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Al-Awad F. Perceived Burden and Quality of Life in Caregivers of Patients with Schizophrenia in Saudi Arabia's Eastern Province: A Cross-sectional Study. Clin Pract Epidemiol Ment Health 2024; 20:e17450179314013. [PMID: 39355198 PMCID: PMC11443458 DOI: 10.2174/0117450179314013240417105321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 10/03/2024]
Abstract
Background and Aims Family Caregivers (FCGs) of patients with schizophrenia (PwS) may face unanticipated sources of stress and responsibility, which can negatively impact their quality of life (QoL). This study aimed to assess FCGs' QoL and the impact of clinical characteristics of patients and sociodemographic factors on their QoL. Patients and Methods A cross-sectional questionnaire-based study surveyed 340 FCGs from outpatient clinics of PwS in two large psychiatric hospitals in Saudi Arabia's eastern province using a convenience sampling approach. We used the Adult Carer Quality of Life (AC-QoL) scale, which has eight subscales and 40 items, to assess QoL. AC-QoL is translated into Arabic in this study. Results The study included 216 FCGs, with 127 (58.8%) being men, 117 (54.2%) being over 45 years old, 91 (42.1%) being a sibling of a PwS, and 82 (38%) being a parent of a PwS. The mean score in our sample was 78.2 ± 21.24 out of 120, indicating mid-range QoL. Lower QoL was associated with more time spent in caregiving per day, a lower educational level of FCG, and recent admission of PwS to an inpatient unit. Conclusion PwS FCGs have a mid-range QoL. FCGs reported a moderate financial burden and low levels of support from healthcare professionals. FCG's QoL and stress can be reduced through healthcare providers, participation in a community support group, and addressing an FCG's in an individual setting.
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Affiliation(s)
- Feras Al-Awad
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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2
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Swai P, Desjardins M, Minja A, Headley J, Lawala P, Ndelwa L, Maboja C, Temu J, Lukens E, Kaaya S, Baumgartner JN. Social support and managing schizophrenia in Tanzania: Perspectives from treatment-engaged individuals and relative caregivers. SSM - MENTAL HEALTH 2024; 5:100312. [PMID: 38993358 PMCID: PMC11238882 DOI: 10.1016/j.ssmmh.2024.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Background In lower-resource settings like Tanzania, people living with schizophrenia (PWS) rely on their families for much of their social support, thus leading family members to become their main caregivers. How PWS and their families understand and implement social support can profoundly impact recovery pathways. This study examines how PWS and caregivers of PWS in Tanzania describe receiving and giving social support. We describe, from the perspectives of treatment engaged PWS and unmatched caregivers, different types of social support experienced and provided and examine any differences in the types and expectations of social support expressed by PWS versus caregivers. Methods A total of 39 semi-structured in-depth interviews were conducted with PWS (n = 19) and caregivers (n = 20) recruited from outpatient psychiatric clinics in tertiary-level hospitals in Tanzania across two geographic regions. Thematic content analyses were based on four dimensions of social support (instrumental, emotional, informational, and appraisal). Results Results revealed four themes: 1) Financial and basic needs support from families is common yet critical for daily living (instrumental support); 2) There were mixed experiences regarding provision and receipt of love and acceptance with desires and calls for more encouragement and moral support (emotional support); 3) Caregivers try to provide knowledge, guidance, and reminders related to illness management for PWS but acknowledge their own gaps in understanding recovery promotion and effective caregiving (informational & appraisal supports), 4) A cross-cutting issue was calls for more social support from the wider community. Conclusion Social support is a multi-dimensional construct recognized by PWS and caregivers as critical for illness management, yet gaps remain, often due to lack of knowledge of how to bolster social support. Given the heavy reliance on families for social support in lower-resource contexts, psychiatric services can intervene with clinic-based psychoeducation for PWS and their families to improve quality of life and functioning.
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Affiliation(s)
- Praxeda Swai
- Department of Psychiatry and Mental Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Anna Minja
- Department of Psychiatry and Mental Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Paul Lawala
- Department of Psychiatry, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Liness Ndelwa
- Department of Psychiatry, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Carina Maboja
- Department of Psychiatry and Mental Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joseph Temu
- Department of Psychiatry and Mental Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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3
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Carroll D, Wales M, Rintell LS, Hojlo M, Gonzalez-Heydrich J, Berbert L, Fitzpatrick M, D'Angelo E, Reed MP. Burden Experienced by Primary Caregivers of Children With Psychotic Disorders and at Clinical High Risk for Psychosis. J Am Psychiatr Nurses Assoc 2024; 30:518-531. [PMID: 36475411 DOI: 10.1177/10783903221141883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the existing research exploring caregiver burden in adult psychosis, few studies have examined the experience of providing care to children diagnosed with psychotic disorders (PDs) and those identified as having clinical high risk for psychosis (CHR-P). AIM This study measured the level of burden in caregivers of children with PD and CHR-P and examined associated risk factors, including social support, caregiver-child relationship, severity of illness, and frequency of psychiatric hospitalizations. METHODS A total of 56 caregivers completed validated measures and provided demographic information. Measures included the Zarit Burden Interview, the Multidimensional Scale of Perceived Social Support, the Behavior Assessment System for Children, Third Edition, Parenting Relationship Questionnaire-Child and Adolescent Form (BASC-3 PRQ-CA), and the Clinical Global Impression-Severity scale. RESULTS The majority of caregivers were women (86%), mothers (84%), White (63%), married (66%), working full-time (50%), college-educated (79%), and whose mean age was 45.7 years (SD = 8.09). Nearly half of the caregivers (45%) reported a high level of caregiver burden, 39% rated their burden in the mild to moderate range, and 16% reported little to no burden. There was no significant difference in mean burden between PD and CHR-P groups. Higher caregiver burden was associated with lower levels of social support (r = -.408, p = .002), lower levels of parenting confidence (r = -.514, p < .001), higher levels of relational frustration (r = .612, p < .001), and higher severity of illness (r = .316 p = .025). CONCLUSIONS These findings underscore the critical unmet need for support for caregivers of children with PD and CHR-P. Applications to clinical practice are discussed.
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Affiliation(s)
- Devon Carroll
- Devon Carroll, PMHNP-BC, MSN, Boston Children's Hospital, Boston, MA, USA; University of Rhode Island, Providence, RI, USA
| | - Meghan Wales
- Meghan Wales, RN, BA, Boston Children's Hospital, Boston, MA, USA
| | | | - Margaret Hojlo
- Margaret Hojlo, BA, Boston Children's Hospital, Boston, MA, USA
| | - Joseph Gonzalez-Heydrich
- Joseph Gonzalez-Heydrich, MD, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Laura Berbert
- Laura Berbert, MS, Boston Children's Hospital, Boston, MA, USA
| | - Molly Fitzpatrick
- Molly Fitzpatrick, MA, Boston Children's Hospital, Boston, MA, USA; William James College, Newton, MA, USA
| | - Eugene D'Angelo
- Eugene D'Angelo, PhD, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mary P Reed
- Mary P. Reed, PhD, RN, ANP, CNRN, NEA-BC, Boston Children's Hospital, Boston, Massachusetts, USA
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Bora ST, Buldukoğlu K, Bailey DE. Effectiveness of an Uncertainty Management Psychoeducation Program for Schizophrenia Caregivers: A Randomized Controlled Trial. J Am Psychiatr Nurses Assoc 2024; 30:590-602. [PMID: 36475415 DOI: 10.1177/10783903221141890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The inconsistent course of schizophrenia causes a long-term experience of uncertainty for individuals and their families. In Turkey, no studies yet exist that have attempted to address this constant uncertainty that is experienced by caregivers of schizophrenic patients. AIMS To evaluate the effects of the Uncertainty Management Psychoeducation Program on reducing uncertainty and intolerance to uncertainty, improving psychological well-being, and coping styles in caregivers of patients with schizophrenia. METHOD Single-blinded randomized controlled trial. Caregivers of schizophrenia inpatients were recruited from the psychiatry clinic of a university-affiliated hospital. Data were collected between April 2019 and August 2020. Eligible individuals were randomly allocated to one of the two groups: intervention or control. The intervention group had five individual psychoeducation sessions: "Recognizing Uncertainty," "Cognitively Reframing Uncertainty," "Solving Uncertainty-Related Issues," "Dealing with Uncertainty Using Communication Skills," and the "Closing Session." Participants in the control group received the usual care. Uncertainty, intolerance to uncertainty, psychological well-being, and stress coping strategies were measured at two points: at baseline and immediately following the intervention. Hypotheses were tested using the Mann-Whitney U and Wilcoxon tests. RESULTS A total of 54 participants were recruited. The intervention group's ratings for "seeking social support" and "optimistic approach" were higher than the control group's ratings. Significant within-group changes in terms of "uncertainty" and "optimistic approach" were reported for the intervention group in the post-intervention. In the control group, significant changes were seen in terms of "uncertainty" and "psychological well-being" over time. CONCLUSION The Uncertainty Management Psychoeducation Program was found to be effective in reducing the level of uncertainty, increasing their optimistic approach, and seeking social support of caregivers of schizophrenic patients.
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Affiliation(s)
| | | | - Donald Etheridge Bailey
- Donald Etheridge Bailey Jr., PhD, RN, FAAN, Duke University School of Nursing, Durham, NC, USA
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Wells I, G-Medhin A, Owen N, Thelwell ELR, Giacco D. Experiences of support received by carers of people who are involuntarily admitted to hospital under the Mental Health Act: qualitative study of carers' perspectives. BJPsych Open 2024; 10:e82. [PMID: 38622966 PMCID: PMC11060084 DOI: 10.1192/bjo.2024.44] [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: 07/19/2023] [Revised: 02/09/2024] [Accepted: 02/27/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Carers of people who are involuntarily admitted to hospital report feeling isolated and unsupported by services. The Independent Review of the Mental Health Act (MHA) recommended that carers be supported. However, no research has directly explored what type of support carers would find most helpful when a relative/friend is involuntary admitted. AIMS To explore carers' experiences and views around the support they want to receive when their relative/friend is involuntarily admitted under the MHA. METHOD A total of 22 one-to-one interviews with carers were conducted online at three sites across England. Audio recordings of the interviews were transcribed, and data were analysed with thematic analysis. RESULTS Four main themes were identified: (a) heterogeneity in the current support for carers, (b) information about mental health and mental health services, (c) continuous support, and (d) peer support and guidance. Carers reported receiving support from professionals, peers and relatives, but this was unstructured, and the extent of support varied across carers. Carers reported wanting more information about mental health services, and for this information to be consistent. Carers also reported wanting emotional support from a single, continuous person, helping them establish a more personal and sincere connection. Peers were also identified as important in the provision of carer support, allowing carers to feel reassured and understood in their experience. CONCLUSIONS The support received by carers is currently unstructured. To meet the MHA review recommendations, carers of patients who are involuntarily admitted should be allocated a named contact person, ideally with lived experience, to offer information and personal continuity of support.
