Burden Assessment Schedule Research Articles

THE UNSEEN: BURDEN IN CAREGIVERS OF PATIENTS WITH SCHIZOPHRENIA IN A TERTIARY CARE INSTITUTE

Objectives: This study aims to evaluate the prevalence of caregiver burden in patients with schizophrenia using the burden assessment schedule (BAS). Methods: A cross-sectional study was conducted with 100 patients diagnosed with schizophrenia and their respective caregivers from the patients admitted in the male and female wards of the psychiatric department to evaluate caregiver burden. The BAS is used to determine the burden on caregivers of schizophrenic patients. Results: This study revealed that 51% of the caregivers had experienced moderate levels of burden. Older caregivers experienced a significantly higher burden (p=0.03), whereas residence and educational status had no significant effect on the burden. The burden was highest among parents, followed by spouses, and the burden is positively correlated with gender and older caregivers. Conclusion: It is evident that an unaddressed burden exists among the caregivers of patients who have mental illness. It is crucial to develop strategies to lessen the load of caregiving and implement them effectively. Counseling and psychological support, though they do not directly mitigate the suffering of patients, may help improve the quality of care given by them to individuals with schizophrenia, thus overall improving the mental well-being of the whole family.

A comparative analysis of burden of care and coping styles between wives of monosubstance- and polysubstance-dependent men.

Polysubstance dependence has emerged as a clinically distinct entity from monosubstance dependence, yet its impact on patients' wives is understudied. Wives of substance-dependent men face a tremendous burden in their social lives, leading to faulty coping and burden of care. Comparative studies between monosubstances and polysubstances are lacking. This study compared the burden of care and coping styles between wives of monosubstance- and polysubstance-dependent men. A comparative analysis was performed between wives of 70 monosubstance-dependent and 70 polysubstance-dependent patients. The burden of care was assessed by the Burden Assessment Schedule (BAS), whereas coping styles were assessed using the Brief Coping Orientation to Problems Experienced (Brief COPE) Inventory. Both groups faced a moderate burden of care, which was significantly higher in wives of polysubstance abusers as compared to monosubstance abusers (U = 366.50, P < 0.01). The difference was mainly seen in their impact on well-being and relationships with others. Avoidant coping was significantly higher in wives of polysubstance abusers (U = 341.00, P < 0.01), whereas emotion-focused and problem-solving coping styles were equally represented. Avoidant and problem-solving coping styles positively correlated with the burden of care (P < 0.01). The burden of care and avoidant coping strategies are higher in wives of polysubstance-dependent men. An increased burden of care is associated with increased use of both avoidant coping and problem-solving coping.

Assessment of Behavioral and Psychological Symptoms in Dementia, Associated Risk Factors and Clinical Correlates

Background: The presence of behavioral and psychological symptoms in dementia (BPSD) are associated with hospitalization, rapid cognitive decline, poor quality of life and higher caregiver burden. Thus, we aim to characterize the BPSD symptoms, its relationship to dementia-related risk factors and their predictive value, if any.Methodology: In 48 adults (mean age: 70.27 ± 10.08) with major neurocognitive disorder (MNCD) as per diagnostic and statistical manual of mental disorders, 5th edition and with Hindi mental status examination scores less than or equal to 23 were recruited. Patients were assessed for cognition by hindi Montreal cognitive assessment (HMOCA) and the clinical dementia rating scale (CDR). BPSD and caregiver burden were assessed using the neuropsychiatric inventory (NPI) and burden assessment schedule (BAS). The correlation of NPI scores with socio-demographic variables and clinical variables was assessed. A forward stepwise linear regression (using p-value &lt; .05) was used to identify possible predictors of the NPI scores.Results: The majority of participants were predominantly males, 25 (52.1%), from urban regions, belonged to middle-class socio-economic status and had severe grading (HMOCA (&lt; 10) of MNCD (25 (52.2%) but had moderate caregiver burden (25 (52.2%)). The most common MNCD type was due to Alzheimer’s disease (22 (45.8%)). Cortical atrophy and ischemic infarcts were the most common neuroimaging abnormalities reported (7 (14.9%)). Mean HMOCA, clinical dementia rating scale (CDR), NPI and BAS scores were 9.13 ± 6.96, 1.50 ± 1.05, 41.79 ± 27.06 and 68.65 ± 22.84, respectively. The most common BPSD domains were sleep disturbance (60.4%) and hallucinations (56.25%). Among the established risk factors, hypertension was present in the highest proportion (21 (43.8%)). As per the stepwise logistic regression model CDR scores, smoking status and HTN were predicted risk factors (R²: 0.452; p = 0.045).Conclusion: Irritability/agitation is most prevalent BPSD. The severity of MNCD, smoking and hypertension may help in the prediction of BPSD and their role may have to be explored in further studies.

