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Wei Y, Peng Y, Li Y, Song L, Ju K, Xi J. Caregivers' burden and schizophrenia patients' quality of life: Sequential mediating effects of expressed emotion and perceived expressed emotion. Front Psychiatry 2022; 13:961691. [PMID: 36090381 PMCID: PMC9454947 DOI: 10.3389/fpsyt.2022.961691] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increasing attention has been paid to the role of caregivers' burden in affecting quality of life (QoL) of schizophrenic patients. However, less is known about potential mediation mechanisms underlying this relationship. The current study aimed to explore the sequential mediating effect of expressed emotion and perceived expressed emotion on the relationship between care burden and QoL among people with schizophrenia. METHODS 135 Chinese families (one patient and one caregiver) participated in this study. Caregivers reported their care burden and expressed emotion, patients reported their perceived expressed emotion and QoL. RESULTS The results of the correlation analysis showed that care burden was negatively related to patients' QoL, including physical, psychological, and social relationships domains, with patients' sex, age, educational level, employment status, and medication-taking as covariates. The sequential mediating effects of criticism and perceived criticism between care burden and QoL were not significant. However, the sequential mediating effects of emotional over-involvement and perceived emotional over-involvement (EOI) between care burden and QoL (including physical and psychological domain) were significant. CONCLUSION The results indicated that reducing the burden and expressed emotion of caregivers could be helpful to improve schizophrenia patients' QoL.
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Affiliation(s)
- Yicheng Wei
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yanan Peng
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yan Li
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Lanjun Song
- Shanghai Changning Mental Health Center, Shanghai, China
| | - Kang Ju
- Shanghai Changning Mental Health Center, Shanghai, China
| | - Juzhe Xi
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
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Nuttall AK, Thakkar KN, Luo X, Mueser KT, Glynn SM, Achtyes ED, Kane JM. Longitudinal associations of family burden and patient quality of life in the context of first-episode schizophrenia in the RAISE-ETP study. Psychiatry Res 2019; 276:60-68. [PMID: 31026764 PMCID: PMC6538431 DOI: 10.1016/j.psychres.2019.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 10/27/2022]
Abstract
The present study examined longitudinal associations between family member perceived burden and clinical correlates to understand potential covariation in change over time in the context of first-episode schizophrenia in the RAISE-ETP study (N = 282). Across 24 months, family burden, patient quality of life, and positive symptoms improved. Findings from the present study suggest covariation in change over time in quality of life and family burden. As patient quality of life improved, family burden decreased. However, initial levels of quality of life were not significantly associated with changes in family burden and vice versa. Initial levels of positive symptoms were significantly associated with initial levels of family burden. These findings have treatment implications by suggesting the potential for interventions aimed at improving quality of life to have a spillover effect on family burden, or alternatively, that reducing perceived family burden may improve patient quality of life.
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Affiliation(s)
- Amy K. Nuttall
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI,Center for Research in Autism, Intellectual and Other Neurodevelopmental Disabilities, Michigan State University, East Lansing, MI, USA,Corresponding Author: Amy K. Nuttall, phone +1 517 884-9443;
| | - Katharine N. Thakkar
- Center for Research in Autism, Intellectual and Other Neurodevelopmental Disabilities, Michigan State University, East Lansing, MI, USA,Department of Psychology, Michigan State University, East Lansing, MI, USA,Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Xiaochen Luo
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Kim T. Mueser
- Center for Psychiatric Rehabilitation and Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston, MA, USA,Departments of Psychological and Brain Sciences and Psychiatry, Boston University, Boston, MA, USA
| | | | - Eric D. Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, USA,Cherry Health, Grand Rapids, MI, USA
| | - John M. Kane
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA,Feinstein Institute for Medical Research, NY, USA,The Zucker Hillside Hospital, Glen Oaks, NY, USA
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3
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La dépression chez les proches de patients souffrant de schizophrénie : effets longitudinaux sur 8 mois du programme ProFamille. Encephale 2018; 44:128-133. [DOI: 10.1016/j.encep.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 11/19/2022]
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Caqueo-Urízar A, Urzúa A, Jamett PR, Irarrazaval M. Objective and subjective burden in relatives of patients with schizophrenia and its influence on care relationships in Chile. Psychiatry Res 2016; 237:361-5. [PMID: 26809366 DOI: 10.1016/j.psychres.2016.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/04/2015] [Accepted: 01/07/2016] [Indexed: 01/28/2023]
Abstract
This study examined the burden on family members of patients with schizophrenia in a Chilean community. Sixty-five caregivers underwent the Subjective and Objective Family Burden Interview. The results showed moderate to high levels of subjective burden and low levels of support from others in providing care. Burden and containment of disturbed behaviour were correlated with worse relationships between patients and caregivers, with the latter spending less time working outside the home. The assessed sample showed a similar pattern of burden to that of caregivers from developed countries; however, the extent of the burden tended to be higher in Chilean caregivers.
