1
|
Rodell S, Parry S. Family members' experiences of seeking help for a young person with symptoms associated with the psychosis spectrum: A narrative review and synthesis. Clin Child Psychol Psychiatry 2024; 29:897-912. [PMID: 37188330 PMCID: PMC11188561 DOI: 10.1177/13591045231176701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Young people often rely on family carers to access support for their mental health. However, stigma can be a barrier to help seeking for young people and families. Little research has been undertaken with young people who experience highly stigmatised symptoms, such as psychosis spectrum symptoms, and even less research has been conducted with parents and carers, meaning barriers to help go unchallenged. Therefore, this narrative review aimed to explore stories of family experiences of seeking help for young people with symptoms associated with the psychosis spectrum. Sources searched were PsycINFO and PubMed. Reference lists of the selected papers were also cross-checked to ensure the search had not missed potential papers for inclusion. Searches returned 139 results, of which 12 were identified for inclusion. A narrative analytic approach was adopted to synthesise qualitative findings to provide a nuanced interpretation of help-seeking experiences. The narrative synthesis provided an opportunity to identify differences, similarities, and patterns across the studies to tell a cumulative emancipatory narrative of family experiences of seeking help for psychosis spectrum symptoms. Help-seeking experiences had a relational impact on families, with stress adding to conflict and anxieties inhibiting hopefulness, although families could emerge stronger and assertively with compassionate support.
Collapse
Affiliation(s)
- Sadie Rodell
- Doctorate of Clinical Psychology, Lancaster University, Lancaster, United Kingdom
| | - Sarah Parry
- Division of Health Research, Lancaster University, Lancaster, LA1 4YW, United Kingdom
| |
Collapse
|
2
|
Norheim I, Pedersen R, Selle ML, Røssberg JI, Hestmark L, Heiervang KS, Ruud T, Åsholt VM, Hansson KM, Møller P, Fosse R, Romøren M. Implementation of guidelines on Family Involvement for persons with Psychotic disorders: a pragmatic cluster randomized trial. Effect on relatives' outcomes and family interventions received. Front Psychiatry 2024; 15:1381007. [PMID: 38855639 PMCID: PMC11157113 DOI: 10.3389/fpsyt.2024.1381007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/01/2024] [Indexed: 06/11/2024] Open
Abstract
Background Family interventions (FI) are recommended as part of the treatment for psychotic disorders, but the implementation in mental health services is generally poor. Recently, The Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, demonstrated significant improvements in implementation outcomes at cluster-level. This sub-study aims to examine the effectiveness of the IFIP intervention on relatives' outcomes and received FI. Methods A cluster randomized controlled trial, was conducted in 15 Norwegian Community Mental Health Center (CMHC) units that were randomized to either the IFIP intervention, including implementation interventions and clinical interventions, or treatment as usual (TAU). The clinical interventions consisted of FI: basic family involvement and support (BFIS) to all patients and family psychoeducation (FPE) to as many as possible. Patients with psychotic disorders and their closest relative were invited to fill in questionnaires at inclusion and 6 months and 12 months follow-up. Received FI was reported by both relatives and clinicians. The relatives' primary outcome was satisfaction with health service support, measured by the Carer well-being and support questionnaire part B (CWS-B). The relatives' secondary outcomes were caregiver experiences, expressed emotions and quality of life. Patients' outcomes will be reported elsewhere. Results In total 231 patient/relative pairs from the CMHC units were included (135 intervention; 96 control).The relatives in the intervention arm received an increased level of BFIS (p=.007) and FPE (p < 0.05) compared to the relatives in the control arm, including involvement in crisis planning. The primary outcome for relatives' satisfaction with health service support, showed a non-significant improvement (Cohen's d = 0.22, p = 0.08). Relatives experienced a significant reduced level of patient dependency (Cohen's d = -0.23, p = 0.03). Conclusion The increased support from clinicians throughout FI reduced the relatives' perceived level of patient dependency, and may have relieved the experience of responsibility and caregiver burden. The COVID-19 pandemic and the complex and pioneering study design have weakened the effectiveness of the IFIP intervention, underscoring possible potentials for further improvement in relatives' outcomes. Clinical Trial Registration ClinicalTrials.gov, identifier NCT03869177.
Collapse
Affiliation(s)
- Irene Norheim
- Department of Mental Health Research and Development, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Maria Lie Selle
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Jan Ivar Røssberg
- Section for Treatment Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Hestmark
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Torleif Ruud
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Vilde Maria Åsholt
- Department of Mental Health Research and Development, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Paul Møller
- Department of Mental Health Research and Development, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Roar Fosse
- Department of Mental Health Research and Development, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Maria Romøren
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
3
|
Powell T, Glozier N, Conn K, Einboden R, Buus N, Caldwell P, Milton A. The impact of early intervention psychosis services on hospitalisation experiences: a qualitative study with young people and their carers. BMC Psychiatry 2024; 24:350. [PMID: 38730333 PMCID: PMC11088060 DOI: 10.1186/s12888-024-05758-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND While a core aim of early intervention psychosis services (EIPS) is to prevent hospitalisation, many with a first episode of psychosis (FEP) will require inpatient care. We explored young people's (YP) and their carers' hospitalisation experiences prior to and during EIPS engagement and how factors across these services influenced these experiences. METHODS Using purposive sampling, we recruited twenty-seven YP, all of whom had been involved with the hospital system at some stage, and twelve support persons (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration with secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician, and academic researchers) used an inductive thematic analysis process. RESULTS Four key themes were identified as influential in shaping participant's hospital experiences and provide ideas for an approach to care that is improved by the effective coordination of that care, and includes this care being delivered in a trauma informed manner: (1) A two-way street: EIPS affected how participants experienced hospitalisation, and vice versa; (2) It's about people: the quality and continuity of relationships participants had with staff, in hospital and at their EIPS, was central to their experience; (3) A gradual feeling of agency: participants viewed EIPS as both reducing involuntary care and supporting their self-management; and (4) Care coordination as navigation for the healthcare system: great when it works; frustrating when it breaks down. CONCLUSIONS Hospitalisation was viewed as a stressful and frequently traumatic event, but a approach to care founded on trust, transparency, and collaboration that is trauma-informed ameliorated this negative experience. Consistent EIPS care coordination was reported as essential in assisting YP and carers navigate the hospital system; conversely, discontinuity in EIPS staff and lack of integration of EIPS with hospital care undermined the positive impact of the EIPS care coordinator during hospitalisation. Care coordinator involvement as a facilitator, information provider, and collaborator in inpatient treatment decisions may improve the usefulness and meaningfulness of hospital interventions.
Collapse
Affiliation(s)
- Tacita Powell
- Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Nicholas Glozier
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- The University of Sydney and Australian Research Council (ARC) Centre of Excellence for, Camperdown, Australia
| | - Katrina Conn
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- Department of Education, NSW, Sydney, Australia
| | - Rochelle Einboden
- School of Nursing, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario (CHEO) & CHEO Research Institute, Ottawa, Canada
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- School of Nursing, Western Sydney University, Camperdown, Australia
| | - Niels Buus
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Patrick Caldwell
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Alyssa Milton
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
- The University of Sydney and Australian Research Council (ARC) Centre of Excellence for, Camperdown, Australia.
| |
Collapse
|
4
|
Karambelas GJ, Byrne LK, Allott KA, Jayasinghe A, Watson AE, Hasty M, Macneil C, Filia K, Cotton SM. Early Maladaptive Schemas and Depression in Caregivers of Individuals With Schizophrenia Spectrum and Bipolar Disorders. Clin Psychol Psychother 2024; 31:e3000. [PMID: 38890794 DOI: 10.1002/cpp.3000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 03/10/2024] [Accepted: 04/26/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Early maladaptive schemas represent unhelpful frameworks of cognitions, emotions and subsequent behavioural responses and can be associated with depressive symptoms. Caregivers of individuals with serious mental illness (SMI) frequently report experiencing depressive symptoms. It is unclear whether depressive symptoms in caregivers are influenced by schemas. We aimed to compare activated schemas in caregivers of people with schizophrenia spectrum (SSD) and bipolar disorder (BD) diagnoses and to determine whether they were differentially related to depressive symptoms. DESIGN AND METHODS Caregivers completed validated measures of depression and schemas. Independent samples t-tests and multivariate generalised linear models were used to assess differences in schemas and depressive symptoms between caregiver groups. Interrelationships between schema domains and caregiver depressive symptoms were delineated using correlational analyses and forward stepwise regressions. RESULTS One hundred eight caregivers participated in the study (SSD n = 68, BD n = 40). No differences in depressive symptom severity or activated schemas were observed between caregiver groups. All schemas were significantly associated with depressive symptoms, and the Disconnection-Rejection schema domain explained the most variance in depressive symptoms in both caregiver groups. CONCLUSIONS Schemas contribute to the severity of caregiver depression regardless of whether the person receiving care is diagnosed with SSD or BD. Schema therapeutic frameworks may be beneficial for use with caregivers to address schemas within the Disconnection-Rejection domain and alleviate depressive symptoms by reducing experiences of social isolation and alienation.
Collapse
Affiliation(s)
- George J Karambelas
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Linda K Byrne
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Kelly A Allott
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Anuradhi Jayasinghe
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | | | | | | | - Kate Filia
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sue M Cotton
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
5
|
Jolley S, Grice S. State of the art in psychological therapies for psychosis: Family interventions for psychosis. Psychol Psychother 2024; 97:19-33. [PMID: 37515432 DOI: 10.1111/papt.12487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE It is a half-century since the coalescence of social psychiatry and systemic family therapy approaches started to inform condition-specific therapeutic work with families to reduce relapse and hospital readmission for people with schizophrenia. Today, family interventions are a cornerstone of international guidelines for the treatment of psychosis, and of workforce development initiatives. Effect sizes for clinical and economic outcomes are large, and the evidence base is robust and reliable, not only for outcomes but also for the underpinning theoretical models, which are coherent and consistent. Few, if any, psychological therapies, have so powerful a framework to drive widespread implementation. Nevertheless, delivery in clinical services is variable, often lagging behind that of individual cognitive behavioural therapy, notwithstanding its considerably weaker implementation framework. Our aim in this article is to formulate this translation failure and offer potential solutions. METHOD We summarise the model/intervention and supporting evidence, then consider why delivery remains problematic. RESULTS We highlight the inter-linked issues of conceptual confusion between and conflation of, different approaches to working with families; of addressing diagnostic uncertainty, complex comorbidity and adapting interventions for specific populations; and of translation from gold-standard research trial practice, through educational curricula and training programmes, to routine delivery in frontline services. CONCLUSION We present our view of clinical, research and workforce development priorities to address these issues and continue the collective effort, moving into the next half-century, to work more effectively with people with psychosis and their families, to further improve outcomes.
Collapse
Affiliation(s)
- Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK
| | - Sarah Grice
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Vaswani-Bye A, McCain C, Blank JM, Tennison ME, Kopelovich SL. A Thematic Analysis Investigating the Inaugural Psychosis REACH Family Ambassador Peer Training Program. Neuropsychiatr Dis Treat 2024; 20:233-245. [PMID: 38348058 PMCID: PMC10860596 DOI: 10.2147/ndt.s432255] [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: 07/25/2023] [Accepted: 12/15/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose Caregivers of loved ones with psychosis are tasked with navigating a barren care landscape for their loved ones and for themselves. The dearth of resources they face has a negative impact on outcomes for caregivers and their loved ones. The Psychosis REACH program, based on principles from Cognitive Behavioral Therapy for psychosis was developed as a community-based resource for families to address this care gap. A role for family peers called the Psychosis REACH Family Ambassadors (pRFAs) was developed to reinforce skill learning for caregivers by utilizing a task-sharing approach. This qualitative study sought to better understand pRFAs' experiences in the inaugural training cohort of this program. Patients and Methods Eleven pRFAs participated in semi-structured interviews with research coordinators via teleconference. Questions assessed the quality of the training, challenges and facilitators experienced in their role, and ways in which the program could be improved and expanded. Using thematic analysis, members of the research team coded interviews individually, discussed codes until consensus was reached, and iteratively developed themes based on codes that clustered based on meaning or content. Results This process identified 5 key themes: The development of hope and recovery, the development of solidarity networks, the challenges of navigating boundaries, preferred pedagogical strategies, and the need for more support. Conclusion Overall, the themes developed from this qualitative analysis demonstrate the value and feasibility of developing a caregiver peer network of pRFAs trained in recovery-oriented care and CBTp-informed skills to support other caregivers. Additionally, they highlight the challenges associated with being in the role of a pRFA and further efforts needed to align training content and learning management systems to the needs of pRFA trainees. These findings highlight the importance of expanding access to family peer training programs for the wellbeing of caregivers and loved ones with psychosis alike.