To Assess Caregiver Burden of Patients with Dementia: Its Sociodemographic and Clinical Correlates

Background and Aim: To assess the primary caregiver burden in the patients of dementia. Dementia is a chronic neurodegenerative disorder that refers to a disease process marked by progressive cognitive impairment in clear consciousness. The morbidities associated with dementia accounts for the poor quality of life. Equally affected are caregivers of these patients. The study aims to assess the caregiver burden (CGB) and how the care of these patients affect them. This further includes sociodemographic and clinical features of the caregivers. Materials and Methods: The cross-sectional study was conducted from June 2021 to May 2022 in the Department of Psychiatry, MGM medical college, Indore (M.P.) after approval from the institutional ethical committee. The study included 60 patients and 60 caregivers attending Psychiatry outpatient department (OPD). They were assessed using a semi-structured proforma consisting of socio-demographic and clinical variables. Clinical rating scale i.e., burden assessment schedule (BAS) was applied for caregivers and dementia severity rating scale (DSRS) for the patients. Pearson's and Spearman's correlation coefficient was applied with P-value &lt; 0.05 considered as significant. Result: The study finds that the mean age of the caregiver is 55.6 ± 10.01 years and that of patient is 69.81± 0.71 years. The mean BAS score is 68.3 ± 11.77. A negative correlation is established between BAS and income of the caregiver and is statistically significant (P &lt; .001), while a positive correlation between BAS and age, number of hospitalization, total duration of illness, and the mean of time spent with the patient during the day and is statistically significant (P &lt; .001). Factors like low income, advancing age, and time spent with the patients in the caregivers had affected the BAS score, and the score was found to be raised. Factors related to the patients affecting the BAS score was total duration of illness and number of hospitalization. Both factors played a key role in the addressed the overall care burden among the caregivers. Conclusion: Factors such as low income, advancing age, and time spent with the patients in the caregivers had affected the BAS score, and the score was found to be raised. Factors related to the patients affecting the BAS score was the total duration of illness and number of hospitalization. Both factors played a key role in the addressed the overall care burden among the caregivers.

ATTITUDES TOWARDS MENTAL ILLNESS TO DECREASE THE FAMILY CAREGIVERS’ BURDEN

Background: Community-based mental health services should be aware of the role of family and society. With the stigma issues in mental illness that still remain, the impact would be greater on the family caregivers. Their behavior toward patients creates a burden on care.&#x0D; Objectives: Assess the relationship between attitude toward mental illness and burden of family caregivers.&#x0D; Methods: Descriptive with a cross sectional approach. There were 120 family caregivers of patients with Schizophrenia in the hospital in Surabaya, Indonesia participated on this study by using purposive sampling technique. The instruments on this study were Attitudes towards Schizophrenia Questionnaire (ATSQ) and Burden Assessment Schedule (BAS).&#x0D; Results: The higher burden correlates with the negative attitude toward mental illness (r(118)= .54, p= .000).&#x0D; Conclusion: Realistic attitude would relieve the burden for family caregiver. Therefore, need more knowledge for family and society to shape their behavior toward patients with mental illness.&#x0D; &#x0D;

