The experiences of family caregivers of people with severe mental illness in the Middle East: A systematic review and meta-synthesis of qualitative data

Caregiver burden, attachment and cognitive emotion among the family caregivers of severe mental illness patients

BACKGROUND

Serious mental illness (SMI) is a debilitating medical condition that causes stress and challenges for the family caregivers (FCs) of affected patients, increasing their caregiver burden (CB). This situation can activate attachment styles (AS) and trigger negative emotions, further contributing to CB. Given that AS and cognitive-emotional regulation (CER) can affect the CB of FCs of patients with SMI, the aim of this study was to evaluate the relationship between CB with AS, and CER among the FCs.

METHODS

This cross-sectional descriptive-correlational study was carried out in May-November 2022. Participants were 278 FCs of patients with SMI consecutively recruited from Roozbeh leading psychiatric hospital, Tehran, Iran. Data were collected using a patients' demographic and clinical characteristics questionnaire, an FCs' demographic characteristics questionnaire, the Attachment Style Questionnaire, the Cognitive Emotion Regulation Questionnaire, and the Burden Scale for Family Caregivers, and were analyzed using the SPSS software (v. 16.0).

RESULTS

CB had significant inverse relationship with secure AS (r = - 0.262) and significant positive relationship with fearful AS (r = 0.194) and dismissive AS (r = 0.242) (P < 0.01). Moreover, CB had significant inverse relationship with adaptive CER strategies and significant positive relationship with maladaptive CER strategies (P < 0.001). Regression analysis also showed that CB had significant relationship with secure AS and catastrophizing, rumination, self-blame, and positive refocusing CER strategies (P < 0.05).

CONCLUSION

This study concludes that AS and CER can impact CB. There is a negative relationship between secure AS and CB, as well as between adaptive CER strategies and CB. Conversely, there is a positive relationship between avoidant AS and increased CB, as well as between maladaptive CER strategies and CB. It is recommended to adopt strategies that promote the use of secure AS and adaptive CER among the FCs of patients with SMI.

Potential Increasing Trend in Schizophrenia Relapse Prevention in the Past 40 Years: A Bibliometric Analysis

OBJECTIVES

Schizophrenia is an organic disease and a severe mental disorder with a relatively high risk of relapse. The rising rate of schizophrenia relapse has motivated researchers and academics to innovate and develop interventions aimed at relapse prevention. This bibliometric study sought to examine the publication trends in schizophrenia relapse prevention from 1973 to 2023, assess the contribution of international collaborations across various journals, identify the most influential authors and articles, and forecast future developments in this field.

METHODS

The study included 683 articles obtained from the Scopus database, analyzed using VOSviewer software, and visualized with Tableau.

RESULTS

Reports of schizophrenia relapse prevention strategies have increased significantly over the last 3 decades. However, fluctuations persist, as evidenced by the annual number of publications ranging from 25 to 40 within the past 5 years. Nevertheless, this increasing trend underscores the sustained interest in this area of research. Regarding contribution size, the United States produced the largest volume of publications on this subject. John M. Kane authored the most articles, while Stefan Leucht exhibited the highest h-index. Frequently used keywords in this field include "relapse AND schizophrenia" AND "prevention."

CONCLUSIONS

These results represent an important reference for determining the current state of research on schizophrenia relapse prevention and future research directions.

The Effect of a Mindful Self-Compassion Intervention on Burden, Express Emotion and Mental Well-Being in Family Caregivers of Patients with Schizophrenia: A Randomized Controlled Trial

The objective of this randomized controlled trial was to examine the impact of a mindful self-compassion intervention on burden, express emotion, and mental well-being in family caregivers of patients with schizophrenia. Standardized measures, including the ZARIT Caregiving Burden Scale, Expressed Emotion Scale and Warwick-Edinburgh Mental Well-Being Scale, were administered at baseline, post-intervention. Statistical analysis was conducted to assess differences between the two groups. Significant reductions in caregiver burden, expressed emotion, and enhanced mental well-being in the intervention group compared to the control group at post-intervention. The results of this randomized controlled trial indicate that the mindful self-compassion intervention significantly reduces caregiver burden, expressed emotion, and improves mental well-being in family caregivers of patients with schizophrenia. These findings underscore the potential utility of mindful self-compassion interventions as effective support for this population, highlighting the importance of integrating such interventions into caregiver support programs.

