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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.
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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
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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.
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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
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Wang YZ, Weng X, Zhang TM, Li M, Luo W, Wong YLI, Yang LH, Thornicroft G, Lu L, Ran MS. Effectiveness of enhancing contact model on reducing family caregiving burden and improving psychological wellbeing among caregivers of persons with schizophrenia in rural China. Psychol Med 2023; 53:5756-5766. [PMID: 36154947 DOI: 10.1017/s0033291722002987] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is unclear whether the enhancing contact model (ECM) intervention is effective in reducing family caregiving burden and improving hope and quality of life (QOL) among family caregivers of persons with schizophrenia (FCPWS). METHODS We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin, Chengdu, China. In total, 253 FCPWS were randomly allocated to the ECM, psychoeducational family intervention (PFI), or treatment as usual (TAU) group. FCPWS in three groups were assessed caregiving burden, QOL and state of hope at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up, respectively. RESULTS Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower caregiving burden scores both at T1 and T2 (p = 0.0059 and 0.0257, respectively). Compared with participants in the TAU group, participants in the PFI group had statistically significantly higher QOL scores in T1 (p = 0.0406), while participants in the ECM group had statistically significantly higher QOL scores in T3 (p = 0.0240). Participants in both ECM and PFI groups had statistically significantly higher hope scores than those in the TAU group at T1 (p = 0.0160 and 0.0486, respectively). CONCLUSIONS This is the first study to explore the effectiveness of ECM on reducing family caregiving burden and improving hope and QOL in rural China. The results indicate the ECM intervention, a comprehensive and multifaceted intervention, is more effective than the PFI in various aspects of mental wellbeing among FCPWS. Future research needs to confirm ECM's effectiveness in various population.
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Affiliation(s)
- Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
| | - Xue Weng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China
| | - Tian-Ming Zhang
- Department of Social Work, Shanghai University, Shanghai, China
| | - Ming Li
- Chengdu Xinjin Second People's Hospital, Chengdu, China
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, Chengdu, China
| | | | - Lawrence H Yang
- Department of Social and Behavioral Sciences, New York University, USA
- Department of Epidemiology, Columbia University, NY, USA
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Wang YZ, Meng XD, Zhang TM, Weng X, Li M, Luo W, Huang Y, Thornicroft G, Ran MS. Affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia in rural China. Int J Soc Psychiatry 2023; 69:1024-1032. [PMID: 36708508 DOI: 10.1177/00207640231152206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although stigma and caregiving burden are important in relation to mental health recovery, few studies have been conducted on affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia (FCPWS) in rural China. AIMS This study aimed to examine the severity level of affiliate stigma and caregiving burden, and identify the correlates among FCPWS in rural China. METHODS A mental health survey was conducted (N = 253 FCPWS) in Xinjin county, Sichuan province, China. Affiliate Self-Stigma Scale and Zarit Burden Interview Short Form were used. The regression analysis was performed to explore the correlates of stigma and burden. RESULTS Most FCPWS reported experiencing high and severe level of affiliate stigma (78.66%) and caregiving burden (95.26%). Family caregivers who were middle aged, unemployed, with high caregiving burden and low quality of life (QoL), showed more severe affiliate stigma. Family caregivers who were female, older, with low income, high affiliate stigma and low QoL, experienced greater caregiving burden. CONCLUSIONS The large majority of FCPWS in rural China experienced severe affiliate stigma, caregiving burden and poor QoL. It is crucial to develop culture-specific anti-stigma interventions to reduce caregivers' stigma and caregiving burden, and improve QoL. Specific risk factors of family caregivers' affiliate stigma and caregiving burden should be considered for development of health policy and community-based mental health services.