Collapse
Affiliation(s)
- Akansha Vaswani-Bye
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Chris McCain
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer M Blank
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Mackenzie E Tennison
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
7
|
Oikonomou V, Gkintoni E, Halkiopoulos C, Karademas EC. Quality of Life and Incidence of Clinical Signs and Symptoms among Caregivers of Persons with Mental Disorders: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:269. [PMID: 38275549 PMCID: PMC10815690 DOI: 10.3390/healthcare12020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Caring for individuals with mental disorders poses significant challenges for caregivers, often leading to compromised quality of life and mental health issues such as stress, anxiety, and depression. This study aims to assess the extent of these challenges among caregivers in Greece, identifying which demographic factors influence their well-being. METHOD A total of 157 caregivers were surveyed using the SF-12 Health Survey for quality-of-life assessment and the DASS-21 questionnaire for evaluating stress, anxiety, and depression symptoms. t-tests, Kruskal-Wallis tests, Pearson's correlation coefficients, and regression analyses were applied to understand the associations between demographics, quality of life, and mental health outcomes. RESULTS The study found that caregivers, especially women and younger individuals, faced high levels of mental health challenges. Marital status, educational level, and employment status also significantly influenced caregivers' well-being. Depression was the most significant factor negatively correlating with the mental component of quality of life. The magnitude of the burden experienced by caregivers highlighted the urgency for targeted social and financial support, as well as strategic treatment programs that consider caregiver well-being. CONCLUSIONS Caregivers of individuals with mental disorders endure significant stress, anxiety, and depression, influencing their quality of life. Demographic factors such as age, gender, marital status, education, and employment status have notable impacts. Findings emphasize the need for society-wide recognition of caregivers' roles and the creation of comprehensive support and intervention programs to alleviate their burden, particularly in the context of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Vasiliki Oikonomou
- School of Social Sciences, Hellenic Open University, 26335 Patras, Greece; (V.O.); (E.C.K.)
| | - Evgenia Gkintoni
- Department of Psychiatry, University General Hospital of Patras, 26504 Patras, Greece
| | | | - Evangelos C. Karademas
- School of Social Sciences, Hellenic Open University, 26335 Patras, Greece; (V.O.); (E.C.K.)
- Department of Psychology, University of Crete, 74100 Rethymnon, Greece
| |
Collapse
|
8
|
Rus-Calafell M, Teismann T, Kullmann F, Alatas D, Ballero-Reque C, Holewa J, Rüsberg M, Brüne M, Paino M, Schneider S. Internet-based psychoeducation and support programme for relatives of young people with early psychosis: results of the first German-language intervention. Front Psychiatry 2024; 15:1248526. [PMID: 38292904 PMCID: PMC10824940 DOI: 10.3389/fpsyt.2024.1248526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Background International clinical guidelines recommend Family Interventions (FIs) especially for families of people at early stages of psychosis. The German S3 treatment guideline for schizophrenia gives FIs the highest level of clinical recommendation. However, some family relatives have limited access to these services due to health system constrains. Digital interventions have emerged as a solution to overcome this hindered access to evidence-based family interventions. Objective The present pilot study evaluates the feasibility and potential efficacy of the first German moderated online psychoeducation and support programme (ePSP) for relatives of people with early psychosis, with the additional purpose to improve accessibility and reduce waiting times. Methods A pre-post study was performed. A brief recruitment period was pre-established (10 weeks) to test potential improvement of regular therapy waiting times in Germany. A total of 25 relatives of people with early psychosis were recruited and received the 12-week moderated online intervention. Assessments were conducted at baseline and at post intervention. Acceptance of the intervention and the user's experience were also evaluated at post intervention. Results Recruitment, retention rates and qualitative data support the feasibility and acceptability of the ePSP. Significant positive effects of the interventions were found on key therapeutic targets, including both primary outcomes (i.e., perceived stress and beliefs about the illness). Twenty-one participants also completed the open-ended questions of the user experience questionnaire, which yielded three main themes: most important modules, difficulties in using the programme and ways to improve ePSP. Discussion These results provide preliminary efficacy estimates for a fully powered RCT to investigate superiority (or equipoise) effects of the ePSP in comparison to the routine face-to-face family therapy groups. This future RCT will also allow further exploration of ePSP to improve access to psychological therapy for relatives of young people with psychosis, also in relation to the new ground-breaking Digital Healthcare Act in Germany.
Collapse
Affiliation(s)
- Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- German Center of Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- German Center of Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Germany
| | - Fine Kullmann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Dilara Alatas
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Cristina Ballero-Reque
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Julia Holewa
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Marilena Rüsberg
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Martin Brüne
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University Bochum, Bochum, Germany
| | - Mercedes Paino
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- German Center of Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Germany
| |
Collapse
|
9
|
Buck B, Wingerson M, Whiting E, Snyder J, Monroe-DeVita M, Ben-Zeev D. User-Centered Development of Bolster, an mHealth Intervention for Early Psychosis Caregivers: Needs Assessment, Prototyping, and Field Trial. JMIR Ment Health 2023; 10:e50522. [PMID: 38032692 PMCID: PMC10722359 DOI: 10.2196/50522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/09/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Caregivers play a critical role in the treatment and recovery of youth and young adults at risk for psychosis. Caregivers often report feeling isolated, overwhelmed, and lacking in resources. Mobile health (mHealth) has the potential to provide scalable, accessible, and in-the-moment support to caregivers. To date, few if any mHealth resources have been developed specifically for this population. OBJECTIVE The aim of this study was to conduct user-centered design and testing of an mHealth intervention to support early psychosis caregivers. METHODS We conducted a multiphase user-centered development process to develop the Bolster mobile app. In phase 1, a total of 21 caregivers were recruited to participate in a qualitative needs assessment and respond to an initial prototype of the Bolster platform. Content analysis was used to identify key needs and design objectives, which guided the development of the Bolster mobile app. In phase 2, a total of 11 caregivers were recruited to participate in a 1-week field trial wherein they provided qualitative and quantitative feedback regarding the usability and acceptability of Bolster; in addition, they provided baseline and posttest assessments of the measures of distress, illness appraisals, and family communication. RESULTS In phase 1, participants identified psychoeducation, communication coaching, a guide to seeking services, and support for coping as areas to address. Live prototype interaction sessions led to multiple design objectives, including ensuring that messages from the platform were actionable and tailored to the caregiver experience, delivering messages in multiple modalities (eg, video and text), and eliminating a messaging-style interface. These conclusions were used to develop the final version of Bolster tested in the field trial. In phase 2, of the 11 caregivers, 10 (91%) reported that they would use Bolster if they had access to it and would recommend it to another caregiver. They also reported marked changes in their appraisals of illness (Cohen d=0.55-0.68), distress (Cohen d=1.77), and expressed emotion (Cohen d=0.52). CONCLUSIONS To our knowledge, this study is the first to design an mHealth intervention specifically for early psychosis caregivers. Preliminary data suggest that Bolster is usable, acceptable, and promising to improve key targets and outcomes. A future fully powered clinical trial will help determine whether mHealth can reduce caregiver burdens and increase engagement in services among individuals affected by psychosis.
Collapse
Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Mary Wingerson
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Erica Whiting
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jaime Snyder
- Information School, University of Washington, Seattle, WA, United States
| | - Maria Monroe-DeVita
- Supporting Psychosis Innovation through Research Implementation and Training (SPIRIT) Lab, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| |
Collapse
|
10
|
Koutra K, Mavroeides G, Basta M, Vgontzas AN. Family Functioning, Illness-Related Self-Regulation Processes, and Clinical Outcomes in Major Depression: A Prospective Study in Greece. Healthcare (Basel) 2023; 11:2938. [PMID: 37998430 PMCID: PMC10671578 DOI: 10.3390/healthcare11222938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Major depressive disorder (MDD) is a common, seriously impairing, and often recurrent mental disorder. Based on the predictions of the Circumplex Model of Marital and Family Systems and the Common-Sense Self-Regulation Model, the aim of the present prospective study is to examine the predictive value of clinical outcomes of a process model in which associations between perceived family functioning and patient's clinical outcomes (i.e., symptom severity and suicide risk) are mediated by illness representations and coping strategies. A total of 113 patients with a clinical diagnosis of MDD (16.8% males and 83.2% females) aged 47.25 ± 13.98 years and recruited from the outpatient department and the mobile mental health unit of the Psychiatric Clinic of the University Hospital of Heraklion in Crete, Greece, and from a Greek online depression peer-support group participated in the study. Family functioning was assessed in terms of cohesion and flexibility (Family Adaptability and Cohesion Evaluation Scales IV) at baseline. Illness representations (Illness Perception Questionnaire-Mental Health) and coping strategies (Brief Cope Orientation to Problems Experienced) were measured about five months later (5.04 ± 1.16 months). Symptom severity (Beck Depression Inventory) and suicidality (Risk Assessment Suicidality Scale) were measured about 10 months after the baseline assessment (9.56 ± 2.52 months). The results indicated that representations about MDD impact and symptom severity serially mediated the association between family cohesion and suicide risk in MDD. Furthermore, family cohesion was found to be linked with maladaptive coping through MDD impact representations. Family-based psychotherapeutic interventions specifically designed to target unhealthy family functioning, along with negative illness perceptions and dysfunctional coping, could be further developed and explored as adjunctive therapy to standard treatment in MDD.
Collapse
Affiliation(s)
- Katerina Koutra
- Department of Psychology, School of Social Sciences, University of Crete, 74100 Rethymnon, Crete, Greece;
| | - Georgios Mavroeides
- Department of Psychology, School of Social Sciences, University of Crete, 74100 Rethymnon, Crete, Greece;
| | - Maria Basta
- Department of Psychiatry & Behavioral Sciences, Faculty of Medicine, University of Crete, 71003 Heraklion, Crete, Greece;
| | - Alexandros N. Vgontzas
- Mobile Mental Health Unit, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Crete, Greece;
- Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, USA
| |
Collapse
|
11
|
Rey R, de Martène B, Baltazar M, Geoffray MM, d'Amato T, Demily C, Bohec AL. A 1-Day Training Course to Disseminate the BREF Psychoeducational Program to Caregivers and Promote Network Establishment between Psychiatry Departments and Family Associations. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:496-503. [PMID: 35474183 PMCID: PMC10602940 DOI: 10.1007/s40596-022-01632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Although international guidelines state that psychoeducation to caregivers should be provided systematically, it remains insufficiently available in psychiatry. This study reports the development and evaluation of an original training course aimed to provide participants with the knowledge and skills to implement "BREF," a psychoeducational program for caregivers. METHODS The BREF program training course, a free, 1-day course incorporating peer role-play was developed. In addition to psychiatrists, nurses, and psychologists, caregivers were involved as preceptors. Participants were mental health professionals and volunteer caregivers. Participants to the first 28 sessions of the course (n=467) completed a post-course questionnaire (n=341) and a cross-sectional questionnaire (n=56). Quantitative data on satisfaction, learning, and behavior changes following the course were collected equating to levels 1, 2, and 3 of Kirkpatrick's model. RESULTS After the course, high levels of satisfaction and commitment were observed with 100% of responders recommending the course and 81% intending to implement the BREF program. Confidence mean score to implement BREF was 7.9/10 (±1.4) with no significant effect of course session. At cross-sectional evaluation, 73% of responders reported improvements in skills related to providing psychoeducation to caregivers, 64% stated that the BREF program was implemented/under implementation, and 66% stated that their department had connected with a family association. CONCLUSIONS Training course sessions alone can increase psychoeducational programs for caregivers and network establishment. The BREF program training course demonstrates a high level of participant satisfaction and is a promising method to disseminate psychoeducation to caregivers, thus addressing a major shortage in mental health organization.
