assessed the effects of a 1-day and a 4-day training on the natural supports (i.e., family and other caregivers) of individuals with psychotic disorders. METHODS Attendees of a 1-day (N=168) and a 4-day (N=29) Psychosis REACH training were surveyed at three timepoints: pretraining, posttraining, and 4-month follow-up. Longitudinal changes across the full sample were evaluated by paired-sample t tests or a one-way repeated-measures analysis of variance (ANOVA). Two-way mixed ANOVAs were conducted with training condition, time, and the training condition × time interactions entered into the model. RESULTS Reductions were noted in self-perceived depression, anxiety, negative aspects of the caregiving experience, and expressed emotion. Trainees also showed more prosocial attitudes toward psychosis immediately and at 4 months after the training. CONCLUSIONS This evaluation of the launch of Psychosis REACH in the United States suggests that the training can improve the mental health, attitudinal, and relational outcomes of family and caregivers of individuals with psychosis. Given the dearth of CBTp and family interventions for psychosis in mental health services in the United States, short-term, intensive training that supplements clinical services has intuitive appeal as a means of surmounting the barriers that have plagued family interventions.
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Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Bryan Stiles
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Kate Hardy
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Kevin Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Douglas Turkington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
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Lobban F, Akers N, Appelbe D, Iraci Capuccinello R, Chapman L, Collinge L, Dodd S, Flowers S, Hollingsworth B, Honary M, Johnson S, Jones SH, Mateus C, Mezes B, Murray E, Panagaki K, Rainford N, Robinson H, Rosala-Hallas A, Sellwood W, Walker A, Williamson PR. A web-based, peer-supported self-management intervention to reduce distress in relatives of people with psychosis or bipolar disorder: the REACT RCT. Health Technol Assess 2021; 24:1-142. [PMID: 32608353 DOI: 10.3310/hta24320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Relatives caring for people with severe mental health problems find information and emotional support hard to access. Online support for self-management offers a potential solution. OBJECTIVE The objective was to determine the clinical effectiveness and cost-effectiveness of an online supported self-management tool for relatives: the Relatives' Education And Coping Toolkit (REACT). DESIGN AND SETTING This was a primarily online (UK), single-blind, randomised controlled trial, comparing REACT plus a resource directory and treatment as usual with the resource directory and treatment as usual only, by measuring user distress and other well-being measures at baseline and at 12 and 24 weeks. PARTICIPANTS A total of 800 relatives of people with severe mental health problems across the UK took part; relatives who were aged ≥ 16 years, were experiencing high levels of distress, had access to the internet and were actively seeking help were recruited. INTERVENTION REACT comprised 12 psychoeducation modules, peer support through a group forum, confidential messaging and a comprehensive resource directory of national support. Trained relatives moderated the forum and responded to messages. MAIN OUTCOME MEASURE The main outcome was the level of participants' distress, as measured by the General Health Questionnaire-28 items. RESULTS Various online and offline strategies, including social media, directed potential participants to the website. Participants were randomised to one of two arms: REACT plus the resource directory (n = 399) or the resource directory only (n = 401). Retention at 24 weeks was 75% (REACT arm, n = 292; resource directory-only arm, n = 307). The mean scores for the General Health Questionnaire-28 items reduced substantially across both arms over 24 weeks, from 40.2 (standard deviation 14.3) to 30.5 (standard deviation 15.6), with no significant difference between arms (mean difference -1.39, 95% confidence interval -3.60 to 0.83; p = 0.22). At 12 weeks, the General Health Questionnaire-28 items scores were lower in the REACT arm than in the resource directory-only arm (-2.08, 95% confidence interval -4.14 to -0.03; p = 0.027), but this finding is likely to be of limited clinical significance. Accounting for missing data, which were associated with higher distress in the REACT arm (0.33, 95% confidence interval -0.27 to 0.93; p = 0.279), in a longitudinal model, there was no significant difference between arms over 24 weeks (-0.56, 95% confidence interval -2.34 to 1.22; p = 0.51). REACT cost £142.95 per participant to design and deliver (£62.27 for delivery only), compared with £0.84 for the resource directory only. A health economic analysis of NHS, health and Personal Social Services outcomes found that REACT has higher costs (£286.77), slightly better General Health Questionnaire-28 