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Affiliation(s)
- Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
| | - Xian-Dong Meng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tian-Ming Zhang
- Department of Social Work, Shanghai University, Shanghai, China
| | - Xue Weng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China
| | - Ming Li
- Chengdu Xinjin Second People's Hospital, China
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, China
| | - Yi Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, King's College London, UK
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Eiroa-Orosa FJ, San Pío MJ, Marcet G, Sibuet I, Rojo E. Interaction between the Participation in and the Impact on Mental Health Service Users and Their Relatives of a Multicomponent Empowerment-Based Psychosocial Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13935. [PMID: 36360813 PMCID: PMC9654201 DOI: 10.3390/ijerph192113935] [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: 09/13/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Relatives play an important role in the recovery journey of mental health service users. Interventions directed either at service users or their relatives may influence the other person as well. The project 'Activa't per la salut mental' (Get active for mental health) consisted of a series of four interventions addressed at people diagnosed with mental disorders and their relatives to help them in their recovery process, increasing their agency and quality of life. The main objective of the present study is to evaluate the interaction of the participation of service users on their relatives' outcomes and vice versa. The impact of the project was evaluated within a randomised controlled trial. The treatment group had access to all the circuit interventions, while the control group received treatment as usual and could only access one of the interventions. All participants were evaluated at baseline, six months, and twelve months after the end of the first intervention. Service users were evaluated with the Stages of Recovery Instrument, and relatives with the Family Burden Interview Schedule II and the Duke-UNC-11 questionnaires. The interaction of participation and impact between service users and their relatives was analysed by means of correlational analyses within the intervention group (n = 111, service users mean age = 40.6, 40% women; relatives mean age = 56.7, 72% women). Service users' baseline characteristics (being in a relationship, educational level, employment, and younger age) influenced in the level of participation of relatives and vice versa (lower educational level). The results also indicated correlations between participation and outcomes at various points as well as the evolution of service users' recovery and the care burden of relatives. Service users' participation levels interacted with the decrease of relatives' frequency of burden and the first steps of their own recovery journey (moratorium, awareness, and preparation) while relative's participation just interacted with the evolution of two stages of service users' recovery levels (preparation and growth). These results can be extremely helpful in fostering interactive benefits in future projects addressing the wellbeing of mental health service users and their relatives. Future studies could use specific designs to explore the directionality of the causality of these effects.
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Affiliation(s)
- Francisco José Eiroa-Orosa
- First-Person Research Group, Veus, Catalan Federation of 1st Person Mental Health Organisations, 08035 Barcelona, Catalonia, Spain
- Section of Personality, Assessment and Psychological Treatment, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Catalonia, Spain
| | | | - Gemma Marcet
- Federation Mental Health Catalonia, 08002 Barcelona, Catalonia, Spain
| | - Isabela Sibuet
- First-Person Research Group, Veus, Catalan Federation of 1st Person Mental Health Organisations, 08035 Barcelona, Catalonia, Spain
| | - Emilio Rojo
- Hospital Benito Menni CASM, Sisters Hospitallers, 08830 Sant Boi de Llobregat, Catalonia, Spain
- Department of Psychiatry, International University of Catalonia, 08195 Sant Cugat del Vallès, Catalonia, Spain
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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.
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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
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7
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Onwumere J, Grice S, Kuipers E. Delivering Cognitive‐Behavioural Family Interventions for Schizophrenia. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12179] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Juliana Onwumere
- Institute of Psychiatry, Psychology & Neuroscience, King's College London,
| | - Sarah Grice
- Institute of Psychiatry, Psychology & Neuroscience, King's College London,
- South London & Maudsley NHS Foundation Trust, and
| | - Elizabeth Kuipers
- Institute of Psychiatry, Psychology & Neuroscience, King's College London,
- In affiliation with the Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neurosciences
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8
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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.