Collapse
Affiliation(s)
- Romain Rey
- University Claude Bernard Lyon 1, Lyon, France.
| | | | | | | | | | | | | |
Collapse
|
12
|
Silaule O, Adams F, Nkosi NG. Strategies for Alleviating the Burden Experienced by Informal Caregivers of Persons With Severe Mental Disorders in Transitional Countries: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e44268. [PMID: 37486756 PMCID: PMC10407773 DOI: 10.2196/44268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Caregiver burden is highly prevalent among the informal caregivers of persons with severe mental disorders (SMDs). As such, strategies to support informal caregivers are necessary to enable them to cope with their caregiving role. Currently, there is limited evidence on the extent of existing strategies for supporting informal caregivers of persons with SMDs in transitional countries. OBJECTIVE This study presents a scoping review protocol to identify and describe the extent and type of evidence on the existing strategies for alleviating caregiver burden among informal caregivers of persons with SMDs in transitional countries. METHODS This scoping review will be conducted using the Joanna Briggs Institute's methodology for scoping reviews. The participants, concept, and context framework will be used to select relevant studies. This review will include studies on strategies for addressing caregiver burden among informal caregivers, with a specific focus on studies outlining caregiver interventions, caregiver support, and policies with strategies for supporting informal caregivers of persons with SMDs. Relevant studies conducted in transitional countries will be considered for inclusion. There will be no restrictions on publication type or design. Published literature will be accessed by searching electronic databases, including PubMed, MEDLINE, CINAHL, and PsycINFO; ProQuest will be used to access gray literature. Additionally, the reference lists of key studies will be reviewed to identify studies for inclusion. The search will be restricted to articles published between 2011 and 2021. Two reviewers will work independently to screen all abstracts and full texts for inclusion in line with the set inclusion criteria. Extracted data will be categorized and described using descriptive qualitative content analysis. RESULTS This protocol will guide a scoping review to identify and describe the extent and type of evidence on the existing strategies for alleviating caregiver burden among informal caregivers of persons with SMDs in transitional countries. The main results of this scoping review will synthesize evidence from peer-reviewed and gray literature sources outlining various services and interventions for supporting informal caregivers of people with SMDs in transitional countries. In addition, existing gaps in the literature will be identified to inform future studies. CONCLUSIONS The increase in caregiver burden among informal caregivers in mental health warrants the development and implementation of strategies for alleviating the burden. This scoping review aims to increase awareness on the various services and intervention strategies for alleviating burden among informal caregivers in transitional countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/44268.
Collapse
Affiliation(s)
- Olindah Silaule
- Department of Occupational Therapy, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Fasloen Adams
- Department of Occupational Therapy, Stellenbosch University, Tygerberg, South Africa
| | - Nokuthula Gloria Nkosi
- Department of Nursing Education, University of the Witwatersrand, Parktown, South Africa
| |
Collapse
|
13
|
Cowan HR, Lundin NB, Moe AM, Breitborde NJK. Discrepancies between self and caregiver perceptions of agency in first-episode psychosis. J Psychiatr Res 2023; 162:220-227. [PMID: 37201222 PMCID: PMC10225345 DOI: 10.1016/j.jpsychires.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
Personal agency-a key element of recovery from psychotic disorders-is formed and maintained in large part through interactions with others. Interactions with caregivers are particularly important in first-episode psychosis (FEP), as these interactions form the foundations for lifelong caregiving relationships. The present study examined shared understandings of agency (operationalized as efficacy to manage symptoms and social behaviors) within families affected by FEP. Individuals with FEP (n = 46) completed the Self-Efficacy Scale for Schizophrenia (SESS) and measures of symptom severity, social functioning, social quality of life, stigma, and discrimination. Caregivers (n = 42) completed a caregiver version of the SESS assessing perceptions of their affected relative's self-efficacy. Self-rated efficacy was higher than caregiver-rated efficacy in all domains (positive symptoms, negative symptoms, and social behavior). Self- and caregiver-rated efficacy correlated only in the social behavior domain. Self-rated efficacy was most associated with lower depression and stigmatization, whereas caregiver-rated efficacy was most associated with better social functioning. Psychotic symptoms did not relate to self- or caregiver-rated efficacy. Individuals with FEP and caregivers have discrepant perceptions of personal agency, perhaps because they base perceptions of agency on different sources of information. These findings highlight specific targets for psychoeducation, social skills training, and assertiveness training to develop shared understandings of agency and facilitate functional recovery.
Collapse
Affiliation(s)
- Henry R Cowan
- Psychiatry and Behavioral Health, The Ohio State University, USA.
| | - Nancy B Lundin
- Psychiatry and Behavioral Health, The Ohio State University, USA
| | - Aubrey M Moe
- Psychiatry and Behavioral Health, The Ohio State University, USA; Psychology, The Ohio State University, USA
| | - Nicholas J K Breitborde
- Psychiatry and Behavioral Health, The Ohio State University, USA; Psychology, The Ohio State University, USA
| |
Collapse
|
14
|
Gleeson JFM, Koval P, Zyphur M, Lederman R, Herrman H, Eleftheriadis D, Bendall S, Cotton SM, Gorelik A, Alvarez-Jimenez M. A randomized controlled trial of moderated online social therapy for family carers of first-episode psychosis patients in a specialist treatment setting. Schizophr Res 2023; 255:203-212. [PMID: 37004332 DOI: 10.1016/j.schres.2023.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/26/2023] [Accepted: 03/11/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Family members, who provide the majority of informal care during the recovery period from first-episode psychosis (FEP), experience high levels of psychological distress. However, there is a lack of effective and accessible interventions for FEP carers. OBJECTIVE To determine the effectiveness of an online intervention ("Altitudes") in relation to the primary outcome of FEP-carer stress at 6 months follow-up. METHODS We conducted a cluster randomized controlled trial in which FEP carers were randomized to Altitudes combined with specialized treatment as usual (STAU) or STAU alone. In addition to questionnaires, we included multiple waves of intensive ecological momentary assessment (EMA) to measure carer stress and family outcomes in 164 carers of young (15-27 years) FEP patients. RESULTS Both groups improved over time on stress and a range of secondary outcomes, including mental health symptoms, self-efficacy, and expressed emotion with no group by time interactions. At 12 months there were significantly fewer visits to emergency departments by FEP patients in the Altitudes group (p = 0.022). Modelling of multiple EMA waves revealed that more time spent by carers with FEP patients predicted greater worry, expressed emotion, and adaptive coping. CONCLUSIONS Engagement and usability findings for Altitudes were positive. Further refinements to our online carer interventions may be needed to engage carers in purposeful skill development for improved management of stress and communication with the young person compared with existing specialist family interventions. TRIAL REGISTRATION ACTRN12616000968471.
Collapse
Affiliation(s)
- John F M Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Level 5, Daniel Mannix Building, Young Street, Fitzroy, VIC 3065, Australia.
| | - Peter Koval
- Melbourne School of Psychological Science, The University of Melbourne, Australia
| | - Michael Zyphur
- School of Business, Faculty of Business, Economics and Law, The University of Queensland, St Lucia, QLD, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Herrman
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Dina Eleftheriadis
- School of Behavioural and Health Sciences, Australian Catholic University, Level 5, Daniel Mannix Building, Young Street, Fitzroy, VIC 3065, Australia
| | - Sarah Bendall
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Alexandra Gorelik
- Musculoskeletal Health and Sustainable Healthcare Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Estradé A, Onwumere J, Venables J, Gilardi L, Cabrera A, Rico J, Hoque A, Otaiku J, Hunter N, Kéri P, Kpodo L, Sunkel C, Bao J, Shiers D, Bonoldi I, Kuipers E, Fusar-Poli P. The Lived Experiences of Family Members and Carers of People with Psychosis: A Bottom-Up Review Co-Written by Experts by Experience and Academics. Psychopathology 2023; 56:371-382. [PMID: 36689938 PMCID: PMC10568611 DOI: 10.1159/000528513] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/20/2022] [Indexed: 01/24/2023]
Abstract
Informal caregivers of individuals affected by psychotic disorder can play a key role in the recovery process. However, little research has been conducted on the lived experiences of carers and family members. We conducted a bottom-up (from lived experience to theory) review of first-person accounts, co-written between academics and experts by experience, to identify key experiential themes. First-person accounts of carers, relatives, and individuals with psychosis were screened and discussed in collaborative workshops involving individuals with lived experiences of psychosis, family members, and carers, representing various organizations. The lived experiences of family members and carers were characterized by experiential themes related to dealing with the unexpected news, the search for a reason behind the disorder, living with difficult and negative emotions, dealing with loss, feeling lost in fragmented healthcare systems, feeling invisible and wanting to be active partners in care, struggling to communicate with the affected person, fighting stigma and isolation, dealing with an uncertain future, and learning from one's mistakes and building resilience and hope. Our findings bring forth the voices of relatives and informal carers of people with psychosis, by highlighting some of the common themes of their lived experiences from the time of the initial diagnosis and throughout the different clinical stages of the disorder. Informal carers are key stakeholders who can play a strategic role, and their contributions in the recovery process merit recognition and active support by mental health professionals.
Collapse
Affiliation(s)
- Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Juliana Onwumere
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Jemma Venables
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Ana Cabrera
- Asociación Madrileña de Amigos y Familiares de Personas con Esquizofrenia (AMAFE), Madrid, Spain
| | - Joseba Rico
- Asociación Madrileña de Amigos y Familiares de Personas con Esquizofrenia (AMAFE), Madrid, Spain
| | - Arif Hoque
- Young Person’s Mental Health Advisory Group (YPMHAG), King’s College London, London, UK
| | - Jummy Otaiku
- Young Person’s Mental Health Advisory Group (YPMHAG), King’s College London, London, UK
| | - Nicholas Hunter
- National Health System (NHS) South London and Maudsley (SLaM) Recovery College, London, UK
| | - Péter Kéri
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe), Brussels, Belgium
| | - Lily Kpodo
- South London and Maudsley (SLaM) NHS Foundation Trust, London, UK
| | - Charlene Sunkel
- Global Mental Health Peer Network (GMHPN), Johannesburg, South Africa
| | - Jianan Bao
- Department of Forensic and Neurodevelopment Sciences, King’s College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- School of Medicine, Keele University, Staffordshire, Newcastle, UK
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Elizabeth Kuipers
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
17
|
Marshall P, Jones S, Gooding P, Robinson H, Lobban F. Caring for a Family Member with Psychosis or Bipolar Disorder Who Has Experienced Suicidal Behaviour: An Exploratory Qualitative Study of an Online Peer-Support Forum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15192. [PMID: 36429907 PMCID: PMC9690796 DOI: 10.3390/ijerph192215192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The likelihood of suicidal behaviour is elevated amongst people with psychosis or bipolar disorder. This study aimed to understand how carers experience supporting family members with psychosis or bipolar disorder who have also experienced suicidal behaviour. METHODS A qualitative thematic analysis of online peer forum posts was carried out on the Relatives Education and Coping Toolkit (REACT) website, an online intervention for carers of people with psychosis and bipolar disorder. Analysis was based on 178 posts by 29 forum users. Posts were selected based on their relevance to suicidal behaviour. RESULTS Three themes were generated. "Suicide as the ultimate threat" highlights fears emerging from carers' difficulties with understanding and managing suicidal behaviour. "Bouncing from one crisis to another" reflects carers' experiences of recurring crises and the challenges of relying on emergency healthcare support. "It definitely needs to be easier to get help" emphasises carers' desires to be acknowledged by healthcare professionals and included in support offered to service users. CONCLUSIONS Digital platforms, including online forums, brief interventions such as safety planning, and interagency crisis models, hold the potential to meet carers' needs in this context. However, further research is required to investigate the effectiveness and implementation of these approaches.
