A longitudinal study of the health and wellbeing of culturally and linguistically diverse caregivers of people with psychosis in Australia

Changes in Psychosocial Variables Among Caregivers of Patients With Schizophrenia: A Short-Term Follow-Up Study

BACKGROUND AND AIMS

Caring for a person with schizophrenia entails considerable effort. The caregiving experience while caring for a person with schizophrenia has been described as both stressful and enriching. The literature on changes in caregiving experience with time has been fairly limited. The present analysis looks at the change in the caregiving experience of caregivers of patients with schizophrenia.

METHOD

This study had a sample of 50 caregivers of patients with schizophrenia who were followed up after a period of 6 to 10 months. Caregiving experience, knowledge of the mental illness, family functioning, coping, social support, psychological distress, quality of life, and spiritual, religious, and personal beliefs were assessed at the two time points.

RESULTS

Among the negative caregiving experiences, caregivers' need for back-up and patient dependency reduced significantly at follow-up as compared to baseline, though total negative or positive experiences of caregiving did not show a significant difference. Knowledge about mental illness did not significantly increase at follow-up, though issues related to poor communication and affective involvement in family functioning reduced over the period of time. Coping and social support remained largely the same, while psychological distress was reduced. All domains of quality of life improved over the follow-up period, while the hope, optimism, and inner peace aspects of spiritual, religious, and personal beliefs improved with time.

CONCLUSION

Some aspects of caregiving experiences may change with time. As caregivers become more adjusted to caregiving roles, their distress may reduce, and their quality of life may improve.

Social connectedness of carers: An Australian national survey of carers

Carers of people living with a disability, mental health problems, alcohol or drug dependency, chronic condition, terminal illness or who are frail due to age may experience negative caregiving impacts. Although carers' social isolation has been reported in many qualitative studies, it has largely been neglected in quantitative studies. Using data collected in the Carers NSW 2020 National Carer Survey, this large-scale quantitative study aimed to identify the extent of Australian carers' social connectedness and what factors may be related to their social well-being. The validated Friendship Scale was used to measure social connectedness of 5585 carers. More than half (56.2%) of these carers were socially isolated. Analysis found that a longer duration of caring, more time spent weekly caring, living with the care recipient, caring for a greater number of people, receiving no help from others, higher reported psychological distress and reporting perceived needs were all associated with greater social isolation. Identifying as female or nonbinary/gender diverse, identifying with a culturally and linguistically diverse background, and caring as a parent, former partner or young carer were also related to poorer social connectedness. Health and social services need to consider the needs of carers, identify carers who are socially isolated and provide resources to promote social connectedness. Greater attention in practice and research to focus on carers' social connectedness to address this crucial caregiving experience is required.

Wellbeing and experiences of Chinese and Vietnamese carers of people with mental illness in Australia

Many studies show that carers of people with mental illness experience a negative impact on their wellbeing. Given the growing number of people relocating to Australia every year, there are limited studies examining the experience of carers of people with mental illness from culturally and linguistically diverse communities in Australia. Using cultural safety as a conceptual framework, this exploratory study recruited 14 carers of Chinese and Vietnamese heritage who were attending culturally and linguistically oriented support groups in Sydney, Australia. Standardised, validated scales were administered to measure carers' wellbeing and knowledge of recovery. Structured interviews were conducted to understand carers' perceived needs. Descriptive statistical and qualitative thematic analysis were used. Findings show that carers experienced social isolation and psychological distress, had multiple diverse needs and had a reasonably good understanding of recovery. Six themes were identified: i) obtaining information in own language; ii) attaining emotional support from support groups; iii) needing respite services to cope with caregiving responsibilities; iv) involvement in planning of treatment and care; v) migration process influencing caregiving, and; vi) cultural and transcultural factors influencing caregiving experience. Findings indicate that some carers might be experiencing some level of culturally unsafe practices in mainstream mental health services. Implications for support groups and mental health services are discussed.