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Affiliation(s)
- Imogen Wells
- Warwick Medical School, University of Warwick, UK
| | | | - Nicole Owen
- Warwick Medical School, University of Warwick, UK
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Pan Z, Li T, Jin G, Lu X. Caregiving experiences of family caregivers of patients with schizophrenia in a community: a qualitative study in Beijing. BMJ Open 2024; 14:e081364. [PMID: 38589261 PMCID: PMC11015265 DOI: 10.1136/bmjopen-2023-081364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES This study aims to understand the caregiving experiences of family caregivers of people with schizophrenia in a community. DESIGN A qualitative study based on phenomenological analysis was conducted through in-depth interviews. SETTING This study was carried out from May to June 2023 in two community health service centres in urban Beijing, China. PARTICIPANTS We selected 16 family caregivers for interviews using purposive sampling method. RESULTS Four themes and 10 subthemes were identified: (1) psychosocial distress of family caregivers (feeling unprepared and helpless at the beginning, confronting negative emotions in long-term care and straying away from social life); (2) adverse impacts on the whole family (poor cooperation within the family, insufficient family involvement in professional care); (3) coping with family caregiving (accepting the reality of the patients' illness, struggling with family life balance and having realistic expectations); (4) concerns about future care (daily living support, physical health management). CONCLUSION Family caregivers experienced psychosocial distress and family stress in the process of caregiving. They had to cope with caregiving stress and were concerned about the long-term care of people with schizophrenia. These findings provide implications for intervention programmes to strengthen social support, family involvement, and active coping for caregivers and develop long-term care mechanisms for people with schizophrenia.
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Affiliation(s)
- Zhaolu Pan
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Ting Li
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Guanghui Jin
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Xiaoqin Lu
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
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Marega J, Bah HT. Burdening caregivers of patients with schizophrenia at Edward Francis Small Teaching Hospital, The Gambia. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02634-0. [PMID: 38498148 DOI: 10.1007/s00127-024-02634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Deinstitutionalization of persons living with mental illness has led to many patients residing in communities with family members and shifting the burden of care and caregiving from hospitals to homes. The aim of the study was to determine the burden on caregivers of patients with schizophrenia at Edward Francis Small Teaching Hospital (EFSTH). METHODS This was a descriptive cross-sectional study design with a sample consisting of 161 randomly selected caregivers of patients with schizophrenia. The GHQ-12 questionnaire was used to determine the general health status of the caregivers. The caregivers' burden was assessed using the Zarit Burden Scale. The data were collected using the researcher-administered method. The collected data were analyzed with IBM SPSS Version 20 using descriptive statistics, mean differences, and the general linear model (GLM). RESULTS The main findings of this study were that caregivers experienced a significantly high level of burden. Most of them experienced high levels of physical (70%), psychological (93.2%), social (78.3%) and financial (55.3%) burdens. Employment status, specifically unemployment status and belonging to the Wolof ethnic group, was a significant predictor of the level of financial burden on the caregivers. Similarly, the total score for social burden was also significantly greater among unemployed caregivers. Educational level was a significant predictor of the total score on the psychological and physical burden scale. CONCLUSION The caregivers of patients with schizophrenia at EFSTH are experiencing a high level of burden as a result of their caregiving role, which affects their health, and this calls for urgent intervention.
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Affiliation(s)
- Jarra Marega
- Department of Psychiatry, Edward Francis Small Teaching Hospital, C/O Edward Francis Small Teaching Hospital, No. 2 Marina Parade, Banjul, The Gambia
| | - Haddy Tunkara Bah
- Department of Nursing and Reproductive Health, University of The Gambia, C/O School of Medicine and Allied Health Sciences, Banjul, The Gambia.
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8
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Kochhar SS, Mishra AK, Chadda RK, Sood M, Bhargava R. Changes in Psychosocial Variables Among Caregivers of Patients With Schizophrenia: A Short-Term Follow-Up Study. Cureus 2024; 16:e55887. [PMID: 38463408 PMCID: PMC10924957 DOI: 10.7759/cureus.55887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND AND AIMS Caring for a person with schizophrenia entails considerable effort. The caregiving experience while caring for a person with schizophrenia has been described as both stressful and enriching. The literature on changes in caregiving experience with time has been fairly limited. The present analysis looks at the change in the caregiving experience of caregivers of patients with schizophrenia. METHOD This study had a sample of 50 caregivers of patients with schizophrenia who were followed up after a period of 6 to 10 months. Caregiving experience, knowledge of the mental illness, family functioning, coping, social support, psychological distress, quality of life, and spiritual, religious, and personal beliefs were assessed at the two time points. RESULTS Among the negative caregiving experiences, caregivers' need for back-up and patient dependency reduced significantly at follow-up as compared to baseline, though total negative or positive experiences of caregiving did not show a significant difference. Knowledge about mental illness did not significantly increase at follow-up, though issues related to poor communication and affective involvement in family functioning reduced over the period of time. Coping and social support remained largely the same, while psychological distress was reduced. All domains of quality of life improved over the follow-up period, while the hope, optimism, and inner peace aspects of spiritual, religious, and personal beliefs improved with time. CONCLUSION Some aspects of caregiving experiences may change with time. As caregivers become more adjusted to caregiving roles, their distress may reduce, and their quality of life may improve.
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Affiliation(s)
- Sanimar S Kochhar
- Clinical Psychology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ashwani K Mishra
- Biostatistics, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | | | - Mamta Sood
- Psychiatry, AIl India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Rachna Bhargava
- Clinical Psychology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Wang G, Huang H, Wang Y, Yang Y, Li C, Luo S, Li Y. A randomized, prospective, active-controlled study comparing intramuscular long-acting paliperidone palmitate versus oral antipsychotics in patients with schizophrenia at risk of violent behavior. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110897. [PMID: 37972752 DOI: 10.1016/j.pnpbp.2023.110897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Paliperidone palmitate (PP) is an effective long-acting antipsychotic injection, but its impact on the behavior of schizophrenia patients with dangerous tendencies requires further investigation. This study aims to explore the effects of long-term antipsychotic treatment on this population in the community. METHODS This 49-week, randomized controlled trial was conducted across 21 communities in Wuhan and enrolled 134 schizophrenia patients at risk for violent behavior. With a fixed block size of 10, participants were randomly assigned to receive either intramuscular PP 1-month formulation (PP1M) or oral antipsychotic medication (OAP) at a 1:1 ratio. Changes in patients' risk for violent/aggressive behavior, family burden, social, and cognitive functioning were measured using VRAPP, MOAS, PANSS, FBS, PSP, and RBANS scales from baseline to endpoint. Longitudinal data from multiple repeated measures were analyzed using linear mixed-effects models. RESULTS The study protocol was completed by 77.6% of the patients overall. Significant improvements were observed in the risk assessment scores, MOAS total score, PANSS total score, PSP total score, and FBS total score of patients in the PP1M group from baseline to the end of treatment (all P < 0.05). Importantly, compared to patients in the OAP group, the improvements in these measures were also significantly greater in the PP1M group. Commonly observed AEs, such as hyperprolactinemia (70.3% vs. 62.65%) and muscle tension (45.3% vs. 57.8%), were considered to be the PP-related AEs. Nonetheless, the differences between the two groups did not reach statistical significance, and no new safety concerns emerged. CONCLUSIONS Our study suggests that PP long-acting injection (LAI) is a safe and effective treatment option for community-dwelling schizophrenia patients with impulsive violence and risky behaviors.
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Affiliation(s)
- Gang Wang
- Wuhan, Mental Health Center, Wuhan, China
| | | | - Yijun Wang
- Wuhan, Mental Health Center, Wuhan, China
| | | | - Chang Li
- Wuhan, Mental Health Center, Wuhan, China
| | - Sen Luo
- Wuhan, Mental Health Center, Wuhan, China
| | - Yi Li
- Wuhan, Mental Health Center, Wuhan, China..
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Saha P, Saha S, Kaloiya GS, Sarkar S. A cross-sectional study exploring the positive aspects of caregiving in opioid dependence and its relation with quality of life, social support, and caregivers' burden. Indian J Psychiatry 2023; 65:862-868. [PMID: 37736223 PMCID: PMC10510645 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_263_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/25/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023] Open
Abstract
Background and Aims Despite a large body of research linking caregiver burden and social support in substance dependence, positive aspects of caregiving in these disorders have received very minimal attention. This exploratory observational study aimed to assess the positive aspects of caregiving for opioid dependence and evaluate the association of these positive aspects with caregiver quality of life, burden, and social support. Methods This cross-sectional study included 199 caregivers of patients with opioid dependence recruited through purposive sampling. Participants were assessed using the Scale for Positive Aspects of Caregiving Experience (SPACE), World Health Organization Quality of Life-BREF version, Family Burden Interview Schedule (FBIS), and Social Support Questionnaire. Results Of the 199 caregivers recruited, a majority of the caregivers were middle-aged women. About two-thirds of the patients were currently using opioids (n = 135, 67.8%), while the remaining were abstinent. Among the SPACE domain scores, the mean was highest for motivation for the caregiving role (2.07), which was followed by self-esteem and social aspect of caring (2.04), caregiving personal gains (1.76), and caregiver satisfaction (1.65). Caregivers of patients currently abstinent experienced greater positive aspects of caregiving (SPACE mean item score 2.57 versus 1.62, P < 0.001), and lesser burden (FBIS mean score 13.4 versus 29.3, P < 0.001). Conclusion Positive aspects of caregiving can be potentially utilized for better caregiver engagement in treatment and improved caregiver outcomes.
