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

Care Bermuda, families of the patients with chronic mental disorders in Iran surrounded by psychosocial problems and needs: a qualitative study

Background

A mental disorder is characterized by a clinically significant impairment of cognition, emotion regulation, or behavior. As a result of the shift in care from medical centers and hospitals to home care, we now see a change in the treatment of patients with chronic mental disorders. Consequently, families have become the main support system in the progressive care of these patients, leading to psychological and social problems. The current qualitative study investigated the social and psychological health needs and problems of family caregivers of patients with chronic mental disorders in Iran's cultural and social context.

Methods

This was a content analysis qualitative study. The study was conducted in three psychiatric hospitals in Farabi, Noor, Modares. Purposive sampling was done and continued until data saturation. Semi-structured, face-to-face, and individual interviews were conducted with 49 participants (15 family caregivers of patients with CMD and 34 members of the mental health care team). Data analysis was done using the conventional content analysis method.

Results

Eight hundred seventy-five primary codes were obtained, which were classified into 10 subcategories and 3 main categories of 'health challenges of caregiver', 'confused concept of care' and "the need for a coherent support system.

Conclusion

In Iranian society, after the patient is discharged from the hospital or care center, family members will change their role to the most important caregivers of these patients. The psychological and social health of these caregivers is destroyed because of the problems they have in providing care for their patients and their needs, which are not met.

Affiliate stigma and its association with family burden among family members of people living with schizophrenia in China

PURPOSE

Understanding affiliate stigma and its impact on family of people living with schizophrenia (PLS) in China is important for culturally informed intervention. This study aims to describe the pattern of affiliate stigma of family members of PLS in China and investigated the association between affiliate stigma and family burden.

METHODS

PLS and their family members dwelling in community were randomly recruited from four cities across China and completed measures of affiliate stigma and family burden. Linear regression analyses were used to determine the association between affiliate stigma and family burden.

RESULTS

A total of 493 dyads of family member and PLS were include in this study. The mean affiliate stigma in family members was 2.21 (SD = 0.61). The vast majority of family members reported the feeling of inferiority, helpless and sad because of their family members' schizophrenia, but few family members refusing to communicate or contact with the PLS. The mean score of overall family burden was 22.25 (SD = 14.90), with 98 % of participants reported moderate or severe burden. A higher level of affiliate stigma was associated with more family burden (b = 7.837, 95CI: 5.240 to 8.747). Affiliate stigma was significantly associated with family daily activities, entertainment activities, family relationship, physical health and mental health of family members, but not family economic burden.

CONCLUSION

A higher level of affiliate stigma was associated with more family burden among family with PLS. Anti-stigma intervention of mental illness should be consider not only PLS but also their family members.

Validating a Caregiving Rewarding Feelings scale among family caregivers of those diagnosed with schizophrenia in China

INTRODUCTION

A culturally adaptive and easy-to-administer 12-item Caregiving Rewarding Feelings (CRF) scale has been developed in China yet never published in English and validated in another population.

AIM

The current study aimed to validate the CRF among a community sample of Chinese caregivers of those diagnosed with schizophrenia.

METHOD

A sample of 449 family caregivers was recruited for scale validation that included factorial validity, construct validity, measurement invariance, item analysis, internal consistency reliability, test-retest reliability, known-group validity, convergent validity and divergent validity.

RESULTS

Confirmatory factor analysis supported the a priori three-factor structure. Construct validity was supported by high standard regression weight (SRW) and average variance extracted (AVE), measurement invariance across age and gender groups. The CRF showed good internal consistency and test-retest reliability. Known-group validity was confirmed by the higher CRF scores among caregivers with certain socio-demographics. The convergent validity of the CRF was supported by its positive correlations with social support, active coping and family functioning. The divergent validity of the CRF was supported by its negative associations with stigma, stress and depressive symptoms.

CONCLUSIONS

This study confirmed the reliability and validity of the CRF specifically designed for caregivers in Chinese culture.

IMPLICATIONS FOR PRACTICE

The CRF may be further applied and validated in other populations and other countries.