Definitions of Culturally and Linguistically Diverse (CALD): A Literature Review of Epidemiological Research in Australia

Objective: To identify how Culturally and Linguistically Diverse (CALD) communities are defined in epidemiological research in Australia and provide a definition of CALD status that aids the consistency and interpretability of epidemiological studies. Methods: Peer-reviewed literature from January 2015 to May 2020 was searched via four databases (Ovid Medline combined with PubMed, Embase, Emcare, and CINAHL) to identify quantitative studies of CALD people in Australia. Results: A total of 108 studies met the criteria for inclusion in the review. Country of birth was the most commonly used CALD definition (n = 33, 30.6%), with combinations of two or more components also frequently used (n = 31, 28.7%). No studies used all the components suggested as core to defining CALD status. including country of birth, languages other than English spoken at home, English proficiency, and indigenous status. Conclusions: There was considerable inconsistency in how CALD status was defined. The review suggests that CALD status would best be defined as people born in non-English speaking countries, and/or who do not speak English at home. Additionally, indigenous peoples should be considered separately. This recommended definition will support the better identification of potential health disparity and needs in CALD and indigenous communities.

Employment disadvantage and associated factors for informal carers of adults with mental illness: are they like other disability carers?

BACKGROUND

Providing unpaid support to family and friends with disabling health conditions can limit a carer's capacity to participate in employment. The emotional support needs and unpredictability of caring for people with mental illness may be particularly demanding. While previous research suggests variable employment rates across carers for different conditions, there are limited data on mental health carers specifically.

METHODS

This study analysed employment patterns for working-age, co-resident carers of adults with mental illness in an Australian cross-sectional household survey, the 2015 Survey of Disability, Ageing and Carers.

RESULTS

Significantly more mental health carers were not employed (42.3%, 95% CI: 36.6-48.1) compared to non-carers (24.0%, 95% CI: 23.5-24.6). Employed mental health carers were more likely to work fewer than 16 h per week (carers: 17.2%, 95% CI: 12.8-22.8, vs. non-carers: 11.7%, 95% CI: 11.3-12.1) and in lower skilled occupations (carers: 22.6, 95% CI: 17.5-28.7, vs. non-carers: 15.7, 95% CI: 15.1-16.2). Among the sub-group of primary mental health carers, 25.8% (95% CI: 15.6-39.5) had reduced their working hours to care and a further 26.4% (95% CI: 17.2-38.2) stopped working altogether. In corresponding comparisons between mental health carers and carers for people with other cognitive/behavioural conditions, and physical conditions with or without secondary mental illness, there were no differences except that mental health carers were more likely to be working in a lower skilled occupation than other cognitive/behavioural condition carers (14.8% of the latter, 95% CI 10.1-21.2). Multivariate logistic regression analyses revealed that female mental health carers were less likely to be employed if they were aged 35-54, had no post-secondary education, had a disability, or cared for someone with severe activity limitations. For male mental health carers, having a disability or caring for someone with severe limitations or who did not receive paid assistance were significantly associated with not being employed.

CONCLUSIONS

These results highlight the employment disadvantage experienced by mental health carers compared to non-carers, and similarities in employment patterns across carers for different conditions. Improving the availability of paid support services for people with mental illness may be an important target to assist carers to maintain their own employment.

Mental health carers' experiences of an Australian Carer Peer Support program: Tailoring supports to carers' needs

Carer Peer Support Workers (CPSWs) are people who have lived experience as carers/family members of persons with a mental illness, and are employed to provide support to other carers/family members. This qualitative study aimed to explore carers' experiences within a community-based CPSW pilot program in an Australian mental health service. Semi-structured phone interviews were conducted with 20 carer participants in 2015, 5-10 months following their last contact with the service. Thematic analysis uncovered that carers were generally positive about the CPSW's emotional support, practical support, shared lived experience and mutual understanding, and the "ripple effect" the support had on service users. Some carers, on the other hand, felt that the support was unnecessary; either because they believed that it did not have a lasting effect, the focus should have been on the service user, or that they had previously received enough support. Nevertheless, the study highlighted how mental health services could best utilise and benefit from CPSWs. Moreover, to be most useful, the nature of the carer peer support work should be tailored to the specific needs of the carers; which may vary according to their culture, years of caring experience, and previous experiences with mental health services.

