Spotlight on sibling involvement in schizophrenia treatment

The psychosocial stressors of siblings of people with experiences of psychosis (SOPEP): A systematic narrative review across cultures

OBJECTIVES

This study aimed to synthesise the psychosocial stressors of siblings of people with experiences of psychosis (SOPEP). Understanding the specific needs of siblings across diverse cultures would help mental health services to provide culturally specific psychosocial family and sibling-centred support. This may result in improved relationships between families, better psychosocial well-being for siblings and better outcomes for patients.

METHODS

Following PRISMA guidelines, a systematic review was conducted to explore the psychosocial stressors of SOPEP. Six databases were utilised to identify literature using qualitative methodology.

RESULTS

Twenty-two studies were included that investigated the Psychosocial Stressors of SOPEP. SOPEP's experiences were influenced by various stages: individual factors, social factors, physical and macro-level environments. Six key components contributed to SOPEP's psychosocial stressors and facilitated or hindered their intentions, behaviours and experiences of caregiving. These were the SOPEP's beliefs about psychosis, caregiving beliefs, family and cultural values, personality traits, pragmatic challenges and access to resources.

CONCLUSIONS

Globally, SOPEP and families may benefit from their involvement in family interventions and individual support that facilitates caregiving and acknowledges their responsibilities, resources, psychosocial needs and emotional experiences.

Experiences of familial stigma among individuals living with mental illnesses: A meta-synthesis of qualitative literature from high-income countries

WHAT IS KNOWN ON THE SUBJECT?: Mental illness stigma has been long acknowledged as a social problem that continues to persist and contribute to social exclusion of affected persons globally. Researchers have explored mental illness stigma in the general public and among health professionals, with little focus on stigma from family members and close relatives of persons with mental illnesses. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study appears to be the first meta-synthesis of familial mental illness stigma in high-income countries. Family members or close relatives of persons with mental illnesses may be perpetrators of stigma. That is, the family may enact stigma of mental illness against their relative to "save face" or by avoiding or narrowing their social contacts. Familial stigma is harmful due to the likely disaffection it brings within one's home environment. Familial mental stigma from the existing literature seems to be a by-product of public stigma and stigma by association WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further research is necessary to look at the existence of familial mental illness stigma as well as available policies to reduce its impact on affected individuals in high-income countries. Researchers in high-income countries should endeavour to examine the relationship between familial, public and associative stigma to establish baseline metrics to inform future anti-stigma programs seeking to reduce familial mental illness stigma.

ABSTRACT

INTRODUCTION: Familial mental illness stigma is a pervasive issue but very subtle in high-income countries. Familial mental illness stigma implies persons living with mental illnesses are discriminated against by their family members or close relatives.

AIM/QUESTION

This meta-synthesis explored the experiences of familial stigma among individuals living with mental illnesses in high-income countries, focusing on empirical literature, to understand the breadth of current literature and ways to reduce this form of stigma.

METHOD

We conducted a meta-synthesis through a structured search of qualitative data from six electronic databases (Sociological Abstract, CINAHL, Medline, PsycINFO, Google Scholar and Embase). Inclusion criteria comprised: empirical primary research, primary technique for data collection is qualitative, studies published in a peer-reviewed journal in the English language between 2000 and 2020, studies reported on experiences of familial mental illness stigma, and studies conducted in high-income countries. The exclusion criteria were as follows: all grey literature, studies not written in English and non-peer-reviewed, studies not focused on familial mental illness stigma, quantitative peer-reviewed articles on the related concept and peer-reviewed articles on the related topic before the year 2000.

RESULTS

The study identified only 28 peer-reviewed articles on the topic within two decades. Concealment of familial stigma was found to be detrimental due to the potential for alienation within one's home environment. Disclosure and social contact within the family system were considered as critical interventions to provide some safety nets for individuals with mental illnesses.

DISCUSSION AND IMPLICATIONS FOR PRACTICE

The paucity of studies over the review period highlights the need for further attention to support optimal environments for persons living with mental illnesses. Families' understanding of the difficulties of mental illness stigma is vital to supporting the development of policies and interventions towards the avoidance of social exclusion within societies. Families should make concerted efforts to reduce stigma, and this includes within the family system. Education and training approaches around mental illness-related stigma should involve individuals with lived experience and their families, as well as service providers and the general public.