Caregivers' experiences in helping individuals with severe and enduring mental health challenges integrate into the community: A qualitative descriptive study in Singapore

WHAT IS KNOWN ABOUT THE SUBJECT

Individuals with severe and enduring mental health challenges continued to consume mental health services for an average of 13 years as they needed multiple acute psychiatric admissions due to the challenges they experienced in their everyday activities. As caregivers of individuals with severe and enduring mental health challenges, they often bear the brunt of caregiving through their assistance with activities of daily living (ADL), providing emotional support and ensuring medication compliance for their loved ones. When caring for their loved ones, caregivers often reported psychological stress, social isolation and emotional exhaustion due to stressors such as uncertainty of the future, the lack of support from professional services and the isolation from their own social network and support mechanism.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Insights from this study revealed that caregivers for individuals with severe and enduring mental health challenges went through a lonely and exhausting journey fraught with psychological, physical, social and financial challenges, echoing the caregiving needs and the prevalence of the caregiver burden.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Insights shared by the caregivers demonstrated the need for a centralised point of contact to navigate Singapore's fragmented mental healthcare sector. Peer-support groups should be further promoted because they offer the benefits of information exchange, mutual support and a sense of empowerment and hopefulness, which may help ease the caregiver burden. Life skills training, such as teaching how to communicate empathetically with family members, resolve conflicts using open communication, maintain a structured daily routine and solve pragmatic problems in daily life, is more critical for individuals with severe and enduring mental health challenges. This will help them learn how to manage their well-being, live independently, and stabilise their conditions. Lastly, public awareness campaigns should honour caregivers by highlighting their strength, resilience, and dedication. The state can provide financial assistance in the form of tax relief for their income per annum or caregiver allowance to alleviate the financial stress that caregivers are facing.

ABSTRACT

Introduction The progressive deinstitutionalisation of mental healthcare has increasingly shifted care responsibilities from healthcare professionals to family caregivers for individuals with severe mental illness. Caregivers must balance many obligations, which often compromise their overall health and well-being, while helping their loved ones integrate into the community. Aim To identify and understand caregivers' needs and challenges as they help individuals with severe and enduring mental health challenges integrate into the community. Methods This study used a descriptive qualitative approach to explore the experiences and challenges of caregivers for individuals with severe and enduring mental health challenges when integrating back into the community. A semi-structured guide was used during the video-conferencing interviews conducted between December 2021 and November 2022. This study was reported according to the 32-item Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Findings Fourteen caregivers were individually interviewed by the primary author. Most caregivers were female, with an average of 15 years of experience caring for their loved ones. Using Braun and Clark's six-phase thematic framework, we inductively generate the themes and subthemes from the data. The two themes were (i) challenges (whose subthemes included personal challenges in caregiving, the lack of awareness, and stigma and employment) and (ii) support (whose subthemes included the importance of socialisation for individuals with mental health conditions, existing avenues of support and potential areas for support). Discussion Our findings informed the contemporary needs of caregivers caring for individuals with severe and enduring mental health challenges integrating into the community. Like the global challenges for people with mental health issues, psychosocial support and other supplementary support are still common themes in mental health settings. The findings further specifically highlighted the importance of accessible points of contact as resources and employment-enabling and sustaining initiatives to help manage caregivers' emotional and system challenges, which addresses the gaps identified in the findings. Caregivers' peer-support groups, life skills training and public mental health awareness are also necessitated by the caregivers' voices. Implications for Practice Priority areas include having a centralised point of contact within the community for caregivers. Government or not-for-profit organisations can take the lead by initiating employment-enabling initiatives for individuals with severe and enduring mental health challenges and their caregivers.

Care burden and the predictive role of spiritual well-being and religious coping: A cross sectional study among Iranian family caregivers of patients with stroke

Background and Aims

The burden of care after a stroke is gaining recognition as a significant healthcare issue. Factors like religion and spirituality, encompassing religious coping and spiritual health, prove to be influential in anticipating the challenges faced by caregivers. The present study aimed to determine the relationship between care burden, spiritual health, and religious coping among caregivers of stroke patients.

Methods

This cross-sectional research was conducted with the participation of 129 caregivers of stroke patients. The data was collected using the Ellison and Paloutzian spiritual well-being instruments, Pargament Religious Coping (RCOPE) brief version, and the Zarit burden interview (ZBI). Through a census, participants were recruited for the investigation. Data were analyzed using descriptive and inferential statistics (multivariate linear regression analysis).

