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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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Peng MM, Ma Z, Luo W, Hu SH, Yang X, Liu B, Lai-Wan Chan C, Ran MS. Longitudinal impact of caregiver transition and family caregiving on psychiatric symptoms and psychosocial functioning among persons with schizophrenia in rural China. FAMILY PROCESS 2022; 61:1663-1680. [PMID: 34921397 DOI: 10.1111/famp.12743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/27/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
This study examines the 21-year longitudinal impacts and predictive effects of family caregiver transition and the presence of family caregiving on the clinical status of persons with schizophrenia (PwSs) in a rural area of China. Using panel data derived from the Chengdu Mental Health Project (CMHP), 250 dyads of PwSs and their family caregivers were investigated in 1994 and 2015. The Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) were utilized. The generalized linear model (GLM) approach was used. The results of this study showed that more severe symptoms in PwSs were found to be significantly predicted by older age and nonmarried status at baseline. Compared with "spousal caregiving in two waves," the PANSS score was significantly higher in the "transition into sibling caregiving" group. A higher degree of psychosocial functioning was found to be significantly predicted by marital status, shorter duration of illness, and better mental status. Compared with "spousal caregiving in two waves," the GAF score was significantly lower in the "transition into parental caregiving" group. The presence of family caregiving was not a significant predictor of the severity of symptoms or psychosocial functioning in the PwSs. In conclusion, this study shows the 21-year predictive effects of family caregiver transition on the mental status of PwSs but not the presence of family caregiving. Psychosocial interventions and specific guidance should be provided to family caregivers to enhance their quality of caregiving and improve the prognosis of PwSs during long periods of home care.
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Affiliation(s)
- Man-Man Peng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Zhiying Ma
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois, USA
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, Xinjin, Chengdu, Sichuan, China
| | - Shi-Hui Hu
- Chengdu Mental Health Center, Chengdu, China
| | - Xin Yang
- Guangyuan Mental Health Center, Guangyuan, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, China
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China.,Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Young LS, Flannigan R. My sibling's mental illness: An interpretative phenomenological analysis of experiences of having an adult sibling with a mental illness in semi-rural South Africa. S Afr J Psychiatr 2021; 27:1585. [PMID: 34192079 PMCID: PMC8182449 DOI: 10.4102/sajpsychiatry.v27i0.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/07/2021] [Indexed: 11/01/2022] Open
Abstract
Background When there is a lack of resources in the community to support deinstitutionalisation, the siblings of an individual with a mental illness are the ones who are the most affected and vulnerable. Nevertheless, sibling care work is still largely unacknowledged in the mental health sector in low- and middle-income countries. Aim This article describes and interprets the lived experiences of 'black' isiXhosa-speaking individuals having a sibling with a mental illness, to shed light on how mental health professionals might support and sustain the involvement of individuals in the treatment and care of their sibling. Setting The study was conducted in a semi-rural town in the Eastern Cape of South Africa. Methods The study employed a qualitative research design using interpretative phenomenological analysis as the research method. Semi-structured interviews were conducted and analysed. Results The findings present interview extracts which give voice to participants' experiences of financial burden, social burden and stigma, and of engaging with psychiatric treatment while providing care for their mentally ill sibling. Findings also highlight the positive aspects of caring for a sibling with a mental illness. Conclusion This study specifically highlights the gendered nature of care work and siblings' increased understanding of mental illness by virtue of their relationship with their brother or sister, thereby possibly pointing to sibling relationships as valuable relational resources for challenging stigma. The study findings suggest that calls for greater cooperation between healing belief systems should include dialogue with western religious belief systems alongside traditional healing belief systems.