Exploring the experience of relatives living with individuals diagnosed with schizophrenia in Oman: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Relatives of individuals diagnosed with schizophrenia experience financial, social, emotional and physical burden. There is a lack of studies on the experience and needs of caregivers of individuals diagnosed with schizophrenia in the Arab world. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first qualitative study to reflect the voice of parents, siblings and spouses living with schizophrenia in the Arab world. The study explored the needs of relatives of hospitalized patients. This study revealed some positive elements of caregiving experience, especially among siblings. The concept of stigma resistance may guide the establishment of stigma reduction programmes. Violence towards the relatives or vice versa is a sensitive issue that needs to be addressed and reported. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should address parents, spouses and siblings' specific needs and challenges to include them in their relatives' treatment plan. Understanding the experience, feelings and needs of relatives living with schizophrenia would enable mental health nurses to provide a range of interventions to help reduce caregivers' burden and promote the positive gains from the caregiving experience. The study emphasizes the need for culturally adapted family interventions to effectively assist relatives in providing care and adjusting to the caregiving role. ABSTRACT: Introduction Relatives of individuals diagnosed with schizophrenia often experience positive and negative impacts. Much of the literature on family experience with schizophrenia comes from western culture, and less is known about Arabic speaking countries. There has been no previous attempt to qualitatively investigate the lived experience of relatives of hospitalized patients with schizophrenia in the Arab world. Aim To explore the experience and needs of Omani relatives of hospitalized patients diagnosed with schizophrenia. Method Qualitative semi-structured interviews with twenty relatives of hospitalized patients from Oman. The interviews were analysed using framework analysis. Results Parents, spouses and siblings were confronted with a burden specific to the demand of different life situations, and their needs differ accordingly. The findings showed four themes: burden, stigma, violence and needs. Discussion This study provides insight into the experience of Omani relatives living with schizophrenia. Although the caregiving experience appears negative, some positive elements of caregiving experience were prominent among siblings. Furthermore, the violence phenomenon among individuals with schizophrenia needs to be addressed as a priority. Implications for practice Understanding the experience, feelings and needs of relatives living with schizophrenia would enable mental health nurses to provide a range of interventions to help reduce caregivers' burden and promote the positive gains from the caregiving experience. The concept of stigma resistance in the Arab world may guide the establishment of stigma reduction programmes.

Adult Sibling Relationships: Perspectives of Service Users with Mental Health Difficulties

Little is known about the perceptions of sibling relationships from the direct perspective of service users with mental health difficulties; this study aimed to address this gap. Semi-structured interviews were carried out with adult male inpatients who had severe and enduring mental health difficulties. Interpretative phenomenological analysis was used to analyse the data and revealed three main themes: (1) The closeness of the sibling bond; (2) The change in sibling dynamics following diagnosis and admission; (3) Siblings' contribution to mental health and recovery. The implications of involving siblings in care and the benefits of service user led research are discussed.

Experiences of caregivers of family member with schizophrenia in China: A qualitative study

PURPOSE

To explore the experience of caregivers of family members with schizophrenia.

DESIGN AND METHODS

A qualitative approach was adopted to examine the experience of caregivers of people with schizophrenia. The researcher conducted semi-structured interviews with 16 participants recruited through purposive sampling.

FINDINGS

The change findings encompassed five major themes: (a) loss of personal life, (b) mixed emotions, (c) changes in family relationships, (d) the need for professional support and help, and (e) coping strategies.

PRACTICE IMPLICATIONS

Clinicians, including nurses, must be aware of the cultural importance of mental illness, particularly the widespread cultural beliefs and patterns of help-seeking behaviors, to provide culturally sensitive health care and develop empirical strategies for helping both these caregivers and their dependents.

Perspectives about Illness, Attitudes, and Caregiving Experiences among Siblings of Persons with Schizophrenia: A Qualitative Analysis

BACKGROUND

Siblings of persons diagnosed with schizophrenia (SPS) are one among the major sources of support for persons with schizophrenia. There is a dearth of psychosocial literature on SPS in India. This qualitative study explored the perspectives about the illness, attitudes, and caregiving experiences of SPS.