Results

The study results indicate a strong and statistically significant relationship between the burden of caring and spiritual health (p < 0.001, β = 0.33). Furthermore, specific variables were identified as indicators of an increased burden of care, including positive religious coping (p = 0.04, β = 0.63), the familial relationship between the caregiver and patient, specifically as a child (p = 0.001, β = 29.26), and a sister (p < 0.001, β = 35.93).

Conclusion

It is advisable to consider adopting and implementing appropriate support measures for coping strategies rooted in religion and spirituality. So, it is recommended to enhance the provision of comprehensive support, including psychological and religious interventions. This can be achieved through the collaborative efforts of support groups comprising psychiatric nurses, psychiatrists, psychologists, and religious experts.

Comparing outcomes of psychiatric rehabilitation between ethnic-religious groups in Israel

Psychiatric rehabilitation for people with severe mental illness (SMI) has many documented benefits, but less is known about cultural related aspects. To date, no comparison of psychiatric rehabilitation outcomes between Israeli Jews and Israeli Arabs has been carried out. Thus, the purpose of the present study was to compare the outcome measures of Israeli Arabs and Israeli Jews consuming psychiatric rehabilitation services. As part of the Israeli Psychiatric Rehabilitation Reported Outcome Measurement project (PR-ROM), a cross-sectional study comparing different ethnic-religious groups was performed. Data is based on 6,751 pairs of psychiatric rehabilitation consumers and their service providers. The consumers filled questionnaires on quality of life (QoL) and functioning, and their providers completed mirroring instruments. The findings revealed that QoL and functioning ratings were lower among Muslim Arabs compared to Jews on both consumers' and providers' ratings. Among Muslim Arabs, differences in outcomes according to the service's location were indicated. The observed differences between Israeli Arabs and Israeli Jews with SMI in the PR-ROM point to the need for culturally adapted rehabilitation services that take into account how cultural differences may affect the benefits of such services.

Experiences of relatives caring for psychiatric patients in the Greater Accra Region of Ghana

PURPOSE

The study aimed at examining the lived experiences of relatives caring for family members with mental illness in Ghana.

METHODS

Interpretative Phenomenological Analysis (IPA) was adopted to explore caregivers' in-depth experiences. Fifteen caregivers were purposefully selected from four hospitals within the Greater Accra Region of Ghana, and they were engaged in face-to-face interview sessions through the semi-structured guided interviews. Interviews were transcribed into text formats and analysed using the IPA approach.

RESULTS

Three superordinate themes and their respective sub-themes were identified. Theme 1: Being with the mentally ill (time consuming; financial burden; healer shopping); Theme 2: Psychosocial effect (stigmatization; stress and depression; changes in social/work life); Theme3: Coping resources (prayers/spirituality; psychological capital - ignoring, self-encouragement, acceptance, routinization; social/family support; reading).

CONCLUSION

It was recommended that healthcare professionals ought to prepare family members for the emotional challenges by providing them with constant therapeutic service to help reduce their emotional strain associated with the burden of care. Public education should be intensified for people to understand the need for accepting people with mental illness in order to reduce the issue of stigmatization. Again, government should institute policies through its agencies (Ministry of Health, Ghana Health Service) to assist the caregivers in the discharge of responsibilities. This could take the form of reducing cost of drugs, and establishing community mental health care to provide immediate support.

Early Maladaptive Schemas and Depression in Caregivers of Individuals With Schizophrenia Spectrum and Bipolar Disorders

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.

Exploring the burden on family caregivers in providing care for their mentally ill relatives in the Upper East Region of Ghana

Caring for the mentally ill involves numerous challenges, including financial difficulties, stigma, and psychosocial issues, among others. Unpaid family caregivers must endure these challenges as they continue their care for their relatives with mental illness. Despite these burdens and their concomitant effects on both the patients and their caregivers, there is no evidence of this burden in the Bolgatanga municipality. This study explored the burden on family caregivers providing care for mentally ill relatives in the Bolgatanga Municipality of the Upper East Region of Ghana. The study employed a phenomenological research design. Fifteen family caregivers were purposively sampled from two secondary-level health facilities. In-depth interviews were conducted, audio-recorded, and transcribed verbatim. NVivo 12 pro software was used for data analysis. Thematic analysis was conducted following Braun and Clarke's approach. The study identified three themes including social, physical, and psychological burdens. Under social burden, financial challenges and stigma were identified, weight loss was identified as a physical burden, and poor concentration as a psychological burden. These themes represent the challenges encountered by the family caregivers as they provided care for their mentally ill relatives. There is a need to provide support for family caregivers including respite, formation of support groups, and financial support to alleviate family caregivers of the burdens they endure. Additionally, it is imperative to integrate mental health services into the national health insurance scheme to alleviate the financial burden on family caregivers.