Depression and the Caregiver Burden for Schizophrenia Patients

Background and objectives: Schizophrenia is a recurring psychiatric condition that severely impairs patients' ability to function in all major spheres of their lives. Since the deinstitutionalization policy, families, especially the primary caregiver who bears a heavy physical and emotional strain, are responsible for providing care. According to estimates, caregivers' rates of depression are higher than those of the general population. The primary caregivers' burden of care, their level of depression, and related caregiver factors were all examined in this crosssectional study. Methods: After gathering socio-demographic and caregiving information, 60 consenting primary caregivers of patients with an ICD-10 diagnosis of schizophrenia were evaluated for burden of care and depression using the Burden Assessment Schedule and the Patient Health Questionnaire–9. Results: A majority of the 35 female and 25 male carers reported experiencing moderate to severe depression, and all had moderate to high levels of burden. More burden was felt by spouses (p=0.0038), older carers (p=0.01), and those with lower educational levels (p=0.01). Depression and caregiving burden had a statistically significant positive connection (p=0.000). Conclusion: Despite the ease with which psychiatric therapies are accessible in one of India's largest metropolitan areas, caregivers continue to experience stress and depression. This may affect not only the caregiver but also the patient's care and the course of the sickness.

PSYCHIATRIC MORBIDITIES AND BURDEN IN CAREGIVERS OF PATIENTS OF OBSESSIVE COMPULSIVE DISORDER

Background: Obsessive–compulsive disorder (OCD) is a chronic mental disorder that can be a source of emotional, financial and/or social burden for family caregivers. Few studies have investigated family caregiving for patients diagnosed with OCD in relation to the coping strategies being used from a theoretical perspective. This study evaluated the burden and coping strategies of family caregivers for people diagnosed with OCD. Methods: A cross-sectional study was conducted, in which 94 participants diagnosed with OCD and their caregivers were surveyed using Burden assessment schedule (BAS) used to measure burden among caregivers of patients of OCD. Results: The mean ages of the patients were 36.03 + 12.03 and the caregivers were 43.28 + 14.76. Only 46.8% of the caregivers were female, compared to 74.5% of the patients who were female. Patients spouses made up half of the caregivers (50%) and parents made up almost a quarter (22%) The average length of the illness was 8.10± 6.60 years, and the average length of the cure was 4.04 ±4.47 years. The mean BAS score for the caregiver was 39.52 ±12.99. The Relationship Between Sociodemographic, Clinical, Quality-of-Life, and Disease Burden of Patients The BAS scores of caregivers who had patients who thought their income was low were significantly higher than those of the other caregivers (p=0.013). Conclusions: Designing strategic interventions for family caregiver coping is necessary to support the unique burdens and coping mechanisms faced by family caregivers of people with OCD.

An explorative study comparing the burden of the caregivers of patients with mood disorders and alcohol dependence syndrome

ABSTRACT Background: Alcohol dependence syndrome (ADS) and mood disorders, such as bipolar disorder and depression, are psychiatric disorders punctuated by many relapses and remissions. Patients suffering from these disorders impose a considerable burden on their caregivers. The burden includes multiple responsibilities such as financial costs and physical care of the patient while compromising on their freedom. Due to their nature of relapses and chronicity, they also harm the caregiver’s mental health. Hence, our attempt to study and compare the caregiver burden imposed by mood disorders and ADS. Aims and Objectives: To study the burden between caregivers of patients with mood disorders and ADS and to identify a significant association, if any, between sociodemographic characteristics and caregiver burden. Methods: It is a cross-sectional hospital-based study. Sixty patients, along with their primary caregivers attending the psychiatry outpatient department at a teaching hospital, were included in the study. Detailed evaluation was done on patients and caregivers using a semi-structured pro forma. The Burden Assessment Schedule is a standardized tool that was used to assess the caregiver burden. Those with severe burden were then screened for psychiatric disorders using the Mini-International Neuropsychiatric Interview. Results: The burden was similar in caregivers of mood disorders and ADS patients. Only 17% of caregivers were found to have a clinically diagnosable psychiatric illness. Marital relation was more affected by alcohol dependence than mood disorder. Furthermore, caregivers of patients with ADS were more likely to develop psychiatric illnesses. A more significant burden was seen with increased duration of illness, though not significantly. Conclusion: The mean total burden score being similar in both groups implies that the degree of burden experienced is the same. Most caregivers reported symptoms of anxiety and depression, though not clinically significant.