Collapse
Affiliation(s)
- Paul Marshall
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
| | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Heather Robinson
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
| |
Collapse
|
18
|
Debono J, Scerri J. Living on a razor's edge: Experiences of mothers caring for a son on synthetic cannabinoids in Malta. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4471-e4478. [PMID: 35593097 DOI: 10.1111/hsc.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 04/15/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Various studies have explored collectively the experiences of carers of individuals using illicit substances. Yet such experiences vary by gender, by relationship status to the substance user, by type of drug taken and whether the substance user lives within the same household. A hermeneutic phenomenological design was undertaken with five mothers of sons on synthetic cannabinoids (SC). These sons were receiving community mental health care following admission to hospital for episodes of drug-induced psychosis. Interview data were collected between August and October 2019. The transcribed texts were analysed using interpretative phenomenological analysis and interpreted using the Common-sense model. The superordinate theme 'Living on a Razor's edge' was extracted and consisted of two themes: 'A living Calvary' and 'Fighting a Lone battle'. The findings highlight the intense psycho-emotional suffering of the mothers, who experienced anxiety and fear relating to their welfare and that of the family; helplessness at not being able to communicate their concerns to their son and shame triggered by the judgmental attitude of others. Carers primarily associated the effects of SC such as psychotic episodes, to their sons being vulnerable individuals with mental health challenges rather than due to their drug habit. The mothers expressed feeling isolated as they could not turn to any family member or friends for support. The highly volatile and impulsive nature of their son further introduced a wedge between the female carer and her spouse, children, extended family and friends. Caring for a son on SC has a significant psycho-emotional and social impact on the mothers as informal carers. Hence, there is a need for a person-centred care approach to be provided, in which the shared understandings of the mothers narratives are explored and where their needs and concerns are integrated and addressed within a care plan.
Collapse
Affiliation(s)
- Josef Debono
- Multi Purpose Unit, Mount Carmel Hospital, Attard, Malta
| | - Josianne Scerri
- Department of Mental Health, Faculty of Health Sciences, University of Malta, Msida, Malta
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, Malta
| |
Collapse
|
19
|
Cotton SM, Betts JK, Eleftheriadis D, Filia K, Seigerman M, Rayner VK, McKechnie B, Hulbert CA, McCutcheon L, Jovev M, Bendall S, Burke E, McNab C, Mallawaarachchi S, Alvarez-Jimenez M, Chanen AM, Gleeson JF. A comparison of experiences of care and expressed emotion among caregivers of young people with first-episode psychosis or borderline personality disorder features. Aust N Z J Psychiatry 2022; 56:1142-1154. [PMID: 34628949 DOI: 10.1177/00048674211050299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Caregivers of individuals with severe mental illness often experience significant negative experiences of care, which can be associated with higher levels of expressed emotion. Expressed emotion is potentially a modifiable target early in the course of illness, which might improve outcomes for caregivers and patients. However, expressed emotion and caregiver experiences in the early stages of disorders might be moderated by the type of severe mental illness. The aim was to determine whether experiences of the caregiver role and expressed emotion differ in caregivers of young people with first-episode psychosis versus young people with 'first-presentation' borderline personality disorder features. METHOD Secondary analysis of baseline (pre-treatment) data from three clinical trials focused on improving caregiver outcomes for young people with first-episode psychosis and young people with borderline personality disorder features was conducted (ACTRN12616000968471, ACTRN12616000304437, ACTRN12618000616279). Caregivers completed self-report measures of experiences of the caregiver role and expressed emotion. Multivariate generalised linear models and moderation analyses were used to determine group differences. RESULTS Data were available for 265 caregivers. Higher levels of negative experiences and expressed emotion, and stronger correlations between negative experiences and expressed emotion domains, were found in caregivers of young people with borderline personality disorder than first-episode psychosis. Caregiver group (borderline personality disorder, first-episode psychosis) moderated the relationship between expressed emotion and caregiver experiences in the domains of need to provide backup and positive personal experiences. CONCLUSION Caregivers of young people with borderline personality disorder experience higher levels of negative experiences related to their role and expressed emotion compared with caregivers of young people with first-episode psychosis. The mechanisms underpinning associations between caregiver experiences and expressed emotion differ between these two caregiver groups, indicating that different supports are needed. For borderline personality disorder caregivers, emotional over-involvement is associated with both negative and positive experiences, so a more detailed understanding of the nature of emotional over-involvement for each relationship is required to guide action.
Collapse
Affiliation(s)
- Sue M Cotton
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jennifer K Betts
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Dina Eleftheriadis
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - Kate Filia
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Victoria K Rayner
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Carol Anne Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Louise McCutcheon
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Sarah Bendall
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Catharine McNab
- Mindful Centre for Training and Research in Developmental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sumudu Mallawaarachchi
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew M Chanen
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - John Fm Gleeson
- Mindful Centre for Training and Research in Developmental Health, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
20
|
Onwumere J, Stubbs B, Stirling M, Shiers D, Gaughran F, Rice AS, C de C Williams A, Scott W. Pain management in people with severe mental illness: an agenda for progress. Pain 2022; 163:1653-1660. [PMID: 35297819 PMCID: PMC9393797 DOI: 10.1097/j.pain.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text.
Collapse
Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, United Kingdom
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mary Stirling
- Involvement Register Member of South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Service User Member of Oxleas NHS Foundation Trust, London, United Kingdom
- Mind and Body Expert Advisory Group, King's Health Partners, London, United Kingdom
- Patient Governor of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Andrew S.C. Rice
- Pain Research Group, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Amanda C de C Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
21
|
Karambelas GJ, Filia K, Byrne LK, Allott KA, Jayasinghe A, Cotton SM. A systematic review comparing caregiver burden and psychological functioning in caregivers of individuals with schizophrenia spectrum disorders and bipolar disorders. BMC Psychiatry 2022; 22:422. [PMID: 35733174 PMCID: PMC9219207 DOI: 10.1186/s12888-022-04069-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Informal primary caregivers provide crucial supports to loved ones experiencing serious mental illnesses with profound outcomes for the caregivers themselves. A comprehensive understanding of how different serious mental illnesses change the caregiving experience may provide important insight into the ways in which caregivers can be better supported in their role. The aim of this review was to synthesize the comparative literature examining caregiver burden and psychological functioning (anxiety, depression, distress, and psychological wellbeing) between caregivers of people with schizophrenia spectrum disorders and bipolar disorder. METHODS Studies were included if they compared caregivers across both diagnostic groups and used measures assessing either caregiver burden or psychological functioning of caregivers. Databases searched up until 11th of January 2022 included: Medline COMPLETE, Embase, PsycINFO and CINAHL. Reference list scans and grey literature searches across government, organisational and dissertation databases were also conducted. RESULTS Twenty-eight studies comprising 6166 caregivers were included. Fourteen studies suggested that caregiving burden was comparable across both groups. The effects of caring on caregiver mental health and stress were comparable across both groups. However, methodological limitations were noted, including a reliance on cross-sectional studies, multiple and sometimes competing definitions of caregiving burden, variable sample sizes, and variation in measures used. CONCLUSION AND IMPLICATIONS The experience of providing care is multidimensional and complex. Symptoms and functional difficulties experienced by people being cared for may affect caregivers more so than diagnosis. Caregivers play a vital role in helping people with serious mental illness. Supporting caregivers by reducing their burden and improving their psychological functioning may help them to continue to provide support, and cope with, the challenges of providing care.
Collapse
Affiliation(s)
- George J. Karambelas
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia ,grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, Victoria Australia
| | - Kate Filia
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Linda K. Byrne
- grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, Victoria Australia
| | - Kelly A. Allott
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Anuradhi Jayasinghe
- grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, Victoria Australia
| | - Sue M. Cotton
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
22
|
Aouira N, Khan S, Heussler H, Haywood A, Karaksha A, Bor W. Practitioners' Perspective on Metabolic Monitoring of Second-Generation Antipsychotics: Existing Gaps in Knowledge, Barriers to Monitoring, and Strategies. J Child Adolesc Psychopharmacol 2022; 32:296-303. [PMID: 35666251 DOI: 10.1089/cap.2022.0021] [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] [Indexed: 11/12/2022]
Abstract
Introduction: Prescription of second-generation antipsychotics (SGAs) in youth is rapidly increasing globally and in Australia. Lack of timely metabolic monitoring for potential adverse effects puts youth at greater risk for lifelong adverse health impact. Metabolic monitoring is recommended as best practice to prevent and/or manage SGA-induced weight gain/metabolic syndrome. The adherence to clinical guidelines remains suboptimal. It is crucial to gauge insight to challenges and strategies from the perspective of prescribers and to recommend strategies in promoting quality use of SGAs and adherence to pharmacovigilance standards. Methods: Psychiatrists participated through semistructured interviews within the community mental health clinics in the Queensland State of Australia. The interviews focused on barriers to monitoring and strategies to enhance rate of monitoring with key focus on practical strategies for future implications in community setting. Results: Ten participants completed the interviews. Barriers were specified such as lack of adequate resources to conduct monitoring, carers' disengagement in their youth's treatments, and patients' refusal to undergo blood tests. Strategies to enhance metabolic monitoring heavily relied on organizational support, provision of training, and education opportunities. Conclusions: Clinical recommendations require mental health providers to facilitate conduction of metabolic monitoring among youth prescribed SGA/s. However, they are not provided with enough support and there are challenges that prevent such care. It is crucial to understand the challenges in managing a complex and vulnerable patient cohort. This research has thrown light on these key aspects of existing gap between best practice standards and clinical practice in youth prescribed SGAs.
Collapse
Affiliation(s)
- Nisreen Aouira
- School of Pharmacy and Medical Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sohil Khan
- School of Pharmacy and Medical Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Prasanna Institute of Public Health and Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Helen Heussler
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Children's Health Queensland Hospital and Health Services, South Brisbane, Queensland, Australia
| | - Alison Haywood
- School of Pharmacy and Medical Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Abdullah Karaksha
- School of Pharmacy and Medical Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - William Bor
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Children's Health Queensland Hospital and Health Services, South Brisbane, Queensland, Australia.,Child and Youth Mental Health Service, Centre for Children's Health Research, Queensland Health, Brisbane, Queensland, Australia
| |
Collapse
|
23
|
McKenna A, Hazell CM, Souray R, Cai W, Man LC, Brown L, Floyd C, Lyons N, Widuch K, James G, Keay D, Souray J, Afsharzadegan R, Raune D. Do carers of adolescents at first episode psychosis have distinctive psychological needs? A pilot exploration. Int J Soc Psychiatry 2022; 68:600-609. [PMID: 33554710 DOI: 10.1177/0020764021992828] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Carers of patients experiencing first episode psychosis (FEP) are at an increased risk of mental and physical health problems themselves. However, little is known about how the psychological needs of carers may differ between those caring for an adolescent versus an adult who has FEP. AIMS This pilot study aimed to explore any differences in the psychological needs of carers caring for adolescents versus adults with FEP. METHODS We surveyed 254 carers of 198 FEP patients (34 carers of adolescents of 24 FEP adolescent patients). Carers completed self-report measures of anxiety, depression, burnout, subjective burden, coping, and key illness beliefs. The sample was divided according to whether the patient was under (adolescent) or over (adult) age 18, and analysed using mixed model logistic regressions. RESULTS Compared to the carers of adult patients, carers of adolescents were more than twice as likely (12% vs. 30%) to experience overall burnout syndrome (all three domains), and to develop it much quicker (19.4 vs. 10.1 months). They were also more likely to adopt behavioural disengagement avoidance as a form of coping. However, there was no difference between carers in terms of anxiety, depression, beliefs and subjective burden. For carers of adolescents, burnout was independently predicted by: a negative belief about the consequences of psychosis for the adolescent patient and an incoherent understanding of the patient's mental health. CONCLUSIONS If our findings can be replicated in a larger sample, then Rapid-Onset-Burnout-Syndrome (ROBS) is a particular problem in carers of adolescents at FEP, suggesting a need for routine screening and possible prophylactic intervention. Carers of adolescent's use of behavioural escape coping maybe also require early intervention. Theoretically, consideration could be given to the development of an adolescent sub-branch to the cognitive model of caregiving.