Exploring the barriers to mental health service utilization in the Bolgatanga Municipality: the perspectives of family caregivers, service providers, and mental health administrators

BACKGROUND

Mental health service utilization remains a challenge in developing countries, with numerous barriers affecting access to care. Albeit data suggest poor utilization of mental health services in the Bolgatanga Municipality in Ghana, no studies have explored the barriers to the utilization of mental health services. Therefore, this study explored the perspectives of family caregivers, service providers, and mental health service administrators on the barriers to mental health service utilization in the Bolgatanga Municipality, Ghana.

METHODS

A qualitative descriptive design was employed for the study. Nineteen participants were purposively sampled from two hospitals including fifteen family caregivers, two service providers, and two mental health administrators. Data were collected through individual in-depth interviews using a semi-structured interview guide. Audio-recorded interviews were transcribed verbatim and thematically analyzed using NVivo 12 pro software.

RESULTS

Five main themes emerged including individual-level barriers, interpersonal barriers, community-level barriers, organizational-level barriers, and policy-level barriers. At the individual level, lack of insight, poor treatment compliance, and financial challenges were prominent barriers. Interpersonal barriers included family pressure influenced by cultural and spiritual beliefs. At the community level, stigma and mental health illiteracy were identified as significant barriers. At the organizational level, barriers encompassed inadequate staffing, limited space, and staff attitudes. Policy-level barriers included the neglect of mental health in policies and the non-inclusion of mental health services in the National Health Insurance Scheme.

CONCLUSION

This study highlights the complexity of barriers to mental health service utilization and underscores the need for a comprehensive approach to address them. Collaborative efforts involving healthcare providers, policymakers, communities, and families are essential to mitigate these barriers. It is imperative to consider these barriers when developing strategies to improve the utilization of mental health services in Ghana.

Analysis of factors associated with family disease burden and correlation with social support among family caregivers of patients with severe mental illnesses

BACKGROUND

Caregivers are responsible for the home care of family members with severe mental illnesses (SMIs) and their lives are often subject to changes that can create stress and burden. The purpose of this study was to explore the current state of family disease burden and its correlation with social support among family caregivers of SMIs patients.

METHODS

Using a random sampling method, a total of 1,108 family caregivers of SMIs patients in community health service centers were selected. A general information questionnaire of family caregivers and patients, the Family Disease Burden Scale, and the Social Support Rating Scale were used.

RESULTS

The score of the Family Disease Burden Scale of 1108 family caregivers was 16.57 ± 10.65. Family disease burden was negatively correlated with social support (p < .05). The main influencing factors of family disease burden were average annual family income, duration of illness, distance to medical care, risk of unpredictable behavior, social support, caregiver-patient relationship, gender, and comorbid chronic conditions (p < .05).

CONCLUSION

Family caregivers of SMIs patients have a relatively low level of caregiver-perceived social support. Interventions to enhance perceived social support could help maintain the health of family caregivers and improve the quality of family care.

Mental illness and help-seeking behaviours among Middle Eastern cultures: A systematic review and meta-synthesis of qualitative data

BACKGROUND

Western literature has long explored help-seeking behaviours related to mental health issues. However, this has been relatively neglected in the Middle East despite an increase in mental health needs in the region. The purpose of this review was to conduct a systematic review and qualitative meta-synthesis exploring help-seeking behaviours related to mental health issues in the Middle East.

METHODS

We conducted a systematic review and meta-synthesis to gain a comprehensive overview of what is known about mental health and help-seeking behaviours in the Middle East from published qualitative research in the Middle Eastern region. A search of electronic databases (MEDLINE, Embase, CINAHL, PsycINFO and QScience) was carried out from inception to July 2022. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool, and the review protocol was pre-registered with PROSPERO (Ref: CRD42022311494).