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Affiliation(s)
- Priyanka Saha
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sayan Saha
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Gauri Shanker Kaloiya
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Sipowicz K, Łuczyńska K, Bąk B, Deska K, Nowakowska-Domagała K, Pietras T, Podgórska-Jachnik D, Małujło-Balcerska E, Kosmalski M. The Structure of Temperament in Caregivers of Patients with Schizophrenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2119. [PMID: 36767486 PMCID: PMC9916194 DOI: 10.3390/ijerph20032119] [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: 12/22/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
The onset of schizophrenia symptoms usually occurs in early youth. As a result, the parents of these patients usually become their caregivers. The role of a caregiver for a person with schizophrenia is a considerable mental and physical burden. Therefore, an interesting issue is what motivates these people to take up this challenge. It is probable that, apart from the moral imperative or kinship, the factor determining this decision is the personality structure of the caregiver. The aim of our study was to compare the structure of temperament (according to the model of temperament as formal characteristics of behavior developed by Jan Strelau) in caregivers of young adults (age 18-25 years) with schizophrenia with the structure of temperament of parents of healthy young adults still living in the family home under their care. The study group consisted of 64 people (51 women), who were taking care of young adults (aged 18-25 years) with schizophrenia, while the control group (53 people, 42 women) consisted of parents of healthy adults still living in the family home. Both groups were asked to complete a questionnaire of the authors' own design on their demographic data as well as The Formal Characteristics of Behavior-Temperament Inventory to assess the temperament traits. The results were given in the number of points obtained on average in each dimension. Both groups did not differ in terms of size and age, with women predominating. Caregivers of young adults with schizophrenia had higher values of briskness (43.22 ± 4.45 vs. 42.90 ± 3.98, p = 0.032), emotional reactivity (46.02 ± 4.39 vs. 41.01 ± 3.12, p = 0.012) and activity level (44.01.89 ± 4.15 vs. 37.59 ± 4.77, p = 0.022) compared to the control group. The remaining dimensions of temperament: perseverance, sensory sensitivity, rhythmicity, and endurance did not differentiate between the two groups. The temperament structure of caregivers of young people with schizophrenia differs from the temperament structure of caregivers of healthy adults. Caregivers of sick people have higher values of briskness, emotional reactivity, and activity level compared to the control group.
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Affiliation(s)
- Kasper Sipowicz
- Department of Interdisciplinary Disability Studies, The Maria Grzegorzewska University in Warsaw, 02-353 Warsaw, Poland
| | - Kamila Łuczyńska
- The Second Department of Psychiatry, Institute of Psychiatry and Neurology in Warsaw, 02-957 Warsaw, Poland
| | - Bartłomiej Bąk
- The Second Department of Psychiatry, Institute of Psychiatry and Neurology in Warsaw, 02-957 Warsaw, Poland
| | - Kacper Deska
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Katarzyna Nowakowska-Domagała
- Department of Clinical Psychology and Psychopathology, Institute of Psychology, Faculty of Educational Sciences, University of Lodz, 90-128 Lodz, Poland
| | - Tadeusz Pietras
- The Second Department of Psychiatry, Institute of Psychiatry and Neurology in Warsaw, 02-957 Warsaw, Poland
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
| | | | | | - Marcin Kosmalski
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
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Estradé A, Onwumere J, Venables J, Gilardi L, Cabrera A, Rico J, Hoque A, Otaiku J, Hunter N, Kéri P, Kpodo L, Sunkel C, Bao J, Shiers D, Bonoldi I, Kuipers E, Fusar-Poli P. The Lived Experiences of Family Members and Carers of People with Psychosis: A Bottom-Up Review Co-Written by Experts by Experience and Academics. Psychopathology 2023; 56:371-382. [PMID: 36689938 PMCID: PMC10568611 DOI: 10.1159/000528513] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/20/2022] [Indexed: 01/24/2023]
Abstract
Informal caregivers of individuals affected by psychotic disorder can play a key role in the recovery process. However, little research has been conducted on the lived experiences of carers and family members. We conducted a bottom-up (from lived experience to theory) review of first-person accounts, co-written between academics and experts by experience, to identify key experiential themes. First-person accounts of carers, relatives, and individuals with psychosis were screened and discussed in collaborative workshops involving individuals with lived experiences of psychosis, family members, and carers, representing various organizations. The lived experiences of family members and carers were characterized by experiential themes related to dealing with the unexpected news, the search for a reason behind the disorder, living with difficult and negative emotions, dealing with loss, feeling lost in fragmented healthcare systems, feeling invisible and wanting to be active partners in care, struggling to communicate with the affected person, fighting stigma and isolation, dealing with an uncertain future, and learning from one's mistakes and building resilience and hope. Our findings bring forth the voices of relatives and informal carers of people with psychosis, by highlighting some of the common themes of their lived experiences from the time of the initial diagnosis and throughout the different clinical stages of the disorder. Informal carers are key stakeholders who can play a strategic role, and their contributions in the recovery process merit recognition and active support by mental health professionals.
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Affiliation(s)
- Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Juliana Onwumere
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Jemma Venables
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Ana Cabrera
- Asociación Madrileña de Amigos y Familiares de Personas con Esquizofrenia (AMAFE), Madrid, Spain
| | - Joseba Rico
- Asociación Madrileña de Amigos y Familiares de Personas con Esquizofrenia (AMAFE), Madrid, Spain
| | - Arif Hoque
- Young Person’s Mental Health Advisory Group (YPMHAG), King’s College London, London, UK
| | - Jummy Otaiku
- Young Person’s Mental Health Advisory Group (YPMHAG), King’s College London, London, UK
| | - Nicholas Hunter
- National Health System (NHS) South London and Maudsley (SLaM) Recovery College, London, UK
| | - Péter Kéri
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe), Brussels, Belgium
| | - Lily Kpodo
- South London and Maudsley (SLaM) NHS Foundation Trust, London, UK
| | - Charlene Sunkel
- Global Mental Health Peer Network (GMHPN), Johannesburg, South Africa
| | - Jianan Bao
- Department of Forensic and Neurodevelopment Sciences, King’s College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- School of Medicine, Keele University, Staffordshire, Newcastle, UK
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Elizabeth Kuipers
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- National Institute for Health and Care Research, Maudsley Biomedical Research Centre, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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13
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Liu C, Marino VR, Howard VJ, Haley WE, Roth DL. Positive aspects of caregiving in incident and long-term caregivers: Role of social engagement and distress. Aging Ment Health 2023; 27:87-93. [PMID: 34749554 PMCID: PMC9126189 DOI: 10.1080/13607863.2021.2000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/17/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Positive caregiver adaptation over time may be associated with reports of positive aspects of caregiving (PAC). We examined differences in PAC by caregiving duration and social engagement, controlling for measures of distress. METHODS Participants included 283 African American or White caregivers from the Caregiving Transitions Study with a wide range of caregiving durations. PAC are defined as positive appraisals that caregivers report about their role, such as feeling appreciated or confident. We fit multivariable linear models with the total PAC score as the outcome to assess its association with years of caregiving and social engagement (social network, monthly social contact). Models were adjusted for age, sex, race, marital status, relationship to care recipient, care recipient's dementia status, perceived stress and caregiving strain. RESULTS Caregivers with higher social engagement reported significantly higher PAC. A non-significant trend was found in most analytic models for caregivers with longer duration of care to report higher PAC. African American caregivers reported higher PAC compared to White caregivers. Dementia caregivers reported lower PAC than non-dementia caregivers in models adjusting for demographics and social network size, but the association was attenuated with the addition of caregiving strain. DISCUSSION Higher social engagement and longer duration of care tend to be associated with higher PAC after adjusting for demographics and measures of distress. Future studies should aim to leverage longitudinal data to understand whether caregivers shift appraisal to positive aspects of their role and explore implementation of caregiving interventions targeting PAC in order to improve the caregiving experience.
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Affiliation(s)
- Chelsea Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Victoria R Marino
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William E Haley
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
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Caregiving burden and positive aspects of caregiving among family caregivers of people living with schizophrenia: Two sides of the same coin. Appl Nurs Res 2022; 67:151619. [DOI: 10.1016/j.apnr.2022.151619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/18/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022]
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15
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Caregiving-related experiences associated with depression severity and its symptomatology among caregivers of individuals with a severe mental disorder: an online cross-sectional study. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01451-3. [PMID: 35771258 PMCID: PMC9245882 DOI: 10.1007/s00406-022-01451-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 06/12/2022] [Indexed: 11/03/2022]
Abstract
Caring for a relative with a severe mental disorder puts family caregivers to a great risk of depression. While overall caregiving burden is a strong predictor of depression, the contribution of the various dimensions of burden to caregivers' depression as well as their relationships with depressive symptoms has received little attention. 384 family caregivers completed a cross-sectional online survey including the Center for Epidemiological Studies Depression (CES-D) scale, the Zarit Burden Interview (ZBI), and the Brief Experience of Caregiving Inventory (BECI), measuring caregiving burden and experience. We estimated the structure of the relationships between caregiving experiences (i.e., ZBI and BECI subscales) and CES-D symptoms using a network approach. Negative Emotion/Consequences, (lack of) Positive Personal Experience, and Stigma/Effects on Family were the most connected caregiving dimensions to depression. To untangle the role of the Negative Emotion/Consequences component (by far the most central node in estimated networks), a secondary analysis incorporating its composing items was estimated. Losing control over life, feeling strained around the relative and impaired self-perceived health emerged as central nodes. Interestingly, these caregiving-related dimensions or experiences were differentially connected to depressive symptoms. We discuss how these findings might help future research and inform tailored psychoeducational interventions for family caregivers of people with a severe mental disorder.