items scores (incremental General Health Questionnaire-28 items score adjusted for baseline, age and gender: -1.152, 95% confidence interval -3.370 to 1.065) and slightly lower quality-adjusted life-year gains than the resource directory only; none of these differences was statistically significant. The median time spent online was 50.8 minutes (interquartile range 12.4-172.1 minutes) for REACT, with no significant association with outcome. Participants reported finding REACT a safe, confidential environment (96%) and reported feeling supported by the forum (89%) and the REACT supporters (86%). No serious adverse events were reported. LIMITATIONS The sample comprised predominantly white British females, 25% of participants were lost to follow-up and dropout in the REACT arm was not random. CONCLUSIONS An online self-management support toolkit with a moderated group forum is acceptable to relatives and, compared with face-to-face programmes, offers inexpensive, safe delivery of National Institute for Health and Care Excellence-recommended support to engage relatives as peers in care delivery. However, currently, REACT plus the resource directory is no more effective at reducing relatives' distress than the resource directory only. FUTURE WORK Further research in improving the effectiveness of online carer support interventions is required. TRIAL REGISTRATION Current Controlled Trials ISRCTN72019945. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 32. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nadia Akers
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Duncan Appelbe
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | | | - Lesley Chapman
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lizzi Collinge
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Susanna Dodd
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | - Sue Flowers
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Bruce Hollingsworth
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Mahsa Honary
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Steven H Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ceu Mateus
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Barbara Mezes
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Katerina Panagaki
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Naomi Rainford
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | - Heather Robinson
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Anna Rosala-Hallas
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Andrew Walker
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Paula R Williamson
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
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13
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Buck B, Chander A, Monroe-DeVita M, Cheng SC, Stiles B, Ben-Zeev D. Mobile Health for Caregivers of Young Adults With Early Psychosis: A Survey Study Examining User Preferences. Psychiatr Serv 2021; 72:955-959. [PMID: 34235943 PMCID: PMC8794233 DOI: 10.1176/appi.ps.202000193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Caregivers play a key role in supporting the recovery of young adults with early psychosis. This role often involves considerable responsibilities and burden. Despite the considerable needs of caregivers, troubling service gaps addressing these needs remain. Digital technologies may increase caregivers' access to supportive resources; however, technologies developed specifically for caregivers lag far behind those developed for their relatives affected by early psychosis. In particular, little is known about the mobile health (mHealth) features that may be most acceptable to caregivers. METHODS The authors surveyed a sample of 43 caregivers on their interests regarding various features of a proposed mHealth intervention. RESULTS Caregivers of young adults with early psychosis were highly interested in a caregiver-facing mHealth intervention, specifically one providing information about psychosis, treatments, and communication with their affected family member. CONCLUSIONS Future caregiver-focused mHealth intervention interventions may be highly acceptable to this population and may address pressing service gaps.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Ayesha Chander
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Maria Monroe-DeVita
- Supporting Psychosis Innovation Through Research, Implementation, and Training (SPIRIT) Lab, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Sunny Chieh Cheng
- Department of Nursing, University of Washington at Tacoma, Tacoma, WA
| | - Bryan Stiles
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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14
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Caring for Patients with Psychosis: Mental Health Professionals' Views on Informal Caregivers' Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062964. [PMID: 33799346 PMCID: PMC8001319 DOI: 10.3390/ijerph18062964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 02/03/2023]
Abstract
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.