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Affiliation(s)
| | - Alfonso Urzúa
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | | | - Matias Irarrazaval
- Departamento de Psiquiatría, Facultad de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile; Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
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Kates WR, Russo N, Wood WM, Antshel KM, Faraone SV, Fremont WP. Neurocognitive and familial moderators of psychiatric risk in velocardiofacial (22q11.2 deletion) syndrome: a longitudinal study. Psychol Med 2015; 45:1629-1639. [PMID: 25394491 DOI: 10.1017/s0033291714002724] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although risk for psychosis in velocardiofacial (22q11.2 deletion) syndrome (VCFS) is well established, the cognitive and familial factors that moderate that risk are poorly understood. METHOD A total of 75 youth with VCFS were assessed at three time points, at 3-year intervals. Time 1 (T1) psychiatric risk was assessed with the Behavior Assessment System for Children (BASC). Data reduction of BASC scores yielded avoidance-anxiety and dysregulation factors. Time 2 (T2) neuropsychological and family function and time 3 (T3) prodromal/overt psychosis were assessed. Poisson regression models tested associations between T3 positive prodromal symptoms/overt psychosis and T1 psychiatric risk, T2 cognitive and familial factors, and their interactions. RESULTS T1 avoidance-anxiety ratings predicted T3 prodromal/overt psychosis. T2 verbal learning scores moderated this association, such that individuals with low avoidance-anxiety scores and stronger verbal learning skills were the least likely to demonstrate prodromal/overt psychosis at T3. Low scores on a T2 visual vigilance task also predicted T3 prodromal/overt psychosis, independently of the effect of T1 avoidance-anxiety scores. T1 dysregulation scores did not predict T3 prodromal/overt psychosis in a linear manner. Instead, the association between dysregulation and prodromal/overt psychosis was amplified by T2 levels of family organization, such that individuals with low dysregulation scores and low family organization scores were the most likely to exhibit T3 prodromal/overt psychosis. CONCLUSIONS Significant moderators of psychiatric risk in VCFS include verbal learning skills as well as levels of family organization, carrying implications for early identification and preventative treatment of youth with VCFS at highest risk for psychosis.
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Affiliation(s)
- W R Kates
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse,NY,USA
| | - N Russo
- Department of Psychology,Syracuse University,Syracuse,NY,USA
| | - W M Wood
- Department of Psychology,Syracuse University,Syracuse,NY,USA
| | - K M Antshel
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse,NY,USA
| | - S V Faraone
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse,NY,USA
| | - W P Fremont
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse,NY,USA
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Mo'tamedi H, Rezaiemaram P, Aguilar-Vafaie ME, Tavallaie A, Azimian M, Shemshadi H. The relationship between family resiliency factors and caregiver-perceived duration of untreated psychosis in persons with first-episode psychosis. Psychiatry Res 2014; 219:497-505. [PMID: 25017617 DOI: 10.1016/j.psychres.2014.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/08/2014] [Accepted: 06/10/2014] [Indexed: 11/16/2022]
Abstract
Although the family has an important role in the early detection and intervention of first-episode psychosis (FEP), there are few findings reporting associations between family strengths and early treatment-seeking experiences. This study aimed to investigate, within the framework of the resiliency model of family stress, adjustment, and adaptation, the association between family coping strategies, resource management factors and duration of untreated psychosis (DUP) in Iranian families with one adult child with FEP. Hundred and seven individuals referred to three medical centers in Tehran and diagnosed with FEP participated in this study. Caregiver-perceived DUP was measured via semi-structured interviews administered to primary caregivers. They also completed two questionnaires regarding family resources of stress management and family coping strategies. Data analysis indicated that the Family Inventory of Resources of Management (FIRM) total scale score did not significantly explain the variance of caregiver-perceived DUP, but one of the FIRM subscales, the Extended Family Social Support, and the Family Crisis-Oriented Personal Evaluation scale (F-COPES) total score and one its subscales, the Acquiring Social Support, explained a significant amount of the variance of caregiver-perceived DUP. The results suggest that higher family resiliency, especially social support, facilitates the family's appropriate adaptive reaction (i.e., treatment-seeking), with the consequent decrease of DUP.