Collapse
Affiliation(s)
- Alice McKenna
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK.,Community Transformation Project, East London NHS Foundation Trust, London, UK
| | - Cassie M Hazell
- Department of Social Sciences, University of Westminster, London, UK
| | - Rowan Souray
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Wenyi Cai
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Lai Chu Man
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Lucy Brown
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Caroline Floyd
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Natasha Lyons
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Kaja Widuch
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Gareth James
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Debra Keay
- CAHMS Ash Tree, Central and North West London NHS Foundation Trust, London, UK
| | - Jonathan Souray
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Roya Afsharzadegan
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - David Raune
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| |
Collapse
|
24
|
Killaspy H, Harvey C, Brasier C, Brophy L, Ennals P, Fletcher J, Hamilton B. Community-based social interventions for people with severe mental illness: a systematic review and narrative synthesis of recent evidence. World Psychiatry 2022; 21:96-123. [PMID: 35015358 PMCID: PMC8751572 DOI: 10.1002/wps.20940] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
People living with severe mental illness (SMI) are one of the most marginalized groups in society. Interventions which aim to improve their social and economic participation are of crucial importance to clinicians, policy-makers and people with SMI themselves. We conducted a systematic review of the literature on social interventions for people with SMI published since 2016 and collated our findings through narrative synthesis. We found an encouragingly large amount of research in this field, and 72 papers met our inclusion criteria. Over half reported on the effectiveness of interventions delivered at the service level (supported accommodation, education or employment), while the remainder targeted individuals directly (community participation, family interventions, peer-led/supported interventions, social skills training). We identified good evidence for the Housing First model of supported accommodation, for the Individual Placement and Support model of supported employment, and for family psychoeducation, with the caveat that a range of models are nonetheless required to meet the varied housing, employment and family-related needs of individuals. Our findings also highlighted the importance of contextual factors and the need to make local adaptations when "importing" interventions from elsewhere. We found that augmentation strategies to enhance the effectiveness of social interventions (particularly supported employment and social skills training) by addressing cognitive impairments did not lead to transferable "real life" skills despite improvements in cognitive function. We also identified an emerging evidence base for peer-led/supported interventions, recovery colleges and other interventions to support community participation. We concluded that social interventions have considerable benefits but are arguably the most complex in the mental health field, and require multi-level stakeholder commitment and investment for successful implementation.
Collapse
Affiliation(s)
- Helen Killaspy
- Department of Epidemiology and Applied Clinical Research, Division of PsychiatryUniversity College LondonLondonUK,Camden & Islington NHS Foundation TrustLondonUK
| | - Carol Harvey
- Psychosocial Research Centre, Department of PsychiatryUniversity of MelbourneMelbourneVICAustralia,North Western Mental HealthParkvilleVICAustralia
| | - Catherine Brasier
- Department of Occupational TherapySocial Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe UniversityMelbourneVICAustralia
| | - Lisa Brophy
- Department of Occupational TherapySocial Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe UniversityMelbourneVICAustralia
| | | | - Justine Fletcher
- Centre for Mental Health, Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVICAustralia
| | - Bridget Hamilton
- Centre for Psychiatric NursingSchool of Health Sciences, University of MelbourneMelbourneVICAustralia
| |
Collapse
|
25
|
Onwumere J, Kuipers E, Wildman E, Mason A, Stahl D. Caregiver wellbeing during Covid-19: does being hopeful play a role? JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 6:100239. [PMID: 34557862 PMCID: PMC8447551 DOI: 10.1016/j.jadr.2021.100239] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background Informal (unpaid) carers represent a core component of health and social care systems. However, their experiences, health impacts and care needs during Covid-19 have been largely overlooked. This study aimed to explore the health and wellbeing impacts of Covid-19 on carers and the contribution of hopefulness. Methods Data were collected from an online survey hosted on the Qualtrics platform. Results Three hundred and sixty-nine participants consented to the survey. Data are reported on 186 participants with an 80% or higher completion rate. Most participants (> 80%) reported poor sleep quality, while nearly half the sample met case threshold for anxiety (46.2%) and 29% for depression. Mood disturbance in carers was associated with higher levels of sleep disturbances. Positive wellbeing in carers was best predicted by having a more hopeful outlook and fewer symptoms of depression. Limitations A cross-sectional survey-based design that is unable to offer no definitive conclusions about the direction of the results. The study was also limited by having carer participants as the only informants. Conclusions Though informal carers are found in all areas of society, their experiences and health correlates during Covid-19 have not attracted much research attention. The additional and unique challenges of the pandemic for the health and wellbeing needs of carers must not be overlooked as is sadly so often the case. Instead, the experiences of carers and their needs should be prioritised, publicised, and matched by needs-led interventions. Identifying carers and enquiring about their wellbeing would be a laudable first step.
Collapse
Affiliation(s)
- Juliana Onwumere
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Elizabeth Kuipers
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Emilie Wildman
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Ava Mason
- University College London, Division of Psychiatry, London, United Kingdom
| | - Daniel Stahl
- King's College London, Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| |
Collapse
|
26
|
Sud D, Maidment I, Bradley E, Tritter J. The experiences of the caring dyad: (Un)articulated realities of living with cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness. Health Expect 2021; 24:1821-1832. [PMID: 34339575 PMCID: PMC8483201 DOI: 10.1111/hex.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Informal carers play an important role in the care of patients with mental illness. Little is known of the relationship experience of the patient and their informal carer (caring dyad) as the context for the intersection between physical and mental health. AIM This study aimed to explore the impact of comorbid cardiometabolic risk (CMR), metabolic syndrome (MetS) and related diseases and severe mental illness (SMI) on the caring dyad. DESIGN Between October 2018 and March 2020, we conducted 11 in-depth semi-structured interviews across 6 adult caring dyads, interviewing each individual separately. SETTING Dyads were recruited within the United Kingdom; informal carers were nominated by the patient as a person who provided a significant amount of support. VARIABLE BEING STUDIED Participants were asked about the impacts of illness and caring on daily life. DATA ANALYSIS Data were analysed at the dyad level using thematic analysis, comparing and contrasting responses from each individual. RESULTS Themes were identified: enhanced closeness, dissonance and balance within the caring dyad. DISCUSSION AND CONCLUSIONS This study uses a particular population of patients with comorbid CMR factors, MetS and related diseases and SMI and their informal carers to explore the relevance and utility of caring dyads as an analytical framework to inform practice and policy. Future interventions should consider factors impacting on dyadic relationships to formulate effective and sustainable dyadic care and treatment to improve health outcomes for both patients with SMI and their informal carers. PATIENT/PUBLIC INVOLVEMENT In this study, patients and informal carers were participants. Topic guides were piloted with a patient and informal carer.
Collapse
Affiliation(s)
- Dolly Sud
- Aston Pharmacy School, College of Life and Health Sciences, Aston University, Birmingham, UK.,Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital Site, Leicester, UK
| | - Ian Maidment
- Aston Pharmacy School, College of Life and Health Sciences, Aston University, Birmingham, UK
| | - Eleanor Bradley
- College of Life, Health and Environmental Sciences, University of Worcester, Grove, UK
| | - Jonathan Tritter
- School of Humanities and Social Sciences, Aston University, Birmingham, UK
| |
Collapse
|
27
|
Alyafei AH, Alqunaibet T, Mansour H, Ali A, Billings J. The experiences of family caregivers of people with severe mental illness in the Middle East: A systematic review and meta-synthesis of qualitative data. PLoS One 2021; 16:e0254351. [PMID: 34242343 PMCID: PMC8270161 DOI: 10.1371/journal.pone.0254351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/25/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is a wealth of literature exploring the experiences of family caregivers of people with severe mental illness (SMI) in western countries, however, this topic has been neglected in the Middle East, despite families being the main source of caregiving in this context. The purpose of this review was to conduct a systematic review and qualitative meta-synthesis to explore the experiences of family caregivers living in countries in the Middle East caring for a relative with severe mental illness. METHODS A systematic review and meta-synthesis were conducted, to comprehensively gain a thorough and detailed overview of what is known about family caregivers' experiences from published qualitative research in the Middle East geographical area from inception to May 2021. The review protocol was pre-registered with PROSPERO (Ref: CRD42020165519). RESULTS The review identified twelve qualitative studies that explored caregivers' experiences of caring for relatives with SMI in Middle East countries. Family caregivers' experiences were captured under seven overarching themes. The participants across all studies reported negative consequences of providing care, increased burden and emotional distress. Many experienced issues with family/marital relationships and stigmatizing attitudes and behaviours from their communities. Caregivers expressed the need for increased support which was perceived to have a critical role in improving family caregivers' experiences. CONCLUSIONS The meta-synthesis revealed many challenges and issues that affect caregivers of people with SMI in the Middle East. Family caregivers experienced distress and burden, and reported significant impact on their psychological well-being. Their experiences highlight the urgent need to provide more support for family caregivers in Middle East countries.
Collapse
Affiliation(s)
| | - Taghrid Alqunaibet
- Division of Psychiatry, University College London, London, United Kingdom
| | - Hassan Mansour
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Afia Ali
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jo Billings
- Division of Psychiatry, University College London, London, United Kingdom
| |
Collapse
|
28
|
Psychological Impact of Parkinson Disease Delusions on Spouse Caregivers: A Qualitative Study. Brain Sci 2021; 11:brainsci11070871. [PMID: 34210042 PMCID: PMC8301855 DOI: 10.3390/brainsci11070871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/15/2022] Open
Abstract
There is growing research on carers of people with Parkinson's disease (PD) experiences. However, the impact on carers by PD delusions is not specifically examined. We conducted a qualitative study using semi-structured interviews of spouse carers of PD patients with delusions. Thematic analysis was employed using MAXQDA 2018. Twelve spouse participants (SPs) were interviewed. Four themes emerged: Managing incredulity: trying to make sense of delusion content; Hypervigilance: constant alertness to bizarre and threatening discourse and behavior; Defensive strategizing: anticipating delusions and potential consequences; Concealing and exposing: ambivalence about disclosing the effect of delusions yet wanting support. SPs reported effects on their emotional well-being and marital relationship and challenges to an orderly, predictable life. SPs were reluctant to share their experiences due to delusion content (often infidelity and sexual in nature) and a desire to protect their spouses' image. SPs' awareness of the potential for delusional thought was low prior to their occurrence. Conclusions: education surrounding potential neurobehavioral changes should occur for patients and carers. Clinicians should be aware that the impact of delusions on carers is often greater than disclosed in clinical interviews. Interdisciplinary teams speaking separately to spousal carers may improve disclosure and delivery of appropriate psychological support.