Caregiver burden among caregivers of mentally ill individuals and their coping mechanisms A facility based study

Problem: Mental illnesses not only affect the individual concerned but also the caregivers. Caregiver burden is a complex phenomenon. Caregivers who perceive high level of burden are those who lack both family and social support. They require tireless endeavor, sympathy and energy. Mostly family members fail to recognize it and caregiver’s own physical, mental and social health is often ignored. Care givers adopt various coping mechanism. A Mechanism, adopted in a positive way would lessen the amount of burden.6 Mal adaptive strategy in turn would affect the well being.7The study was done to measure and analyze caregiver burden and factors associated with the burden respectively. The study was also intended to explore coping mechanisms adapted by the caregivers in response to burden perceived by them. Approach: A cross sectional analytical study was conducted among 60 caregivers of patients with mental illnesses attending psychiatric medicine outpatient department in a tertiary care hospital, at Karur(India) between July 2022 and Dec 2022. After obtaining Institutional Ethics clearance and informed consent, study tool was administered. It consisted of 4 parts. Part 1 dealt with socio-demographic details of the participants. Part 2 enquired about clinical information of care recipient. Part 3 included the Burden Assessment Schedule. Part 4 was the brief COPE assessment scale. Data entry was done in Microsoft Excel. Entered data were exported to SPSS software version 20 for analysis. Appropriate descriptive and inferential statistics were done. Independent T test, one way ANOVA, Pearson’s correlation and Chi square tests were applied. Findings: Among caregivers other than spouses, male caregivers perceive higher burden (mean score +/- SE = 28.75 +/- 2.272) than the female caregivers (mean score +/- SE = 26.25 +/- 2.192). Perceived severity of disease was higher among Care givers residing in urban area (mean score +/- SE = 8.0385 +/- 0.36577) than those residing in rural area (mean score +/- SE = 6.9118 +/- 0.28438). Among caregivers other than spouses, caregivers who had completed higher secondary schooling or diploma holders perceive higher level of burden (mean – 28.75) than those who completed primary schooling (mean – 24.75). Impact of chronic mental illness of care recipients on well being of caregivers was higher among spousal caregivers than the others. A Positive correlation existed between burden perceived among spousal caregivers and problem focused, emotional focused and adaptive coping. All these associations were statistically significant at p value 0.05, 0.01 or 0.001. Distribution of moderate to severe burden among caregivers other than spouses (52.3%) is slightly higher than that of spousal caregivers (50%) and the difference is not statistically significant (p = 0.876). Conclusion: Among various factors, gender, education, residence and chronic nature of care recipient’s mental illness were found to be significantly associated with either one or another component of burden or the whole. Mental health professionals should broaden their vision so that burden perceived by the caregivers would also be attended. Public health personnel should take measures to implement family as well as community level approach to attend caregivers along with their mentally ill care recipients.

Gender differences in burden of care and coping strategies among caregivers of schizophrenia patients

Caregivers of patients with schizophrenia have a considerable burden of care and develop different coping strategies to deal with the caregiving burden. The aim of this article is to assess gender differences in the burden of care and coping strategies used among caregivers of clinically stable patients with schizophrenia. In this cross-sectional study, a total of 57 caregivers (33 males and 24 females) of the patients with schizophrenia attending a psychiatric outpatient setting were included by purposive sampling. The caregivers were assessed with the Burden Assessment Schedule 20 items (BAS-20) and Brief Approach/Avoidance Coping Questionnaire (BACQ) to assess the burden of care and coping strategies, respectively. Average BAS-20 score was comparable between the male and female caregivers. If the patient was a spouse, the male caregivers had a significantly higher burden of the marital relationship than the female caregivers. On the BACQ, the socio-emotional approach subscale was significantly higher in female caregivers. The avoidance-oriented coping score and socio-emotional avoidance subscale were significantly higher in male caregivers. A significant positive correlation was found between BAS-20 score and avoidance-oriented coping scores in all caregivers except the females where a significant negative correlation was found between BAS score and socio-emotional avoidance type of coping. There are no gender differences in the burden of care in caregivers of clinically stable patients with schizophrenia except the male caregivers have a higher burden in the domain of marital relationship. The socio-emotional approach type of coping is higher in females while the socio-emotional avoidance type of coping is lower in male caregivers.