MATERIALS AND METHODS

Qualitative audio-recorded interviews were conducted with 15 SPS, purposively selected from a tertiary mental health hospital of Southern India. A general inductive approach was adopted to analyze the qualitative data.

RESULTS

Four broad themes were identified from qualitative data analysis. (1) SPS described several explanatory models of mental illness in terms of causal attributions and treatment care. (2) They had expressed emotion toward their ill siblings, such as criticality, hostility, and emotional over-involvement. (3) They experienced objective and subjective burden while caring for their ill sibling. In spite of all these, (4) they were part of their ill siblings' care in terms of ensuring regular follow-ups and drug adherence and supported their livelihood. They coped up with adaptive as well as maladaptive strategies.

CONCLUSION

SPS provide significant support to their affected siblings. However, they do have non-biomedical models of mental illness and negative attitudes toward patients and experience burden. Hence, psychosocial interventions may help SPS while caregiving for their affected siblings.

What is related to the well-being of the siblings of patients with schizophrenia: An evaluation within the Lazarus and Folkman's Transactional Stress and Coping Model

BACKGROUND

Schizophrenia is a chronic mental illness that strongly affects not only the patients with schizophrenia, but also their families and close relatives. So far, family research on patients with schizophrenia has mainly focused on parents, but has neglected siblings.

AIM

This study aims to evaluate the well-being of 103 siblings of patients with schizophrenia within the Lazarus and Folkman's Transactional Coping and Stress Model.

MATERIALS

A Sociodemographic Information Form, Subjective Well-being Scale, Zarit Caregiver Burden Scale, Multidimensional Perceived Social Support Scale, Ways of Coping Scale and Shortened Perceived Parental Rearing Styles Form were administered to the siblings of patients with schizophrenia.

RESULTS

The results of this study revealed that well-being was associated with perceived mother overprotection, perceived social support, problem-focused coping and indirect coping. Social support moderated the relationship between burden and well-being as a buffering factor.

CONCLUSION

Therefore, siblings of patients with schizophrenia should be given access to social support and their problem-focused coping strategies should be strengthened. Besides, parents should be supported to provide suitable care for the siblings of patients with schizophrenia.

Women who suffer from schizophrenia: Critical issues

Many brain diseases, including schizophrenia, affect men and women unequally - either more or less frequently, or at different times in the life cycle, or to varied degrees of severity. With updates from recent findings, this paper reviews the work of my research group over the last 40 years and underscores issues that remain critical to the optimal care of women with schizophrenia, issues that overlap with, but are not identical to, the cares and concerns of men with the same diagnosis. Clinicians need to be alert not only to the overarching needs of diagnostic groups, but also to the often unique needs of women and men.

Short term effects of brief need based psychoeducation on knowledge, self-stigma, and burden among siblings of persons with schizophrenia: A prospective controlled trial

Siblings of persons with schizophrenia are important in providing long-term social support to the patients. Interventions addressing their needs are very sparse. Hence, this study aimed at testing the short-term effects of brief need based psychoeducation on knowledge, self-stigma, and burden among siblings of persons with schizophrenia. In this prospective controlled open label trial, 80 siblings of persons with schizophrenia were allocated in equal numbers to the brief need based psychoeducation group and the treatment-as-usual group. The outcomes were measured at baseline, and after the first and third month post-intervention. RM-ANCOVA was conducted to test the effect of the brief psychoeducation on outcome scores. The groups were similar with respect to socio-demographic, clinical, and outcome scores at the baseline. There was a significant group×time interaction effect on knowledge (F=8.71; p<0.01; η_p²=0.14) and self-stigma scores (F=14.47; p<0.001; η_p²=0.21), wherein the brief psychoeducation group showed a significant increase in knowledge and reduction in self-stigma with medium effect size through baseline to the third month follow-up as compared to the treatment as usual group. We also observed a significant main effect of time; irrespective of the group allocation, there was a significant increase in the knowledge through baseline to third month follow-up (F=5.69; p=0.02; η_p²=0.09). No main or interaction effects of group and time were observed on burden. The findings suggest that brief need based psychoeducation may increase knowledge about the illness and reduce self-stigma. Further systematic studies are warranted to test this intervention for long-term effects.