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Cohen M, Lima AFBDS, Silva CPDA, Miguel SRPDS, Fleck MPDA. Quality of life of family primary caregivers of individuals with bipolar disorder and schizophrenia in south of Brazil. Int J Soc Psychiatry 2022; 68:818-826. [PMID: 33789497 DOI: 10.1177/00207640211006737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The process of deinstitutionalization of individuals with mental disorders (MD) brought greater family responsibility in terms of patient care. AIMS Evaluate the Quality of Life (QoL) and its associated factors of primary caregivers of bipolar and schizophrenic subjects. METHODS A cross-sectional survey was conducted from 2012 to 2015 with 125 caregivers at an outpatient service of a teaching hospital in the South of Brazil. QoL instruments (WHOQOL-Bref, SF-36), questionnaires regarding socio-demographic, clinical data and depressive symptoms (BDI) were applied. RESULTS Caregivers of schizophrenic individuals presented lower QoL scores than caregivers of bipolar individuals, with moderate effect in physical, and social domains of WHOQOL-Bref, and in physical functioning, role-physical, and role-emotional domains of SF-36. QoL scores of caregivers were lower when compared with the normative data of the Brazilian population. The factors associated with lower QoL scores were: patient diagnosis of schizophrenia, female gender, presence of clinical disease and presence of depressive symptoms in the caregiver. CONCLUSIONS Caregivers of patients with schizophrenia or bipolar disorder present a significant impairment in their QoL when compared with the general population, highlighting the relevance of developing support programs in the mental health services that include these caregivers.
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Affiliation(s)
- Mírian Cohen
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Instituto de Avaliação de Tecnologia em Saúde (IATS), Porto Alegre, Brazil
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17
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Clari R, Headley J, Egger J, Swai P, Lawala P, Minja A, Kaaya S, Baumgartner JN. Perceived burden and family functioning among informal caregivers of individuals living with schizophrenia in Tanzania: a cross-sectional study. BMC Psychiatry 2022; 22:10. [PMID: 34983438 PMCID: PMC8728903 DOI: 10.1186/s12888-021-03560-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Globally, families play a critical role in providing care and support for persons living with schizophrenia. It is important to identify potentially modifiable factors that influence perceived caregiver burden in order to properly address the needs of caregivers. This is especially relevant in low-resource settings where psychiatric services are scarce and interventions could be most effective if targeted to both the individual living with schizophrenia and their caregiver. This study examines correlates of perceived burden among informal caregivers of individuals with schizophrenia in Tanzania, in particular, the association between burden and caregiver-reported family functioning. METHODS This study used baseline data from an individually randomized controlled trial with 65 pairs of individuals with schizophrenia and their informal caregivers in Dar es Salaam and Mbeya, Tanzania. Caregiver burden was measured using the Burden Assessment Scale. Univariable and multivariable regression analyses were performed to determine the relationship between caregiver burden and family functioning and to explore other correlates of burden. RESULTS Sixty-three percent of caregivers reported experiencing high burden as a result of caring for a relative with schizophrenia. Multivariable regression analyses revealed that poor family functioning and the caregiver being employed were associated with high caregiver burden, while higher levels of hopefulness in the caregiver was associated with low caregiver burden. CONCLUSION Caregivers who were employed, reported poor family functioning, and/or had low levels of hopefulness were more likely to perceive high caregiver burden. Future interventions aiming to reduce caregiver burden may benefit from improving family functioning and nurturing hope among caregivers of individuals living with schizophrenia. Policies and programs should be cognizant of the needs of caregivers that work in addition to providing care for a relative with schizophrenia in order to better support them.
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Affiliation(s)
- Rosarito Clari
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Joseph Egger
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Praxeda Swai
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Lawala
- Mirembe National Mental Health Hospital, Dodoma, Tanzania
| | - Anna Minja
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sylvia Kaaya
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Roncone R, Giusti L, Bianchini V, Casacchia M, Carpiniello B, Aguglia E, Altamura M, Barlati S, Bellomo A, Bucci P, Cascino G, Concerto C, Fagiolini A, Marchesi C, Monteleone AM, Pinna F, Siracusano A, Galderisi S. Family functioning and personal growth in Italian caregivers living with a family member affected by schizophrenia: Results of an add-on study of the Italian network for research on psychoses. Front Psychiatry 2022; 13:1042657. [PMID: 36713911 PMCID: PMC9880038 DOI: 10.3389/fpsyt.2022.1042657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
To date, the role of family members in caring for relatives affected by schizophrenia has focused largely on the negative aspects of impact of the illness. The present study aimed to: (1) assess family functioning and burden of care in caregivers living in Northern, Central, and Southern Italy who looked after subjects affected by chronic schizophrenia; (2) evaluate the relationship between aspects of family functioning and burden of care, in particular personal growth (PG) of caregivers; and (3) identify variables capable of affecting PG of caregivers. A total of 136 caregivers (mean length of illness of family member more than 20 years) were recruited from 9 Italian research sites and evaluated in terms of "positive" family functioning-problem-solving, communication skills and personal goals Family Functioning Questionnaire (FFQ), burden of care, and PG Family Problems Questionnaire (FPQ). Caregivers reported an overall good family functioning with a relatively low objective and subjective burden of care. The latter was positively correlated with length of illness, with women showing a higher subjective burden than men. Reduced problem-solving skills and ability of each family member to pursue personal goals were both associated with reduced objective and subjective burden which, conversely, were both increased by inadequate support and scarce positive comments from relatives and friends. Approximately 50% of caregivers stated that "they had learned something positive from the situation," highlighting a statistically higher proportion of caregivers in southern Italy than in northern and central Italy. Caregivers' PG was associated with good family functioning, adequate professional support, and positive comments. PG also seemed to be positively influenced by support from relatives and friends (O.R. 14.306). The numerous challenges and positive aspects associated with caregiving should be duly acknowledged by mental health services and integrated into routine clinical assessment and intervention framework.
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Affiliation(s)
- Rita Roncone
- Psychiatry Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Laura Giusti
- Psychiatry Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valeria Bianchini
- Psychiatry Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo Casacchia
- Psychiatry Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Bernardo Carpiniello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eugenio Aguglia
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Stefano Barlati
- Psychiatric Unit, Department of Clinical and Experimental Sciences, Brescia University, Brescia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Carmen Concerto
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Carlo Marchesi
- Psychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alberto Siracusano
- Psychiatry and Clinical Psychology Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Lee Y, Li L. Evaluating the Positive Experience of Caregiving: A Systematic Review of the Positive Aspects of Caregiving Scale. THE GERONTOLOGIST 2021; 62:e493-e507. [PMID: 34216215 DOI: 10.1093/geront/gnab092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As attention to positive caregiving experience increases, there is growing evidence concerning how the identification of the positive aspects of caregiving can be beneficial in supporting caregivers. The purpose of the current study is to review the literature where the Positive Aspects of Caregiving Scale (PACS) was used, identify the ways studies have used the PACS, and summarize the relationship between PACS and the contextual factors as well as outcomes of caregiving. RESEARCH DESIGN AND METHODS A systematic literature review was conducted. Electronic databases were searched, and empirical research studies written in English that were published in a peer-reviewed journal after 2004 were identified. After a careful review of the 194 abstracts yielded from the databases and the reference lists of the associated articles, 52 eligible studies were identified, and relevant findings were extracted. RESULTS Some commonality in terms of how studies have used the PACS emerged. The literature reviewed was further grouped into three categories depending on whether the study tested the PACS as a valid and reliable measurement, examined the PACS as outcomes of caregiving, or as a predictor of certain outcomes. DISCUSSION AND IMPLICATIONS This review suggests that PACS is utilized for multiple purposes and yields considerable evidence supporting the importance of understanding the positive experience of caregiving. However, there is limited adaptation of the PACS in a large survey, and studies were heavily focused in the U.S. with little evidence from other countries. Further studies to address these limitations will be needed.
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Affiliation(s)
- Yeonjung Lee
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Lun Li
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
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Intharit J, Kittiwattanagul K, Chaveepojnkamjorn W, Tudpor K. Risk and protective factors of relapse in patients with first-episode schizophrenia from perspectives of health professionals: a qualitative study in northeastern Thailand. F1000Res 2021; 10:499. [PMID: 36033234 PMCID: PMC9379331 DOI: 10.12688/f1000research.53317.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Schizophrenia is a serious mental illness that can relapse after treatments. Risk and protective factors for relapse are dependent on multicultural contexts. Objective: To identify risk and protective factors related to relapse in first-episode schizophrenia (FES) in northeastern Thailand from perspectives of health professionals. Methods: This qualitative research collected data from 21 health professional staff members (psychiatric nurses, psychiatrists, psychologists, social workers, occupational therapists and nutritionist) of a tertiary psychiatric hospital of northeastern Thailand who had been involved in mental health care for schizophrenia for at least 5 years by in-depth interviews and group interview using semi-structured interview schedule. Content analyses was used to identify staff perception of factors that put patients at risk of relapse. Results: Data analyses demonstrated that factors related to relapse in FES patients were drug adherence (drug discontinuation, limited access to new generation drugs, self-dose reduction and skipping medication, and poor insight), family factors (stressful circumstances and family supports), substance abuses (narcotics, addictive substances, caffeinated drinks), concurrent medical illness (insomnia, thyroid diseases, and pregnancy-related hormonal changes), and natural course of disease. Conclusion: Factors affecting relapse in FES was not only drug adherence. Family factors, drug abuses, and concurrent health status should be also taken into account. A comprehensive mental health care program should be developed for FES patients in the region.
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Affiliation(s)
- Jarunee Intharit
- Faculty of Public Health, Mahasarakham University, Kantarawichai, Maha Sarakham, 44150, Thailand
| | | | - Wisit Chaveepojnkamjorn
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Rajthevee, Bangkok, 10400, Thailand
| | - Kukiat Tudpor
- Faculty of Public Health, Mahasarakham University, Kantarawichai, Maha Sarakham, 44150, Thailand
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21
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Onwumere J, Wilson S, Billings J, Brown L, Floyd C, Widuch K, Lyons N, Man LC, James G, Afsharzadegan R, Khan S, Padayatchi M, Souray J, Raune D. First episode psychosis: A comparison of caregiving appraisals in parents caring for the same child. Early Interv Psychiatry 2021; 15:525-535. [PMID: 32524757 DOI: 10.1111/eip.12975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/18/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The first onset of psychosis can be a traumatic event for diagnosed individuals but can also impact negatively on their families. Little is known about how parents of the same child make sense of the illness. In mothers and fathers caring for the same child with early psychosis, the current study assessed their similarities and differences in key areas of their caregiving role. METHODS Using a cross-sectional design, parental pairs caring for the same child treated within an early intervention in psychosis service, completed self-report measures on their caregiving experiences, illness beliefs, coping styles and affect. RESULTS Data from 44 mothers and fathers were analysed. Analyses confirmed that parents reported similar levels of emotional dysfunction and conceptualized the illness in broadly similar ways with regard to what they understood the illness to be, their emotional reactions to the illness, perceived illness consequences and beliefs about treatment. Significant differences were identified in their beliefs about the timeline of the illness and reported approaches to coping. CONCLUSIONS With exception of beliefs about illness timeline and an expressed preference for use of emotion-based coping, parent caregivers of the same child in early psychosis services are likely to report similar illness beliefs and caregiving reactions. Efforts to ensure staff awareness of the potential areas of divergence in parental caregiving appraisals and exploring the implications of the divergence for the caregiving relationship and patient outcomes are indicated.