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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
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Stiekema APM, van Heugten CM, de Vugt ME. Joining forces to improve psychosocial care for people with cognitive deficits across diagnoses: social health as a common framework. Aging Ment Health 2019; 23:1275-1281. [PMID: 30450949 DOI: 10.1080/13607863.2018.1498446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cognitive deficits such as memory problems have a major impact on independence in daily life and participation in society in several populations, such as people with dementia, brain injury (i.e. stroke) or a severe mental illness such as schizophrenia. Similarities in the impact on participation and well-being have resulted in the development of comparable psychosocial interventions across populations, aiming to support people to adapt to cognitive deficits or by adapting the environment. These interventions are developed separately, without using the expertise in other fields. We argue that each of the fields and the field of psychosocial care in general would benefit from closer collaboration on development and evaluation of innovative psychosocial interventions. Collaboration has been complicated by the use of different care models and theoretical frameworks, each with their own terminology. The concept of social health - the ability to participate in work or other meaningful activities and to feel healthy despite a condition - translates to the leading care models within the fields of dementia, brain injury and severe mental illness. The concept of social health provides a common language and framework. In this paper, we elaborate on strategies for collaboration using examples of interventions to improve social health.
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Affiliation(s)
- Annemarie P M Stiekema
- a School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Caroline M van Heugten
- a School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center , Maastricht , The Netherlands.,b School for Mental Health and Neuroscience, Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University , Maastricht , The Netherlands
| | - Marjolein E de Vugt
- a School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center , Maastricht , The Netherlands
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10
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Clibbens N, Berzins K, Baker J. Caregivers' experiences of service transitions in adult mental health: An integrative qualitative synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e535-e548. [PMID: 31206928 DOI: 10.1111/hsc.12796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 06/09/2023]
Abstract
Approximately 5% of the UK population live with serious mental health problems. Data show that informal caregivers of people with mental illness provide care for the highest number of hours compared to other illness and the economic cost of this care is highest in the UK when compared internationally. People living with serious mental health problems make transitions between different intensities of service as their needs fluctuate, including referral, admission, transfer or discharge. Although caregiving is associated with both stress and positive reward, service transitions are particularly associated with increased stress. This review aimed to investigate what is known about the experiences of informal caregivers during mental health service transitions. An integrative qualitative synthesis was conducted following searches in six bibliographic databases and of the grey literature. Studies published in English between 2001 and 2017 were included if the study focus was on serious mental health problems, the experiences of caregivers and service transitions. Eleven studies were included, appraised using the Mixed Methods Appraisal Tool and synthesised, resulting in four themes: (a) Caregiver information, (b) Caregiver involvement in decisions about care and treatment, (c) Accessing services, (d) Being a caregiver. Caregivers' experiences were similar during transitions to their usual caregiving role but they faced more challenges and their experiences were amplified. Concerns about confidentiality created barriers to information sharing. Continuity of professionals across transitions was helpful. Caregivers struggled to deal with their own conflicting emotions and with the behaviours of the person yet rarely received help. The review findings point to a need for continuity of professionals across service transitions, co-designed and delivered training for professionals and caregivers about information sharing, greater understanding of barriers to implementation of family interventions and interventions that address emotional needs of caregivers.
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Affiliation(s)
| | | | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
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11
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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.
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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
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Stomski NJ, Morrison P. Predictors of burden in Australian mental health caregivers: a cross-sectional survey. J Ment Health 2019; 30:411-416. [PMID: 30862222 DOI: 10.1080/09638237.2019.1581340] [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: 10/27/2022]
Abstract
BACKGROUND The shift towards providing mental healthcare in the community has resulted in caregivers becoming more involved in the delivery of these services. Supporting mental health consumers can be burdensome which, in conjunction with the anguish that may result from observing their relative develop a mental illness, can lead to carers experiencing significant levels of distress. AIMS This study aimed to quantify the extent to which specific aspects of caregiving contribute to mental health burden in Australia. METHODS Participants were included if they were Australian mental health caregivers. An online questionnaire was distributed via email. Multivariate logistic regression was used to identify predictors of burden in mental health caregivers. RESULTS Completed questionnaires were collected from 231 respondents. The logistic regression analysis yielded five factors that contributed significantly to mental health caregiver burden. Of these factors, a strained atmosphere and regularly carrying out tasks for consumers were the two strongest predictors of burden. CONCLUSION Community health professionals could focus on interpersonal relationships between family members, access to disability and financial support services, and carers' views about the quality of healthcare provided to consumers. Addressing these issues may decrease carer burden and improve the quality of life for all family members.