Collapse
|
29
|
Onwumere J, Wilson S, Billings J, Brown L, Floyd C, Widuch K, Lyons N, Man LC, James G, Afsharzadegan R, Khan S, Padayatchi M, Souray J, Raune D. First episode psychosis: A comparison of caregiving appraisals in parents caring for the same child. Early Interv Psychiatry 2021; 15:525-535. [PMID: 32524757 DOI: 10.1111/eip.12975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/18/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The first onset of psychosis can be a traumatic event for diagnosed individuals but can also impact negatively on their families. Little is known about how parents of the same child make sense of the illness. In mothers and fathers caring for the same child with early psychosis, the current study assessed their similarities and differences in key areas of their caregiving role. METHODS Using a cross-sectional design, parental pairs caring for the same child treated within an early intervention in psychosis service, completed self-report measures on their caregiving experiences, illness beliefs, coping styles and affect. RESULTS Data from 44 mothers and fathers were analysed. Analyses confirmed that parents reported similar levels of emotional dysfunction and conceptualized the illness in broadly similar ways with regard to what they understood the illness to be, their emotional reactions to the illness, perceived illness consequences and beliefs about treatment. Significant differences were identified in their beliefs about the timeline of the illness and reported approaches to coping. CONCLUSIONS With exception of beliefs about illness timeline and an expressed preference for use of emotion-based coping, parent caregivers of the same child in early psychosis services are likely to report similar illness beliefs and caregiving reactions. Efforts to ensure staff awareness of the potential areas of divergence in parental caregiving appraisals and exploring the implications of the divergence for the caregiving relationship and patient outcomes are indicated.
Collapse
Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,The National Psychosis Unit & PiCuP Services, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Sophie Wilson
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Jo Billings
- Department of Clinical, Educational and Health Psychology, University College, London, UK
| | - Lucy Brown
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Caroline Floyd
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Kaja Widuch
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Natasha Lyons
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Lai Chu Man
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Gareth James
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Roya Afsharzadegan
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Sanna Khan
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Mellisha Padayatchi
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Jonathan Souray
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - David Raune
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| |
Collapse
|
30
|
Caring for Patients with Psychosis: Mental Health Professionals' Views on Informal Caregivers' Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062964. [PMID: 33799346 PMCID: PMC8001319 DOI: 10.3390/ijerph18062964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 02/03/2023]
Abstract
The aim of this study was to explore the views of mental health professionals regarding the needs of the informal caregivers of patients with chronic psychotic syndrome. A qualitative research design was used. The sample consisted of 12 mental health professionals selected by a purposive sampling strategy. Data were collected through semistructured, face to face interviews. Framework analysis was used to analyze qualitative data and establish main themes and subthemes. Three main themes emerged namely, (i) impact of caring on caregivers’ lives, (ii) caregivers’ needs, and (iii) recommendations for better care. Informal caregivers’ needs were conceptualized into subthemes within the main themes. Caregivers’ increased responsibilities of caring for their relatives, the impact on their mental and physical health status and the restrictions in their social and professional life were revealed. Targeted health interventions and social policy planning are recommended for supporting informal caregivers and improving patient care.
Collapse
|
31
|
Onwumere J. Informal carers in severe mental health conditions: Issues raised by the United Kingdom SARS-CoV-2 (COVID-19) Pandemic. Int J Soc Psychiatry 2021; 67:107-109. [PMID: 32390480 PMCID: PMC8191166 DOI: 10.1177/0020764020927046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| |
Collapse
|
32
|
The Effects of Family Psychoeducation Courses on Depression, Anxiety and Family Functioning in the Caregivers of Schizophrenic Patients. HEALTH SCOPE 2021. [DOI: 10.5812/jhealthscope.104116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Schizophrenia is one of the most serious psychiatric diseases that affects the patient’s family members in addition to the patient himself. This disease can lead to depression and anxiety in the family members of the patient and even affect their functioning. Objectives: The present study was conducted to investigate the effect of a short-term family psychoeducation course on the depression and anxiety family functioning in caregivers Methods: In this before-after clinical trial, 163 first-degree family members of patients with schizophrenia were invited to participate in a short-term FPE course. A total of 65 of this group attended the first training session. Prior to the first session, the beck depression inventory (BDI), the beck anxiety inventory (BAI), and the family assessment device (FAD) were completed for the participants based on a family functioning model. Six months after the end of the FPE course, the 36 subjects who had completed the initial questionnaires and fully attended the sessions were invited to complete the questionnaires again. A total of 31 subjects completed the questionnaires again at this stage. The data were analyzed by SPSS-20 software using Mann–Whitney and Wilcoxon rank tests. Results: The mean age of the participants in both stages of questionnaire completion was 48.64 ± 11.85 years. Among them, 16 (51.6%) were female, and 15 (48.4%) were male. Also, six (19.4%) subjects had an education above high school, and mothers were the most frequent participating family members with a frequency of 11 (35.5%). The anxiety and depression scores of these subjects were 10.8 ± 5.14 and 6.9 ± 2.45 at baseline, respectively. These scores decreased significantly after six months to 5.03 ± 2.48 and 4.40 ± 1.9, respectively. In addition, among family functioning, Role and Behavioral control was significantly improved (P-value < 0.05). Conclusions: The results of this study showed that depression and anxiety levels decreased in the family members of the examined patients six months after an FPE course. This effect can be further investigated through studies conducted with control groups. These findings suggest that the integration and institutionalization of FPE programs in the healthcare system are essential for improving the status of patient caregivers with severe psychiatric illnesses and their families.
Collapse
|
33
|
Family achievements in struggling with schizophrenia: life experiences in a qualitative content analysis study in Iran. BMC Psychiatry 2021; 21:7. [PMID: 33402137 PMCID: PMC7786938 DOI: 10.1186/s12888-020-03025-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/22/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The challenges of living with and taking care of a patient with schizophrenia can lead to positive changes depending on the experiences and reactions of family caregivers. Such changes may directly affect the family performance and the patient's recovery stage. Present study aimed to explain the positive experiences reported by family caregivers of patients with schizophrenia. METHODS The present study is a qualitative study of content analysis. Data were collected using semi-structured and in-depth interviews with 15 family caregivers of patients with schizophrenia referring to one of the psychiatric hospitals in Zahedan, Southeast part of Iran. Purposive sampling method was applied and data analysis was conducted using conventional content analysis proposed by Graneheim and Lundman. RESULTS Data analysis created a theme entitled "family achievements in struggling with schizophrenia". This theme included four categories including Developing positive personality traits in family members, Strengthening family ties, developing insight into the life, and social mobility. CONCLUSIONS The results provided insights that the experience of taking care of patients with schizophrenia led to positive consequences for family caregivers. Thus, it is recommended that psychiatrists or consultants help families rely on positive experiences and share these experiences with families with a newly-suffered patient.
Collapse
|
34
|
A Randomised Controlled Trial of a Caregiver-Facilitated Problem-Solving Based Self-Learning Program for Family Carers of People with Early Psychosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249343. [PMID: 33327452 PMCID: PMC7764939 DOI: 10.3390/ijerph17249343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 01/14/2023]
Abstract
Facilitated self-help and problem-solving strategies can empower and support family carers to cope with caregiving for people with severe mental illnesses. This single-blind multi-site randomised controlled trial examined the effects of a five-month family-facilitated problem-solving based self-learning program (PBSP in addition to usual care), versus a family psychoeducation group program and usual psychiatric care only in recent-onset psychosis, with a six-month follow-up. In each of three study sites (integrated community centres for mental wellness), 114 people with early psychosis (≤5 years illness onset) and their family carers were randomly selected and allocated to one of three study groups (n = 38). Caregiving burden (primary outcome) and patients' and carers' health conditions were assessed at recruitment, and one-month and six-months post-intervention. Overall, 106 (94.7%) participants completed the assigned intervention and ≥1 post-test. Generalised estimating equations and subsequent contrast tests indicated that the PBSP participants showed significantly greater improvements in carers' burden, caregiving experiences and problem-solving ability, and patients' psychotic symptoms, recovery, and duration of re-hospitalisations over the six-month follow-up, compared with the other two groups (moderate to large effect size, η2 = 0.12-0.24). Family-assisted problem-solving based self-learning programs were found to be effective to improve both psychotic patients' and their carers' psychosocial health over a medium term, thus reducing patients' risk of relapse.
Collapse
|
35
|
Shiraishi N, Reilly J. Content analysis of the emotions affecting caregivers of relatives with schizophrenia. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-01185-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
36
|
Bucci S, Berry K, Barrowclough C, Haddock G. Family Interventions in Psychosis: A Review of the Evidence and Barriers to Implementation. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12172] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sandra Bucci
- School of Psychological Sciences, The University of Manchester
| | - Katherine Berry
- School of Psychological Sciences, The University of Manchester
| | | | - Gillian Haddock
- School of Psychological Sciences, The University of Manchester
| |
Collapse
|
37
|
Jolley S, Johns LC, O'Donoghue E, Oliver J, Khondoker M, Byrne M, Butler L, De Rosa C, Leal D, McGovern J, Rasiukeviciute B, Sim F, Morris E. Group acceptance and commitment therapy for patients and caregivers in psychosis services: Feasibility of training and a preliminary randomized controlled evaluation. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:524-551. [PMID: 32944971 DOI: 10.1111/bjc.12265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/16/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Psychological interventions reduce the impact of psychosis, but widescale implementation is problematic. We tested the feasibility of group acceptance and commitment therapy for Psychosis (G-ACTp), delivered by frontline staff, and co-facilitated by service-user experts-by-experience (SU-EbyE), for service-users and informal caregivers (ISRCTN: 68540929). We estimated recruitment/retention rates and outcome variability for future evaluation. METHODS Staff and SU-EbyE facilitators completed 1-day workshops, then delivered closely supervised G-ACTp, comprising four sessions (weeks 1-4) and two boosters (10 and 12 weeks). Participants recruited from adult community psychosis services were randomized to receive G-ACTp immediately or after 12 weeks, completing outcome assessments at 0, 4, and 12 weeks. Service-use/month was calculated for 1-year pre-randomization, weeks 0-12, and 5-year uncontrolled follow-up. RESULTS Of 41 facilitators trained (29 staff, 12 SU-EbyE), 29 (71%; 17 staff, 12 SU-EbyE) delivered 18 G-ACTp courses. Participant refusal rates were low (9% of service-users [10/112]; 5% of caregivers [4/79]); 60% of those invited to participate attended ≥1 G-ACTp session (64% of service-users [39/61]; 56% of caregivers [35/63]). Randomization of facilitators and participants proved problematic and participant follow-up was incomplete (78% [66/85]; 82% of service-users [36/44]; 73% of caregivers [30/41]). Effect sizes ranged from very small to large mostly favouring treatment. Service-use reductions require cautious interpretation, as very few participants incurred costs. CONCLUSIONS Implementation appears feasible for service-users; for caregivers, retention needs improving. Outcome variability indicated n = 100-300/arm followed up (α = 0.05, 90% power). Methodological limitations' mean replication is needed: identified sources of potential bias may be reduced in a cluster randomized design with sessional outcome completion. PRACTITIONER POINTS Group acceptance and commitment therapy can be successfully adapted for people with psychosis and their caregivers. Implementation (training and delivery) is possible in routine community mental health care settings. Clinical and economic outcomes are promising, but replication is needed. Recommendations are made for future studies.