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15
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Onwumere J, Grice S, Kuipers E. Delivering Cognitive‐Behavioural Family Interventions for Schizophrenia. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12179] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Juliana Onwumere
- Institute of Psychiatry, Psychology & Neuroscience, King's College London,
| | - Sarah Grice
- Institute of Psychiatry, Psychology & Neuroscience, King's College London,
- South London & Maudsley NHS Foundation Trust, and
| | - Elizabeth Kuipers
- Institute of Psychiatry, Psychology & Neuroscience, King's College London,
- In affiliation with the Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neurosciences
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16
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Dillinger RL, Kersun JM. Caring for caregivers: Understanding and meeting their needs in coping with first episode psychosis. Early Interv Psychiatry 2020; 14:528-534. [PMID: 31452318 DOI: 10.1111/eip.12870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 11/16/2018] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
AIM The first episode of psychosis is a challenging time for both patients and those who care for them. Although literature on treatment is plentiful, literature on how to best support caregivers is more scarce. This review was undertaken to better understand the caregiver experience, determine which interventions most effectively alleviate their burden and examine which other factors may affect outcomes. METHODS Articles were retrieved from PubMed and OVID using the following search terms: first episode psychosis (FEP), schizophrenia, caregiver, intervention and burden in various combinations. Only peer-reviewed articles germane to FEP caregiver experience and interventions written in English were included. RESULTS Caregivers can experience grief, guilt and anxiety during this time. While concerned for their loved one, their own lives take a back seat and their mental and physical health are adversely affected. Some are better prepared to cope and are typically warm, decisive, confident and optimistic. Their families are organized and flexible. Others are less prepared and are more likely to have poor self-esteem, use avoidant coping strategies and be overly critical. Their families are controlling and have difficulty with communication and balance. These caregivers stand to benefit most from interventions. CONCLUSIONS Effective interventions incorporate psychoeducation, problem solving strategies, peer support and clinician guidance. A higher level of interaction with facilitators and peers is associated with better results. Benefits include decreases in caregiver burden, depressive and anxious symptoms and feelings of shame and isolation. Although the literature has yet to isolate the key factors of a successful intervention, this review provides practical suggestions for clinicians and further illustrates the need for more research.
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Affiliation(s)
| | - Jonathan M Kersun
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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17
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Lobban F, Appelbe D, Appleton V, Aref-Adib G, Barraclough J, Billsborough J, Fisher NR, Foster S, Gill B, Glentworth D, Harrop C, Johnson S, Jones SH, Kovacs TZ, Lewis E, Mezes B, Morton C, Murray E, O’Hanlon P, Pinfold V, Rycroft-Malone J, Siddle R, Smith J, Sutton CJ, Viglienghi P, Walker A, Wintermeyer C. An online supported self-management toolkit for relatives of people with psychosis or bipolar experiences: the IMPART multiple case study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Digital health interventions have the potential to improve the delivery of psychoeducation to people with mental health problems and their relatives. Despite substantial investment in the development of digital health interventions, successful implementation into routine clinical practice is rare.
Objectives
Use the implementation of the Relatives’ Education And Coping Toolkit (REACT) for psychosis/bipolar disorder to identify critical factors affecting uptake and use, and develop an implementation plan to support the delivery of REACT.
Design
This was an implementation study using a mixed-methods, theory-driven, multiple case study approach. A study-specific implementation theory for REACT based on normalisation process theory was developed and tested, and iterations of an implementation plan to address the key factors affecting implementation were developed.
Setting
Early-intervention teams in six NHS mental health trusts in England (three in the north and three in the south).
Participants
In total, 281 staff accounts and 159 relatives’ accounts were created, 129 staff and 23 relatives took part in qualitative interviews about their experiences, and 132 relatives provided demographic data, 56 provided baseline data, 21 provided data at 12 weeks’ follow-up and 20 provided data at 24 weeks’ follow-up.
Interventions
REACT is an online supported self-management toolkit, offering 12 evidence-based psychoeducation modules and support via a forum, and a confidential direct messaging service for relatives of people with psychosis or bipolar disorder. The implementation intervention was developed with staff and iteratively adapted to address identified barriers. Adaptations included modifications to the toolkit and how it was delivered by teams.
