Lived experiences of family caregivers of mentally ill relatives

Attitude toward patients with mental disorders: what is going on amongst Iranian pharmacies?

INTRODUCTION

As the incidence of mental disorders continues to rise, and pharmacy staff can significantly affect the willingness of patients with mental disorders to seek help; we aimed to evaluate the stigmatizing attitude of the pharmacy staff toward these patients in Iran.

METHODS

We conducted this cross-sectional study between April 2020 and December 2021 in Tehran, Iran, and included pharmacists, pharmacy technicians and pharmacy students, with the experience of working in a pharmacy for at least three months. The social distance scale (SDS) and dangerousness scale (DS) were used to measure the stigmatizing attitude of the participants. Higher scores indicated more stigmatizing attitudes.

RESULTS

We included a total of 186 participants with a mean age of 32.97 ± 9.41 years, of which 101 (54.3%) were male, and 75 (40.3%) were pharmacists, 101 (54.3%) were pharmacy technicians, and 8 (4.3%) were pharmacy students. The mean SDS score was 14.2 ± 4.13, and the mean DS score was 33.85 ± 8.92. The greatest tendency for social distance was reported for a patient with a mental disorder, 'being the caretaker of their children for an hour or two' and 'marrying their children.' The most perceived dangerousness was reported for a patient with a mental disorder 'owning a gun.' Positive personal history of psychopharmacological treatment was statistically correlated with lower DS (P = 0.001) and SDS (P = 0.007) scores. Positive family history of psychiatric inpatient admission was significantly correlated with higher DS (P = 0.05) and SDS (P = 0.03) scores. Higher rates of 'received psychiatric prescriptions per month' was associated with lower DS scores (P = 0.04).

CONCLUSION

Our participants did not have an overall positive attitude toward patients with mental disorders. Although, compared to previous studies, they held a more positive attitude. Positive personal history of psychopharmacological treatment predicted a more positive attitude and positive family history of psychiatric inpatient admission predicted a more negative attitude.

Stigma, lost opportunities, and growth: Understanding experiences of caregivers of persons with mental illness in Tamil Nadu, India

This study aimed to address gaps in understanding of the lived experiences of caregivers of persons with mental illness in low-income countries. It was conducted among caregivers of persons with mental illness making use of a free non-governmental clinic in and around Chennai, India. The study adopted a qualitative methodology, with semi-structured interviews and life history exercises (n = 29) and six focus group discussions with caregivers (n = 21) and mental health professionals and community-based workers (n = 39). The experiences of caregivers were analyzed in the framework of "The Banyan model of caregiving," which identifies six phases. Major themes in caregivers' experience were: embarrassment and losing honor; fear; awareness; stigma and social exclusion; and reduced social interaction and loneliness. Posttraumatic growth considered as the result of caregiver experiences was found to consist mainly of personal growth and focusing on positive life experiences. Lost opportunities particular to the context of Tamil Nadu were described as the inability to get married, obtaining less education than desired, and loss of employment. Siblings faced lower levels of burden, while elderly mothers experienced especially high levels of burden and lack of happiness in life. Caregiver gains were identified as greater compassion for other people with disabilities, resulting in a desire to help others, as well as increased personal strength and confidence. Understanding the nuances of the caregiving experiences over time can provide a framework to devise more fine-tuned support structures that aim to prevent reductions in social interaction and lost opportunities, and improve a sense of meaning, in order to assist caregivers to continue providing care for their relatives with mental illness in a context with scarce mental health resources.

Perceived stigma, common mental disorders and associated factors among primary caregivers of adult patients with mental illness attending at public hospitals, Harari regional state, Eastern Ethiopia: A multicenter cross-sectional study

Background

Giving care to someone who is experiencing mental distress is a difficult and challenging task that could be detrimental to the caregiver's overall quality of life. Numerous studies show that caregivers frequently experience mental distress and feel stigmatized. However, there is limited study done on this topic in our country.

Objective

To determine the magnitude and associated factors of perceived stigma and common mental disorder among primary caregivers of adults with mental illness in public hospitals at Harari regional state, Eastern Ethiopia, 2022.

Methods

A cross-sectional study design was conducted. A total of 419 participants were recruited by a systematic random sampling technique. The data was collected by using a face-to-face interview and by reviewing patients' charts. Perceived stigma and common mental disorder were assessed by Family Interview Schedule and Self-Reporting Questionnaire, respectively. Epi-data version 4.6.2 was used to enter data, and SPSS version 20 was used to analyze. Bivariable and multivariable logistic regression were performed. P-values < 0.05 were considered statistically significant.

Result

The magnitude of perceived stigma and common mental disorder were 42.5% (95% CI, 37.7-47.3) and 39.4% (95% CI, 34.8-44.0) respectively. Age of caregiver between 26 and 33 [AOR = 3.13, 95% CI: (1.71-8.93)], no formal education [AOR = 3.85, 95% CI: (1.81-8.15)], illness duration ≥7 years [AOR = 1.93, 95% CI: (1.04-3.57)], family history of mental illness [AOR = 1.92, 95% CI: (1.09-3.39)] and poor social support [AOR = 4.87, 95% CI: (3.74-12.71)] were significantly associated with perceived stigma. Being female [AOR = 1.92, 95% CI: (1.31-3.34)], having no formal education [AOR = 4.04, 95% CI: (2.15-10.01)], having a family history of mental illness [AOR = 2.26, 95% CI: (1.29-4.00)], having comorbid other illness [AOR = 2.13, 95% CI: (1.15-3.94)], and having poor social support [AOR = 4.58, 95% CI: (2.53-8.28)] were significantly associated with common mental disorder.

Conclusion

The magnitude of perceived stigma and common mental disorder was high among primary caregivers of patients with mental illness compared with other studies. Age of caregiver between 26 and 33, no formal education, duration of illness ≥7 years, family history of mental illness and poor social support were associated with perceived stigma and being female, no formal education, family history of mental illness, comorbid other illness and poor social support were associated with common mental disorder.

Loneliness in the presence of others: A mixed-method study of social networks of caregivers of patients with severe mental disorders

BACKGROUND

One in four families has at least one member with a mental disorder and families are the main caregivers in most patients in low and middle-income countries. Caregivers experience disruption in their routine lives, increased responsibilities, increased need for support, and changes in their network. The role of personal support networks in the health and burden of the caregivers is complex and depends on the context, cultural and socioeconomical variables. In this study, we aimed to investigate the personal support network of caregivers of patients with severe mental illness in Iran.