Collapse
Affiliation(s)
- Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Louise C Johns
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,Department of Psychiatry, University of Oxford, UK
| | - Emma O'Donoghue
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Majella Byrne
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Lucy Butler
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Daniela Leal
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jessica McGovern
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Brigita Rasiukeviciute
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Faye Sim
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Eric Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
38
|
Cheng SC, Backonja U, Buck B, Monroe-DeVita M, Walsh E. Facilitating pathways to care: A qualitative study of the self-reported needs and coping skills of caregivers of young adults diagnosed with early psychosis. J Psychiatr Ment Health Nurs 2020; 27:368-379. [PMID: 31930633 DOI: 10.1111/jpm.12591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 01/20/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: In clinical psychiatry and mental health nursing practice, family caregivers are known to provide the bulk of care and play an important role in facilitating recovery outcomes for their loved ones diagnosed with psychosis. Providing services and interventions to family caregivers is as important as to patients in the early stage of psychotic experience for having a beneficial impact on the patients' clinical and social outcomes. Limited qualitative research has focused on family caregivers' subjective views of what they need during the critical period to identify early warning signs and connect their loved ones to professional help as they have no prior experience in caring for persons with psychosis. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Using qualitative analysis of family caregiver focus groups, this manuscript provides readers in clinical nursing practice with an understanding of family caregivers' lived experiences of supporting their loved one diagnosed with early psychosis. Understanding family caregivers' caregiving unmet needs in supporting their loved one diagnosed with early psychosis could inform both the technology-assisted intervention development and nursing practice in improving family-centred care and facilitate self-management practice. IMPLICATIONS FOR MENTAL HEALTH NURSING: Psychiatry and mental health nursing has long been engaged with the health and well-being of individuals with psychosis and supporting their families in the development, evaluation and implementation of innovative approaches to patient and family education. Digital technologies designed to deliver tailored intervention for family caregivers are underdeveloped, and the present study identifies a number of potential features that could comprise technology to meet the needs of this population. ABSTRACT: Introduction Caregivers play a critical role in detecting and managing psychotic symptoms before young people diagnosed with early psychosis present to care. Little is known about the specific needs of caregivers in navigating pathways to care for their loved one. Aim The purpose of this study was to understand the needs of family caregivers and their ways of coping on the pathway to care for early psychosis. Method Twenty family caregivers of individuals diagnosed with early psychosis participated in three focus groups that explored caregiving needs provision for early psychosis. Thematic analysis was conducted. Results We identified four major themes: education and skill training; raising wider awareness, such as police offers and teachers; adopting technologies for coping; and effective coping strategies. Implications for practice These findings provide important insights into caregiving needs and the ways for nurses to address those needs and better equip carers to recognize early symptoms, monitor behaviour changes and navigate care to support people with first-episode psychosis. Nursing researchers can use the information to develop on-demand and tailored family-centred intervention in addressing caregivers' needs in education, increasing awareness of early psychosis and fostering effective coping strategies.
Collapse
Affiliation(s)
- Sunny Chieh Cheng
- Nursing & Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, USA.,Department of Psychosocial & Community Health, University of Washington School of Nursing, Seattle, WA, USA
| | - Uba Backonja
- Nursing & Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, USA.,Department of Psychosocial & Community Health, University of Washington School of Nursing, Seattle, WA, USA.,Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, WA, USA
| | - Benjamin Buck
- Denver-Seattle Center of Innovation (COIN), Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Maria Monroe-DeVita
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elaine Walsh
- Department of Psychosocial & Community Health, University of Washington School of Nursing, Seattle, WA, USA
| |
Collapse
|
39
|
Hazell CM, Hayward M, Lobban F, Pandey A, Pinfold V, Smith HE, Jones CJ. Demographic predictors of wellbeing in Carers of people with psychosis: secondary analysis of trial data. BMC Psychiatry 2020; 20:269. [PMID: 32487127 PMCID: PMC7265638 DOI: 10.1186/s12888-020-02691-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/21/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Carers of people with psychosis are at a greater risk of physical and mental health problems compared to the general population. Yet, not all carers will experience a decline in health. This predicament has provided the rationale for research studies exploring what factors predict poor wellbeing in carers of people with psychosis. Our study builds on previous research by testing the predictive value of demographic variables on carer wellbeing within a single regression model. METHODS To achieve this aim, we conducted secondary analysis on two trial data sets that were merged and recoded for the purposes of this study. RESULTS Contrary to our hypotheses, only carer gender and age predicted carer wellbeing; with lower levels of carer wellbeing being associated with being female or younger (aged under 50). However, the final regression model explained only 11% of the total variance. CONCLUSIONS Suggestions for future research are discussed in light of the limitations inherent in secondary analysis studies. Further research is needed where sample sizes are sufficient to explore the interactive and additive impact of other predictor variables.
Collapse
Affiliation(s)
- Cassie M. Hazell
- grid.12896.340000 0000 9046 8598School of Social Sciences, University of Westminster, London, W1W 6UW UK ,grid.414601.60000 0000 8853 076XResearch and Development Department, Sussex Education Centre, Brighton and Sussex Medical School, Nevill Avenue, Hove, BN3 7HZ UK ,grid.12082.390000 0004 1936 7590University of Sussex, Brighton, UK
| | - Mark Hayward
- grid.12082.390000 0004 1936 7590University of Sussex, Brighton, UK ,grid.451317.50000 0004 0489 3918Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ UK
| | - Fiona Lobban
- grid.9835.70000 0000 8190 6402Health & Medicine, Lancaster University, Furness Building, Lancaster, LA1 4YX UK
| | - Aparajita Pandey
- grid.451317.50000 0004 0489 3918Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ UK
| | - Vanessa Pinfold
- grid.490917.2The McPin Foundation, 32-36 Loman Street, London, SE1 0EH UK
| | - Helen E. Smith
- grid.414601.60000 0000 8853 076XResearch and Development Department, Sussex Education Centre, Brighton and Sussex Medical School, Nevill Avenue, Hove, BN3 7HZ UK ,grid.59025.3b0000 0001 2224 0361Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232 Singapore
| | - Christina J. Jones
- grid.414601.60000 0000 8853 076XResearch and Development Department, Sussex Education Centre, Brighton and Sussex Medical School, Nevill Avenue, Hove, BN3 7HZ UK ,grid.5475.30000 0004 0407 4824School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH UK
| |
Collapse
|
40
|
Smith LM, Onwumere J, Craig TK, Kuipers E. An ethnic-group comparison of caregiver beliefs about early psychotic illness in a UK sample: Implications for evidence-based caregiver interventions. Transcult Psychiatry 2020; 57:432-444. [PMID: 32106782 DOI: 10.1177/1363461519900596] [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] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate potential ethnic differences in cognitive responses to caregiving in psychosis that might be relevant to the delivery of caregiver interventions for difficulties related to psychosis. We compared cross-sectional outcomes across early-stage caregivers who self-identified as white British (n = 37) and those who self-identified as black African or Caribbean (n = 41) using United Kingdom (UK) census ethnicity criteria. Self-report questionnaires were used to examine caregiver beliefs about psychosis, including the perceived causes, consequences, timeline, the degree of control that patients have over their difficulties, as well as their appraisals of caregiving. Caregivers from black African or Caribbean backgrounds reported a significantly shorter expected duration of illness than white British caregivers. They were also more likely to cite psychosocial causes (e.g., relationship issues), and less likely to cite biological and genetic causes, as their principal explanations for problems. However, overall differences in perceived causes of illness between ethnicities were not significant, despite the power in this sample to detect medium-sized effects. Factors associated with ethnicity may contribute to individual differences in explanatory models of illness and in experiences of caregiving. A degree of sensitivity to the range of views that people might hold about psychosis may help to engage caregivers from diverse ethnic backgrounds.
Collapse
Affiliation(s)
- Lindsay M Smith
- Department of Psychology, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Juliana Onwumere
- Department of Psychology, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Tom Kj Craig
- Department of Health Service & Population Research, King's College London, London, UK
| | | |
Collapse
|
41
|
Farhall J, Cugnetto ML, Mathews S, Ratcliff K, Farnan S, Higgins K, Constantine E. Outcomes and change processes of an established family education program for carers of adults diagnosed with a serious mental health condition. Psychol Med 2020; 50:1099-1109. [PMID: 31030696 DOI: 10.1017/s0033291719000965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Family education programs (FEPs) target caregiving-related psychological distress for carers of relatives/friends diagnosed with serious mental health conditions. While FEPs are efficacious in reducing distress, the mechanisms are not fully known. Peer group support and greater mental health knowledge are proposed to reduce carers' psychological distress by reducing stigmatising attitudes and self-blame, and strengthening carers' relationship with their relative. METHODS Adult carers (n = 1016) who participated in Wellways Australia's FEP from 2009 to 2016 completed self-report questionnaires at the core program's start and end, during the consolidation period, and at a 6-month follow-up. Those who enrolled early completed questionnaires prior to a wait-list period. We used linear mixed-effects modelling to assess the program's effectiveness using a naturalistic wait-list control longitudinal design, and multivariate latent growth modelling to test a theory-based process change model. RESULTS While there was no significant change over the wait-list period, psychological distress, self-blame and stigmatising attitudes significantly decreased, and communication and relationship quality/feelings increased from the core program's start to its end. Changes were maintained throughout the consolidation period and follow-up. Peer group support significantly predicted the declining trajectory of distress. Peer group support and greater knowledge significantly predicted declining levels of self-blame and stigmatising attitudes, and increasing levels of communication. CONCLUSIONS This is the first study to quantitatively validate the mechanisms underlying the effect of FEPs on carers' psychological distress. Peer group support is key in modifying carers' appraisals of their friend/relatives' condition. Continued implementation of FEPs within mental health service systems is warranted.
Collapse
Affiliation(s)
- John Farhall
- Academic Psychology Unit, NorthWestern Mental Health, Epping, Australia
- Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
| | - Marilyn L Cugnetto
- Academic Psychology Unit, NorthWestern Mental Health, Epping, Australia
- Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
| | - Stephanie Mathews
- Academic Psychology Unit, NorthWestern Mental Health, Epping, Australia
- Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
| | | | - Sue Farnan
- Wellways Australia, Fairfield, Australia
| | | | | |
Collapse
|
42
|
Ma CF, Chan SKW, Chien WT, Bressington D, Mui EYW, Lee EHM, Chen EYH. Cognitive behavioural family intervention for people diagnosed with severe mental illness and their families: A systematic review and meta-analysis of randomized controlled trials. J Psychiatr Ment Health Nurs 2020; 27:128-139. [PMID: 31549461 DOI: 10.1111/jpm.12567] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/12/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Cognitive behavioural therapy for psychosis (CBTp) and family intervention (FI) for psychosis are effective evidence-based interventions, but they are practically difficult to be implemented in many clinical settings. The CBTp and FI approaches have been integrated to form cognitive behavioural family intervention (CBFI). This brief intervention may be more feasible to implement in clinical practice. A few individual studies reported the effectiveness of CBFI, but no systematic review and meta-analysis have been conducted. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: CBFI was effective for reducing overall positive and negative symptoms immediately following the intervention. Compared to CBTp, the intervention seems to be more effective to reduce delusions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results of this review suggest that the brief CBFI is an effective family-inclusive intervention that could be integrated into clinical practice. Mental health nurses with adequate training and support may implement and develop CBFI to improve the recovery of people diagnosed with SMI and support their families. Abstract Introduction Cognitive behavioural family intervention (CBFI) may be an effective brief psychosocial intervention for people diagnosed with severe mental illness (SMI) and their families. No systematic review has summarized the effectiveness of CBFI. Aim This review aimed to systematically examine the trial evidence of the effectiveness of CBFI versus treatment as usual (TAU) on improving the outcomes of people diagnosed with SMI and their families. Method Eligible randomized controlled trials were identified from nine databases. Three investigators independently took part in selection of articles, data extraction and risk assessment. Pooled treatment effects were computed using random-effects models. Results Four studies consisting of 524 participants were included. The risk of bias was low-unclear in most areas. The pooled CBFI effect on four service user outcomes including overall positive symptoms, delusions, overall negative symptoms and general psychopathology was significantly improved at post-treatment, compared with TAU, whereas effects on hallucinations and insight were equivocal. Discussion The findings reveal that CBFI is superior to TAU in treating positive and negative symptoms immediately following the intervention. Implications for Practice Mental health nurses may practise CBFI to enrich the psychiatric nursing service and promote nurse-led intervention. However, there is currently no substantial evidence that the intervention is effective over the longer term.