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Affiliation(s)
- Lisa Saville Young
- Department of Psychology, Faculty of Humanities, Rhodes University, Grahamstown, South Africa
| | - Raylene Flannigan
- Department of Psychology, Faculty of Humanities, Rhodes University, Grahamstown, South Africa.,Department of Health, Fort England Psychiatric Hospital, Grahamstown, South Africa
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Non-psychopathology Related Outcomes Among Siblings of Individuals with Mental Illness: A Systematic Review. Clin Child Fam Psychol Rev 2020; 24:38-64. [PMID: 33052503 DOI: 10.1007/s10567-020-00331-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
The current study consists of a systematic review of the quantitative literature on siblings of individuals with mental illness (MI). Despite the prevalence of mental illness, little is known about how siblings are specifically affected in areas of psychosocial, emotional, and behavioral outcomes. The review yielded 56 studies that examined outcomes such as behavior problems, the sibling relationship, caregiving experiences, and knowledge of mental illness among siblings. The majority of studies from the initial search were focused on siblings-as-comparison group, examining siblings for risk factors for developing mental illness. In total, the study samples covered a sibling age range of 6-81 and a patient age range of 4-84. About half (k = 27) of the included studies had samples primarily composed of siblings of individuals with schizophrenia, leaving other MI diagnoses such as depression, anxiety, and mood disorders underrepresented. However, results from comparison studies were mixed-half found that the MI-Sibs had fewer negative outcomes than the comparison group, and half found that MI-Sibs had more negative outcomes. Multiple factors, including female sibling gender, greater severity of MI symptoms, and belief in the patient's ability to control their own behavior, were all related to more negative outcomes for MI-Sibs. Future work will focus on expanding the representativeness of MI-Sibs samples and analyzing experiences of both the sibling and the individual with MI.
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Plessis L, Wilquin H, Pavani JB, Bouteyre E. Explaining Differences Between Sibling Relationships in Schizophrenia and Nonclinical Sibling Relationships. Front Psychiatry 2020; 11:321. [PMID: 32362849 PMCID: PMC7180867 DOI: 10.3389/fpsyt.2020.00321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/31/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Good sibling relationships in adulthood are known to be a protective factor for mental health. The quality of these relationships is influence by the sibship's inherent characteristics (e.g., birth order, number of brothers and sisters, sex composition, age gaps). The present study explored whether these same determinants can help to explain how individuals experience their relationship with a sibling who has been diagnosed with schizophrenia. METHOD A total of 374 adults completed the Adult Sibling Relationship Questionnaire, a scale that probes the quality of these relationships on three dimensions: warmth, conflict, and rivalry. We also collected sociodemographic data and information about family structure from each of the participants. Participants were divided into two matched groups: nonclinical sibling group (n = 187) or schizophrenia sibling group (n = 187). Regression analyses were conducted to extract possible predictors of sibling relationship quality for each group. Further regression analyses then focused exclusively on relationships with an ill sibling, in order to study the role of disease-related variables in explaining each of the three dimensions. RESULTS Results showed that sociodemographic and family structure data explained a significant proportion of variance in the sibling relationship, but solely for nonclinical siblings. When participants had a sibling with schizophrenia, we found that disease-related variables (symptom severity, frequency of treatment) also had to be included to predict the conflict dimension. CONCLUSIONS Our results suggest that feelings of conflict experienced by the schizophrenia sibling group were fueled by the symptoms the ill person displayed. Healthy brothers and sisters probably have only a poor understanding of these symptoms. This could be improved by supporting them and helping them learn more about the disease. Future research will have to prove that providing such support for siblings does indeed improve the quality of their sibling relationships and, by so doing, enhance the wellbeing of both members of a sibling dyad.