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Affiliation(s)
- N J Stomski
- College of Science, Health, Engineering, and Education, Murdoch University, Perth, Australia
| | - P Morrison
- College of Science, Health, Engineering, and Education, Murdoch University, Perth, Australia
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13
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Sedgwick R, Duff A, Lines S, Akenzua A, Jones F. Family-inclusive practice in a psychiatric intensive care unit. BJPsych Bull 2019; 43:259-263. [PMID: 30855003 DOI: 10.1192/bjb.2019.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and MethodThe National Institute for Health and Care Excellence recommends involving the families of patients admitted to psychiatric hospital care, without specific guidance on how to do it. To improve family involvement in a National Health Service psychiatric intensive care unit, a relatives' and carers' clinic was set up. Fifty family members attended and completed questionnaires. Nine went on to take part in interviews, the results of which were analysed using thematic analysis. RESULTS: Families felt more informed and found the increased access to information useful. They felt that the process showed respect for them and their family member, and that their contribution was valued. Running throughout the interviews was the contrast with previous experiences; families reported feeling heard and understood and attributed this in part to timing and environment.Clinical implicationsThe clinic was viewed positively by families and met the trust's commitment to including carers, as well as national guidance which suggests it should be part of routine practice.Declaration of interestNone.
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Affiliation(s)
- Rosemary Sedgwick
- South London and Maudsley NHS Foundation Trust/King's College London
| | - Alexa Duff
- St George's University Hospitals NHS Foundation Trust
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Stomski NJ, Morrison P, Sealey M, Skeffington P, O'Brien G. The association between gratitude and burden in Australian mental health carers: a cross-sectional study. Scand J Caring Sci 2018; 33:215-221. [PMID: 30311247 DOI: 10.1111/scs.12623] [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] [Received: 11/16/2017] [Accepted: 09/17/2018] [Indexed: 01/29/2023]
Abstract
The level of carer burden has increased as carers take on more responsibility for mental health consumers as a result of the contemporary shift in the delivery of services from institutional to community settings. Interventions are required to mitigate mental health carer burden. Therefore, we examined the association between dispositional gratitude and burden in a cross-sectional survey of 231 Australian mental health carers. Dispositional gratitude was assessed by the S-GRAT, and carer burden was measured using the Involvement Evaluation Questionnaire. The results of a general linear model demonstrated that higher levels of a lack of sense of deprivation were significantly associated with lower levels of tension, worrying and urging. In contrast, higher levels of simple appreciation were significantly associated with higher levels of supervision, worrying and urging. Our findings highlight that gratitude interventions should focus on promoting a lack of sense of deprivation and appreciation of others in order to reduce mental health carer burden.
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Affiliation(s)
| | - Paul Morrison
- School of Health Professions, Murdoch University, Perth, WA, Australia
| | - Margaret Sealey
- School of Health Professions, Murdoch University, Perth, WA, Australia
| | - Petra Skeffington
- School of Health Professions, Murdoch University, Perth, WA, Australia
| | - Geraldine O'Brien
- School of Psychology and Exercise Science, Murdoch University, Perth, WA, Australia
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15
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Zhang T, Xu L, Tang Y, Cui H, Li H, Wei Y, Xu Y, Jiang L, Zhu Y, Li C, Jiang K, Xiao Z, Wang J. Using 'WeChat' online social networking in a real-world needs analysis of family members of youths at clinical high risk of psychosis. Aust N Z J Psychiatry 2018; 52:375-382. [PMID: 28587479 DOI: 10.1177/0004867417712460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The argument surrounding the safety and effectiveness of interventions for the population of individuals at a clinical high risk of developing psychosis has been ongoing for the past 30 years. However, few studies have assessed the needs of this special young population, who are struggling with the recent onset of psychotic symptoms. METHOD The sample consisted of 171 family members of 108 clinical high-risk individuals included from the ShangHai at Risk for Psychosis research programme. A 'WeChat' group was established to provide mutual support. There were 22,007 valid messages sent within the group between 1 April 2015 and 27 June 2016. Chat records were subsequently analysed to determine the needs of families during intervention at the early stages of psychosis. RESULTS Families of clinical high-risk individuals were highly involved in the entire medical process, and the major concerns of the families of clinical high-risk individuals focused on both functional recovery and medication. The themes of 'take medication', 'go to school' and 'study in school' were often discussed within the group. CONCLUSION A family-focused intervention targeting functional recovery and real-time professional explanations of medication would meet the major needs of families of Chinese clinical high-risk individuals.