Collapse
Affiliation(s)
- Chak Fai Ma
- Kwai Chung Hospital, Kowloon, Hong Kong.,Department of Psychiatry, Li Ka Shing Faculty of Medicine, Queen Mary Hospital/The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, Queen Mary Hospital/The University of Hong Kong, Pok Fu Lam, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Daniel Bressington
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | | | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, Queen Mary Hospital/The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, Queen Mary Hospital/The University of Hong Kong, Pok Fu Lam, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong
| |
Collapse
|
43
|
Barbeito S, Sánchez-Gutiérrez T, Becerra-García JA, González Pinto A, Caletti E, Calvo A. A systematic review of online interventions for families of patients with severe mental disorders. J Affect Disord 2020; 263:147-154. [PMID: 31818771 DOI: 10.1016/j.jad.2019.11.106] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/29/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several studies show the effectiveness of face-to-face interventions with families in improving the prognosis of patients with severe psychiatric disorders and their relatives; however, the effectiveness of online interventions is poorly understood. The current study aims to provide an overview of evidence for the effectiveness of online treatments (web/app) for patients with severe psychiatric disorders and their families. METHOD We performed a systematic review of online treatments for informal family caregivers of patients with a severe psychiatric disorder. The study psychological interventions had to have been administered in an exclusively online format (app, internet) and aimed at families of patients with severe mental disorder (at least one of first episode psychosis, schizophrenia, schizoaffective, bipolar disorder, and psychotic disorder). RESULTS Of a total of 1331 articles, we identified 9 viable studies; 4 randomized clinical trials, and 5 nonrandomized clinical studies. The present study is the first systematic review in this area. Online interventions were well accepted, with good adherence and satisfaction among the caregivers and patients and improved the symptoms of both caregivers and patients. LIMITATIONS Clinical and methodological diversity of the studies. CONCLUSIONS Burden improved, and perceived stress decreased in families. Moreover, the severity of positive symptoms decreased and fewer hospitalizations were recorded in patients than in the control group. Therefore, online interventions are a promising therapeutic approach for patients with severe mental disorder and their families. However, more studies-particularly randomized clinical trials-are needed in this area.
Collapse
Affiliation(s)
- Sara Barbeito
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain.
| | | | | | - Ana González Pinto
- University of the Basque Country, Biomedical Research Center in Mental HealthNet (CIBERSAM), Department of Neurosciences, University of the Basque Country, Vitoria, Spain.
| | - Elisabetta Caletti
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, Milan, Italy.
| | - Ana Calvo
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain.
| |
Collapse
|
44
|
Stuart R, Akther SF, Machin K, Persaud K, Simpson A, Johnson S, Oram S. Carers' experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis. BJPsych Open 2020; 6:e19. [PMID: 32043435 PMCID: PMC7176830 DOI: 10.1192/bjo.2019.101] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice. AIMS We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation. METHOD We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis. RESULTS The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care. CONCLUSIONS Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends.
Collapse
Affiliation(s)
- Ruth Stuart
- Research Assistant, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Karen Machin
- Visiting Lecturer, School of Health and Social Work, University of Hertfordshire, UK
| | - Karen Persaud
- Honorary Research Associate, NIHR Mental Health Policy Research Unit, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Alan Simpson
- Professor of Mental Health Nursing, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and Director (KCL), NIHR Mental Health Policy Research Unit, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, Faculty of Brain Sciences, University College London; Director (UCL), NIHR Mental Health Policy Research Unit; and Consultant Clinical Psychiatrist, Camden and Islington NHS Foundation Trust, UK
| | - Sian Oram
- Lecturer and Head of the Section of Women's Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London; Deputy Director (KCL), NIHR Mental Health Policy Research Unit, UK
| |
Collapse
|
45
|
Service evaluation of a sole-session psychoeducational intervention to improve caregivers’ key illness beliefs after first episode psychosis (FEP). COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Carers of people experiencing a first episode of psychosis are at an increased risk of developing their own physical and mental health problems. Psychoeducation has been found to improve carer wellbeing and reduce distress. However, few psychoeducation interventions have considered the resource constraints on mental health services and the impact that these can have on the implementation of any such interventions. The present service evaluation aimed to evaluate an abbreviated version (sole session) of a previously tested psychoeducation intervention (three sessions) that targets less adaptive illness beliefs (n = 17). Pre–post effect sizes reveal that all of the carers’ illness beliefs changed in the desired direction, with four out of the 10 illness beliefs associated with large to moderate improvements. When compared with the outcomes obtained in our evaluation of the more intensive, three-session version of the intervention, the between-group effects largely favoured the three-session version but were mostly small. Moderate to large effects in favour of the three-session version were found for two of the 10 illness beliefs. These findings support the further investigation of the sole session psychoeducation intervention as part of a randomised controlled trial.
Key learning aims
(1)
To evaluate the impact of a sole-session psychoeducation intervention on illness beliefs.
(2)
To compare the outcomes of the sole-session psychoeducation intervention to the previous, more intensive (three-session) version of the same intervention.
(3)
To consider the value of research approaches to evaluating psychoeducation interventions for carers of people with psychosis.
Collapse
|
46
|
Izon E, Berry K, Law H, Au-Yeung K, French P. “I don’t know how to fix it and sometimes it’s so overwhelming” Identifying the barriers and facilitators for family caregivers supporting someone at high-risk of psychosis: A qualitative study. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2019. [DOI: 10.1080/17522439.2019.1688858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Emma Izon
- Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
| | - Heather Law
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Karmen Au-Yeung
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul French
- Department of Research and Innovation, Pennine Care NHS Foundation Trust, Lancashire, UK
- Faculty of Health Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
47
|
Shiraishi N, Watanabe N, Katsuki F, Sakaguchi H, Akechi T. Effectiveness of the Japanese standard family psychoeducation on the mental health of caregivers of young adults with schizophrenia: a randomised controlled trial. BMC Psychiatry 2019; 19:263. [PMID: 31477061 PMCID: PMC6719377 DOI: 10.1186/s12888-019-2252-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/22/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study examined the effects of the standard model of family psychoeducation (SM-FPE) in Japan on the mental health of relatives who care for young patients with a psychotic disorder. METHODS Stratified by recent-onset/chronic psychosis, 74 caregivers of outpatients aged 30.1 years (mean) were randomly assigned to receive TAU (treatment as usual) alone or TAU plus SM-FPE. All outcomes were measured at baseline, at the end of the intervention (10 weeks), and 1 month post-intervention (14 weeks). The primary outcome was the trait anxiety of caregivers at 14 weeks. Secondary outcomes included caregivers' state anxiety, psychological distress, care burden, and expressed emotion. Integrating these secondary outcomes, a conceptual framework of caregivers' health state was assessed via structural equation modelling. RESULTS Compared with TAU alone, SM-FPE plus TAU did not significantly improve all caregivers' individual outcomes. Direct effects of the intervention were observed in the caregivers of chronic patients as significant improvements of their overall mental health state at 10 weeks, which indirectly continued until 14 weeks. However, such intervention effects were not observed in the caregivers of recent-onset patients. CONCLUSIONS The lack of effectiveness in the recent-onset stage suggests that the usefulness of the SM-FPE needs to be corroborated by further research. TRIAL REGISTRATION The study protocol was retrospectively registered at ClinicalTrials.gov (registration number: NCT01731977; date of registration: 22 November 2012).
Collapse
Affiliation(s)
- Nao Shiraishi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Norio Watanabe
- 0000 0004 0372 2033grid.258799.8Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Fujika Katsuki
- 0000 0001 0728 1069grid.260433.0Department of Psychiatric and Mental Health Nursing, Nagoya City University School of Nursing, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 Japan
| | - Hajime Sakaguchi
- Midorino Kaze Minamichita Hospital, Magohazama-86 Toyooka, Minamichita, Aichi, Chita District 470-3411 Japan
| | - Tatsuo Akechi
- 0000 0001 0728 1069grid.260433.0Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 Japan
| |
Collapse
|
48
|
Mui EYW, Chan SKW, Chan PY, Hui CLM, Chang WC, Lee EHM, Chen EYH. Systematic review (meta-aggregation) of qualitative studies on the experiences of family members caring for individuals with early psychosis. Int Rev Psychiatry 2019; 31:491-509. [PMID: 31547726 DOI: 10.1080/09540261.2019.1659236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the importance of the role of caregivers of people with psychosis being widely recognized, comprehensive understanding of their experience is limited. A thorough understanding of the experience of caregivers over the journey of the illness, particularly during its early stages, is crucial. Qualitative studies published between 1 January 1949 and 31 January 2018 were obtained from seven databases based on PICo search strategy. Meta-aggregation methodology of the Joanna Briggs Institute (JBI) was adopted to aggregate existing qualitative findings about caregivers' experiences. Twenty-eight qualitative studies on 635 caregivers and family members were included in the review. Six inter-related categories-'stigma', 'help-seeking', 'service encounter', 'emotional challenges', 'on becoming a caregiver' and 'making sense of experience'-were aggregated from 129 themes from the sub-acute stage, the acute stage and the recovery or residual stage. Three statements about caregivers' experiences of their relative's first episode of psychosis were synthesized from the findings. Results highlighted the need of incorporating caregiver intervention into the existing services to support the emotional challenges, uncertainty, and stigma-related burden along the caregiving journey.
Collapse
Affiliation(s)
- Esther Yee Wai Mui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Sherry K W Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
| | - Pik Ying Chan
- Department of Social Work and Social Administration, The University of Hong Kong , Hong Kong SAR , China
| | - Christy L M Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Wing C Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
| | - Edwin H M Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Eric Y H Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
| |
Collapse
|
49
|
Abstract
OBJECTIVES To explore Australian mental health carers' prioritisation of key elements of caregiving and establish the extent to which particular issues contribute to carer burden. DESIGN Cross-sectional survey. SETTING All Australian States and Territories. PARTICIPANTS Responses were received from 231 Australian mental health caregivers. MAIN OUTCOME MEASURES The Involvement Evaluation Questionnaire was used to assess caregiver burden. RESULTS Smallest space analysis identified three distinct regions, which we conceptualise as: 1) promoting the safety and health of mental health consumers; 2) impact of caring on caregivers' personal lives and 3) enabling daily living functional recovery of mental health consumers. The analysis demonstrates that carers are most concerned with enabling daily living functional recovery, for which the mean value was considerably higher than the personal impact and promoting safety and health regions. In terms of the individual questionnaire items, the issues of most importance are assisting with self-care, worrying about consumers' future, finances and general health, encouraging consumer involvement in activities and concerns over the treatment consumers are receiving. CONCLUSION Caregiving often came at significant personal cost. The burden that results from caring for mental health consumers could perhaps be alleviated through the expansion of psychiatric disability services, increasing government financial support and providing tailored psychosocial interventions that meet the needs of families.
Collapse
Affiliation(s)
- Paul Morrison
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Norman Jay Stomski
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| |
Collapse
|
50
|
Luderowski A, Boden ZV. Love and incomprehensibility: The hermeneutic labour of caring for and understanding a loved one with psychosis. Health (London) 2019; 24:737-754. [PMID: 30935237 DOI: 10.1177/1363459319829189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Informal carers are increasingly involved in supporting people with severe and enduring mental health problems, and carers' perceptions impact the wellbeing of both parties. However, there is little research on how carers actually make sense of what their loved one is experiencing. Ten carers were interviewed about how they understood a loved one's psychosis. Data were analysed using a hermeneutic-phenomenological approach. Three themes described the carers' effortful quest to understand their loved one's experiences while maintaining their relational bonds. Carers described psychosis as incomprehensible, seeing their loved one as incompatible with the shared world. To overcome this, carers developed hermeneutic 'mooring points', making sense of their loved one's unusual experiences through novel accounts that drew on material or spiritual explanations. The findings suggest that informal carers resist biomedical narratives and develop idiosyncratic understandings of psychosis, in an attempt to maintain relational closeness. We suggest that this process is effortful - it is hermeneutic labour - done in the service of maintaining the caring relationship. Findings imply that services should better acknowledge the bond between carers and care-receivers, and that more relationally oriented approaches should be used to support carers of people experiencing severe mental health problems.
Collapse
|