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Affiliation(s)
- Léa Plessis
- Clinical Psychology, Pysychopathology and Psychoanalysis Laboratory (LPCPP), Aix Marseille Univ, Aix-en-Provence, France
| | - Hélène Wilquin
- Clinical Psychology, Pysychopathology and Psychoanalysis Laboratory (LPCPP), Aix Marseille Univ, Aix-en-Provence, France
| | - Jean-Baptiste Pavani
- Centre for Research on the Psychology of Cognition, Language and Emotion (PsyCLE), Aix Marseille Univ, Aix-en-Provence, France
| | - Evelyne Bouteyre
- Clinical Psychology, Pysychopathology and Psychoanalysis Laboratory (LPCPP), Aix Marseille Univ, Aix-en-Provence, France
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Kovacs T, Possick C, Buchbinder E. Experiencing the relationship with a sibling coping with mental health problems: Dilemmas of connection, communication, and role. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1185-1192. [PMID: 30983043 DOI: 10.1111/hsc.12761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
Prolonged mental health problems of one family member influences the whole family system, including sibling relationships. The current research focuses on the way siblings of persons with mental health problems experience the relationship. The findings identify the challenges and difficulties these siblings face and can help mental health practitioners support siblings as well as their brothers and sisters with mental health problems. This qualitative research employs the Interpretative Phenomenological Analysis method. Data were collected through in-depth semi-structured interviews with 14 adult siblings of persons coping with prolonged mental health problems. The sample included seven men and seven women, between the ages of 20-55. Three main themes were identified: (a) Connection: Between involvement and distance; (b) Communication: Controlled confrontation or cautious vagueness; (c) Role: Positioning in the sibling relationship. The discussion introduces the Relational Dialectics Theory in order to understand contradictory statements that arise from the interviewees' experience of dialectal tensions between: involvement versus distancing; direct confrontation versus cautious vagueness; and opposing positions in relation to the sibling coping with mental health problems. A multi-voiced discourse allows for dialogue that incorporates the contradictory poles of the dialectic, thus enabling the siblings to balance the tension in the relationship. In addition, the concept of ambiguous loss is used to interpret the findings. The study is limited by the small homogeneous sample. The results highlight the need for practitioners to give special attention to siblings of persons with mental health problems in order to help them process and cope with the challenges in the relationship, thus providing an opportunity for growth and empowerment.
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Affiliation(s)
- Tehila Kovacs
- School of Social Work, Ariel University, Ariel, Israel
| | - Chaya Possick
- School of Social Work, Ariel University, Ariel, Israel
| | - Eli Buchbinder
- School of Social Work, University of Haifa, Haifa, Israel
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Bowman S, Alvarez-Jimenez M, Wade D, Howie L, McGorry P. The Positive and Negative Experiences of Caregiving for Siblings of Young People with First Episode Psychosis. Front Psychol 2017; 8:730. [PMID: 28588522 PMCID: PMC5440581 DOI: 10.3389/fpsyg.2017.00730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/24/2017] [Indexed: 11/26/2022] Open
Abstract
Background: The impact of first episode psychosis (FEP) upon parents’ experience of caregiving has been well-documented. However, the determinants and nature of this remain poorly understood in siblings. It is hypothesized that siblings of young people with FEP are also impacted by caregiving and burden. This study aimed to characterize the experience of caregiving for siblings of young people with FEP. Method: Survey methodology was used to explore the experience of 157 siblings in the first 18 months of their brother or sister’s treatment for FEP. Participants reported on their appraisal of the negative and positive aspects of caregiving as measured by the Experience of Caregiving Inventory (ECI). Descriptive statistics were used to establish the results for the total sample as well as for gender and birth order differences. A series of multivariate regression analyses were conducted to determine the relationships between illness characteristics and siblings’ experience of caregiving. Results: Older brothers reported the lowest scores for negative experiences in caregiving and younger sisters reported the highest. Negative experiences in caregiving resulted in less warmth within the sibling relationship and impacted negatively upon quality of life. When the young person with FEP had attempted suicide and/or been physically violent, siblings experienced more caregiver burden. Multivariate analysis showed that female gender was a significant factor in explaining the impact of illness related variables on the experience of caregiving. Conclusion: Suicide attempts and a history of violence resulted in higher caregiving burden for siblings regardless of whether they lived with the young person experiencing FEP or not. Female siblings are at higher risk of negative experiences from caregiving resulting in a reduced quality of life and a changed sibling relationship. Suicide attempts and violence are indicators for intensive case management to improve outcomes for the individual with FEP which may in turn reduce the burden experienced by the sibling. Clinicians can use these findings to identify siblings, assertively intervene and provide increased psychological support, psychoeducation and practical problem solving to reduce the burden. The caregiving role that they already play for their ill brother or sister should be recognized.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, La Trobe University, MelbourneVIC, Australia
| | - Mario Alvarez-Jimenez
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, MelbourneVIC, Australia
| | - Darryl Wade
- The Australia Centre for Post Traumatic Mental Health, The University of Melbourne, MelbourneVIC, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, La Trobe University, MelbourneVIC, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, MelbourneVIC, Australia
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Cuskelly M. Contributors to Adult Sibling Relationships and Intention to Care of Siblings of Individuals With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 121:204-218. [PMID: 27119212 DOI: 10.1352/1944-7558-121.3.204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The contribution of childhood sibling relationships to adult sibling relationships and intention to provide care was investigated in a sample in which one member of each dyad had Down syndrome. Thirty-nine adult siblings of an adult with Down syndrome who had participated in a study of sibling relationships in childhood/adolescence provided data about the quality of current relationships and of their intention to provide care for their brother/sister with Down syndrome in the future. Only behavior problems in the child with Down syndrome predicted warmth of the current adult relationship. Although adult sibling relationships were reported to be warm, the quality of neither the current nor the past relationship was associated with the reported intention to provide care.