METHODS

By using a mixed-methods design, we focused on the structure and composition of caregiver networks, as well as self-perceived caregiver support.

RESULTS

We found that the support network of caregivers was mostly composed of immediate family members whom themselves were selectively chosen as a result of the multidimensional process of interaction between stigma, availability, and the perceived needs of caregivers. The participants mentioned economic and instrumental supports more frequently than emotional support, probably reflecting their unmet basic needs. Advocacy for providing formal systemic supports to caregivers, as well as interventions that expand caregivers personal support network is recommended.

CONCLUSIONS

Most participants of the study were relatively isolated and had a small network of support, mostly composed of immediate family members. Stigma was a serious source of family distress for caregivers and a limiting factor in social relationships.

Informal caregivers of people with a diagnosis of schizophrenia: determinants and predictors of resilience

BACKGROUND

The extant literature portrays informal caregiving by family members who care for a person with a diagnosis of schizophrenia, as one that involves a tremendous amount of stress and burden.

AIM

This investigation sought to assess informal caregiving experience with regard to variables such as perceived positive aspects, preparedness, resilience, and life satisfaction.

METHOD

Data was collected from two groups of respondents accessing services at the Thanjavur Medical College Hospital, Tamil Nadu, India. The study group consisted of 75 family caregivers of persons with a diagnosis of schizophrenia and the reference group had an equal number of caregivers of people with minor physical ailments. The two groups were matched on important background factors, ensuring their comparability. Standardised instruments were administered to all respondents to collect data pertaining to the key variables and analysed using appropriate statistical procedures.

RESULTS

Results indicated that caregivers of people with a diagnosis of schizophrenia, while manifesting higher levels of resilience, perceived lesser positive aspects in their caring role. A significant statistical difference between both groups of respondents in terms of their life satisfaction and resilience. Regression analyses extracted preparedness and life satisfaction as significant contributors to the manifestation of resilience in the caregivers.

CONCLUSIONS

The study highlights the importance of caregiver preparedness and life satisfaction in enhancing their resilience.

Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma

BACKGROUND

The fear and lack of understanding of mental illness can lead to stigma. The stigma of mental illness affects not only individuals who suffer from it, but also the caregivers. Stigma among caregivers can lead to delay in seeking care, poor adherence to treatment and a high risk of relapse. Caregivers of patients with mental illness are at an increased risk of distress due to the burden to stigma and caregiving burden. An increase in caregivers' burden can lead to a reduction in caregivers' involvement. There is a relationship between caregivers' involvement, burden, and affiliated stigma. The present study examined the mediating role of affiliated stigma in the relationship between caregivers' burden and involvement among informal caregivers of hospital-admitted patients with mental illness in Uganda.

METHODS

A cross-sectional study was conducted among 428 informal caregivers (mean age: 39.6 years [SD±14.6]; females = 62.1%). Information was collected regarding sociodemographic characteristics, affiliated stigma, and the involvement and burden of informal caregivers.

RESULTS

The findings indicate that affiliated stigma serves as a full mediator between the caregiver's roles and involvement (β=15.97, p<0.001). Being female increased the caregivers' burden of caregiving (β= -0.23, p<0.001).

CONCLUSION

The findings in the present study suggest that intervention to address affiliated stigma among caregivers of patients with mental illness should be incorporated into mainstream mental health care to reduce the caregiving burden.

Promoting Psychosocial Health of Family Caregivers of Patients with Chronic Mental Disorders: A Review of Challenges and Strategies

The present study aimed to investigate the mental and social health challenges of family caregivers of the patients with chronic mental disorders (CMD) and strategies which can be helpful in this regard. This study is a narrative review conducted in PubMed, Web of Science, Scopus, Elsevier, Google Scholar, Proquest, Magiran, and Sid databases where keywords such as Family caregiver, Chronic Mental disorder, Health Promotion, Program, Psychosocial, Support, Challenge, and Problem were searched in both Persian and English. A total of 5,745 published documents were found and were screened based on inclusion and exclusion criteria. Finally, 64 studies were found which had examined the related challenges, needs and strategies. According to the results, information deficits, needs for support, community participation deficits, and psychological suffering were recognized as challenges of family caregivers of these patients. Moreover, empowerments programs for the enhancement of the knowledge and skills of caregivers and peer-centered support programs were used to improve the level of mental and social health of family caregivers of these patients. Psychosocial problems and challenges that family caregivers of the patients with CMD face affect their health, satisfaction and quality of life. Using a collaborative approach, mental health service providers and government systems can help improve the psychosocial health of caregivers. The related managers and policymakers can reduce the emotional and psychological burden of families and promote their psychosocial health through developing a comprehensive program including practical objectives and strategies and taking into account the challenges that exist for caregivers in caring for patients with CMD.

Requirements of caregivers of patients with schizophrenia: A qualitative study in Turkey

Caregivers have different experiences and difficulties in the patient care process during which the role of providing care is fulfilled. Understanding the requirements of caregivers may help determine the content of the country-specific psychoeducation program needed. Caregivers of patients with schizophrenia want certain needs to be met while they provide care to these patients. This qualitative study aims to determine and analyze these needs. The researchers conducted face-to-face semi-structured interviews with 15 caregivers. Themes were Themes identified included determined as managing disease behavior, gaining independent living skills, managing social-educational problems, and psychosocial support needs of the family members. Mental health and psychiatric nurses should understand, accept, and protect the needs of caregivers. It is suggested that mental health and psychiatric nurses plan group training about the determined needs and provide support for caregiving family members.

Service Utilization, Self-Efficacy, Positive Attitude and Well-Being Among Asian American Family Caregivers of Persons with Serious Mental Illnesses

The well-being of the family caregivers of people with serious mental illnesses (SMIs) is a crucial success factor in the recovery of the afflicted family member. This cross-sectional quantitative study examined the associations between the use of formal mental health services, self-efficacy, and positive attitudes and their effects on the well-being of Asian American family caregivers of people with SMIs. Using convenience and snowball sampling, 116 Asian American family caregivers of people with SMIs in Northern California were recruited for this study. We found that formal mental health service utilization predicted an enhanced sense of self-efficacy. Higher levels of self-efficacy were related to attitudes being more positive, and these positive attitudes contributed to enhanced overall well-being. These findings suggest that mental health professionals should develop culturally competent and tailored services for Asian American family caregivers to support self-efficacy, which is fundamental to maintaining positive attitudes and promoting wellness.