Dyadic effects of stigma on quality of life in people with schizophrenia and their family caregivers: Mediating role of patients' perception of caregivers' expressed emotion

Schizophrenia, as a stressful diagnosis, profoundly impacts the whole family, especially people with schizophrenia and their caregivers. This study tested the potential mediating role of expressed emotion in the association between mental health stigma and quality of life in caregiver-patient dyads. Using a 2-wave longitudinal design with a 6-month interval between assessments, 161 dyads of patients with schizophrenia and their family caregivers (one patient and one caregiver) completed measures of mental health stigma, expressed emotion, and quality of life. The results showed that patients' self-stigma had no significant actor or partner effect on expressed emotion or quality of life. In contrast, caregivers' stigmatizing attitudes toward patients had a significant partner effect on patients' perception of caregivers' expressed emotion and quality of life. The mediating effect of patients' perception of caregivers' expressed emotion in the association between caregivers' stigmatizing ideas toward patients and patients' quality of life was significant. By focusing on the interdependence of patients and their caregivers, this study highlights the role of caregivers' stigmatizing attitudes toward patients and patients' perception of caregivers' expressed emotion on patients' quality of life. Psychoeducation and interventions should not only aim to reduce the self-stigma of people with schizophrenia but also their caregivers' stigmatizing ideas toward patients. Family interventions targeted at reducing the EE level of caregivers and patients' perception of caregivers' EE would also benefit the adaptation and quality of life of people with schizophrenia and their caregivers.

Factors that influence family-focused practice in Chinese mental health workers: A cross-sectional survey

INTRODUCTION

Family-focused practice has become an emerging paradigm in mental health services. However, little is known about family-focused practice and associated factors in Chinese mental health workers.

AIM

To examine family-focused practice and associated factors in Chinese mental health workers.

METHOD

A cross-sectional survey was conducted in a convenience sample of mental health workers (n = 515) in Beijing, China. The Family-Focused Mental Health Practice Questionnaire was used to measure family-focused practice, as well as worker, workplace and client factors that might influence family-focused practice. Multiple linear regression analysis was performed to investigate the factors associated with family-focused practice.

RESULTS

On average, the participants exhibited a moderate level of engagement in family-focused practice. The factors that most significantly influenced family-focused practice in Chinese mental health workers were skill and knowledge, worker confidence and time and workload. Moreover, psychiatrists were found to engage more in family-focused practice than psychiatric nurses, and community mental health workers were more active in family-focused practice than hospital-based ones.

DISCUSSION

This study provided important data concerning family-focused practice and associated factors in Chinese mental health workers.

IMPLICATIONS FOR PRACTICE

The varying level of Chinese mental health workers to engage in family-focused practice has advocacy, training, research and organizational implications for mental health services in China and elsewhere.

The psychosocial stressors of siblings of people with experiences of psychosis (SOPEP): A systematic narrative review across cultures

OBJECTIVES

This study aimed to synthesise the psychosocial stressors of siblings of people with experiences of psychosis (SOPEP). Understanding the specific needs of siblings across diverse cultures would help mental health services to provide culturally specific psychosocial family and sibling-centred support. This may result in improved relationships between families, better psychosocial well-being for siblings and better outcomes for patients.

METHODS

Following PRISMA guidelines, a systematic review was conducted to explore the psychosocial stressors of SOPEP. Six databases were utilised to identify literature using qualitative methodology.

RESULTS

Twenty-two studies were included that investigated the Psychosocial Stressors of SOPEP. SOPEP's experiences were influenced by various stages: individual factors, social factors, physical and macro-level environments. Six key components contributed to SOPEP's psychosocial stressors and facilitated or hindered their intentions, behaviours and experiences of caregiving. These were the SOPEP's beliefs about psychosis, caregiving beliefs, family and cultural values, personality traits, pragmatic challenges and access to resources.

CONCLUSIONS

Globally, SOPEP and families may benefit from their involvement in family interventions and individual support that facilitates caregiving and acknowledges their responsibilities, resources, psychosocial needs and emotional experiences.

Psychosocial experiences of caring by family caregivers of patients living with prostate cancer in a teaching hospital: A descriptive phenomenological study

AIM

This study explored the psychosocial experience of caregiving on the family caregiver of patients with prostate cancer in the Cape Coast metropolis of Ghana.

DESIGN

A descriptive phenomenological study was conducted through in-depth face-to-face semi-structured interviews. Twelve family caregivers of prostate cancer patients were selected through purposive sampling. Interviews were conducted until data saturation. All interviews were taped, transcribed verbatim and analysed thematically.