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Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,The National Psychosis Unit & PiCuP Services, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Sophie Wilson
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Jo Billings
- Department of Clinical, Educational and Health Psychology, University College, London, UK
| | - Lucy Brown
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Caroline Floyd
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Kaja Widuch
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Natasha Lyons
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Lai Chu Man
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Gareth James
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Roya Afsharzadegan
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Sanna Khan
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Mellisha Padayatchi
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Jonathan Souray
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - David Raune
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
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Lök N, Bademli K. The Relationship Between the Perceived Social Support and Psychological Resilience in Caregivers of Patients with Schizophrenia. Community Ment Health J 2021; 57:387-391. [PMID: 32591991 DOI: 10.1007/s10597-020-00665-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 06/19/2020] [Indexed: 11/25/2022]
Abstract
The present study aimed to explore the relationship between perceived social support and psychological resilience levels of caregivers of patients with schizophrenia. The study was designed as a descriptive relational study and conducted in Community Mental Health Center. Resilience Scale for Adults (RSA) and the Multidimensional Scale of Perceived Social Support (MSPSS) were used for data collection. There were significant, positive and high correlations between RSA and MSPSS. Findings of this study may be referenced in the development of resilience-based nursing caring models in the future.
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Affiliation(s)
- Neslihan Lök
- Psychiatric Nursing Department, Faculty of Nursing, Selcuk University, Konya, Turkey
| | - Kerime Bademli
- Psychiatric Nursing Department Campus, Faculty of Nursing, Akdeniz University, Antalya, 07058, Turkey.
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Jilili M, Liu L, Yang A. The impact of perceived discrimination, positive aspects of caregiving on depression among caregivers: mediating effect of job satisfaction. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01397-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Understanding the caregivers' experiences of aggressive persons with mental disorders is very important from the public health point of view. Only a few Indian studies have focused on this. No Indian studies could be found that explored the caregivers' experiences of aggressive persons with schizophrenia. This study was conducted to explore the same. METHODS A qualitative phenomenological study was conducted in the outpatient and inpatient settings at a tertiary care mental health institute at Bengaluru, Karnataka. Ten participants meeting the eligibility criteria were selected using purposive sampling. Data collection was done by individual, in-depth, face-to-face, semi-structured interviews using topic guide along with subjective observation and field notes. Each interview was audio-recorded, transcribed, translated, and coded. A total of five master themes and 22 subthemes were derived from the codes by using the qualitative research software ATLAS-Ti. RESULTS The themes derived based on the experiences of caregivers living with their aggressive persons with schizophrenia were the aggressive behaviors of the patients, reasons for the aggression of the patients, dealing with the aggression of the patients, the impact of aggression on the caregivers, and the coping methods of the caregivers. CONCLUSION This study explored the experiences of the caregivers living with the aggressive patients. The results show the need for care and support to the caregivers. The themes can guide mental health professionals while developing culture-specific tools and interventions for future research as well as suggest them standard operating procedures for prevention and management of aggressive patients in the psychiatric hospitals.
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Affiliation(s)
- Neha A
- Dept. of Mental Health Nursing, Jubilee Mission College of Nursing, Thrissur, Kerala, India
| | | | - Manjula M
- Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
| | - Padmavathi N
- Dept. of Nursing, NIMHANS, Bengaluru, Karnataka, India
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Zhou Z, Wang Y, Feng P, Li T, Tebes JK, Luan R, Yu Y. Associations of Caregiving Knowledge and Skills With Caregiver Burden, Psychological Well-Being, and Coping Styles Among Primary Family Caregivers of People Living With Schizophrenia in China. Front Psychiatry 2021; 12:631420. [PMID: 34122169 PMCID: PMC8187614 DOI: 10.3389/fpsyt.2021.631420] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/15/2021] [Indexed: 02/03/2023] Open
Abstract
Background: There is a lack of clarity regarding the correlation of caregiving knowledge and skills with caregiving experiences of people living with schizophrenia (PLSs). To address this gap, this comprehensive study examines the relationships of caregiving knowledge and skills to the primary family caregiver's experiences of burden, psychological well-being (stress, anxiety, depression, caregiving rewarding feelings), and coping styles in China. Methods: A total of 395 primary family caregivers of PLSs were enrolled in a cross-sectional study between May 2019 and September 2019. Each family caregiver was independently assessed on caregiving knowledge and skills, caregiver burden, and psychological well-being, as well as coping styles. Results: A higher level of caregiving knowledge and skills was positively correlated with less stress (b = -0.48, P < 0.001), anxiety (b = -0.23, P = 0.029), depression (b = -0.29, P = 0.013), and more caregiving rewarding feelings (b = 0.54, P < 0.001). Also, caregivers with more knowledge and skills were more inclined to adopt positive coping strategies (b = 0.44, P < 0.001). Despite these differences, caregivers with different levels of caregiving knowledge and skills reported comparable caregiver burden (b = 0.11, P = 0.705) and the use of a passive coping style (b = 0.10, P = 0.169). Conclusion: Caregiving knowledge and skills are a reliable predictor of psychological well-being and active coping among the primary family caregivers of PLSs. These findings inform the development of psychoeducational interventions to support family caregivers of PLSs.
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Affiliation(s)
- Zonglei Zhou
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yao Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ping Feng
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Tongxin Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jacob Kraemer Tebes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Rongsheng Luan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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26
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Shiraishi N, Reilly J. Content analysis of the emotions affecting caregivers of relatives with schizophrenia. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-01185-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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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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28
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Tate JA, Choi J. Positive Appraisal of Caregiving for Intensive Care Unit Survivors: A Qualitative Secondary Analysis. Am J Crit Care 2020; 29:340-349. [PMID: 32869072 DOI: 10.4037/ajcc2020953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND More than half of intensive care unit survivors require assistance from family caregivers after discharge. Caregiving is associated with negative consequences including poor health-related quality of life, psychosocial distress, and burden. Little is known about how family caregivers find satisfaction and meaning in their experience. OBJECTIVES To explore positive descriptions of the experiences of family caregivers of critically ill patients and to describe factors that family caregivers view as important to a positive caregiving experience from hospitalization to 4 months after discharge. METHODS Qualitative secondary analysis was performed on data from semistructured interviews conducted as part of a longitudinal study that examined physical and psychological responses to stress in a convenience sample of family caregivers of adult intensive care unit patients who underwent prolonged mechanical ventilation (≥ 4 days). Interviews were conducted at 4 time points: during the hospitalization and within 2 weeks, 2 months, and 4 months after discharge. RESULTS Participants (n = 41) reported factors that helped them positively appraise their caregiving experience in 113 interviews conducted face to face or via telephone. During patients' hospitalization, caregivers described changes in their role, with their primary responsibility being to advocate for the patient. They described how this experience fulfilled their identity and strengthened their relationship with the patient. Most family caregivers mentioned the importance of social support and prayer. CONCLUSIONS Family caregivers of intensive care unit patients can identify positive aspects of caregiving during the experience. Interventions to reframe the caregiving experience in a positive light are warranted.
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Affiliation(s)
- Judith A. Tate
- Judith A. Tate is an assistant professor at the Ohio State University College of Nursing, Columbus, Ohio
| | - JiYeon Choi
- JiYeon Choi is an assistant professor at Yonsei University College of Nursing, Mo-Im Kim Nursing Research Institute, Seoul, Korea. At the time of the study, Choi was at the University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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29
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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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30
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Yu Y, Li TX, Li YL, Qiu D, Xi SJ, Xiao SY, Tebes JK. A cross-sectional study on spouse and parent differences in caregiving experiences of people living with schizophrenia in rural China. BMC Psychiatry 2020; 20:226. [PMID: 32398050 PMCID: PMC7216408 DOI: 10.1186/s12888-020-02633-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Conflicting evidence exists on whether parent or spouse caregivers experience better outcomes when caring for family members with schizophrenia. The current study aims to examine relative caregiving experiences and impacts of spouse and parent caregivers for people living with schizophrenia (PLS) in China. METHODS A cross-sectional study was conducted in a sample of 264 community-dwelling primary family caregivers of PLS. Face-to-face interviews were conducted to collect information on family caregiving activities; negative caregiving impacts including objective and subjective burden, and caregiver psychological distress such as depression and anxiety; positive caregiving impacts including caregiving rewarding feelings, and family functioning for spouse and parent caregivers. RESULTS Both types of caregivers report engaging in similar caregiving activities and report comparable levels of objective burden. However, parent caregivers report significantly higher subjective burden than spouse caregivers (b = 7.94, 95%CI:2.08, 13.80, P < 0.01), which is also reflected in significantly higher depression (b = 3.88, 95%CI:1.35, 6.41, P < 0.01) and anxiety (b = 2.53, 95%CI: 0.22, 4.84, P < 0.05), and lower family functioning (b = - 1.71, 95%CI: - 2.73, - 0.49, P < 0.01). Despite these differences, both groups of caregivers report comparable rewarding feelings about caregiving. CONCLUSIONS Our findings have implications for family caregivers globally, but especially for countries that adhere to Confucian cultural values and provide guidance for future family intervention programs. Such programs may do well to incorporate cultural values and beliefs in understanding caregiving and kinship family dynamics so as to support family caregivers, and in particular, the specific vulnerabilities of parent caregivers.