Mental health literacy: A systematic review of knowledge and beliefs about mental disorders in Malaysia

BACKGROUND

Mental health problems in Malaysia are on a rise. This study aimed at performing a systematic review of mental health literacy (MHL) in Malaysia.

METHODS

Medline, Embase, ERIC/Proquest, ScienceDirect, Pubmed, PsycINFO, CINAHL, Scopus, EBM Reviews - Cochrane Central Register of Controlled Trials, Ovid Emcare and reference lists of included studies were searched in February 2020. Studies that evaluated at least one of the main components of MHL, including (1) knowledge related to mental health issues, and (2) stigma, were included irrespective of study design. As secondary findings, the review also synthesized results related to facilitators and barriers to seeking mental health services. Depending on the research design, the quality of each study was assessed through checklists.

RESULTS

Forty six studies published between 1995 to 2019 were included. Most studies used cross-sectional designs to investigate MHL. Findings indicate that most Malaysians have stigmatizing attitudes towards mental health problems. Participants in the included studies endorsed multifactorial explanations of mental health issues with a dominance of supernatural and religious aetiologies. Likewise, the commonest barrier was considering sources other than professional sources of mental-health services. Presence of adequate knowledge and considering providers as competent facilitated help-seeking. Additionally, there was considerable heterogeneity in studies and a lack of standardized measures assessing MHL.

CONCLUSIONS

There is an increase in studies on MHL in Malaysia. A few of these studies, based on experimental design, have shown positive effects. Researchers, practitioners, and policymakers should develop standardized measures and interventional studies based on all the components of MHL.

Is Coping with Stigma by Association Role-Specific for Different Family Members? A Qualitative Study with Bipolar Disorder Patients' Relatives

Trying to cope with stigma by association (SBA) often results in behaviors leading to social isolation and withdrawal. This study aimed at exploring the stigma-related experiences of family members of persons living with bipolar disorder (PW-BD). A semi-structured interview was conducted with relatives of PW-BD. Open-ended questions addressed three issues: awareness of public stigma of bipolar disorder, experiences of associative stigma, and ways of coping with experiences of SBA. Data were collected from a purposive sample of 21 family members. Experiences of SBA were specifically related to the different family roles. Parents had to deal with responsibility, partners with the choice of staying or not, and siblings with "a sort of duty." These specific prejudices enhanced specific coping strategies. This is the first study to highlight specific issues and coping from the perspective of family members. Based on these findings, specific targeted interventions could be developed.

An Exploration of Family Caregiver Experiences of Burden and Coping While Caring for People with Mental Disorders in Saudi Arabia-A Qualitative Study

Family caregivers of people with mental disorders face a number of burdens and stressors, such as associative stigma and burnout. These burdens are often a result of their caring role coupled with insufficient support or ineffective coping strategies, which can affect their quality of life and biopsychosocial integrity that, in turn, may affect the care they provide. This study aimed to explore the experiences of family caregivers of people with mental disorders, through examining the burdens that they face and the coping strategies that they use. Using a descriptive qualitative approach, 13 semi-structured interviews were conducted with members of the Saudi public, recruited through popular social media platforms and analyzed using thematic analysis. Five main themes were constructed from the data: Type of care, Challenges, Coping and support, Perceptions of public awareness, and Messages to others. The findings emphasize the different types of burdens that caregivers experience, and their needs that require a range of responses such as educational training on effective coping strategies, and psychological support in the form of counseling or group therapy. This study highlights the voice of caregivers and their message to the public, in order to correct the misconceptions surrounding mental disorders and those associated with them.

Effects of biogenetic beliefs for schizophrenia on potential caregivers in China: Exploring the role of affiliate stigma

Schizophrenia affects more than eight million people in China. Stigmatization of schizophrenia may prevent family members and close others from providing social support to those with schizophrenia. This article aims to investigate the potential use of a biogenetic approach to reduce the stigma of schizophrenia using a cross-sectional (study 1, n = 141) and an experimental design (study 2, n = 100) in China. In the first study, mediation analysis reveals that perceived affiliate stigma, the negative prejudice, and discrimination towards family members of individuals with socially stigmatized identities due to their affiliation with the person mediates the path between biogenetic beliefs and desire for social distance. This pattern is replicated in study 2 in which two 10-min lectures were created and used to influence participants' beliefs in biogenetic causes of schizophrenia. Findings suggest that the biogenetic approach may increase Chinese participants' desired social distance towards their family members with schizophrenia through increasing their concerns about the negative consequences of being affiliated with the family member. Therefore, future research should investigate aspects of biogenetic anti-stigma campaigns that do not increase participants' perception of affiliate stigma in China.

Experiences of caregivers of family member with schizophrenia in China: A qualitative study

PURPOSE

To explore the experience of caregivers of family members with schizophrenia.

DESIGN AND METHODS

A qualitative approach was adopted to examine the experience of caregivers of people with schizophrenia. The researcher conducted semi-structured interviews with 16 participants recruited through purposive sampling.

FINDINGS

The change findings encompassed five major themes: (a) loss of personal life, (b) mixed emotions, (c) changes in family relationships, (d) the need for professional support and help, and (e) coping strategies.

PRACTICE IMPLICATIONS

Clinicians, including nurses, must be aware of the cultural importance of mental illness, particularly the widespread cultural beliefs and patterns of help-seeking behaviors, to provide culturally sensitive health care and develop empirical strategies for helping both these caregivers and their dependents.

Experiences of Family Caregivers of Individuals With Chronic Psychiatric Illness in Turkey: A Qualitative Study

The purpose of the current descriptive qualitative study was to reveal experiences of family caregivers of individuals with chronic psychiatric illness. Family caregivers who provided care to 16 individuals with chronic mental illness were interviewed. Three themes emerged from the interviews: Illness Management, The Caregiver's World: Changes and Effects, and Coping From the Caregiver's Point of View. Understanding the experiences of family caregivers contributes to content development of family intervention programs. [Journal of Psychosocial Nursing and Mental Health Services, 58(3), 38-46.].