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Affiliation(s)
- Hadi Mo'tamedi
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peyman Rezaiemaram
- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.
| | - Maria E Aguilar-Vafaie
- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Abaas Tavallaie
- Behavioral Sciences Research Center, Baqiyatallah Medical University, Tehran, Iran
| | - Mojtaba Azimian
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hashem Shemshadi
- Department of Clinical Sciences and Speech Reconstructive Surgery, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Genetic liability, prenatal health, stress and family environment: risk factors in the Harvard Adolescent Family High Risk for schizophrenia study. Schizophr Res 2014; 157:142-8. [PMID: 24836971 DOI: 10.1016/j.schres.2014.04.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/06/2014] [Accepted: 04/11/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The familial ("genetic") high-risk (FHR) paradigm enables assessment of individuals at risk for schizophrenia based on a positive family history of schizophrenia in first-degree, biological relatives. This strategy presumes genetic transmission of abnormal traits given high heritability of the illness. It is plausible, however, that adverse environmental factors are also transmitted in these families. Few studies have evaluated both biological and environmental factors within a FHR study of adolescents. METHODS We conceptualize four precursors to psychosis pathogenesis: two biological (genetic predisposition, prenatal health issues (PHIs)) and two environmental (family environment, stressful life events (SLEs)). Participants assessed between 1998 and 2007 (ages 13-25) included 40 (20F/20M) adolescents at FHR for schizophrenia (FHRs) and 55 (31F/24M) community controls. 'Genetic load' indexed number of affected family members relative to pedigree size. RESULTS PHI was significantly greater among FHRs, and family cohesion and expressiveness were less (and family conflict was higher) among FHRs; however, groups did not significantly differ in SLE indices. Among FHRs, genetic liability was significantly associated with PHI and family expressiveness. CONCLUSIONS Prenatal and family environmental disruptions are elevated in families with a first-degree relative with schizophrenia. Findings support our proposed 'polygenic neurodevelopmental diathesis-stress model' whereby psychosis susceptibility (and resilience) involves the independent and synergistic confluence of (temporally-sensitive) biological and environmental factors across development. Recognition of biological and social environmental influences across critical developmental periods points to key issues relevant for enhanced identification of psychosis susceptibility, facilitation of more precise models of illness risk, and development of novel prevention strategies.
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Gaebel W, Riesbeck M. Are there clinically useful predictors and early warning signs for pending relapse? Schizophr Res 2014; 152:469-77. [PMID: 23978776 DOI: 10.1016/j.schres.2013.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/18/2013] [Accepted: 08/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Despite the availability of effective long-term treatment strategies in schizophrenia, relapse is still common. Relapse prevention is one of the major treatment objectives, because relapse represents burden and costs for patients, their environment, and society and seems to increase illness progression at the biological level. Valid predictors for relapse are urgently needed to enable more individualized recommendations and treatment decisions to be made. METHODS Mainly recent evidence regarding predictors and early warning signs of relapse in schizophrenia was reviewed. In addition, data from the first-episode (long-term) study (FES; Gaebel et al., 2007, 2011) performed within the German Research Network on Schizophrenia were analyzed. RESULTS On the basis of FES data, premorbid adjustment, residual symptoms and some side effects are significant predictors. Although a broad spectrum of potential parameters has been investigated in several other studies, only a few and rather general valid predictors were identified consistently. Data of the FES also indicated that predictive power could be enhanced by considering interacting conjunctions, as suggested by the Vulnerability-Stress-Coping model. Prospective studies, however, are rare. In addition, prodromal symptoms as course-related characteristics likewise investigated in the FES add substantially to early recognition of relapse and may serve as early warning signs, but prognosis nevertheless remains a challenge. CONCLUSIONS Comprehensive and well-designed studies are needed to identify and confirm valid predictors for relapse in schizophrenia. In this respect, broadly accepted and specifically defined criteria for relapse would greatly facilitate comparison of results across studies.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany.