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Affiliation(s)
- TianHong Zhang
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - LiHua Xu
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - YingYing Tang
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - HuiRu Cui
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - HuiJun Li
- 2 Department of Psychology, Florida Agricultural & Mechanical University, Tallahassee, FL, USA
| | - YanYan Wei
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - YangYang Xu
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - LiJuan Jiang
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - YiKang Zhu
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - ChunBo Li
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - KaiDa Jiang
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - ZePing Xiao
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - JiJun Wang
- 1 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- 3 Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, P.R. China
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16
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Susanti H, Lovell K, Mairs H. What does the literature suggest about what carers need from mental health services for their own wellbeing? A Systematic Review. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30047-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Cort E, Meehan J, Reeves S, Howard R. Very Late-Onset Schizophrenia-Like Psychosis: A Clinical Update. J Psychosoc Nurs Ment Health Serv 2017; 56:37-47. [PMID: 28990640 DOI: 10.3928/02793695-20170929-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/07/2017] [Indexed: 11/20/2022]
Abstract
Psychosis symptoms (delusions and hallucinations) are multifactorial in origin and, in later life, occur in the context of schizophrenia, delirium, dementia, delusional and schizophrenia-like disorders, mood disorders, and alcohol or substance abuse. The current article provides a clinical overview of very late-onset (after age 60) schizophrenia-like psychosis (VLOSLP), summarizing the literature on treatment options and reflecting on the role of psychiatric-mental health nurses (PMHNs). Increased awareness of the clinical presentation, key features, and evidence-based treatment options will assist PMHNs to confidently recognize this often under-diagnosed disorder and adopt a more assertive role in terms of engagement and follow up. Pragmatic research involving individuals with VLOSLP is required to increase the evidence base for treatment and improve outcomes of care. [Journal of Psychosocial Nursing and Mental Health Services, 56(1), 37-47.].
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18
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Jansen JE, Haahr UH, Lyse HG, Pedersen MB, Trauelsen AM, Simonsen E. Psychological Flexibility as a Buffer against Caregiver Distress in Families with Psychosis. Front Psychol 2017; 8:1625. [PMID: 29046649 PMCID: PMC5632725 DOI: 10.3389/fpsyg.2017.01625] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 09/04/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Research has shown that caregivers of persons with psychosis play an invaluable role in recovery, but unfortunately, often report high levels of distress. While cognitive models of caregiver distress have been well-supported, there is still limited knowledge of the psychological factors involved. Recent advances in cognitive behavioral therapy seem to converge on the importance of acceptance- and mindfulness based processes. Aim: To examine the impact of psychological flexibility on caregiver distress in the early phases of psychosis, while controlling for known predictors of caregiver distress. Method: Within a cross-sectional design, 101 caregivers of 38 persons with first-episode psychosis in a clinical epidemiological sample completed a series of self-report measures. Results: A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service user symptoms, drug use and global functioning, psychological flexibility was a significant predictor of caregiver distress. Conclusion: Greater level of psychological flexibility in caregivers, seems to be related to lower levels of caregiver distress. This finding corresponds to studies within a broad range of emotional disorders. There may be important clinical implications in terms of facilitating the process of acceptance through interventions from the ‘third-wave’ or contextual cognitive behavioral therapies.