RESULTS

The family caregiver's psychosocial experience associated with caregiving uncovered two significant themes with 13 sub-themes. 'Psychological impact' emerged as the first central theme, with anxiety, care as an obligation and feelings of inadequacy, hopelessness, uncertainty, denial and concealment as the sub-themes. The second central theme was 'Social impact' with sexual concerns, role adjustment, loss of livelihood, turmoil and reduced leisure activities emerging as sub-themes.

CONCLUSION

The findings demonstrated that caring significantly impacts the psychological and social well-being of the caregivers of prostate cancer patients. Therefore, there is a need for holistic assessment to include the psychosocial well-being of family caregivers to improve quality of life. Therefore, psychiatric nurses support family caregivers through education and psychosocial interventions to improve their quality of life and enable them to care for their loved ones more effectively.

Determinants of Burden in Family Caregivers of Individuals With Schizophrenia: A Systematic Review

The current systematic review was performed to determine the specific burdens placed on families of individuals with schizophrenia. Scopus, PubMed, and CINAHL databases were searched, resulting in 21 articles that met inclusion criteria. Results showed that treatment of individuals with schizophrenia poses a burden on families. Most caregivers experienced emotional and financial problems that affected their quality of life. Influencing factors in caregivers were age, sex, educational level, family status, income, time spent with the individual per day, knowledge regarding schizophrenia, attitude, and psychological stress. Influencing factors in individuals with schizophrenia were age, sex, severity of illness, social function, and treatment adherence. Environmental factors were stigma, social support, and professional support from health care providers. Family caregivers of individuals with schizophrenia need to be empowered to improve resilience and acceptance in caring for these individuals. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 38-43.].

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.

Perceived mental health and emotional trajectories of long-term family caregivers of persons with mental conditions: A mixed-methods study

AIMS AND OBJECTIVES

To explore the emotional experience and the perceived mental health of experienced family caregivers of people with mental disorders.

BACKGROUND

Family caregiving for individuals with mental disorders differs from other health conditions, as it implies a burden, deterioration in physical and mental health, stigma and a perceived lack of support from mental health services.

METHODS

A mixed-method study was undertaken with family caregivers of people diagnosed with mental disorders.

RESULTS

A total of 13 experienced family caregivers were included in the study. The qualitative data were classified into two major themes: emotions and perceived mental health. Emotions included five categories: irritability, painful emotions, pressure, emotions orientated towards coping, and positive emotions. The perceived mental health status embraced five categories: anxiety, burden and exhaustion, needing psychological or psychiatric treatment, insomnia and suicidal thoughts. An emotional path could be constructed from their discourses, starting with lack of control or irritation that evolved towards resignation, peace or satisfaction. The quantitative analysis partially replicated the qualitatively reported anxiety, depressive symptoms and insomnia.

CONCLUSION

Past and present emotions related to caregiving described by experienced family caregivers were identified. Their emotional trajectories converged in that negative emotions gave way to emotions towards coping, which in turn were followed by positive emotions. The participants' descriptions about their mental status were partially reflected through objective mental health measurements.

RELEVANCE TO CLINICAL PRACTICE

More support from mental health services could help caregivers to progress in their emotional trajectory towards coping, and improve their caregiving knowledge and skills. Mental health nurses have a role in patients and caregivers education and in the promotion of caregivers' psychological wellbeing.

Needs, challenges, and coping strategies among primary caregivers of schizophrenia patient: A systematic review & meta-synthesis

INTRODUCTION

Deinstitutionalization and rising psychiatric care in society have led to an increase in the role of caregivers of persons diagnosed with schizophrenia.

OBJECTIVE

The objective of this systematic review was to identify and synthesize qualitative research findings that explored the needs, challenges, and coping strategies among the primary caregivers of a schizophrenia patient.

METHODOLOGY

The electronic databases namely PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Scopus, Web of Science, ProQuest, and ClinicalKey were searched to identify relevant articles published from 2005 to October 2021. The quality of the included articles was independently appraised by two reviewers using Walsh and Downe criteria and was analysed thematically. The meta-synthesis was modelled on Lucas framework.

RESULTS

The richness of information across 38 papers involving 543 participants was noteworthy. The needs of the primary caregivers were rehabilitation and vocational centre, information and education, self-help groups, augmented healthcare services, and communication and collaboration. The challenges reported were treatment expenses, bizarre beliefs, self and other directed harm and violence, therapeutic noncompliance, onerous caregiving task, crumbling family relations, misconception and discrimination, and self-stigmatization. The coping strategies adopted were problem-focused coping, emotional coping, behavioural coping, coping through social support, religious coping and cognitive reappraisal.