RESULTS

We identified 16 qualitative studies exploring mental health-seeking behaviours in Middle East countries. Facilitators and barriers to help-seeking were captured under six overarching themes. Across all studies, we identified negative attitudes towards seeking help for mental health issues, economic and structural barriers to accessing mental healthcare, and misconceptions surrounding religious beliefs, all of which had a critical role in impacting decisions to seek mental healthcare services. Many sought help from alternative sources, such as traditional healers or family members before consulting a healthcare professional. The role of the family and cultural norms was also identified as key contributors to people's help-seeking behaviours.

CONCLUSIONS

This meta-synthesis indicates the existence of many challenges surrounding mental health-seeking in the Middle East, including public and internalizing stigmas. This suggests an urgent need for an increase in psychoeducation and mental health awareness in the region.

Growing up with a sibling with depression: A qualitative study in Israel

Depression has major consequences for the entire family, among them emotional distress, disrupted daily routine and social damage caused by negative stigmas. The aim of this study was to explore the retrospective experiences of young adults who lived with a sibling with depression while they were adolescents. The present study adopted a qualitative-phenomenological approach. The research participants were recruited via purposive sampling on social networks across Israel from May to September 2022. Semi-structured interviews were conducted with 21 participants aged 18-29 who lived with a sibling with depression during their adolescence. Data collection continued until saturation of concepts was reached. The results underwent thematic analysis. Three themes emerged from the qualitative analyses: 1) "I felt like I was living in a minefield": Adolescence while living with a sibling with depression; 2) "One step forward and two steps back": Siblings' coping strategies; 3) "My parents were not there for me when I needed them": Participants' experiences with their parents during their adolescence. The research findings indicate that adolescents who grew up with a sibling affected by depression had to cope with an acute family crisis, whose serious ramifications required emotional and social support. Mental health professionals and counselors working within educational institutions and the broader community should provide support and intervention for adolescents who have siblings struggling with depression. This intervention may take the form of individual or group therapy that aims to foster a sense of belonging and help affected individuals. Creating a supportive environment that meets the needs of the affected siblings is also crucial in addressing this issue effectively.

Strategies for Alleviating the Burden Experienced by Informal Caregivers of Persons With Severe Mental Disorders in Transitional Countries: Protocol for a Scoping Review

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.

Perceived social support and family members of patients with mental disorders: A mixed method study

Introduction

Family members are the caregivers to patients with mental disorders at home, and the mental and spiritual pressures caused by this responsibility necessitate physical, mental, and perceived social support for these families. The present mixed method study is an attempt to elaborate on the perceived social support by Iranian families of patients with chronic mental disorders.

Materials and methods

Using a sequential mixed method explanatory study (quantitative and qualitative), 200 family members of patients with chronic mental disorders were selected through convenient sampling (quantitative phase). Data gathering was started using a demographics form and Stewart and Sherburne's perceived social support scale. The qualitative phase included 10 participants who obtained low scores in the quantitative phase and took part in private, face-to-face, in-depth, and semi-structured interviews. The data obtained in the quantitative phase were analyzed using statistical tests, and the interviews were analyzed using qualitative content analysis.

Findings

The perceived social support by the participants was at a moderate level in different fields of tangible support, information and emotional support, kindness, and positive social interactions. The results of the qualitative phase revealed social support status in 15 subcategories, 6 categories, and 2 themes of support and acceptance by family, relatives, and friends, with support and being understood by society. The results of the qualitative and quantitative sections emphasized the needs of the patient's family members (who acted as caregivers for patients) for support in family, social, and emotional areas.

Conclusion

The family members of patients with chronic mental disorders have different needs in the area of perceived social support. Such needs are more tangible in family members such as children with mentally ill parents or parents with mentally ill children. The results of this study can be used for educational and supportive planning for caregivers of patients, most of whom are family members.