Burden Of Care and Depression in Caregivers of Patients with Schizophrenia

Background: Schizophrenia, a chronic psychiatric disorder affecting all major domains of a patient’s life, leads to significant disability. Since the deinstitutionalization policy, the onus of care is on families especially the primary caregiver who experiences physical and emotional burden. Depression among caregivers has been estimated to be higher than the general population. This cross-sectional study aimed to assess burden of care and depression in primary caregivers and associated caregiver variables. Methods: 75 consenting primary caregivers of patients with ICD-10 diagnosis of schizophrenia were assessed for burden of care and depression using the Burden Assessment Schedule and the Patient Health Questionnaire - 9 after collecting socio-demographic and caregiving details. Results: All the caregivers, 49 females and 26 males, had moderate to high levels of burden with a majority having moderate to severe levels of depression. Spouses (p=0.0038), older caregivers (p=0.01) and those with lower educational levels (p=0.01) experienced more burden. There was a significant positive correlation between burden of care and depression (p=0.000). Conclusion: In one of India’s largest metropolitan cities, though psychiatric services are easily available, caregivers continue to feel burdened and depressed. This can impact not just the caregiver but also care being provided to the patient and illness outcome.

A comparison of burden of care in caregivers of patients with schizophrenia and obsessive-compulsive disorder

Background: Schizophrenia and obsessive-compulsive disorder (OCD) are two common and chronic psychiatric illnesses known to be associated with a considerable burden of caregiving. Various sociodemographic and clinical variables can influence the caregiving experience of the caregivers of these patients. Aim and Objectives: The present study aims to assess the burden of care, with the help of a well-standardized tool, and its relationship with different factors related to the caregivers. Materials and Methods: After obtaining the ethical approval from the Institutional Ethical Committee, a total of 50 adult caregivers with their patients with OCD as well as 50 caregivers with their patients with schizophrenia were enrolled on the study. The burden assessment schedule (BAS) was the principal tool to assess the burden of care in the caregivers of both patient groups. Results: The majority of the caregivers were male in both study groups. Both the study groups were comparable in terms of all sociodemographic variables except education and occupation. An education level of high school and above was found in a significantly higher number of the caregivers of patients with the OCD than those with schizophrenia (76% vs. 34%; χ2= 25.76; P&lt;0.001). A significantly higher number (70% vs. 42%, χ2=8.227, P&lt;0.05) of caregivers of patients with schizophrenia were unemployed. Both groups were comparable in terms of the overall burden of care (i.e., total BAS score), but the caregivers of patients with schizophrenia had a significantly higher mean score of the burden in the domain “caregiver’s routine” (8.92±1.82 vs. 8.08±1.85; t=2.291; P&lt;0.05) and in the domain “taking responsibility” (11.0±0.50 vs. 10.08±0.94; t=6.103; P&lt;0.001) than the caregivers of patients with OCD. Conclusion: The burden of care in the caregivers of patients with the OCD was not less than that in patients with schizophrenia in almost all of its domains except the burden of caregiver’s routines and taking responsibilities which were higher than the caregivers of patients with schizophrenia. There is a need for the development of educational inputs and support programs for these caregivers based on their local needs.