Main outcome measures
The main outcome was factors affecting implementation of REACT, assessed primarily through in-depth interviews with staff and relatives. We also assessed quantitative measures of delivery (staff accounts and relatives’ invitations), use of REACT (relatives’ logins and time spent on the website) and the impact of REACT [relatives’ distress (General Health Questionnaire-28), and carer well-being and support (Carer Well-being and Support Scale questionnaire)].
Results
Staff and relatives were generally positive about the content of REACT, seeing it as a valuable resource that could help services improve support and meet clinical targets, but only within a comprehensive service that included face-to-face support, and with some additional content. Barriers to implementation included high staff caseloads and difficulties with prioritising supporting relatives; technical difficulties of using REACT; poor interoperability with trust information technology systems and care pathways; lack of access to mobile technology and information technology training; restricted forum populations leading to low levels of use; staff fears of managing risk, online trolling, or replacement by technology; and uncertainty around REACT’s long-term availability. There was no evidence that REACT would reduce staff time supporting relatives (which was already very low), and might increase it by facilitating communication. In all, 281 staff accounts were created, but only 57 staff sent relatives invitations. In total, 355 relatives’ invitations were sent to 310 unique relatives, leading to the creation of 159 relatives’ accounts. The mean number of logins for relatives was 3.78 (standard deviation 4.43), but with wide variation from 0 to 31 (median 2, interquartile range 1–8). The mean total time spent on the website was 40.6 minutes (standard deviation 54.54 minutes), with a range of 0–298 minutes (median 20.1 minutes, interquartile range 4.9–57.5 minutes). There was a pattern of declining mean scores for distress, social dysfunction, depression, anxiety and insomnia, and increases in relatives’ well-being and eHealth literacy, but no changes were statistically significant.
Conclusions
Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, with staff and service user input, as part of a long-term strategy to develop integrated technology-enabled services. Implementation strategies must instil a sense of ownership for staff and ensure that they have adequate training, risk protocols and resources to deliver the technology. Cost-effectiveness and impact on workload and inequalities in accessing health care need further testing, along with the generalisability of our findings to other digital health interventions.
Limitations
REACT was offered by the same team running the IMPlementation of A Relatives’ Toolkit (IMPART) study, and was perceived by staff and relatives as a time-limited research study rather than ongoing clinical service, which affected engagement. Access to observational data was limited.
Trial registration
Current Controlled Trials ISRCTN16267685.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fiona Lobban
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Duncan Appelbe
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | | | | | | | | | - Naomi R Fisher
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Bethany Gill
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Steven H Jones
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Elizabeth Lewis
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Barbara Mezes
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Puffin O’Hanlon
- Division of Psychiatry, University College London, London, UK
| | | | | | | | - Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, UK
| | - Chris J Sutton
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | | | - Andrew Walker
- Division of Health Research, Lancaster University, Lancaster, UK
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Lobban F, Akers N, Appelbe D, Chapman L, Collinge L, Dodd S, Flowers S, Hollingsworth B, Johnson S, Jones SH, Mateus C, Mezes B, Murray E, Panagaki K, Rainford N, Robinson H, Rosala-Hallas A, Sellwood W, Walker A, Williamson P. Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar (REACT): online, observer-blind, randomised controlled superiority trial. BMC Psychiatry 2020; 20:160. [PMID: 32290827 PMCID: PMC7158157 DOI: 10.1186/s12888-020-02545-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/11/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Relatives Education And Coping Toolkit (REACT) is an online supported self-management toolkit for relatives of people with psychosis or bipolar designed to improve access to NICE recommended information and emotional support. AIMS Our aim was to determine clinical and cost-effectiveness of REACT including a Resource Directory (RD), versus RD-only. METHODS A primarily online, observer-blind randomised controlled trial comparing REACT (including RD) with RD only (registration ISRCTN72019945). Participants were UK relatives aged > = 16, with high distress (assessed using the GHQ-28), and actively help-seeking, individually randomised, and assessed online. Primary outcome was relatives' distress (GHQ-28) at 24 weeks. Secondary outcomes were wellbeing, support, costs and user feedback. RESULTS We recruited 800 relatives (REACT = 399; RD only = 401) with high distress at baseline (GHQ-28 REACT mean 40.3, SD 14.6; RD only mean 40.0, SD 14.0). Median time spent online on REACT was 50.8 min (IQR 12.4-172.1) versus 0.5 min (IQR 0-1.6) on RD only. Retention to primary follow-up (24 weeks) was 75% (REACT n = 292 (73.2%); RD-only n = 307 (76.6%)). Distress decreased in both groups by 24 weeks, with no significant difference between the two groups (- 1.39, 95% CI -3.60, 0.83, p = 0.22). Estimated cost of delivering REACT was £62.27 per person and users reported finding it safe, acceptable and convenient. There were no adverse events or reported side effects. CONCLUSIONS REACT is an inexpensive, acceptable, and safe way to deliver NICE-recommended support for relatives. However, for highly distressed relatives it is no more effective in reducing distress (GHQ-28) than a comprehensive online resource directory. TRIAL REGISTRATION ISRCTN72019945 prospectively registered 19/11/2015.