Violence against primary caregivers of people with severe mental illness and their knowledge and attitudes towards violence: A cross-sectional study in China

PURPOSE

The purpose of this study is to investigate the current situation of violence on primary caregivers of people with severe mental illness outside the hospital and the cognition of primary caregivers about violence among mental patients.

METHODS

A self-designed questionnaire was used to investigate the primary caregivers (N = 208) of people with severe mental illness in a psychiatric hospital in Beijing.

RESULTS

The incidence rate of violence suffered by primary caregivers was 74.03%, of which 61.54% had experienced verbal attacks, 54.33% had experienced threats, and 45.19% experienced physical attacks. Physical violence, mainly by unarmed attacks, has resulted in soft tissue injury and pain in the majority of caregivers. Multiple admission times, a lower educational level, single in marital status and involuntary hospitalizations were risk factors; growing older was protective factor. The causes of violence were dominated by mental symptoms in 120 cases (57.69%). Tolerance and avoidance were the coping styles of most caregivers adopted after violence, accounting for 51.44%. Furthermore, most of primary caregivers have limited knowledge of violence and adopted an attitude of pessimism towards patients' violence.

CONCLUSIONS

It was reported that violence was suffered by primary caregivers of persons with severe mental illness outside the hospital. The study indicated that formulating reasonable nursing intervention, providing health education as well as organizing training towards violence of patients are required to play an important role in effectively preventing and reducing the violence among the people with severe mental illness in China. More information and support needs to be obtained to help caregivers fulfill their duty of care outside the hospital.

Affiliate Stigma and Psychosocial Adaption Among Adolescents Who Have a Parent With Serious Mental Illness: Mediation Role of Family Cohesion

The current cross-sectional study examined the relationship between affiliate stigma and externalizing and internalizing problems by investigating the role of family cohesion among adolescents having a parent with serious mental illness (SMI). One hundred sixty-four adolescents were recruited from two community mental health centers. Family cohesion, affiliate stigma, and adolescent internalizing and externalizing problems were assessed. A significant relationship was found between adolescent externalizing and internalizing problems and family cohesion (r = -0.462, p < 0.01 and r = -0.534, p < 0.001, respectively) and affiliate stigma (r = 0.512, p < 0.01 and r = 0.656, p < 0.001, respectively). Family cohesion partially mediated the relation between affiliate stigma and externalizing problems (Z = -4.97, p < 0.001) and fully mediated the relation between affiliate stigma and internalizing problems (Z = -5.18, p < 0.001). The current study highlights the need for effective interventions aimed at families to support parents with SMI in their parenting role and enhance family cohesion. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 39-47.].

Effects of a Brief Empowerment Program for Families of Persons with Mental Illness in South Korea: A Pilot Study

Families of persons with mental illness (PMIs) are considered important resources for PMIs rather than as contributors to their mental illness. However, these families experience not only the burden of caregiving but also social stigma and discrimination in various aspects of their lives, and their psychosocial needs tend to be overlooked. This was a pilot study to explore the effects of a brief empowerment program on the empowerment and quality of life of families of PMIs in South Korea. A repeated-measures design with a control group and pre/post-follow-up testing was used. We enrolled 18 participants (experimental group = 9, control group = 9). The experimental group participated in an empowerment program consisting of four sessions over 4 weeks. Data were collected before and after the program, and again 4 weeks later. The χ²-test, Fisher's exact probability test, t-test, and repeated-measures analysis of covariance were used, as appropriate, to analyze data. The program significantly increased empowerment (F = 4.66, p = .020) and quality of life (F = 5.83, p = .009) among participants in the experimental group over time. Its therapeutic features, such as sharing their experiences, discussion, and presentations, can be applied to create effective psychosocial interventions for families of PMIs.

Who cares for the schizophrenia individuals in rural China - A profile of primary family caregivers

OBJECTIVE

The present study aims to provide a comprehensive profile of the primary family caregivers of schizophrenia individuals in rural China.

METHOD

A cross-sectional study was conducted with a sample of 327 primary family caregivers of schizophrenia individuals recruited through a one-stage cluster sampling in Ningxiang County of Hunan province, China. The social demographic and psychological profiles of primary caregivers were measured using standard scales and self-designed scales.

RESULTS

The typical caregiver profile consists of a 58-year old married first degree relative (mostly parents or spouses) with a low socio-economic position. Most of them have been caregiving for over 10 years (74.3%) and have some physical illness (67.0%). The major caregiving activities were medicine management (71.6%) and hospital visit (69.4%), yet there is still 17.1% primary caregivers involved with neither of the care. Most (84%) of caregivers reported some kind of burden, with anxiety in 45.9% of caregivers and depression in 45.4%. Family caregivers also reported positive aspects of caregiving including a well-functional family (51.0%) and rewarding feelings (58.3%).

CONCLUSION

The findings of the present study have brought attention to a special group of family caregivers for schizophrenia, with implications for intervention on them in the future.

Evaluation of an interaction-skills training for reducing the burden of family caregivers of patients with severe mental illness: a pre-posttest design

BACKGROUND

Family members who care for patients with severe mental illness experience emotional distress and report a higher incidence of mental illness than those in the general population. They report feeling inadequately prepared to provide the necessary practical and emotional support for these patients. The MAT training, an Interaction-Skills Training program (IST) for caregivers, was developed to meet those needs. This study used a single-arm pretest-posttest design to examine the impact of the training on caregivers' sense of competence (self-efficacy) and burden.

METHODS

One hundred family caregivers recruited from three mental health institutions participated in the training. Burden was assessed using the Involvement Evaluation Questionnaire, and self-efficacy using the Self-Efficacy Questionnaire. Analysis of variance with repeated measures was used to investigate whether participation in the training changed the level of family caregivers' burden and self-efficacy. Pearson's correlation was used to examine the relationships between self-efficacy and burden.

RESULTS

Our results indicate that, after the training, self-efficacy increased significantly over time (p < 0.001) and that burden decreased significantly (p < 0.001). However, the results could not demonstrate the expected association between an increase of self-efficacy and decrease of burden. Caregivers expressed high appreciation for the training.

CONCLUSIONS

After following the IST program, family caregivers of patients with severe mental illness experienced a greater sense of competence and a significant decrease in burden. The training was greatly appreciated and satisfied caregivers' need to acquire the skills required in complex caregiving situations.