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Affiliation(s)
- Monica Cuskelly
- Monica Cuskelly, The University of Queensland, School of Education, Brisbane, Queensland, Australia
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Dimitropoulos G, Klopfer K, Lazar L, Schacter R. Caring for a sibling with anorexia nervosa: a qualitative study. EUROPEAN EATING DISORDERS REVIEW 2009; 17:350-65. [PMID: 19585664 DOI: 10.1002/erv.937] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Few studies have explored eating disorders from the perspective of non-affected siblings. The aim of this investigation was to explore the unique experiences and challenges of siblings of women with anorexia nervosa (AN). METHOD Twelve semi-structured qualitative interviews were conducted with sibling participants to ascertain their perspective of caring for a sister with chronic AN. RESULTS Qualitative analyses gleaned six themes: (1) the sibling role as protector and mediator; (2) familial factors that influence and reinforce these sibling roles; (3) consequences and benefits of AN to non-affected sibling; (4) coping strategies; (5) current and future intentions of caregiving and (6) professional and informal support. DISCUSSION The findings from this qualitative study provide a window into the perceptions, feelings, and roles of siblings of women afflicted with AN. An intervention guided by the elicited themes may facilitate family functioning that is more adaptive for both siblings.
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Affiliation(s)
- Gina Dimitropoulos
- Inpatient Eating Disorders Program, Department of Psychiatry, University Health Network, Toronto, Canada.
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Schmid R, Schielein T, Binder H, Hajak G, Spiessl H. The forgotten caregivers: Siblings of schizophrenic patients. Int J Psychiatry Clin Pract 2009; 13:326-37. [PMID: 24916945 DOI: 10.3109/13651500903141400] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective. The situation of caregivers of psychiatric patients is mostly focussed on burdens of parents or spouses of patients. The burden of siblings due to the illness, however, is mostly underestimated and disregarded. Methods. Thirty-seven narrative interviews with siblings of schizophrenia inpatients were analysed by using a summarizing content analysis. The founded global statements were quantitatively analysed. Regression-analysis as well as regression trees were used to evaluate the data linked with sociodemographic and disease-related variables of the patient and siblings. Results. The results showed a high proportion of siblings engaged in caregiving activities. A total of 492 individual statements were summarized in 26 global types of statements. The three most often reported burdens by the healthy siblings are: "Handling the symptoms of illness" (100%), "Emotional burden due to the illness of the sibling" (100%) and "Uncertainty in judging what amount of stress the patient can cope with" (81.1%). Linear regression and regression tree analysis show predictors for higher burdened siblings. Conclusion. Siblings of schizophrenia patients are burdened in various aspects and in a specific matter. Their special needs will therefore have to be recognised before they can receive appropriate intervention.