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Affiliation(s)
- Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Nadia Akers
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Duncan Appelbe
- Clinical Trials Research Centre, Institute of Child Health, Alder Hey, University of Liverpool, Liverpool, UK
| | - Lesley Chapman
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lizzi Collinge
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Susanna Dodd
- Clinical Trials Research Centre, Institute of Child Health, Alder Hey, University of Liverpool, Liverpool, UK
| | - Sue Flowers
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Bruce Hollingsworth
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sonia Johnson
- University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Steven H Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ceu Mateus
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Barbara Mezes
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Elizabeth Murray
- e-Health and Primary Care, Primary Care & Population Health Institute of Epidemiology & Health, Faculty of Pop Health Sciences, University College London, London, UK
| | - Katerina Panagaki
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Naomi Rainford
- Clinical Trials Research Centre, Institute of Child Health, Alder Hey, University of Liverpool, Liverpool, UK
| | - Heather Robinson
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Anna Rosala-Hallas
- Clinical Trials Research Centre, Institute of Child Health, Alder Hey, University of Liverpool, Liverpool, UK
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Andrew Walker
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Paula Williamson
- Clinical Trials Research Centre, Institute of Child Health, Alder Hey, University of Liverpool, Liverpool, UK
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19
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Service evaluation of a sole-session psychoeducational intervention to improve caregivers’ key illness beliefs after first episode psychosis (FEP). COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Carers of people experiencing a first episode of psychosis are at an increased risk of developing their own physical and mental health problems. Psychoeducation has been found to improve carer wellbeing and reduce distress. However, few psychoeducation interventions have considered the resource constraints on mental health services and the impact that these can have on the implementation of any such interventions. The present service evaluation aimed to evaluate an abbreviated version (sole session) of a previously tested psychoeducation intervention (three sessions) that targets less adaptive illness beliefs (n = 17). Pre–post effect sizes reveal that all of the carers’ illness beliefs changed in the desired direction, with four out of the 10 illness beliefs associated with large to moderate improvements. When compared with the outcomes obtained in our evaluation of the more intensive, three-session version of the intervention, the between-group effects largely favoured the three-session version but were mostly small. Moderate to large effects in favour of the three-session version were found for two of the 10 illness beliefs. These findings support the further investigation of the sole session psychoeducation intervention as part of a randomised controlled trial.
Key learning aims
(1)
To evaluate the impact of a sole-session psychoeducation intervention on illness beliefs.
(2)
To compare the outcomes of the sole-session psychoeducation intervention to the previous, more intensive (three-session) version of the same intervention.
(3)
To consider the value of research approaches to evaluating psychoeducation interventions for carers of people with psychosis.