TRIAL REGISTRATION

This study was retrospectively registered (14/01/2018) in the ISRCTN registry with study ID ISRCTN44495131 .

Experiences of Family Stigma among Mothers of Adult Children with Mental Illness in South Korea

People with mental illness suffer from stigma in addition to the illness itself; their families also suffer from the stigma of having a family member with a mental illness. The aim of the present study was to explore the lived experiences of the family stigma among mothers of mentally ill children in South Korea. The work was qualitative in nature; we used the phenomenological method of Colaizzi. Mothers with an adult child enrolled as mentally ill patients in the Mental Health Centre of K Province in South Korea were eligible for inclusion.

FINDINGS

Six themes emerged; these were being ashamed, feeling of being ignored, isolating oneself from social relationships, becoming a mentally sick person, living like a guilty person, and becoming a part of the socially weak. The study contributes to our understanding of stigma experienced by family members in a socio-cultural context and will aid in the development of culturally appropriate strategies for the destigmatization of families of mentally ill persons.

Psychological Correlates of Burden Among Jordanian Caregivers of Patients With Serious Mental Illness

PURPOSE

To examine prediction power of personality traits, expressed emotion, and coping strategies on caregivers' burden.

DESIGNS AND METHODS

Cross-sectional descriptive correlational design was used to collect data from 196 caregivers using the Self-Administered Questionnaire from Jordanian caregivers of patients with serious mental illness.

FINDINGS

Jordanian caregivers had a moderate-to-severe burden level (M = 47.1, SD = 11.5). Burden had a significant negative relationship with coping (r = -.15, p = .04) and significant positive relationship with personality dysfunction (r = .16, p = .021). Emotional expression, coping, and personality were found to be significant predictors of burden (F = 5.16, p = .002).

PRACTICE IMPLICATIONS

Mental health professionals need to address family caregivers in their plans of care.

The Offense as Perceived by the Parents of Forensic Psychiatric Patients

This study aims to describe the views of forensic psychiatric patients' parents, and especially how they feel about the patient's offense. The data analyzed was collected by interviews with forensic psychiatric patients' parents and analyzed by inductive content analysis. The findings suggest that the offense committed has a significant effect on the lives of parents of forensic psychiatric patients and in many ways these people felt like a marginalized group even though they were frequently a major resource for their child who had been taken into forensic psychiatric care. The parents of a forensic psychiatric patient have a prominent role in the life of the patient and this role and the parents' coping should also be supported by the forensic psychiatric treatment system.

Relationship Between Caregiving Burden and Anger Level in Primary Caregivers of Individuals With Chronic Mental Illness

OBJECTIVES

The objective of this study was answer to the question: to what extent are the anger of the caregivers of patients diagnosed with schizophrenia and their perceived level of burden are related?

METHOD

The study is a descriptive and correlational study. The information form prepared by the researchers which questions the socio-demographic information of the individuals along with the "Caregiving Burden Inventory" which examines the burden of the caregiver as well as "Trait Anger and Anger Expression Style Scale (TAAES)" which determines the anger levels of the caregivers were used.

RESULTS

The caregiving burdens of the caregivers according to the score averages were determined as 11.88±9.78 for time and dependency burden, 11.93±8.46 for developmental burden, 8.47±6.63 for physical burden, 5.61±5.26 for social burden, 6.29±5.25 for emotional burden and the total burden score was determined as 44.19±26.75. According to the trait anger and anger expression style scale score averages; trait anger was determined as 15.12±5.95, anger expression as 9.70±3.43, anger-in as 15.22±4.02, anger control as 28.05±5.57 and anger total score average as 68.11±9.97.

CONCLUSION

According to the results obtained from this study, caregivers of schizophrenia patients experience developmental, physical, social and emotional burdens in addition to trait anger. The caregivers of schizophrenia patients need knowledge and support in order to control the burden and the anger they experience during the caregiving process.

Mental health literacy about schizophrenia and depression: a survey among Chinese caregivers of patients with mental disorder

OBJECTIVE

To investigate the knowledge of schizophrenia and depression among caregivers of patients with mental disorder in China.

METHOD

A convenience sample of 402 caregivers at the Department of Psychiatry of a general hospital in China was investigated (response rate 95.7%), using vignettes based investigation methodology.

RESULTS

The number of caregivers using the term "depression" to describe the depression vignette was 43.6%, which was significantly higher than the number of caregivers using the term "schizophrenia" to describe the schizophrenia one (28.5%). A high percentage of caregivers believed that "psychiatrist", "psychologist" and "close family members" would be helpful, and the top three most helpful interventions were "becoming more physically active", "getting out and learning more" and "receiving psychotherapy". The number of caregivers endorsed "antipsychotics" and "antidepressants" as helpful for the schizophrenia and the depression vignettes were 82.0 and 80.7%, respectively. Regarding the causes of mental illness, items related to psychosocial factors, including "daily problems" and "work or financial problems", and "weakness of character" were highly rated, with half considered genetic or chemical imbalance causes.

CONCLUSION

Caregivers expressed a high knowledge about treatments and interventions of mental disorders. But there are still some areas, particularly regarding the recognition and causes of mental disorders, that are in need of improvement. This is particularly the case for schizophrenia.

Strategies to reduce the stigma toward people with mental disorders in Iran: stakeholders' perspectives

BACKGROUND

Stigma affects all aspects of mental disorders, and is the most important risk factor for promoting mental health. The aim of this study was to explore strategies effective in reducing the stigma toward people with mental disorders in Iran.

METHODS

This qualitative study was conducted from 2013 to 2016. All participants were recruited by purposive sampling method. The majority of them were stakeholders of mental health in Iran. Data were collected through eight individual interviews, two focus groups, and six written narratives. The data were collected, coded and analyzed simultaneously. Content analysis was employed to analyze the qualitative interview data.

RESULTS

The major themes that emerged were: "Emphasis on education and changing attitudes", "Changing the culture", "Promoting supportive services", "Role of various organizations and institutions", "Integrated reform of structures and policies to improve the performance of custodians", and "Evidence-based actions".

CONCLUSIONS

This study did not investigate the extent of stigma or its origins, rather it examines strategies appropriate for implementation in Iran. Additional studies are needed to evaluate the effectiveness of strategies for reducing the stigma attached to patients with mental disorders.