Experiences of caring for a sibling with schizophrenia in a Chinese context: A neglected issue

Adult clients with schizophrenia are primarily cared for by their ageing parents. When the parents become ill or die, siblings are considered to be responsible for taking over the caregiving role. However, little is known about caregiving for a sibling with schizophrenia, and no studies have explored this phenomenon in an Asian context. The aim of the present descriptive, qualitative study was to understand the experiences of being the primary caregiver of a sibling with schizophrenia. Data were collected from 10 siblings of currently-hospitalized patients diagnosed with schizophrenia using semistructured, in-depth interviews. Recorded interviews were transcribed and analysed by qualitative content analysis. This analysis identified four themes: (i) stepping forward to become caregiver; (ii) challenges of caregiving; (iii) need for support; and (iv) worries about future care. Our findings suggest that mental health-care professionals should involve all family members, including siblings, in the care plan for the person with schizophrenia, and provide appropriate psychoeducation for all family members to reduce not only the tension and stress of current caregiving, but also anxieties about future care.

Wellbeing, mental health knowledge and caregiving experiences of siblings of people with psychosis, compared to their peers and parents: an exploratory study

PURPOSE

The wellbeing and caregiving experiences of family carers supporting people with psychosis has garnered increasing interest. Evidence indicates that the burden of caregiving can adversely impact on parents' wellbeing, few studies have investigated whether this is also the case for siblings, who often take on caregiving responsibilities. This exploratory study investigated the wellbeing, mental health knowledge, and appraisals of caregiving in siblings of individuals with psychosis.

METHOD

Using a cross-sectional design, 90 siblings completed three validated questionnaires: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), Mental Health Knowledge Schedule (MAKS), and Experience of Caregiving Inventory (ECI). Data obtained were compared to general population norms and parent-carers' scores. Multi-variable regression analyses were conducted to examine relationships between questionnaire scores and demographic characteristics including age, sex, birth order, marital status, accommodation and educational level.

RESULTS

Siblings, especially sisters, had significantly poorer mental wellbeing, compared to normative scores. Conversely, they had better mental health knowledge. Siblings and parent-carers had comparable high levels of negative appraisals of caregiving experiences, but siblings reported more satisfaction with personal experiences and relationships. Education level was a significant predictor for better mental health knowledge; there were no other relationships between siblings' demographic factors and outcomes.

CONCLUSION

Study findings suggest that siblings have overlapping as well as distinct needs, compared to parent-carers. Further research is required to better understand siblings' experiences so as to inform development of targeted interventions that enhance wellbeing and caregiving capacity.

Assessing the needs of siblings of persons with schizophrenia: A qualitative study from India

There is a lack of studies on siblings of persons with schizophrenia (SOPS) in Asia. This study aims to explore the needs of SOPS in India. 15 SOPS participated in this qualitative explorative study. All the interviews were audio recorded and later transcribed. Data analysis was carried out using General Inductive Approach. Five themes emerged from the data: managing illness or socio-occupational functioning; follow up services; informational needs; personal needs; and miscellaneous needs. SOPS in India have some distinctive needs. Identifying these needs might help in developing and designing specific psychosocial interventions for better management.

Family adjustment and interventions in neurodevelopmental disorders

PURPOSE OF REVIEW

Developmental disabilities are increasingly recognized, and remarkable progress is being made on the genetic and neurobiological underpinnings of many disorders. Yet, only a tiny percentage of the disability literature addresses families of children with disabilities. A review of recently published family studies reveals salient trends and gaps.

RECENT FINDINGS

Consistent with previous work, high levels of parent stress, illness, anxiety, and depression are apparent. Studies in the USA focused on parents of children with autism; in contrast, studies on parents of children with intellectual disabilities were almost always conduced abroad. Compared to other disabilities, families of children with psychiatric disorders and genetic syndromes are understudied. The majority of family studies are descriptive, with very few trials or interventions aimed at reducing parental stress. Of these, mindfulness practices and a peer-mentor model of treatment delivery hold much promise for effective stress reduction. Psychoeducational programs and respite care are differentially beneficial.

SUMMARY

A new era of family intervention research is in order. This work can take advantage of many advances in telemedicine, peer-mentor models, smart technology, and biomarkers as indices of change. Benefit could also stem from group interventions with parents who share similar concerns, regardless of their child's diagnostic label.