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20
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Gérain P, Zech E. Informal Caregiver Burnout? Development of a Theoretical Framework to Understand the Impact of Caregiving. Front Psychol 2019; 10:1748. [PMID: 31428015 PMCID: PMC6689954 DOI: 10.3389/fpsyg.2019.01748] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/15/2019] [Indexed: 01/26/2023] Open
Abstract
Informal caregiving is a rewarding but demanding role. The present theoretical framework proposes to adapt the tridimensional concept of burnout to informal caregiving as a way to address the potential consequences of caregiving. This adaptation reflects caregivers' reported difficulties, as well as empirical findings on emotional exhaustion, depersonalization, and personal accomplishment as caregiving outcomes. But to understand burnout in informal caregiving contexts, it is also necessary to find ways to model it. The Informal Caregiving Integrative Model (ICIM) is thus proposed. This model is based on the integration of elements from literature on both informal caregiving stress and professional burnout. The goal of the ICIM is to emphasize the importance of every category of determinants of informal caregiver burnout (i.e., relating to the caregiver, the caregiving setting, and the sociocultural context), with a key mediating role for the caregivers' appraisal of their situation and their relationship with the care-recipient. This article is a first integrative step in the consideration of a form of burnout specific to informal caregivers and supports the design of empirical and interventional studies based on the theoretical foundation that the ICIM proposes.
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Affiliation(s)
- Pierre Gérain
- National Fund for Scientific Research, Brussels, Belgium.,Person Centred Research and Training Lab, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Emmanuelle Zech
- Person Centred Research and Training Lab, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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21
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Predictors and moderators of burden of care and emotional distress in first-episode psychosis caregivers: results from the GET UP pragmatic cluster randomised controlled trial. Epidemiol Psychiatr Sci 2019; 29:e27. [PMID: 30968810 PMCID: PMC8061200 DOI: 10.1017/s2045796019000155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS First-episode psychosis (FEP) is a major life event and can have an adverse impact on the diagnosed individual and their families. The importance of intervening early and providing optimal treatments is widely acknowledged. In comparison to patient groups, literature is scarce on identifying treatment predictors and moderators of caregiver outcomes. This study aimed to identify pre-treatment characteristics predicting and/or moderating carer outcomes, based on data from a multi-element psychosocial intervention to FEP patients and carers (GET-UP PIANO trial). METHODS Carer demography, type of family relationship, patient contact hours, pre-treatment carer burden, patient perceptions of parental caregiving and expressed emotion (EE) were selected, a priori, as potential predictors/moderators of carer burden and emotional distress at 9 months post treatment. Outcomes were analysed separately in mixed-effects random regression models. RESULTS Analyses were performed on 260 carers. Only patient perceptions of early maternal criticism predicted reports of lower carer burden at follow-up. However, multiple imputation analysis failed to confirm this result. For treatment moderators: higher levels of carer burden at baseline yielded greater reductions in carer emotional distress at follow-up in the experimental group compared with treatment as usual (TAU). Higher levels of perceived EE moderated greater reductions in carer reports of tension in experimental group, compared with TAU, at follow-up. In younger caregivers (<51 years old), there were greater reductions in levels of worry during the baseline to follow-up period, within the experimental group compared with TAU. CONCLUSION The study failed to identify significant treatment predictors of FEP carer outcomes. However, our preliminary findings suggest that optimal treatment outcomes for carers at first episode might be moderated by younger carer age, and carers reporting higher baseline levels of burden, and where patients perceive higher levels of negative effect from caregivers.
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22
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Internal validity of the French version of the Family Coping Questionnaire (FCQ): A confirmatory factor analysis. Psychiatry Res 2018; 269:337-344. [PMID: 30173039 DOI: 10.1016/j.psychres.2018.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/18/2018] [Accepted: 08/10/2018] [Indexed: 11/21/2022]
Abstract
Family members of patients with schizophrenia, especially when they assume caregivers' positions, experience difficulties to adapt to the situation. To gain insight into these caregivers' coping style is a challenge to decrease the stress of family members, and in this way, improve patient related outcome. The FCQ (Family Coping Questionnaire) is an adapted clinical assessment tool that focuses on specific ways to cope with dysfunction that characterize the psychotic pathology. The goal of this study was to provide validity evidence about the French version of the FCQ. Swiss and French family members of individuals suffering from schizophrenia (n = 204) responded to the FCQ. A confirmatory factor analysis (CFA) was applied estimating two models. The seven-factor model showed adequate fit to the data while the three-factor model fit was poor. This FCQ internal validation showed an adequate model fit with a French population including various family members (parents, siblings, etc.) of persons with enduring mental illness.