A study to assess the burden and perceived stigma among caregivers of patient with schizophrenia at Dharwad Institute of Mental Health and Neurosciences, Dharwad (DIMHANS)

Background and Objectives: The level of stigma associated to mental illness is much higher than that is already perceived in India. Though some studies in western culture have reported co-relation between stigma and burden, amongst family members of persons with mental illness. There are few studies carried out in India that co-relates stigma with burden of schizophrenia caregiver’s. There is a need to highlight the association between perceived stigma and level of burden among caregivers of patient with schizophrenia.Methods: A quantitative cross sectional descriptive study was conducted to assess and correlate the burden and perceived stigma among caregiver of schizophrenia patients at DIMHANS Dharwad during Jan- April 2017. 100 caregivers of schizophrenia patients who are attending outpatient department or admitted at psychiatric wards were selected based on convenient sampling technique. The data were collected by using Burden Assessment Schedule (BAS) and Affiliate Stigma Scale. Interview was used to collect data from caregivers. Result: Among the total 100 respondents 64% were male, 81% were married, 88% belonged to Hindu religion and proportion participants were residing rural area. The mean burden scores of caregivers were 36.35±3.68 and mean perceived stigma scores were 53.94±4.41. Out of 100 participants 78% have high burden and 57% have high perceived stigma scores. There was a significant positive correlation between perceived stigma and burden among caregivers of schizophrenia patients. The association between perceived stigma and burden with socio-demographic variables revealed that there was a significant association between gender, income and duration of illness with burden (x2=4.21, p=0.04, x2=5.65, p=0.01, x2=8.68, p=0.03). There was a significant association between type of family with perceived stigma (x2=4.61, p=0.03).

Burden of care and quality of life in caregivers of children and adolescents with autism spectrum disorder.

Autism spectrum disorder is a neurodevelopmental disorder which is increasing across the globe. The disorder in children not only creates burden of care in caregivers but also leads to impaired quality of life of families. To study the burden of care and quality of life in caregivers of children and adolescents with ASD. Cross sectional study conducted in Child and Adolescent psychiatry outpatient services at a government centre in north India between September 2014 to August 2015. The sample consisted of 40 caregivers of children with Autism. Mean age of the caregiver's were 34.72±6.32 years. Burden of care and quality of life were measured by Burden Assessment Schedule (BAS) and World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire respectively. Mean burden of care on BAS was 71.73±8.62 indicating quite a high degree of burden on the caregivers of ASD. Significantly higher burden was reported by caregivers belonging to low income families and caregivers of children in age group 6-12 years. A positive correlation was observed between severity of autism and burden of care in caregivers. The study also found that as the severity of symptom increases the QoL in caregiver worsens. Caregivers of children with ASD suffer from high burden of care and impaired QoL.

Relation of expressed emotions and burden of care in primary caregivers to severity of illness in schizophrenia patients: A cross-sectional, hospital based study

Background: Negative expressed emotions are a significant characteristic of the family milieu that has been found to predict symptom relapse in schizophrenia and may be related to severity of illness and burden of care. Aim: The aim of this article is to study the expressed emotions and burden of care in primary caregiver of patients suffering from schizophrenia, with relation to severity of illness. Methods: This cross-sectional, hospital-based study included 60 schizophrenia patients and their primary caregivers. Positive and Negative Syndrome Scale (PANSS), modified Global Assessment of Functioning scale (mGAF), and Family Emotional Involvement and Criticism Scale (FEICS) were applied on the patients. Burden Assessment Schedule (BAS) was applied on the caregivers. Results: Patients were mostly male, symptomatic, diagnosed as paranoid schizophrenia and aged between 20 and 50 years. Caregivers were predominantly married and employed. Expressed emotions and burden of care were significantly related to caregiver and patient education, gender, employment, marital status, type of family, diagnosis, duration of illness, caregiver relation, duration of care giving, and severity of schizophrenia symptoms. Burden of care showed significant variations according to patient and caregiver economic status, domicile, religion, and age. Both expressed emotions and burden of care had moderately positive and statistically significant correlation with severity of the disease. Conclusion: Both expressed emotions and burden of care in primary caregiver of patients suffering from schizophrenia are influenced by a number of sociodemographic, clinical, and disease-related factors. Thus increase or decrease in expressed emotions and burden of care is caused by the complex interaction of various factors that the patients and caregivers experience.