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Affiliation(s)
- Jens E Jansen
- Mental Health Center Copenhagen, Frederiksberg, Denmark.,Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Ulrik H Haahr
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Hanne-Grethe Lyse
- Early Psychosis Intervention Center, Psychiatry East Region Zealand, Roskilde, Denmark
| | - Marlene B Pedersen
- Early Psychosis Intervention Center, Psychiatry East Region Zealand, Roskilde, Denmark
| | | | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Effectiveness of psychoeducational interventions for family carers of people with psychosis: A systematic review and meta-analysis. Clin Psychol Rev 2017; 56:13-24. [DOI: 10.1016/j.cpr.2017.05.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/25/2016] [Accepted: 05/23/2017] [Indexed: 02/03/2023]
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20
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Onwumere J, Kuipers E. Caregiving roles: when will they be routinely recognized and supported? J Ment Health 2017; 26:95-97. [DOI: 10.1080/09638237.2017.1301649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Juliana Onwumere
- Psychology Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Elizabeth Kuipers
- Psychology Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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21
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Valentini J, Ruppert D, Magez J, Stegbauer C, Bramesfeld A, Goetz K. Integrated care in German mental health services as benefit for relatives--a qualitative study. BMC Psychiatry 2016; 16:48. [PMID: 26921216 PMCID: PMC4769565 DOI: 10.1186/s12888-016-0760-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As mental health services undergo the process of deinstitutionalization, this is resulting in a higher burden of care for relatives. Evidence suggests that interventions for carers have a beneficial impact on their psychological health. A reduction of responsibility for relatives is linked with a significantly improved outcome for the severely mentally ill. The aim of the study was to explore the relatives' experiences with severely mentally ill patients in different integrated care service providers. METHODS Semi-structured focus groups and interviews were conducted with 24 relatives of patients receiving community based integrated care for severe mental illness. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories. RESULTS Four main categories were found related to the structural aspects of the integrated care services and for the experiences of the relatives within these services. Relatives reported that the services offered significant relief and substantial support in daily life. In addition, relatives felt a reduced burden of carer responsibility and therefore that they were provided with more protection and stability. This resulted in a sense of encouragement and not feeling left alone to face challenges. CONCLUSION Relatives are a critical resource for patients suffering from mental health problems and benefit from formal structures and interventions to support them in carer role. An important need is to ensure continuity of care for patients and the bridging of gaps concerning information and support needs for relatives when providing integrated mental health services in the community.
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Affiliation(s)
- Jan Valentini
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany.
| | - Daniel Ruppert
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany.
| | - Julia Magez
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany.
| | - Constance Stegbauer
- AQUA - Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
| | - Anke Bramesfeld
- AQUA - Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
| | - Katja Goetz
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany. .,Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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22
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Stigma- and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers. Psychiatry Res 2015; 228:612-9. [PMID: 26115840 DOI: 10.1016/j.psychres.2015.05.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 04/20/2015] [Accepted: 05/03/2015] [Indexed: 11/23/2022]
Abstract
Delayed treatment seeking for people experiencing symptoms of mental illness is common despite available mental healthcare. Poor outcomes are associated with untreated mental illness and caregivers may eventually need to seek help on the service user's behalf. More attention has recently focused on the role of stigma in delayed treatment seeking. This study aimed to establish the frequency of stigma- and non-stigma-related treatment barriers reported by 202 service users and 80 caregivers; to compare treatment barriers reported by service users and caregivers; and to investigate demographic predictors of reporting stigma-related treatment barriers. The profile of treatment barriers differed between service users and caregivers. Service users were more likely to report stigma-related treatment barriers than caregivers across all stigma-related items. Service users who were female, had a diagnosis of schizophrenia or with GCSEs (UK qualifications usually obtained at age 16) were significantly more likely to report stigma-related treatment barriers. Caregivers who were female or of Black ethnicities were significantly more likely to report stigma-related treatment barriers. Multifaceted approaches are needed to reduce barriers to treatment seeking for both service users and caregivers, with anti-stigma interventions being of particular importance for the former group.