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
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Pertile R, Donisi V, Grigoletti L, Angelozzi A, Zamengo G, Zulian G, Amaddeo F. DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience. Soc Psychiatry Psychiatr Epidemiol 2011; 46:651-60. [PMID: 20473480 DOI: 10.1007/s00127-010-0231-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 04/26/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to identify services-related and area-based measures together with socio-demographic factors that could improve diagnosis-related groups in explaining length of stay variability in general hospital psychiatric units in Veneto Region (North East of Italy). METHODS Data were collected from the regional hospital discharge records database. A hierarchical multiple regression model with only diagnosis-related groups as predictors of actual and ln-transformed length of stay was compared with a second model in which patient-, service- and area-level variables were included. Local health district was used as group-level in the hierarchical multiple regression analysis. RESULTS The only diagnosis explains 6.4% of actual length of stay total variance (14.8% for ln-transformation). In the second model length of stay resulted related also to gender, age, severity of hospitalization, patient's local health district, number of psychiatrists, psychologists, hospital attendants/nurses, social workers and educators in the general hospital psychiatric units, number of outpatients in each local health district and percentages of divorced and single people, with almost a 2% point increase on actual length of stay in explained variance (5% point increase for ln-transformation). CONCLUSIONS For the first time the hospital discharge card regional survey of all public acute inpatient psychiatric facilities in Veneto Region were used. The innovative aspect of this study was the attempt to investigate the relationship between length of stay and other indexes, characterizing not only the inpatient facilities, but also the resident population structure in each area. The information about factors that influence length of stay can be useful to inform service planning and resource allocation.
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Affiliation(s)
- Riccardo Pertile
- Section of Psychiatry and Clinical Psychology, Department of Public Health and Community Medicine, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
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Murphy BP. Beyond the first episode: candidate factors for a risk prediction model of schizophrenia. Int Rev Psychiatry 2010; 22:202-23. [PMID: 20504060 DOI: 10.3109/09540261003661833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Many early psychosis services are financially compromised and cannot offer a full tenure of care to all patients. To maintain viability of services it is important that those with schizophrenia are identified early to maximize long-term outcomes, as are those with better prognoses who can be discharged early. The duration of untreated psychosis remains the mainstay in determining those who will benefit from extended care, yet its ability to inform on prognosis is modest in both the short and medium term. There are a number of known or putative genetic and environmental risk factors that have the potential to improve prognostication, though a multivariate risk prediction model combining them with clinical characteristics has yet to be developed. Candidate risk factors for such a model are presented, with an emphasis on environmental risk factors. More work is needed to corroborate many putative factors and to determine which of the established factors are salient and which are merely proxy measures. Future research should help clarify how gene-environment and environment-environment interactions occur and whether risk factors are dose-dependent, or if they act additively or synergistically, or are redundant in the presence (or absence) of other factors.
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Affiliation(s)
- Brendan P Murphy
- Recovery and Prevention of Psychosis Service, Southern Health, Melbourne, Victoria, Australia.
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Abstract
The aim of this paper is to help physicians deliver the diagnosis of schizophrenia by adopting and adapting the popular oncology protocol, SPIKES. Data sources for the paper are PubMed searches (1984-2009), entering the phrase "breaking bad news." Of the 269 articles retrieved, those with face relevance to schizophrenia were selected and references contained in them were further searched. The conclusion of the paper is that, as in oncology, revealing a serious psychiatric diagnosis is emotionally difficult for both physician and patient; guidelines help, but individualization is essential.
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