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23
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Onwumere J, Howes S, Shiers D, Gaughran F. Physical health problems in people with psychosis: The issue for informal carers. Int J Soc Psychiatry 2018; 64:381-388. [PMID: 29584519 DOI: 10.1177/0020764018763684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Reduced life expectancies are recorded in adults with psychotic disorders. Informal carers play key roles in improving illness outcomes for patients, including significantly reducing rates of relapse and hospitalisation. There is, however, a dearth of literature detailing carers' perspectives on physical health problems in the relatives they care for and implications for those in the caregiving role. The study sought to explore carers' subjective experiences of supporting a relative with psychosis and physical health problems. METHODS Carers of adults with psychosis were interviewed individually, or as part of a group, about physical health problems in the relatives they care for. RESULTS Five key themes were identified from the interviews that reflected (1) ubiquity of physical health problems in psychosis, (2) gaps in service provision for those living with mental and physical health problems, (3) carers' role in responding to service gaps, (4) difficult conversations and (5) impact on carer health. CONCLUSION Service initiatives that are designed to improve patient physical health in psychosis should not overlook the role that informal carers might have in supporting this process. The implications that patient physical health problems present for carer well-being and the quality of the caregiving relationship in psychosis deserve further investigation.
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Affiliation(s)
- Juliana Onwumere
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sophia Howes
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Shiers
- 2 Psychosis Research Unit, Prestwich Hospital Manchester, Manchester, UK.,3 The University of Manchester, Manchester, UK
| | - Fiona Gaughran
- 4 Department of Psychosis Studies, Institute of Psychosis, Psychology and Neuroscience, King's College, London
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24
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Onwumere J, Jansen JE, Kuipers E. Editorial: Family Interventions in Psychosis Change Outcomes in Early Intervention Settings - How Much Does the Evidence Support This? Front Psychol 2018; 9:406. [PMID: 29875709 PMCID: PMC5974118 DOI: 10.3389/fpsyg.2018.00406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/12/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Juliana Onwumere
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - Jens E. Jansen
- Psykiatrisk Center København, afd. Rigshospitalet, Region Hovedstadens Psykiatri, Copenhagen, Denmark
| | - Elizabeth Kuipers
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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25
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Claxton M, Onwumere J, Fornells-Ambrojo M. Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis. Front Psychol 2017; 8:371. [PMID: 28396643 PMCID: PMC5366348 DOI: 10.3389/fpsyg.2017.00371] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/27/2017] [Indexed: 11/13/2022] Open
Abstract
Family interventions for psychosis (FIp) are effective in reducing service user relapse and carer distress in people with schizophrenia-spectrum conditions. Several treatment and best practice guidelines recommend FIp for all people with schizophrenia. However, outcome findings in relation to early psychosis groups have been inconsistent. The current paper reports a systematic review and meta-analyses of articles that evaluated FIp in early psychosis with a clearly defined comparison group. A combination of electronic database searches (using PsychINFO, Medline, and CENTRAL), citation searches and hand searches of key journals and reviews was conducted. Peer-reviewed articles published in English from database inception to June 2016 were included. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Seventeen papers from 14 studies met inclusion criteria for review, the overall quality of which was moderate. Meta-analytic synthesis showed that FIp improved service user functioning and reduced the likelihood of relapse by the end of treatment. Psychotic symptoms were significantly reduced in the FIp group at follow up, but this was not evident at end of treatment. In terms of FIp target mechanisms, carers receiving FIp were more likely to shift from high to low expressed emotion and less likely to report patient focused criticism or engage in conflict communication than carers randomized to standard care. Carer burden and well-being were improved by the end of treatment but gains were not sustained at follow up. FIp had no impact on carer emotional over-involvement. The findings indicate that FIp is an effective intervention for early psychosis service users and their relatives. However, further research is required to establish which key therapeutic components of FIp are most effective for whom, in addition to understanding the mechanisms by which FIp might affect positive change.