A longitudinal population-based study of carers of people with psychosis

AIMS

Few studies have examined the experiences of carers of people with psychosis using a representative sample. Aiming to obtain generalisable results concerning carers in the context of increased emphasis on involving carers in Australian mental health service delivery and policy frameworks, this study recruited carers within the second Australian national survey of psychotic disorders (Survey of High Impact Psychosis, SHIP). Given that most SHIP participants had long-term illness and extended relationships with carers, the health and wellbeing of carers as a group were expected to be relatively stable. However, since it is unknown whether carers' health and wellbeing would change, our main aim was to explore change and stability in carers' health and wellbeing and the relationship between any changes experienced by individual carers and corresponding SHIP participants' functioning over time.

METHODS

Ninety-eight caregivers of SHIP participants were recruited at baseline and completed validated instruments assessing their health and wellbeing. Seventy-eight carers were re-interviewed at 1-year follow-up. Clinical factors were extracted from the SHIP database. Wilcoxon matched-pairs signed-rank test and t-test were used to analyse changes in variables over time. Cross-lagged analyses were conducted to identify possible causative relationships in changes in SHIP participant and carer variables.

RESULTS

A substantial percentage of carers experienced social isolation (28.6%), psychological distress (37.7%) and poorer quality of life than population norms. There were no statistically significant changes between baseline and follow-up scores for almost all carers' health and wellbeing variables, other than a poorer perception of their quality of life in relation to their physical health after 1 year. Cross-lagged analyses suggested that poorer functioning of people with psychosis influenced carers' social isolation, grief and psychological distress.

CONCLUSIONS

Findings show that carers' perception of their health and wellbeing did not improve within current mental health service delivery frameworks over time. Carer's persistently poor health and wellbeing suggests a pressing need to enhance services that improve carers' health and wellbeing especially their physical health and the functioning of people with psychosis whom they support.

Responding to challenges for people with psychotic illness: Updated evidence from the Survey of High Impact Psychosis

OBJECTIVE

The objective is to summarise recent findings from the 2010 Australian Survey of High Impact Psychosis (SHIP) and examine their implications for future policy and planning to improve mental health, physical health and other circumstances of people with a psychotic disorder.

METHODS

Survey of High Impact Psychosis collected nationally representative data on 1825 people with psychotic illness. Over 60 papers have been published covering key challenges reported by participants: financial problems, loneliness and social isolation, unemployment, poor physical health, uncontrolled symptoms of mental illness, and lack of stable, suitable housing. Findings are summarised under the rubric of participant-ranked top challenges.

RESULTS

The main income source for the majority (85%) of participants was a government benefit. Only one-third was employed, and the most appropriate employment services for this group were under-utilised. High rates of loneliness and social isolation impacted mental and physical health. The rate of cardiometabolic disease was well above the general population rate, and associated risk factors were present from a very young age. Childhood abuse (30.6%), adult violent victimisation (16.4%) and alcohol and substance abuse/dependence (lifetime rates of 50.5% and 54.5%, respectively) complicated the clinical profile. Treatment with medication was suboptimal, with physical health conditions undertreated, a high rate of psychotropic polypharmacy and underutilisation of clozapine in chronic persistent psychotic illness. Only 38.6% received evidence-based psychosocial therapies. In the previous year, 27.4% had changed housing and 12.8% had been homeless, on average for 155 days.

CONCLUSION

Money, social engagement and employment are the most important challenges for people with psychotic illness, as well as good physical and mental health. An integrated approach to recovery is needed to optimise service delivery and augment evidence-based clinical practice with measures to improve physical health and social circumstances. Meeting these challenges has the potential to reduce costs to government and society, as well as promote recovery.