Patients' and primary carers' views on clozapine treatment for schizophrenia: A cross-sectional study in Qatar

Subjective views of clozapine treatment among patients with schizophrenia in the Middle East and North African MENA Region have not previously been assessed. Globally, few studies have assessed the views of carers to clozapine treatment. We conducted a cross-sectional survey, using a clinician administered structured interview, of patients with schizophrenia/schizoaffective disorder prescribed clozapine in Qatar, and their primary carers. Participants were asked to rate clozapine against prior their antipsychotic treatment in terms of specific benefits and side effects. Forty-two patients and 33 carers participated in the study. Of the patients, two thirds were male, approximately half were Qatari and the mean age was 33.9 years. Patients and carers rated clozapine as superior to prior antipsychotic treatment on all 7 potential benefits inquired about. The greatest perceived benefit was improved mood. Patients rated clozapine as less likely to cause extrapyramidal side effects but more likely to cause 18 other potential side effects compared to prior antipsychotic treatment, with the greatest difference being for nocturnal salivation, increased appetite, and constipation. Nearly half of patients (48 %) and two thirds of carers (64 %) stated that they would have preferred to start clozapine earlier in their illness. Sixty percent of patients and 37 % of carers regarded the information that they had received from health professionals on clozapine as inadequate. Less than half of patients and approximately-two thirds of carers had adequate knowledge of haematological monitoring for clozapine. Generally, there were significantly positive correlation between patients and carers regarding the overall side effects of clozapine treatment. Likewise, improvement in hearing voices paranoid thoughts correlated with improved quality of life. In summary, the results show that patients and carers appreciate the benefits of clozapine despite its side effects being problematic. The results support clozapine being offered earlier in treatment and services providing more information on clozapine to patients and carers.

Combating with Compassion Fatigue: The Perspective of Family Caregivers of People with Schizophrenia

PURPOSE

The purpose of this study was to explore the coping processes used by family caregivers of individuals with schizophrenia to deal with compassion fatigue (CF).

METHODS

Grounded theory was used in this study. For recruitment, purposive and theoretical samplings were used to recruit participants. Data were collected from 29 family caregivers through in-depth interviews and field notes. Data were analyzed using constant and comparative methods.

RESULTS

The study revealed a core process for dealing with CF as "Combating with compassion fatigue" that comprised three dynamic phases: strengthening attachment with the care recipient to increase willpower, learning how to deal with the illness, and self-empowerment to fight to the physical and mental fatigue.

CONCLUSIONS

Family caregivers of people with a diagnosis of schizophrenia use various strategies to fight to CF. These combine the past experiences of strategies that work and new approaches. Our research will allow mental health professionals to provide basic strategies to family caregivers of people with a diagnosis of schizophrenia to help them to cope with CF.

Exploring the Mental, Social, and Lifestyle Effects of a Positive COVID-19 Infection on Syrian Refugees in Jordan: A Qualitative Study

Migrants and refugees are among the vulnerable populations that suffered disproportionately from the COVID-19 crisis. However, their experiences with COVID-19 positivity status have not been investigated. This study explored the physical, mental, and psychosocial impacts of a positive COVID-19 diagnosis on Syrian refugees living in Jordan. Using a qualitative approach, twenty phone interviews were conducted with ten adult Syrian refugees living within the camp and ten refugees living in non-camp (host community) settings in Jordan. Follow-up interviews with five health care providers at a refugee camp were conducted to explore the services and support provided to the refugees with COVID-19 infection. The findings were thematically analyzed and grouped into major themes, subthemes, and emerging themes. Refugees living within camp settings had better access to testing, healthcare, and disease management and did not experience fear of being deported. Refugees in both settings suffered mental and psychosocial health impacts, social isolation, fear of death, and disease complications. COVID-19 infection has negatively impacted refugees' well-being with noticeable disparities across the different living conditions. Refugees living within host community settings may need more support for managing their condition, accessibility to free testing, as well as treatment and healthcare services.

Evaluating family knowledge about sexual health in patients with severe mental illness: a qualitative study in Iran

INTRODUCTION

Although paying more attention to sex education in patients with severe mental illness is recommended in the literature, the role of families has not been specifically clarified.  AIM: This study aims to explore family knowledge about sexual health in patients with severe mental illness in Iran.

METHODS

We conducted a total number of 21 interviews with 4 patients, 5 families, 7 psychiatrists, 1 general practitioner, 2 nurses, and 2 psychologists through purposive sampling. The text was analyzed using conventional qualitative content analysis.

RESULTS

The family knowledge about patients' sexual health is described in three subcategories: 'informal sources for knowledge acquisition', 'common myths, and 'inappropriate reaction to the patients' needs".

CONCLUSIONS

Family sex education should be integrated into a comprehensive rehabilitation program to promote sexual health in patients with severe mental illness. Family members should be aware of the necessity of accurate information about patients' sexual concerns.