Parents Caring For Adult Children With Serious Mental Illness

BACKGROUND

Parents often become the caregivers for their adult children with serious mental illness (SMI) due to the chronic and debilitating course of the illness and shortages in funding for community mental health services and residential placements.

OBJECTIVE

To examine parents' management styles when caring for adult children with SMI and parents' perspectives on what type of community-based mental health interventions would support and/or enhance overall family functioning.

DESIGN

A qualitative descriptive study using semistructured interviews with parents caring for adult children with SMI. The study was undergirded by Knafl and Deatrick's Family Management Style Framework.

RESULTS

Four major themes emerged from the data describing prolonged and difficult phases that parents and the family undergo in caring for an adult child with SMI.

CONCLUSIONS

Successful management of these phases must include increasing access to mental health information, mental health screening, early interventions, and violence prevention for adult children and their families.

Using the Affiliate Stigma Scale with caregivers of people with dementia: psychometric evaluation

Background

In this study, we examined the psychometric properties of the Affiliate Stigma Scale to measure affiliate stigma for caregivers of family members with dementia, a topic scantily covered in the literature.

Methods

Two hundred seventy-one caregivers were recruited. Each completed the Affiliate Stigma Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, Beck Anxiety Inventory, and 28-item World Health Organization Quality of Life questionnaire. The data were evaluated for internal consistency and concurrent validity, and they were analyzed using Rasch statistics and confirmatory factor analysis (CFA).

Results

CFA and Rasch analysis suggested that the Affiliate Stigma Scale contains three underlying unidimensional concepts (cognition, affect, and behavior). The three concepts had satisfactory internal consistency (α = 0.822–0.855) and concurrent validity (r = 0.290–0.628 with caregiver burden, 0.391–0.612 with depression, 0.367–0.467 with anxiety, and −0.590 to −0.365 with quality of life).

Conclusions

The Affiliate Stigma Scale is a promising instrument with sound psychometric properties for measuring affiliate stigma. Healthcare providers might want to use it to understand the caregivers’ perspectives and to design appropriate interventions to decrease their affiliate stigma.

Integrated care in German mental health services as benefit for relatives--a qualitative study

BACKGROUND

As mental health services undergo the process of deinstitutionalization, this is resulting in a higher burden of care for relatives. Evidence suggests that interventions for carers have a beneficial impact on their psychological health. A reduction of responsibility for relatives is linked with a significantly improved outcome for the severely mentally ill. The aim of the study was to explore the relatives' experiences with severely mentally ill patients in different integrated care service providers.

METHODS

Semi-structured focus groups and interviews were conducted with 24 relatives of patients receiving community based integrated care for severe mental illness. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories.

RESULTS

Four main categories were found related to the structural aspects of the integrated care services and for the experiences of the relatives within these services. Relatives reported that the services offered significant relief and substantial support in daily life. In addition, relatives felt a reduced burden of carer responsibility and therefore that they were provided with more protection and stability. This resulted in a sense of encouragement and not feeling left alone to face challenges.

CONCLUSION

Relatives are a critical resource for patients suffering from mental health problems and benefit from formal structures and interventions to support them in carer role. An important need is to ensure continuity of care for patients and the bridging of gaps concerning information and support needs for relatives when providing integrated mental health services in the community.

Caregiver Stigma and Burden in Memory Disorders: An Evaluation of the Effects of Caregiver Type and Gender

Despite considerable gains in public awareness of dementia, dementia patients and their caregivers continue to be stigmatized. Previous work has explored stigma and burden among adult children of persons with dementia in Israel, but no similar data exist for spousal caregivers or caregivers in general in the United States. This study examines the differences in stigma and burden experienced by spousal and adult child caregivers and male and female caregivers of persons with dementia. Eighty-two caregivers were given the Zarit Burden Inventory Short Form (ZBI) and the Caregiver Section of the Family Stigma in Alzheimer's Disease Scale (FS-ADS-C). Scores on the FS-ADS-C and ZBI were positively correlated (r s = .51, p < .001). Female caregivers reported experiencing more stigma on the FS-ADS-C (t(80) = -4.37, p < .001) and more burden on the ZBI (t(80) = -2.68, p = .009) compared to male caregivers, and adult child caregivers reported experiencing more stigma on the FS-ADS-C (t(30.8) = -2.22, p = .034) and more burden on the ZBI (t(80) = -2.65, p = .010) than spousal caregivers. These results reinforce the importance of support for caregivers, particularly adult child and female caregivers who may experience higher levels of stigma and burden.

Caregiver coping with the mentally ill: a qualitative study

BACKGROUND

Mental illness is a disease that affects millions of people every year. It not only causes stress to the mentally ill patients, but also for the family members who provide them the care. The family caregivers, therefore need some form of coping strategies in dealing with their mentally ill family members.

AIMS

This qualitative study aims at identifying and analysing the coping strategies adopted by the family caregivers in dealing with their mentally ill family members.

METHOD

A total of 15 family caregivers from the state of Kedah, Malaysia participated in the face-to-face semi structured interview.

RESULTS

The study findings identified an array of coping strategies used by the family caregivers, including religious coping, emotional coping, acceptance, becoming engaged in leisure activities, and the use of traditional healing to help them cope with their mentally ill members. Suggestions and conclusions: Study suggests that the family caregivers should engage themselves in social support groups to learn about and obtain the positive coping strategies used by other caregivers who have similar experiences in caring for the mentally ill. Study also suggests that they should get appropriate training from the mental health professionals in order to enhance the caregivers' coping skills.

Caregivers' perceptions of coercion in psychiatric hospital admission

While knowledge on service users' perspective on their admissions to psychiatric wards has improved substantially in the last decade, there is a paucity of knowledge of the perspectives of caregivers. This study aimed to determine caregiver's perception of the levels of perceived coercion, perceived pressures and procedural justice experienced by service users during their admission to acute psychiatric in-patient units. The perspective of caregivers were then compared to the perspectives of their related service users, who had been admitted to five psychiatric units in Ireland. Caregivers were interviewed using an adapted version of the MacArthur admission experience interview. Sixty-six caregivers participated in this study and the majority were parents. Seventy one percent of service users were admitted involuntarily and nearly half had a diagnosis of schizophrenia or schizoaffective disorder. Caregivers of involuntarily admitted individuals perceived the service users' admission as less coercive than reported by the service users. Caregivers also perceived a higher level of procedural justice in comparison to the level reported by service users. Reducing the disparity of perceptions between caregivers and service users could result in caregivers having a greater understanding of the admission process and why some service users may be reluctant to be admitted.