CONCLUSION

The primary caregivers provide unparalleled service to the health system and for the patient. The healthcare providers need to give undue attention to the unmet needs and challenges of the caregivers, which would benefit the health system by enabling the caregivers in providing long-term care for the schizophrenic.

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.

Exploring the experience of relatives living with individuals diagnosed with schizophrenia in Oman: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Relatives of individuals diagnosed with schizophrenia experience financial, social, emotional and physical burden. There is a lack of studies on the experience and needs of caregivers of individuals diagnosed with schizophrenia in the Arab world. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first qualitative study to reflect the voice of parents, siblings and spouses living with schizophrenia in the Arab world. The study explored the needs of relatives of hospitalized patients. This study revealed some positive elements of caregiving experience, especially among siblings. The concept of stigma resistance may guide the establishment of stigma reduction programmes. Violence towards the relatives or vice versa is a sensitive issue that needs to be addressed and reported. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should address parents, spouses and siblings' specific needs and challenges to include them in their relatives' treatment plan. Understanding the experience, feelings and needs of relatives living with schizophrenia would enable mental health nurses to provide a range of interventions to help reduce caregivers' burden and promote the positive gains from the caregiving experience. The study emphasizes the need for culturally adapted family interventions to effectively assist relatives in providing care and adjusting to the caregiving role. ABSTRACT: Introduction Relatives of individuals diagnosed with schizophrenia often experience positive and negative impacts. Much of the literature on family experience with schizophrenia comes from western culture, and less is known about Arabic speaking countries. There has been no previous attempt to qualitatively investigate the lived experience of relatives of hospitalized patients with schizophrenia in the Arab world. Aim To explore the experience and needs of Omani relatives of hospitalized patients diagnosed with schizophrenia. Method Qualitative semi-structured interviews with twenty relatives of hospitalized patients from Oman. The interviews were analysed using framework analysis. Results Parents, spouses and siblings were confronted with a burden specific to the demand of different life situations, and their needs differ accordingly. The findings showed four themes: burden, stigma, violence and needs. Discussion This study provides insight into the experience of Omani relatives living with schizophrenia. Although the caregiving experience appears negative, some positive elements of caregiving experience were prominent among siblings. Furthermore, the violence phenomenon among individuals with schizophrenia needs to be addressed as a priority. Implications for practice Understanding the experience, feelings and needs of relatives living with schizophrenia would enable mental health nurses to provide a range of interventions to help reduce caregivers' burden and promote the positive gains from the caregiving experience. The concept of stigma resistance in the Arab world may guide the establishment of stigma reduction programmes.

The Meaning of Recovery: The Lived Experience of Patients with Bipolar Disorder in Turkey

Recovery in mental illness refers to a process with many aspects, steps and meanings. This study aims to provide a deeper understanding of the lived experience of recovery of patients with bipolar disorder. A qualitative approach with 28 participants was performed. Data were collected through semi-structured interviews. The experiences of the individuals regarding the recovery processes were themed with the journey metaphor: the beginning of the journey, the route of the journey, a stop in the journey, the meaning of the journey. This study suggests ways clinicians must be aware of and adopted contemporary approach which recovery is defined as a process beyond treatment.

Determinants of family independence in caring for hebephrenic schizophrenia patients

Background: Schizophrenic patients are very susceptible to recurrent incidences, therefore the family plays a key role in providing care as a part of the recovery team. This study aimed to determine the relationship between knowledge, perceptions, attitudes and support with family independence in caring for hebephrenic schizophrenic patients. Design and Methods: It was used a correlational analytic design with cross sectional approach, and consecutive sampling technique was used, which attained 57 respondents. The independent variables were knowledge, perceptions, attitudes, and support, while independence was the dependent variable, and both were measured using questionnaires, and Spearman rank test was used for data analysis. Results: The results indicate the presence of a relationship between knowledge, perceptions, attitudes, as well as support and family independence in caring for hebephrenic schizophrenia. In addition, the spearman rank test showed P-values of 0.008, 0.011, 0.032, and 0.027 in family knowledge, perception, attitudes and support, respectively, at <0.05. Conclusions: This study indicates the importance of family support in attempts to improve the self-esteem of schizophrenic patients. Based on this data, the hospital is expected to improve the family-based patient recovery program.