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23
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Yesufu-Udechuku A, Harrison B, Mayo-Wilson E, Young N, Woodhams P, Shiers D, Kuipers E, Kendall T. Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry 2015; 206:268-74. [PMID: 25833867 DOI: 10.1192/bjp.bp.114.147561] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Informal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met. AIMS To determine whether interventions provided to people caring for those with severe mental illness improve the experience of caring and reduce caregiver burden. METHOD We conducted a systematic review and meta-analyses of randomised controlled trials (RCTs) of interventions delivered by health and social care services to informal carers (i.e. family or friends who provide support to someone with severe mental illness). RESULTS Twenty-one RCTs with 1589 carers were included in the review. There was evidence suggesting that the carers' experience of care was improved at the end of the intervention by psychoeducation (standardised mean difference -1.03, 95% CI -1.69 to -0.36) and support groups (SMD = -1.16, 95% CI -1.96 to -0.36). Psychoeducation had a benefit on psychological distress more than 6 months later (SMD = -1.79, 95% CI -3.01 to -0.56) but not immediately post-intervention. Support interventions had a beneficial effect on psychological distress at the end of the intervention (SMD = -0.99, 95% CI -1.48 to -0.49) as did problem-solving bibliotherapy (SMD = -1.57, 95% CI -1.79 to -1.35); these effects were maintained at follow-up. The quality of the evidence was mainly low and very low. Evidence for combining these interventions and for self-help and self-management was inconclusive. CONCLUSIONS Carer-focused interventions appear to improve the experience of caring and quality of life and reduce psychological distress of those caring for people with severe mental illness, and these benefits may be gained in first-episode psychosis. Interventions for carers should be considered as part of integrated services for people with severe mental health problems.
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Affiliation(s)
- Amina Yesufu-Udechuku
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Bronwyn Harrison
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Evan Mayo-Wilson
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Norman Young
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Peter Woodhams
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - David Shiers
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Elizabeth Kuipers
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Tim Kendall
- Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
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Caregiver distress in first-episode psychosis: the role of subjective appraisal, over-involvement and symptomatology. Soc Psychiatry Psychiatr Epidemiol 2015; 50:371-8. [PMID: 25053150 DOI: 10.1007/s00127-014-0935-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Caregivers of persons with first-episode psychosis (FEP) often report high levels of distress. Preventing long-term or chronic distress within the whole family is an important focus of early intervention for psychosis. However, a more comprehensive understanding of the psychological factors involved is needed. AIMS To examine the impact of subjective appraisals and expressed emotion on caregiver distress in FEP. METHOD Within a cross-sectional design, 154 caregivers of 99 persons with FEP in a clinical epidemiological sample completed a series of questionnaires to examine potential predictors of caregiver distress. RESULTS Thirty-seven percent of caregivers were suffering from clinically significant distress. A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service-user symptoms and global functioning, emotional over-involvement and subjective appraisal of caregiving were significant predictors of caregiver distress. CONCLUSION Caregiver distress is significant in the early phase of illness, and this seems to be more related to their subjective appraisal and over-involvement, than to variations in symptoms and global functioning of the person diagnosed with FEP. This lends further support to the stress-appraisal coping model and the cognitive model of caregiving in FEP, and highlights supportive interventions aimed at handling unhelpful cognitions and behaviors.