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Affiliation(s)
- Rita Schmid
- Department of Psychiatry and Psychotherapy, University Medical Center Regensburg, Regensburg, Germany
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Smith MJ, Barch DM, Wolf TJ, Mamah D, Csernansky JG. Elevated rates of substance use disorders in non-psychotic siblings of individuals with schizophrenia. Schizophr Res 2008; 106:294-9. [PMID: 18774264 PMCID: PMC2627404 DOI: 10.1016/j.schres.2008.07.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 07/21/2008] [Accepted: 07/28/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with schizophrenia use psychoactive substances more frequently than the general population. The genetic vulnerability to develop schizophrenia may also increase risk for the development of substance use disorders. We examine this hypothesis by assessing the rates of substance use disorders and nicotine use in non-psychotic siblings of individuals with schizophrenia. METHODS Participants included 59 individuals with DSM-IV schizophrenia, 53 of their siblings, 80 community controls, and 75 of their siblings. Statistical regression was used to assess the rates of substance use disorders and nicotine use in study participants while controlling for age, gender, lifetime diagnosis of a mood or anxiety disorder, and a family history of substance use disorder. RESULTS Individuals with schizophrenia and their non-psychotic siblings reported higher rates of alcohol and cannabis use disorders and nicotine use when compared to siblings of comparison subjects. CONCLUSIONS The vulnerability to develop schizophrenia may also extend to substance use disorders. Future research is needed to investigate the neurobiological basis of increased substance use in non-psychotic siblings and the psychosocial mechanisms that may contribute to increased substance use in non-psychotic siblings.
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Affiliation(s)
- Matthew J. Smith
- Northwestern University,Feinberg School of Medicine,Department of Psychiatry and Behavioral Sciences
| | - Deanna M. Barch
- Washington University,Department of Psychiatry,Department of Psychology,Department of Radiology
| | | | | | - John G. Csernansky
- Northwestern University,Feinberg School of Medicine,Department of Psychiatry and Behavioral Sciences
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Smith MJ, Cloninger CR, Harms MP, Csernansky JG. Temperament and character as schizophrenia-related endophenotypes in non-psychotic siblings. Schizophr Res 2008; 104:198-205. [PMID: 18718739 PMCID: PMC2565802 DOI: 10.1016/j.schres.2008.06.025] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 06/27/2008] [Accepted: 06/29/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Quantitative endophenotypes are needed to better understand the pathogenesis of schizophrenia. The psychobiological model of temperament and character suggests that personality traits are heritable and regulated by brain systems influencing schizophrenia susceptibility. Thus, measures of temperament and character may serve as schizophrenia-related endophenotypes in individuals with schizophrenia and their non-psychotic siblings. METHODS Individuals with schizophrenia (n=35), their non-psychotic siblings (n=34), controls (n=63), and their siblings (n=56) participated in a study of the clinical, neurocognitive and neuromorphological characteristics of schizophrenia. A mixed-model approach assessed group differences on the Temperament and Character Inventory (TCI). Neurocognitive deficits and psychopathology were correlated with the TCI. Configurations of TCI domains were examined using a generalized linear model. RESULTS Individuals with schizophrenia and their non-psychotic siblings had higher harm avoidance than controls and their siblings. Individuals with schizophrenia had lower self-directedness and cooperativeness, and higher self-transcendence than their non-psychotic siblings, controls, and the siblings of controls. Neurocognition was not related to temperament and character in individuals with schizophrenia or either control group. In non-psychotic siblings, self-directedness and cooperativeness were correlated with working memory and crystallized IQ. CONCLUSION Evidence supports harm avoidance as a schizophrenia-related endophenotype. An increased risk of schizophrenia may be associated with asociality (configured as high harm avoidance and low reward dependence), schizotypy (configured as low self-directedness, low cooperativeness, and high self-transcendence), and neurocognitive deficits (poor executive functioning, working/episodic memory, attention, and low IQ). The non-psychotic siblings demonstrated features of a mature character profile including strong crystallized IQ, which may confer protection against psychopathology.
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Affiliation(s)
- Matthew J Smith
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL 60611, United States.
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