Experiences of family carers of people diagnosed with borderline personality disorder

There is limited understanding of the experience of family carers of people diagnosed with borderline personality disorder (BPD). This study aimed to explore their experiences of being carers, their attempts to seek help for the person diagnosed with BPD and their own carer needs. An invitation to participate in an online survey was distributed to carers across multiple consumer and carer organizations and mental health services, by the Private Mental Health Consumer Carer Network (Australia) in 2011. Responses from 121 carers showed that they experience significant challenges and discrimination when attempting to engage with and seek support from health services. Comparison with consumers' experiences (reported elsewhere) showed that these carers have a clear understanding of the discrimination faced by people with this diagnosis, largely because they also experience exclusion and discrimination. Community carer support services were perceived as inadequate. General practitioners were an important source of support; however, they and other service providers need more education and training to support attitudinal change to address discrimination, recognize carers' needs and provide more effective support. This study provides the first detailed account of BPD carers' experiences across a broad range of support needs and interactions with community support and health services.

A qualitative exploration of the perspectives of mental health professionals on stigma and discrimination of mental illness in Malaysia

BACKGROUND

Stigma of mental illness has been identified as a significant barrier to help-seeking and care. Basic knowledge of mental illness - such as its nature, symptoms and impact - are neglected, leaving room for misunderstandings on mental health and 'stigma'. Numerous researches have been conducted on stigma and discrimination of people with mental disorders. However, most of the literature investigates stigma from a cultural conception point of view, experiences of patients or public attitudes towards mental illness but little to none from the standpoint of mental health professionals. In Malaysia, this research on stigma is particularly limited. Therefore, the state of stigma and discrimination of people with mental illness was investigated from the perspectives of mental health professionals in Malaysia.

METHODS

In-depth, face-to-face, semi-structured interviews were conducted with 15 mental health professionals from both government and private sectors including psychiatrists, psychologists and counsellors. The interviews were approximately 45-minutes long. The data was subsequently analysed using the basic thematic approach.

RESULTS

Seven principal themes, each with their own sub-themes, emerged from the analysis of 'stigma of mental illness' from mental health professionals' point of view, including: (1) main perpetrators, (2) types of mental illness carrying stigma, (3) demography and geography of stigma, (4) manifestations of stigma, (5) impacts of stigma, (6) causes of stigma and (7) proposed initiatives to tackle stigma. Stigma of mental illness is widespread in Malaysia. This is most evident amongst people suffering from conditions such as schizophrenia, bipolar disorder and depression. Stigma manifests itself most often in forms of labelling, rejection, social exclusion and in employment. Family, friends and workplace staff are reported to be the main perpetrators of discriminatory conducts.

CONCLUSION

According to the perspectives of the mental health professionals, implications of stigma include patients being trapped in a vicious cycle of discrimination leading to detrimental consequences for the individual, their families, communities and society as a whole. There is a pressing need to address stigma of mental illness and its consequences, especially through raising awareness of mental health and wellbeing in Malaysia, as reported by the mental health professionals.

Factors affecting disruption in families of adults with mental illness

PURPOSE

This study examined relationships between vulnerability/risk and protective factors, and family functioning in women family members of adults with serious mental illness.

DESIGN AND METHODS

Using a descriptive, correlational design, this secondary analysis examined characteristics of the family member with mental illness (e.g., diagnosis, level of care) and measures of caregiver stigma and strain, client dependence, family disruption, sense of coherence, and resourcefulness.

FINDINGS

Family disruption was greatest in women who provided direct care and whose family member had major depression, followed by bipolar disorder, schizophrenia, and panic disorder. Sense of coherence and resourcefulness were associated with lower family disruption, but did not mediate the effects of caregiver strain.

PRACTICE IMPLICATIONS

Interventions restricted to one family member may be insufficient for improving the family functioning.

Experiences of stigma and discrimination among caregivers of persons with schizophrenia in China: a field survey

In China, caregivers for family members with schizophrenia play an important role in treatment and recovery but may experience stigma and discrimination simply because of their family relationship. The object of this study was to measure the degrees and correlates of stigma and discrimination experiences among this group. Four hundred twenty-seven caregivers participated in this hospital-based and cross-sectional study in Ningbo and Guangzhou, China. Data were collected by trained interviewers using fixed questionnaires. Stigma and discrimination experiences were measured by the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). Caregivers’ social support was measured by the Social Support Rating Scale. Parametric analysis, nonparametric analysis and multivariate linear regression were used. The mean (SD) score of MCESQ was 2.44(0.45), 2.91(0.71) for stigma experiences and 1.97(0.37) for discrimination experiences on a five-point score (“1 = never” and “5 = very often”). Approximately 65% of caregivers reported that they tried to conceal their family members’ illness, and 71% lacked the support of friends. The experience of stigma was significantly negatively associated with the perceived social support of caregivers (standard β = −0.2,p<0.001). Caregivers who were children of the patients experienced fewer stigmas than other (standard β = −0.18, p<0.001). Urban residence (standard β = −0.12, p<0.01) and patients did not complete primary school education (standard β = −0.13, p<0.01) were negatively related with stigmas. In addition, stigma and discrimination was more experienced in Zhejiang than in Guangdong (p<0.05). In conclusion, this study performed that caregivers of people with schizophrenia in China experienced general stigmas and rare discrimination and found the relations with social support, kinship, patient’s educational level and regional differences. More interventions and supports should been given to caregivers who are lack of social support, who live in rural area and who are the patients’ parents, spouses or siblings.

Parents' experience of living with and caring for an adult son or daughter with schizophrenia at home in Ireland: a qualitative study

This study explored the experience of parents living with, and caring for, an adult son or daughter with schizophrenia. There is increasing emphasis on the involvement of carers and users in the care for people with schizophrenia. 'A Vision for Change' highlights the need for a partnership approach and emphasizes that carers are an integral part in the planning and delivery of mental health services. In order to meet such requests, it was necessary to explore the meaning of caregiving for Irish families. A descriptive qualitative design was used to enable parents to describe their experiences. Semi-structured, in-depth interviews with a convenience sample of six parents in Ireland were carried out in 2007. The study encompassed four major themes: psychological tsunami, caring activities, coping with enduring illness and an uncertain pathway. Parents reported severe psychological distress when their son or daughter was diagnosed with schizophrenia. Their deep sense of loss was followed by acceptance of the situation. Feelings of love and a sense of responsibility helped to give meaning to their caring role. This study gave a voice to some parents of a son or daughter with schizophrenia. A family-centred approach should be at the core of care planning for this vulnerable population.