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25
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Jansen JE, Gleeson J, Cotton S. Towards a better understanding of caregiver distress in early psychosis: a systematic review of the psychological factors involved. Clin Psychol Rev 2014; 35:56-66. [PMID: 25531423 DOI: 10.1016/j.cpr.2014.12.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 12/04/2014] [Accepted: 12/07/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVES We sought to review empirical studies of psychological factors accounting for distress in caregivers of young people with early psychosis. METHOD Following the PRISMA guidelines, we included studies that empirically tested psychological models of caregiver distress in early psychosis by searching the following databases up until March 2014: PsycINFO, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL). This was followed by additional manual searches of reference lists and relevant journals. RESULTS The search identified 15 papers describing 13 studies together comprising 1056 caregivers of persons with early psychosis. The mean age of caregivers was 47.2years (SD=9.8), of whom 71.5% were female and 74.4% were parents. Nine different psychological variables were examined in the included studies, which were categorised in the following non-mutually exclusive groups: coping, appraisal/attribution and interpersonal response. There was considerable data to support the link between distress and psychological factors such as avoidant coping, appraisal and emotional over-involvement. However, the possibilities of drawing conclusions were limited by a number of methodological issues, including cross-sectional data, small sample sizes, confounding variables not being accounted for, and a wide variation in outcome measures. DISCUSSION The strengths of the review were the systematic approach, the exclusion of non-empirical papers and the rating of methodological quality by two independent raters. Limitations were that we excluded studies published in languages other than English, that data extraction forms were developed for this study and hence not tested for validity, and that there was a potential publication bias in favour of significant findings. CONCLUSION AND IMPLICATIONS A better grasp of the psychological factors accounting for caregiver distress early in the course of illness may help us understand the trajectory of distress. This is an important step in preventing long-term distress in caregivers and supporting recovery in the whole family.
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Affiliation(s)
- Jens Einar Jansen
- Early Psychosis Intervention Center/Psychiatric Research Unit, Region Zealand, Smedegade 10, 4000 Roskilde, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark.
| | - John Gleeson
- School of Psychology, Australian Catholic University, Locked Bag 4115, Fitzroy MDC, Victoria 3065, Australia
| | - Sue Cotton
- Orygen Youth Health Research Centre, Locked Bag 10, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, 3052, Australia
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26
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Llanque S, Savage L, Rosenburg N, Caserta M. Concept Analysis: Alzheimer's Caregiver Stress. Nurs Forum 2014; 51:21-31. [PMID: 24787468 DOI: 10.1111/nuf.12090] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this article was to analyze the concept of caregiver stress in the context of caring for a person with Alzheimer's disease and related dementias. BACKGROUND Currently, there are more than 15 million unpaid caregivers for persons suffering from Alzheimer's disease and related dementias. This unpaid care can be stressful for caregivers due to the chronic nature of the disease process, as well as other factors. METHOD The paper incorporates the modified method of Wilson's concept analysis procedure to analyze the concept of caregiver stress. DATA SOURCES A review of the literature was undertaken using the Cumulative Index to Nursing and Allied Health Literature, Google Scholar, and PubMed. RESULTS A theoretical definition of caregiver stress is provided, and the defining attributes, related concepts, antecedents, and consequences of caregiver stress are proposed, and case studies are presented. CONCLUSIONS The analysis demonstrates that caregiver stress is the unequal exchange of assistance among people who stand in close relationship to one another, which results in emotional and physical stress on the caregiver. Implications for future nursing research and practice conclude the paper.
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Absalom-Hornby V, Gooding PA, Tarrier N. Implementing family intervention within forensic services: The perspectives of clinical staff. J Ment Health 2011; 20:355-67. [DOI: 10.3109/09638237.2011.583948] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The first episode of psychosis frequently occurs during adolescence and early adulthood, and is associated with high levels of trauma, affective disturbance and suicide. The social networks of service users often decrease significantly following the first onset, although many will remain in close contact with some family members particularly during the early phases. However, the negative impact of psychosis on families and their relationship with the identified service user are well documented. Family intervention is a recommended and evidence-based treatment in later psychosis. In this paper, we review the literature on family interventions in early psychosis in the context of new evidence for its efficacy and its routine incorporation in early intervention services for psychosis.
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Kuipers E. Cognitive behavioural therapy and family intervention for psychosis – evidence-based but unavailable? The next steps. PSYCHOANALYTIC PSYCHOTHERAPY 2011. [DOI: 10.1080/02668734.2011.542966] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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