ASSESSMENT OF THE CORRELATION BETWEEN FAMILY BURDEN IN PRIMARY CAREGIVERS AND DISABILITY IN PATIENTS WITH SCHIZOPHRENIA

Background: Schizophrenia is one of the most devastating, and a chronic, relapsing mental illness associated with increased morbidity, poor quality of life and low recovery rates. In India, families are the major providers of long-term care and they represent an important supportive, social network for patients with schizophrenia. Indian families experience significant degrees of burden in the care of their relatives with schizophrenia. Illness severity and patients' disability have a direct positive relationship with perceived family burden.&#x0D; Methods: This study is a cross-sectional study, done to assess the correlation between family burden in primary caregivers and disability in patients with schizophrenia. 60 patients with schizophrenia and their primary caregivers were recruited from the outpatient and inpatient units of Department of Psychiatry, Government Rajaji Hospital, Madurai. IDEAS (Indian Disability Evaluation Assessment Scale) scale was used to assess the disability of patients with schizophrenia and BAS (Burden Assessment Schedule) of SCARF (Schizophrenia Research Foundation) was used to assess the family burden in their primary caregivers.&#x0D; Results: Among the 60 primary caregivers, (48.3%) were having caregiver burden between 50 and 70%. (56.4%) of female caregivers had burden range 50- 70%. (56.5%) of caregivers delivering care for patients with illness between 15 and 20 years experienced burden &gt;70%. Statistical analysis revealed that the correlation between caregiver burden and disability was statistically significant.&#x0D; Conclusions: The severity of caregiver burden increases with increasing grades of disability and indicates that caregiver burden affects the overall outcome of schizophrenia&#x0D; Keywords: Schizophrenia, Caregiver burden, Disability, Outcome

Burden &amp; Coping in Caregivers of Persons with Dementia

Background: Dementia is a serious loss of global cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging. Dementia is often associated with physical, mental and financial burden. Care giving is associated with more psychological complaints & coping is most often conceptualized as a response to the demands of specific stressful situations. Aim: To assess the burden in caregiver of persons with dementia and also assess the coping strategies used by the caregivers. Settings and design: The study was conducted in the Department of Psychiatry, Assam Medical College & Hospital, Dibrugarh. The subjects for the study were recruited from the outpatient & indoor facilities of the department of Psychiatry, Assam Medical College & Hospital, Dibrugarh. After application of the inclusion and exclusion criteria, (n=40) cases of Dementia and theircaregivers (n=40) were included in the study. Materials &Methods: Diagnosis of dementia was done by fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR).The tools used were Burden Assessment Schedule by Thara et al 15 , Assamese version of ways of Coping Questionnaire by Susan Folkman and Richard S. Lazarus 16-17 . Statistical analysis was done by using SPSS- 20. Results: The results revealed that level of burden reported by caregivers of dementia patients was high. The most common coping strategies used by caregivers of Dementia patients were confronting coping (72%), distancing(45%), seeking social support(45%) and self-controlling (45%). Conclusion: The various findings in our study evidence that dementia can have serious consequences on families particularly the primary caregivers. Results highlight the importance of improving the mixed coping skills in burdened caregivers. Keywords:Dementia, caregivers, Burden, Coping strategies

ASSESSMENT OF CAREGIVER BURDEN OF MENTALLY ILL PATIENTS: A CROSS SECTIONAL STUDY

One of the main aspects of community care of mentally ill patient is family support. Caregiver Burden is the Physical, Emotional &amp; Financial toll of providing care. A caregiver may go into depression, anxiety, physical burnout or emotional burnout due to stress of giving care to the patient. By assessing the burden and nding out the factors related to high burden we can nd out the coping strategies. This cross-sectional study was planned to assess Caregiver burden of mentally ill patients and also to nd out the factors associated with high caregiver burden among the study subjects. This study was conducted in tertiary mental health care centres of Thiruvananthapuram among 80 primary care givers using Burden Assessment Schedule (BAS) developed by Schizophrenia Research Foundation (SCARF), Chennai and data was analysed to get Proportions and Chi Square. We found that majority of caregivers had high burden and caregiver's relationship with patient is signicantly associated with high burden.