Validation of the Violence Risk Screening-10 instrument among clients discharged from a psychiatric hospital in Beijing

The Violence Risk Screening-10 is one of the few instruments available for evaluating violence risk in mental health clients during and after hospitalization. This prospective study examined the applicability of this brief instrument with a sample of 289 clients in the 6 months after discharge from a general psychiatric hospital in Beijing. During the research period, 24 of the 289 clients demonstrated aggression. The receiver-operator characteristic curve yielded an area under the curve of 0.62. At the cut-off point of 4.5, its sensitivity/specificity was 79.2%/33.3%, and the corresponding positive/negative predictive value was 9.9%/94.5%. The predictive accuracy of this instrument was lower compared with the results of the original study, and was also less accurate than when it was administered while the clients were in the hospital. While promising in its utility for use beyond the hospital, it deserves further modification prior to its wide use across culturally-diverse China.

The importance of relationship in understanding the experiences of spouse mental health carers

The burden of caring for family members with mental illness has been researched extensively; however, knowledge of spouse carers' experiences is limited. In this article, we explore this from a carers' perspective, with 28 spouse carers, using qualitative open-ended semistructured interviews and a grounded theory approach informed by the social interactionism tradition to collect and analyze the data. We present six interrelated themes around the central theme of this being "a real and genuine relationship." The findings indicate that caring for a spouse with severe mental illness is a unique role compared with other caring roles. First and foremost, spouse carers strive for the relationship with their partner and accommodate mental illness into their lives to protect the relationship. Because of this, they often lead surreal lives marked by significant emotional pressure and isolation. This has implications for how mental health service providers work with and support spouse carers.

Self-stigma among caregivers of people with mental illness: toward caregivers' empowerment

BACKGROUND

In addition to economic and material burdens, caregivers of people with mental illness are exposed to psychosocial challenges. Self-stigma is among the psychological challenges that can be exacerbated by intrinsic and/or extrinsic factors. Caregivers' self-stigma can negatively influence the patients' treatment and rehabilitation process. The objective of this study was to measure the level and correlates of self-stigma among caregivers of people with mental illness.

METHODS

An interviewer-administered cross-sectional study was conducted in the Jimma University Specialized Hospital Psychiatry Clinic in Ethiopia on a sample of 422 caregivers. Data were collected by trained nurses working in the clinic using a pretested questionnaire. Multivariate linear regression was performed to identify the correlates of self-stigma among caregivers of people with mental illness.

RESULTS

The majority (70.38%) of the caregivers were male. On a scale of 0 to 15, with 0 being low and 15 being high, the average self-stigmatizing attitude score was 4.68 (±4.11). A statistically significant difference in mean self-stigma score was found between urban and rural respondents (t=3.95, P<0.05). Self-stigma of caregivers showed significant positive correlation with perceived signs of mental illness (r=0.18, P<0.001), perceived supernatural explanations of mental illness (r=0.26, P<0.001), and perceived psychosocial and biological explanations of mental illness (r=0.12, P<0.01). The only independent predictor of caregivers' self-stigma was perceived supernatural explanation of mental illness (standardized β=0.22, P<0.001).

CONCLUSION

The tendency of caregivers to avoid being identified with the patients was observed. Low exposure to mental health information was also reported. Caregivers' self-stigma in this study was significantly correlated with perceived supernatural explanation of mental illness. Since caregivers' self-stigma may negatively influence patients' treatment-seeking, adherence, and rehabilitation processes, programs that enhance coping strategies by strengthening self-esteem and empowerment by health care providers and establish family support groups may be helpful to tackle self-stigma among caregivers of people with mental illness.

"Their depression is something different . . . it would have to be": findings from a qualitative study of black women's perceptions of depression in black men

This study reports findings from the Black Women's Perceptions of Black Men's Depression (BWP) study, which included eight focus groups with Black women (N = 46) from southeastern Michigan. Four themes illustrated the impressions of Black women from different socioeconomic backgrounds: Black men's depression is a cultured and gendered phenomenon, the role of Black women in Black men's depression, intergenerational differences with how depression is handled by Black men, and the need (and ways) to reach Black men with depression resources. Results underscore not only the importance of understanding the kind of depression in Black men that meets criteria described by the Diagnostic and Statistical Manual of Mental Disorders (DSM) but also the psychological distress that may coexist with (or be separate from) DSM depression. Implications for interventions that educate, diagnose, and treat depression in Black men are discussed.

Psychological impact on caregivers traumatized by the violent behavior of a family member with schizophrenia

BACKGROUND

A combination of factors such as substance abuse problems, medication noncompliance, and insufficient insight are generally known to increase the risk of violent behavior. However, little is known regarding the psychological impact on caregivers who are traumatized by the violent behavior of a family member with schizophrenia. Therefore, we carried out an investigation to measure this impact.

METHOD

A questionnaire was given to 116 caregivers of individuals with schizophrenia in family support groups in Seoul and Daegu, Korea. Their responses were then evaluated using the 22-item version of the Impact of Event Scale-Revised (IES-R), the 8-item short version of the Zarit Caregiver Burden Interview (ZBI-8), and the 15-item version of the Mental Illness and Disorder Understanding Scale (MIDUS).

RESULTS

The mean (SD) IES-R score was 26.69 (17.83) (range, 1-84). Multiple regression analysis showed that the psychological impact of traumatic experiences was significantly associated with the following factors: medical non-adherence (P<0.01), living without the patient (P<0.01), and caregiver burden (P<0.05).

CONCLUSION

Our results from the present study suggest that even when family caregivers live apart from the patient, they still experience the harmful psychological impact of trauma from the patient's violent behavior. The psychological impact continued as a result of the huge caregiver burden and the medication non-adherence of the family member with schizophrenia in spite of receiving long-term treatment and multiple hospitalizations. The present findings suggest the need for improved community-based service for preventive long-term care, including medication adherence, for outpatients with schizophrenia instead of multiple hospitalizations.