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Affiliation(s)
- Melanie Claxton
- Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
| | - Juliana Onwumere
- Department of Psychology, King's College, London, Institute of Psychiatry, Psychology and NeuroscienceLondon, UK
| | - Miriam Fornells-Ambrojo
- Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
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26
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Stjernswärd S, Hansson L. Effectiveness and Usability of a Web-Based Mindfulness Intervention for Families Living with Mental Illness. Mindfulness (N Y) 2016; 8:751-764. [PMID: 28515801 PMCID: PMC5408047 DOI: 10.1007/s12671-016-0653-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Families living with mental illness express needs of support and experiences of burden that may affect their own health detrimentally and hence also their ability to support the patient. Mindfulness-based interventions have shown beneficial health effects in both clinical and healthy populations. The aim of the current study was to explore the effectiveness and usability of a web-based mindfulness program for families living with mental illness, which was first tested in a feasibility study. The study was designed as a randomized controlled trial with an experiment group and a wait-list control group with assessments on primary and secondary outcomes at baseline, post-intervention, and at a 3-month follow-up. Significant positive improvements in mindfulness and self-compassion, and significant decreases in perceived stress and in certain dimensions of caregiver burden were found, with good program usability. Easily accessible mindfulness-based interventions may be useful in addressing caregivers' needs of support and in preventing further ill health in caregivers. Further studies are needed, among others, to further customize interventions and to investigate the cost-effectiveness of such programs.
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Affiliation(s)
- Sigrid Stjernswärd
- Department of Health Sciences, Lund University, Box 157, 221 50 Lund, Sweden
| | - Lars Hansson
- Department of Health Sciences, Lund University, Box 157, 221 50 Lund, Sweden
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27
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Kingston C, Onwumere J, Keen N, Ruffell T, Kuipers E. Posttraumatic stress symptoms (PTSS) in caregivers of people with psychosis and associations with caregiving experiences. J Trauma Dissociation 2016; 17:307-21. [PMID: 26387937 DOI: 10.1080/15299732.2015.1089969] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Posttraumatic stress symptoms (PTSS) have been identified in caregivers of people with psychosis, but their clinical correlates are less well known. This study aimed to assess PTSS in a sample of caregivers of people with psychosis and to examine the relationship between PTSS and caregiving experiences. METHOD A total of 32 caregivers of people with psychosis completed self-report questionnaires and structured interviews assessing PTSS and caregiving processes, including expressed emotion, burden, and coping. RESULTS In all, 44% of the sample reported PTSS, which were associated with caregiver reports of burden and less adaptive (avoidant) coping. No links were observed with expressed emotion in this sample. CONCLUSION Almost half of caregivers of people with psychosis reported PTSS related to their caring role, which may have implications for their caregiving experiences and coping efforts. The findings highlight the importance of assessing need in caregivers and optimizing opportunities to offer needs-led therapeutic interventions to caregivers.
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Affiliation(s)
- Cara Kingston
- a Department of Psychology , Institute of Psychiatry, Psychology & Neuropsychology, King's College London , London , United Kingdom
| | - Juliana Onwumere
- a Department of Psychology , Institute of Psychiatry, Psychology & Neuropsychology, King's College London , London , United Kingdom
| | - Nadine Keen
- a Department of Psychology , Institute of Psychiatry, Psychology & Neuropsychology, King's College London , London , United Kingdom.,b PICuP Clinic , South London and Maudsley NHS Foundation Trust , London , United Kingdom
| | - Tamatha Ruffell
- a Department of Psychology , Institute of Psychiatry, Psychology & Neuropsychology, King's College London , London , United Kingdom
| | - Elizabeth Kuipers
- a Department of Psychology , Institute of Psychiatry, Psychology & Neuropsychology, King's College London , London , United Kingdom.,c Biomedical Research Centre , South London and Maudsley NHS Foundation Trust , London , United Kingdom
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