English

BACKGROUND Mental health is an important aspect of health, and it should be cherished, promoted, and conserved, to the maximum. World-wide, around 450 million people suffering from mental illness and contributing to important causes for years lived with disability. Caring is a fundamental issue in the treatment of a patient with mental illness. Majority of patients stay with their families and they have been the mainstay of care giving for patients with mental illness. Taking care of chronic mentally ill patients puts stress and burden on the caregivers. Caregivers use different methods of coping. This study was conducted to assess burden among caregivers of chronic mentally ill patients. METHODS This is a hospital based cross-sectional study. A consecutive sample of 150 caregivers of both inpatients and outpatients who satisfy the inclusion criteria, attending psychiatry department were recruited in the study. Caregivers were assessed with socio-demographic proforma. The burden assessment schedule (BAS) developed by SCARF measures the burden experienced by caregivers of chronic mentally ill patients. Statistical analysis was done using statistical package for social sciences (SPSS). Categorical and quantitative variables were expressed as frequency (percentage) and mean ± SD respectively. Chi-square test was used to association between categorical variables. RESULTS Of the 150 participants, 16 % experienced mild burden, 57.3 % had moderate levels of burden and 26.7 % had severe burden levels. CONCLUSIONS This study concluded that caregivers of the mentally ill individuals do undergo a lot of burden or strain. Highest areas of burden were seen in the areas of physical and mental health, external support, and spouse related. The caregivers are in need of support and understanding. Clinicians dealing with the caregivers of patients with chronic mental illness must systematically assess the coping mechanisms of caregivers and encourage the use of adaptive and problem-focused coping mechanism to improve the caregiving and patient related outcome. Hence, there is a need to develop strategies that can help them such as providing them with a support structure as well as counseling services. KEYWORDS Caregiver, Burden, Mental Illness, Coping

Care at door-steps for persons with severe mental disorders: A pilot experience from Karnataka district mental health program.

Public funded outreach services for persons with severe mental disorders (SMDs), a norm in developed nations, is non-existent in India. We share our pilot experience with an indigenous model named 'Care at Doorsteps' (CADs) for persons with SMDs who dropped out from clinical care of District Mental Health Program (DMHP) at three sites of Karnataka, a south Indian state. The objectives of this study were to identify the reasons for drop outs from routine care and to assess the burden of illness and disability after the intervention. Six-month prospective observational study on patients aged 18-60 years, diagnosed as Schizophrenia or bipolar disorder was conducted. Three home visits were made by the team and provided medications, also offered brief psychoeducation and counselling. Care-givers were interviewed to identify the reasons for drop outs and their expectations from the treating team. Patients were also assessed using the Clinical Global Impression Scale (CGI), Indian Disability Evaluation and Assessment Scale (IDEAS) and Burden Assessment Schedule (BAS) during each visit. Ninety-six patients (50 males and 46 females) were followed up, of which 85 had a diagnosis of schizophrenia and 11 with bipolar illness. Common reasons for drop out were: single caregiver (breadwinner) unable to accompany the patient, loss of faith in medical treatment and financial constraints. Symptomatic improvement and restoration of productive work were the priority expectations. Over the course, the mean CGI-S showed significant reduction (4.81 ± 1.57, 4.46 ± 1.32 and 4.11 ± 1.39 respectively; p = 0.001). Mean score on BAS showed a significant reduction (85.76 ± 12.15, 83.46 ± 11.30, 84.27 ± 11.82; p = 0.04). Mean total IDEAS scores did not show significant change (13.27 ± 4.78, 12.82 ± 4.24, 13.17 ± 4.40; p = 0.16). Meaningful assertive outreach care is feasible in India and is found to be useful for persons with SMDs by utilising the already existing public sector resources.