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Affiliation(s)
- Yu Yu
- grid.452223.00000 0004 1757 7615Hospital Evaluation Office, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, Hunan 410008 China ,grid.47100.320000000419368710Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT 06511 USA
| | - Tong-xin Li
- grid.216417.70000 0001 0379 7164Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan 410008 China
| | - Yi-lu Li
- grid.216417.70000 0001 0379 7164Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan 410008 China
| | - Dan Qiu
- grid.216417.70000 0001 0379 7164Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan 410008 China
| | - Shi-jun Xi
- grid.216417.70000 0001 0379 7164Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan 410008 China
| | - Shui-yuan Xiao
- grid.216417.70000 0001 0379 7164Mental Health Center, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008 Hunan China
| | - Jacob Kraemer Tebes
- grid.47100.320000000419368710Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT 06511 USA
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King G, Nalder E, Stacey L, Hartman LR. Investigating the adaptation of caregivers of people with traumatic brain injury: a journey told in evolving research traditions. Disabil Rehabil 2020; 43:3102-3116. [PMID: 32078400 DOI: 10.1080/09638288.2020.1725158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine how conceptualizations of caregiver adaptation to traumatic brain injury have changed over time. The objectives were to identify research traditions, adaptive outcomes assessed in these traditions, and psychosocial variables associated with adaptive outcomes. METHODS A meta-narrative review was conducted on 29 identified articles published over a 25-year period (1990-2015). RESULTS Four traditions were identified with varying storylines. Burden/Strain (1990-1999) focused on adjustment as the absence of a negative state. Appraisal/Coping (2000-2005) recognized that caregiving experiences could be both positive and negative. In Quality of Life (2006-2011), there was increasing recognition that both personal and contextual factors influence adaptation. Resiliency (2012-2015) used the term "resiliency" as an organizing framework for a broad group of variables and assessed resilience, quality of life, community re-integration, and life/marital satisfaction. CONCLUSIONS These storylines reflect an evolution from problem-based to strengths-based conceptualizations, from interest in crisis to considering adaptation as a process unfolding over time, from quantitative to qualitative methods, and towards more holistic views of adaptive outcomes. Variables significantly associated with outcomes across the traditions included social support, reframing and positive appraisal, and behavior strategies. Implications concern the need for longitudinal studies, measurement of environmental factors, and the development of best practices.IMPLICATIONS FOR REHABILITATIONResearch studies on the adaptation of caregivers for people with TBI have evolved from a focus on burden, to coping and quality of life, and most recently to resiliency.It is important to assist caregivers of people with TBI to obtain social support, find positive ways of viewing their experiences, and take part in respite and enjoyed activities.Service providers can help caregivers by adopting a strengths-based perspective to help them recognize available resources, supports, and opportunities.Since caregiver adaptation changes over time, service providers should pay attention to changes in family circumstances and the mental health of caregivers.
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Affiliation(s)
- Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Lauren Stacey
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Laura R Hartman
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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Analyse qualitative du vécu d’aidants familiaux de patients atteints de schizophrénie à différents stades d’évolution de la maladie. ANNALES MEDICO-PSYCHOLOGIQUES 2019. [DOI: 10.1016/j.amp.2018.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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33
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Lu N, Jiang N, Sun Q, Lou VWQ. Community Social Capital and Positive Caregiving Experiences Among Adult-Children Caregivers of Older Adults With Disabilities in Urban China. Res Aging 2019; 42:3-12. [PMID: 31542998 DOI: 10.1177/0164027519876095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study aimed to examine the association between community social capital and positive caregiving experiences among adult-children caregivers of disabled older adults in urban China. Data for this study were derived from the 2016 wave of the Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai. The final analysis featured 440 disabled older adult and adult-children caregiver dyads. Multiple indicators and multiple causes modeling was used to test the proposed model from a structural equation modeling perspective. Provision of support to others was significantly associated with self-affirmation. Citizenship activity was significantly associated with life enrichment. Support of units (i.e., employers) was significantly associated with self-affirmation and life enrichment. The findings support the integration of the stress process model and social capital theory and highlight the important role of community social capital in enhancing the subdimensions of positive caregiving experiences. Policy and intervention implications are discussed.
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Affiliation(s)
- Nan Lu
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Nan Jiang
- Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
| | - Qian Sun
- Department of Social Security, School of Public Administration, Hebei University of Economics and Business, Shijiazhuang, China
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
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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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35
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Mittendorfer-Rutz E, Rahman S, Tanskanen A, Majak M, Mehtälä J, Hoti F, Jedenius E, Enkusson D, Leval A, Sermon J, Taipale H, Tiihonen J. Burden for Parents of Patients With Schizophrenia-A Nationwide Comparative Study of Parents of Offspring With Rheumatoid Arthritis, Multiple Sclerosis, Epilepsy, and Healthy Controls. Schizophr Bull 2019; 45:794-803. [PMID: 30184197 PMCID: PMC6581137 DOI: 10.1093/schbul/sby130] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The study aimed to (1) compare the risk of health care use, adverse health status, and work productivity loss of parents of patients with schizophrenia to parents of patients with multiple sclerosis (MS), rheumatoid arthritis (RA), epilepsy, and healthy controls; and (2) evaluate such outcome measures while considering disease severity of schizophrenia. METHODS Based on linkage of Swedish registers, at least one parent was included (n = 18215) of patients with schizophrenia (information 2006-2013, n = 10883). Similarly, parental information was linked to patients with MS, RA, epilepsy, and matched healthy controls, comprising 11292, 15516, 34715, and 18408 parents, respectively. Disease severity of schizophrenia was analyzed. Different regression models yielding odds ratios (OR), hazard ratios (HR), or relative risks (RR) with 95% confidence intervals (CI) were run. RESULTS Psychiatric health care use, mainly due to anxiety and affective disorders, showed a strongly increasing trend for parents of patients with schizophrenia throughout the observation period. During the follow-up, these parents had an up to 2.7 times higher risk of specialized psychiatric health care and receipt of social welfare benefits than other parents. Parents of the moderately severely ill patients with schizophrenia had higher risk estimates for psychiatric health care (RR: 1.12; 95% CI: 1.07-1.17) compared with parents of least severely ill patients. CONCLUSIONS Parents of patients with schizophrenia have a considerably higher risk of psychiatric health care and social welfare benefit receipt than other parents. Psychiatric health care use worsens over time and with increasing disease severity of the offspring.
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Affiliation(s)
- Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,To whom correspondence should be addressed; tel: +46-8-524-820-25, fax: +46-8-524-832-05, e-mail:
| | - Syed Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Antti Tanskanen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,The Impact Assessment Unit, National Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | | | | | - Amy Leval
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Heidi Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
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Abstract
PURPOSE OF REVIEW To better understand the overall burden of schizophrenia, we aimed to explore informal caregivers' experiences by evaluating the current evidence on caregiver and patient characteristics, the type of care provided by caregivers, and the impacts of caregiving on caregivers' lives. RECENT FINDINGS Caregivers provide direct care, assistance with activities of daily living, and emotional, social, and financial support to individuals with schizophrenia. Increased duration of illness and of care, severe or persistent schizophrenia symptoms, criticism of the care recipient, financial burden, and patient disability intensify caregiver burden. Caregivers of individuals with persistent symptoms often feel overwhelmed, stressed, drained, burdened, frustrated, or angry. Financial impacts of caregiving include treatment costs for care recipients, providing financial support, and lost productivity and income. Depression and anxiety are common health impacts for caregivers, who also have increased physical healthcare resource use relative to healthy controls. Caregiver burden is reduced by formal support programs to improve caregivers' stress management and coping skills and informal sources of social support. SUMMARY Targeted efforts to improve access to care and provide additional support for caregivers are needed to alleviate caregiver burden and improve outcomes for individuals with schizophrenia.
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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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Shiraishi N, Reilly J. Positive and negative impacts of schizophrenia on family caregivers: a systematic review and qualitative meta-summary. Soc Psychiatry Psychiatr Epidemiol 2019; 54:277-290. [PMID: 30349961 DOI: 10.1007/s00127-018-1617-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Schizophrenia places a heavy burden on the individual with the disorder, as well as on his or her family; this burden continues over the long course of the disease. This study aimed to provide an overview of the positive and negative impacts of schizophrenia on family caregivers. METHODS From April to June 2017, two investigators conducted a systematic review and meta-summary of studies obtained from five electronic databases and the footnotes and citations of eligible studies. Qualitative studies that explored the experiences of family caregivers of individuals with schizophrenia were included. Study findings published between 1993 and 2017 were extracted and synthesised using narrative and summative approaches. RESULTS After the removal of duplicates, independent reviewers screened 864 records. Subsequently, 46 full-text articles were assessed for eligibility and 23 papers were included in the synthesis. Negative impacts identified were traumatic experiences, loss of expectation of life and health, lack of personal and social resources, uncertainty and unpredictability, family disruption, conflict in interpersonal relationships, difficulty in understanding, and stigma and heredity. Meanwhile, the positive impacts identified were family solidarity, admiration, affirmation, affection, compassion, learning knowledge and skills, self-confidence, personal growth, and appreciation. CONCLUSIONS Analysis of the studies suggested that family members of individuals with schizophrenia face a series of traumatic situations during the course of the illness. Their subsequent experiences can be conceptualised as a continuous circle of caregiving, in which the positive impacts can be centrally positioned within the negative impacts.
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Affiliation(s)
- Nao Shiraishi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Jacqueline Reilly
- Department of Public Health, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
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Onwumere J, Parkyn G, Learmonth S, Kuipers E. The last taboo: The experience of violence in first-episode psychosis caregiving relationships. Psychol Psychother 2019; 92:1-19. [PMID: 29399952 DOI: 10.1111/papt.12173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 10/26/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Informal caregiving relationships play an important role in facilitating recovery outcomes in psychosis. The relationship can serve as a source of positive experiences that co-exist alongside common challenges typically associated with mental health problems. People with psychosis, when compared to the general population, are more likely to perpetrate acts of violence, a relationship that is particularly evident during the first psychosis episode. Although victims of service user violence are typically people already known to them, such as informal carers, there remains a lack of understanding about their caring experiences and needs. This study sought to address gaps in the literature by exploring the subjective accounts of informal carers supporting a relative experiencing their first episode of psychosis who has also behaved violently towards them. DESIGN A cross-sectional design was employed. METHODS Individual semi-structured interviews, which were audio recorded and later transcribed for analyses, were undertaken with a convenience sample of eight carers drawn from a specialist early psychosis service. Interview questions focused on their experiences of patient violence, the subjective impact, and coping strategies. An interpretative phenomenological approach was used to analyse the data. RESULTS Participants were mostly living with their relative with psychosis and were typically female, parents, and from a black and minority ethnic background. Data analyses identified seven key themes from participant interviews including the lack of predictability over when the violence occurred, being scared and fearful, keeping quiet about what happens at home and in the caregiving relationship, and staying safe. CONCLUSIONS Reports by informal carers about experiencing violence and victimization from their relatives with psychosis are an important issue in some caregiving relationships during the first episode. Developing a more informed understanding of the specific needs of these carers and the caregiving relationship is indicated. The implications for service providers are discussed. PRACTITIONER POINTS Carers were exposed to a broad range of patient violence, which included being kicked and having weapons used against them. The violence typically occurred within carers' homes, when no other people were around. Patient violence impacted negatively on carer emotional and physical functioning, which included leaving carers living in fear of their own safety and what might become of their relative. The results highlight the importance of routinely asking first-episode carers about their experience of patient violence. The development of interventions (e.g., identification of early triggers, de-escalation) that are able to take account of the ongoing nature and complexity of the caregiving relationship but are purposefully aimed at supporting carers to remain safe in their relationship should be explored for their impact.
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Affiliation(s)
- Juliana Onwumere
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK
| | - Grace Parkyn
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK
| | - Stephanie Learmonth
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Elizabeth Kuipers
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Smith LM, Onwumere J, Craig T, Kuipers E. Caregiver correlates of patient-initiated violence in early psychosis. Psychiatry Res 2018; 270:412-417. [PMID: 30308465 DOI: 10.1016/j.psychres.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 08/29/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022]
Abstract
Patient-initiated violence may pose a significant risk to the strength and longevity of informal caregiving relationships in psychosis. We aimed to assess caregiver reports of patient-initiated violence in early psychosis and to examine the relationship between violent incidents and appraisals of caregiving, perceived mental wellbeing in caregivers and Expressed Emotion (EE) in the caregiving relationship. Eighty psychosis caregivers were recruited via Early Intervention (EI) psychosis services in London, United Kingdom. Caregivers were questioned about their experiences of patient-initiated violence during the semi-structured Camberwell Family Interview, and completed the Experience of Caregiving Inventory and the RAND SF-36 health survey in a cross-sectional experimental design. One third of the sample reported at least one incident of patient-initiated violence. Reports of violence were associated with poorer mental wellbeing scores amongst caregivers and more negative appraisals of caregiving. Patient-initiated violence also correlated with greater criticism and hostility expressed towards patients, and a rating of high EE in caregiver reports. The results underscore the need to ask explicitly and routinely about the physical safety of caregivers looking after someone with psychosis. Families should be directed towards appropriate interventions to help manage any risk of violence and the likely negative impact on the caregiving relationship.
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Affiliation(s)
- Lindsay M Smith
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Juliana Onwumere
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK.
| | - Thomas Craig
- King's College London, Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Elizabeth Kuipers
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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Fauziana R, Sambasivam R, Vaingankar JA, Abdin E, Ong HL, Tan ME, Chong SA, Subramaniam M. Positive Caregiving Characteristics as a Mediator of Caregiving Burden and Satisfaction With Life in Caregivers of Older Adults. J Geriatr Psychiatry Neurol 2018; 31:329-335. [PMID: 30260715 PMCID: PMC6262596 DOI: 10.1177/0891988718802111] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Satisfaction with life is recognized to be a factor in alleviating burden in stressful caregiving duties. However, the mechanism underlying this relationship is indistinct. Positive aspects of caregiving (PAC) may help to regulate caregiving burden among caregivers of older adults. The study aims to examine whether positive caregiving characteristics mediate the effect between satisfaction with life and burden of care. METHODS Participants were 285 caregivers of older adults (aged 60 and above) in Singapore and were recruited in a cross-sectional, self-report study (mean [M] = 47.0 years; 64.6% females). Measures included in the study were the Zarit Burden Interview (ZBI), Positive Aspects of Caregiving (PAC), and the Satisfaction with Life Scale (SWLS). Mediation analyses were used to study the indirect effects of life satisfaction on caregiver burden through features of PAC. RESULTS Mean scores for the ZBI, PAC, and SWLS scales were M = 23.15 (standard deviation [SD] = 15.98), M = 34.55 (SD = 8.19), and M = 23.56 (SD = 6.62) respectively. Results from the mediation analysis revealed that the association between life satisfaction and caregiving burden was significantly mediated by the PAC ( P < .001). DISCUSSION Positive aspects of caregiving may be a mechanism that links satisfaction with life and caregiver burden. Findings may represent attempts to manage caregiving duties as well as maintaining a positive attitude toward their responsibilities.
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Affiliation(s)
- Restria Fauziana
- Institute of Mental Health, Research Division, Singapore, Singapore
| | - Rajeswari Sambasivam
- Institute of Mental Health, Research Division, Singapore, Singapore,Rajeswari Sambasivam, Institute of Mental Health, Research Division, Singapore, Singapore.
| | | | - Edimansyah Abdin
- Institute of Mental Health, Research Division, Singapore, Singapore
| | - Hui Lin Ong
- Institute of Mental Health, Research Division, Singapore, Singapore
| | - Min-En Tan
- Institute of Mental Health, Research Division, Singapore, Singapore
| | - Siow Ann Chong
- Institute of Mental Health, Research Division, Singapore, Singapore
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The development and validation of the Brief Experience of Caregiving Inventory (BECI). Compr Psychiatry 2018; 86:54-59. [PMID: 30077807 DOI: 10.1016/j.comppsych.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The social network supporting an individual with psychosis may be adversely affected by the experience of caregiving. The Experience of Caregiving Inventory (ECI) is 66 item self-report measure of the impact of caregiving for carers of people diagnosed with psychotic disorders. This study aimed to create a brief version of the ECI, and evaluate its reliability and validity (n = 626). METHODS The validation process was conducted through a Multidimensional Item Response Theory (MIRT) approach, using a graded response model and a complementary network approach. RESULTS This resulted in a 19 item, four factor inventory with a good model fit, displaying good reliability and validity. CONCLUSION The BECI is a valid measure. The simplicity, ease of application and robust psychometric properties further enhances its acceptability and usefulness as a brief measure in clinical research and trials, as well as in routine practice providing reliable and valid data on experience of caregiving in families of an individual with psychosis.
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Onwumere J, Sirykaite S, Schulz J, Man E, James G, Afsharzadegan R, Khan S, Harvey R, Souray J, Raune D. Understanding the experience of "burnout" in first-episode psychosis carers. Compr Psychiatry 2018; 83:19-24. [PMID: 29505884 DOI: 10.1016/j.comppsych.2018.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 01/23/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The first onset of psychosis can exert a significant negative impact on the functioning and positive wellbeing of family carers. Carer reports of "burnout" have recently been recorded in early psychosis carers, though the literature is scarce detailing our understanding of how burnout relates to the primary experience of caregiving. The current study investigated reports of burnout and its relationship with beliefs about caregiving and wellbeing in a large group of early psychosis carers who were routinely assessed within an early intervention team. METHODS AND MATERIALS Using a cross-sectional design, 169 early psychosis carers completed the Maslach Burnout Inventory alongside measures of caregiving experiences, affect and wellbeing. RESULTS The mean illness length for patients with psychosis was 18 months. Their mean age was 24.4 years and most was male (65%). The majority of carer participants were parental caregivers and living with their relative with psychosis. Across the three key burnout dimensions, 58% of the sample reported high levels of emotional exhaustion; 31% endorsed high levels of depersonalization; and 43% reported low levels personal accomplishment. The most severe level of burnout, reflecting elevated rates across all three dimensions, was observed in 16% of the sample. Carer burnout was positively associated with negative caregiving experiences (i.e. burden), poor affect, and reduced levels of positive wellbeing and perception of being in good health. CONCLUSIONS Reports by early psychosis carers of exhaustion, feeling inadequate and expressing negativity towards the relative they care for is not uncommon and are closely associated with their overall negative appraisals of caregiving. The results underscore the importance of developing targeted interventions during the early phase, which are designed to reduce the development and entrenchment of burnout responses in carers, but to also mitigate its negative sequelae.
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Affiliation(s)
- Juliana Onwumere
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | | | - Joerg Schulz
- Department of Psychology, University of Hertfordshire, UK
| | - Emma Man
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Gareth James
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Roya Afsharzadegan
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Sanna Khan
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Raythe Harvey
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Jonathan Souray
- Early Intervention in Psychosis Service, West London Mental Health NHS Trust, UK
| | - David Raune
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
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Malhotra R, Chei CL, Menon EB, Chow WL, Quah S, Chan A, Ajay S, Matchar DB. Trajectories of positive aspects of caregiving among family caregivers of stroke-survivors: the differential impact of stroke-survivor disability. Top Stroke Rehabil 2018; 25:261-268. [DOI: 10.1080/10749357.2018.1455369] [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]
Affiliation(s)
- Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Choy-Lye Chei
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | | | - Wai-Leng Chow
- Health Services Research, Eastern Health Alliance, Singapore, Singapore
| | - Stella Quah
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Angelique Chan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Shweta Ajay
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - David Bruce Matchar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Lin E, Durbin J, Guerriere D, Volpe T, Selick A, Kennedy J, Ungar WJ, Lero DS. Assessing care-giving demands, resources and costs of family/friend caregivers for persons with mental health disorders: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:613-634. [PMID: 29498120 DOI: 10.1111/hsc.12546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 06/08/2023]
Abstract
As mental health (MH) care has shifted from institutional settings to the community, families and friends are responsible for providing the majority of the care at home. The substantial literature on the adverse effects experienced by caregivers has focused mainly on psychological morbidity. Less attention has been paid to how caregivers for persons with MH disorders interact with larger social systems and the impacts of factors such as financial strain, lost time from leisure activities, and the availability of health and social services. We conducted a scoping review of MH and other caregiver questionnaires published between 1990 and 2016 to determine whether they addressed four key domains: caregiver work demands, resource needs, resource utilisation and costs. A range of health and social care databases were searched, including MEDLINE and Health and Psychosocial Instruments. After screening for relevance and quality, our search identified 14 instruments addressing elements related to one or more of our domains. Because these instruments covered only a small portion of our domains, we conducted a second targeted search of the general care-giving literature and consulted with experts, identifying an additional 18 instruments. A total of 32 questionnaires were reviewed, 14 specific to care-giving for mental health problems and 18 for other health conditions. Our search identified instruments or items within instruments that assess constructs in each of our domains, but no one instrument covered them completely. Additionally, some constructs were evaluated in detail and others only addressed by single items. While these instruments are helpful for moving measurement beyond the psychological impacts of care-giving, our results serve only as an initial guide. Additional methodological work is needed to more comprehensively measure the impact of care-giving for individuals with MH disorders and to contribute to the development of more meaningful and effective policies and programmes.
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Affiliation(s)
- Elizabeth Lin
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Janet Durbin
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Denise Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tiziana Volpe
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Avra Selick
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Julia Kennedy
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donna S Lero
- Centre for Families, Work and Well-Being, University of Guelph, Guelph, ON, Canada
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Caqueo-Urízar A, Rus-Calafell M, Craig TKJ, Irarrazaval M, Urzúa A, Boyer L, Williams DR. Schizophrenia: Impact on Family Dynamics. Curr Psychiatry Rep 2017; 19:2. [PMID: 28097634 DOI: 10.1007/s11920-017-0756-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In many societies, family members are now the primary caregivers of mental health patients, taking on responsibilities traditionally under the purview of hospitals and medical professionals. The impact of this shift on the family is high, having both an emotional and economic toll. The aim of this paper is to review the main changes that occur in family dynamics for patients with schizophrenia. The article addresses three central themes: (i) changes in the family at the onset of the disorder, (ii) consequences for family members because of their caregiver role, and (iii) family interventions aimed at improving the complex dynamics within the family. After analyzing and discussing these themes, it is observed that despite advances in the field, the viability of taking care of a patient with schizophrenia by the family remains a challenge. Improving care will require commitments from the family, the mental health service system, and local and national governments for greater investments to improve the quality of life of society in general and individuals with schizophrenia in particular.
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Affiliation(s)
- Alejandra Caqueo-Urízar
- Escuela de Psicología y Filosofía, Universidad de Tarapacá, Avenida 18 de Septiembre 2222, Arica, Chile.
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA.
| | - Mar Rus-Calafell
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Thomas K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matias Irarrazaval
- Departamento de Psiquiatría, Facultad de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| | - Alfonso Urzúa
- Universidad Católica del Norte, Avda. Angamos 0610, Antofagasta, Chile
| | - Laurent Boyer
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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Guan L, Xiang Y, Ma X, Weng Y, Liang W. Qualities of Life of Patients with Psychotic Disorders and Their Family Caregivers: Comparison between Hospitalised and Community-Based Treatment in Beijing, China. PLoS One 2016; 11:e0166811. [PMID: 27870906 PMCID: PMC5117722 DOI: 10.1371/journal.pone.0166811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/06/2016] [Indexed: 11/18/2022] Open
Abstract
Background Community healthcare in mainland China is still at an early stage. The qualities of life (QOLs) of patients with psychotic disorders undergoing rehabilitation in hospitals or in the community, as well as those of their caregivers, may differ from each other. Objectives The study was performed to evaluate the QOL of patients with psychotic disorders and assess the differences in the QOLs between patients receiving care in diverse settings (hospital vs. the community). Methods This study was a descriptive study, in which all cases were collected from two psychiatric hospitals and five communities. Patients (n = 43) and caregivers (n = 40) in the psychiatric hospitals were grouped according to the length of illness and areas of residence and these criteria were also used to group patients (n = 55) and caregivers (n = 59) in the community. All participants were assessed using the WHOQOL-BREF (Chinese version). ANOVA was adopted to compare the QOL scores among the four groups (cases and caregivers in two settings), while confounding factors, such as age and marital status, were adjusted. Results Among the four groups of participants, namely, hospitalised and community patients and their corresponding caregivers, community samples had a significantly lower QOL score. The QOL score for the social relationships domain of the hospitalised patients’ caregivers was significantly higher than that of the caregivers of community patients (P = 0.019). Conclusion Community patients and their caregivers tend to have lower QOL scores than their hospitalised counterparts. The support of family members is urgently needed to provide better care for patients.
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Affiliation(s)
- Lizheng Guan
- Department of Family Medicine, School of Public Health and Family Medicine, Capital Medical University, Beijing, China
| | - Yingqiang Xiang
- Beijing An Ding Hospital, Capital Medical University, Beijing, China
| | - Xin Ma
- Beijing An Ding Hospital, Capital Medical University, Beijing, China
| | - Yongzhen Weng
- Beijing An Ding Hospital, Capital Medical University, Beijing, China
| | - Wannian Liang
- Department of Family Medicine, School of Public Health and Family Medicine, Capital Medical University, Beijing, China
- Department of Healthcare Reform, National Health and Family Planning Commission of P.R.C., Beijing, China
- * E-mail:
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Abstract
On the Road is a classic American novel that appeared at a time of great political, cultural, and psychiatric upheaval. Published almost 60 years ago, it still exerts great influence. We propose that the affirmative approach toward "madness" in the novel can enlighten our understanding of alternative perceptions of mental illness. The novel is analyzed with quantifying and narrative methods focusing on the concept of madness, which is a prominent theme in the novel. Stigma and glorification of madness can be found throughout the text. The positive sides and the pitfalls of an overly positive attitude toward mental illness and minority group members are discussed, including benevolent discrimination, recovery, and positive psychiatry.
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Rofail D, Regnault A, le Scouiller S, Lambert J, Zarit SH. Assessing the impact on caregivers of patients with schizophrenia: psychometric validation of the Schizophrenia Caregiver Questionnaire (SCQ). BMC Psychiatry 2016; 16:245. [PMID: 27431493 PMCID: PMC4950699 DOI: 10.1186/s12888-016-0951-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/15/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Schizophrenia Caregiver Questionnaire (SCQ) was developed to assess the impact on caregivers of caring for patients with schizophrenia. The objective of this study was to develop a scoring algorithm for the SCQ, and evaluate its measurement properties. METHODS The SCQ was administered to 358 caregivers of patients with schizophrenia included in the observational PATTERN study of stabilized patients with persistent symptoms of schizophrenia receiving outpatient care. SCQ item selection and creation of scores were based on exploration of item response distribution, factor analyses, and Rasch model. Construct validity, reliability, and ability to detect change of the SCQ scores were investigated. RESULTS The final questionnaire comprised a 'Humanistic impact' supra-domain composed of a global score and four subdomain scores ('Physical'; 'Emotional'; 'Social'; 'Daily life'), and eight other domain scores related to the caregiving role ('Exhaustion with caregiving'; 'Feeling alone'; 'Patient Dependence'; 'Worries for the patient'; 'Perception of caregiving'; 'Financial dependence of the patient'; 'Financial impact of caregiving'; 'Overall difficulty of caregiving'). Two items from the SCQ were deleted. SCQ scores showed very good construct validity: Item convergent/discriminant validity were satisfactory; SCQ scores of caregivers of patients with more severe symptoms were higher indicating more impact (p < 0.05 for all scores); SCQ scores were meaningfully associated with measures of schizophrenia severity (PANSS and PSP) and caregivers' Health-Related Quality of Life (Medical Outcome Survey Short Form 36 items). The SCQ Humanistic impact supra-domain scores demonstrated very good internal consistency reliability (Cronbach's alphas between 0.80 and 0.96) and test-retest reliability (Intraclass Coefficient correlations ranging from 0.75 and 0.87); Other SCQ domain scores showed lower but still acceptable reliability coefficients. SCQ scores clearly increased for caregivers of patients whose schizophrenia worsened. CONCLUSIONS Overall, the 30-item SCQ demonstrated very good measurement properties supporting its relevance to comprehensively measure the experience of caregivers of patients with schizophrenia.
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Affiliation(s)
- Diana Rofail
- Roche Products LTD, Shire Park, Welwyn Garden City, Hertfordshire UK
| | - Antoine Regnault
- Patient-centered Outcomes, Mapi, 27 rue de la Villette, 69003 Lyon, France
| | | | - Jérémy Lambert
- Patient-centered Outcomes, Mapi, 27 rue de la Villette, 69003, Lyon, France.
| | - Steven H. Zarit
- Human Development and Family Studies, The Pennsylvania State University, University Park, PA USA
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Noguchi M, Tachimori H, Naganuma Y, Zhao X, Kono T, Horii S, Takeshima T. Families' opinions about caring for patients with psychiatric disorders after involuntary hospitalization in Japan. Int J Soc Psychiatry 2016; 62:167-75. [PMID: 26631271 DOI: 10.1177/0020764015614595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE It is imperative to know families' opinions about where patients should live after discharge from involuntary hospitalization in the era of community mental health. METHODS Questionnaires were sent (March-May 2011) to 808 guardians of patients who were involuntarily hospitalized in Japan (response rate = 54.2%). The final sample size was 365 family members. Whether families wanted to live with the patient after discharge from the hospital was the primary outcome variable. The associations of the demographic characteristics of the patients and families with the outcome variable were tested using logistic regression analysis. RESULTS Approximately, 19% of the family guardians wanted to live with the patient after discharge from the hospital. Their wish to cohabit was positively associated with being a female (vs male) patient, having three or more cohabitants in the home and having lived together before hospitalization, after adjusting for the other covariates. Long-term hospitalization (10 years or longer) and siblings were significantly associated with the families not wanting to cohabit, after adjusting for the other covariates. CONCLUSION It is important to know families' opinions about patients' living situations after discharge from involuntary hospitalization to provide them with an effective support system.
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Affiliation(s)
- Masayuki Noguchi
- Okayama Prefectural Mental Health and Welfare Center, Okayama, Japan
| | - Hisateru Tachimori
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoichi Naganuma
- Department of Social Work, School of Health Sciences, Tokai University, Kanagawa, Japan
| | - Xianghua Zhao
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Toshiaki Kono
- Department of Forensic Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shigeo Horii
- Department of Psychiatry, Zikei Hospital, Okayama, Japan
| | - Tadashi Takeshima
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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