Family Burden In Schizophrenia Research Articles

Family burden in schizophrenia: the influence of age of onset and negative symptoms.

To investigate the determinants of family burden in a sample of patients with schizophrenia and their caregivers. Thirty-one stable patients with schizophrenia and their main caregivers were recruited. Sociodemographic variables were assessed in a semi-structured interview, and positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Cognitive performance was assessed with the Schizophrenia Cognition Rating Scale (SCoRS). Levels of burden on caregivers were assessed with the Family Burden Interview Schedule (FBIS). Interactions among variables were analyzed using Pearson correlations and linear regression analysis. Objective and subjective FBIS scores were 1.9 (standard deviation [SD] = 0.5) and 2.4 (SD = 0.6) respectively. Objective burden correlated positively with positive and negative symptoms, and cognitive impairment. Subjective burden correlated positively with positive symptoms and negatively with mean age of disease onset. Positive, negative and cognitive symptoms accounted for 47.6% of the variance of objective burden, with negative symptoms accounting independently for 30.3%. Age of onset, parents as caregivers and positive symptoms accounted for 28% of the variance of subjective burden, with age of onset independently explaining 20.3%. Patients' clinical and sociodemographic variables are important determinants of family burden in schizophrenia. Objective burden is predicted by symptoms, particularly negative ones. Subjective burden is predicted by symptoms and sociodemographic variables, particularly age of disease onset.

Factors associated with family burden in schizophrenia

Background: Family burden affects the health of both patient and caregivers. Identifying determinants of family care burden in patients with schizophrenia has significant psychosocial implications. Aim: To investigate the sociodemographic factors associated with caregiver burden in patients with schizophrenia. Materials and Methods: A series of one hundred schizophrenia within the age group of 18–47 and above and having more than 2 year's history of illness and 100 caregivers of such a patient have been taken up for the study, within the age group of 18–63 and above. To identify the primary care givers of the above patients, Pollack and Perlick scale was used. The International Classification of Disease-10 – Diagnostic Criteria for Research were used for psychiatric diagnosis. Patient and caregivers of the patients were assessed on self-developed sociodemographic pro forma. Pearson correlation coefficient test was used to study the correlation between patient, caregivers, and family burden. Results: Family care burden has statistically significant correlation with patients advanced age (r = 0.239, P Conclusion: Patient advanced ages, duration of illness, poor patient income, caregivers' advanced ages, low education level, poor family income, and length of contact with patients were the factors most likely associated with family care burden in schizophrenia.

Second generation antipsychotics are not superior in relieving family burden in schizophrenia compared with the first generation antipsychotic perphenazine

Second generation antipsychotics are not superior in relieving family burden in schizophrenia compared with the first generation antipsychotic perphenazine

Impact of antipsychotic medication on family burden in schizophrenia: Longitudinal results of CATIE trial

Background This study evaluated the effectiveness of first- and second-generation antipsychotics in reducing family burden associated with schizophrenia. Methods The family caregivers of 623 SCID-diagnosed patients enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) randomly assigned to a first-generation antipsychotic (perphenazine) or one of four second-generation drugs (olanzapine, quetiapine, risperidone or ziprasidone) were interviewed about resources provided and stresses experienced at baseline and followed for 18 months. Patient symptoms, side effects and service use were assessed as well. Hierarchical regression analyses evaluated the effect of treatment assignment on four burden factors: problem behavior, resource demands and disruption, impairment in activities of daily living and patient helpfulness. Intention-to-treat analyses with all available observations classified based on initial treatment assignment, including observations after medications changed were followed by secondary analyses excluding observations after the first medication change, i.e. only considering initial medication. Results Despite significant reductions on the problem behavior and resource demands/disruption factors, there were no significant differences between perphenazine and any of the second-generation medications. When only initial treatment period observations were included, patients were perceived as more helpful when medicated with perphenazine as compared to risperidone. In comparisons between second-generation drugs, patients on quetiapine were perceived as more helpful than those on risperidone ( p = 0.004). Conclusion In this 18-month randomized trial, there was no evidence of superiority of second-generation antipsychotics in relieving family burden.

Psychoeducation and the family burden in schizophrenia: a randomized controlled trial

BackgroundThe majority of patients with schizophrenia live with their relatives in Pakistan, thereby families experience a considerable burden. We aimed to study the impact of psychoeducation on the burden of schizophrenia on the family in a randomised controlled trial.MethodsA total of 108 patients with schizophrenia and their family members from the outpatient department of a teaching hospital in Lahore, Pakistan were randomised. Both groups received psychotropic drugs but one group received psychoeducation in addition. Family burden was assessed at the time of recruitment and at 6 months post intervention.ResultsIn all, 99 patients and their relatives completed the treatment. There was significant reduction in burden at post-intervention assessment in the psychoeducation group based on intention to treat analysis.ConclusionFamily psychoeducation can be an important intervention for patients with schizophrenia in Pakistan.

P.3.f.003 Illness activity or medical history – what is most important for family burden in schizophrenia? The impact of remission

Illness activity or medical history: what is most important for family burden in schizophrenia? The impact of remission

The perceived burden among Chinese family caregivers of people with schizophrenia

The aim of this study was to examine the level of perceived burden of the Chinese families caring for a relative with schizophrenia and to test its associations with their demographic characteristics, social and family factors and health condition. Despite the increased demands on family members to provide care for patients with schizophrenia in community care, little is known about the level of family burden among these family caregivers and its relationship with their demographic, social and cultural backgrounds. This was a cross-sectional descriptive study. A total of 203 family caregivers were recruited from three regional psychiatric outpatient clinics in Hong Kong. They were asked to complete a set of well-validated questionnaires, consisting of the Chinese version of four instruments - Family Burden Interview Schedule, Family Assessment Device, Six-item Social Support Questionnaire and MOS 36-Item Short Form Health Survey and a socio-demographic data sheet. Statistical analyses were conducted to test the differences in mean burden scores between subgroups, the inter-relationships among the mean scores of the scales and socio-demographic variables and the predictors of family burden. The families who perceived a higher level of caregiver burden were those who lived in a family with poorer functioning, worse health status and less satisfaction of social support. The caregivers' burden score was positively correlated with their age; conversely, it was negatively correlated with their monthly household income and number of family members living with patient. Social support was the best predictor of caregiver burden. These findings increase our understanding about the socio-demographic and cultural variables influencing the well being of family caregivers of a relative with schizophrenia. Helping families to maintain and enhance a supportive social network may represent a useful means to reduce family burden in schizophrenia. This understanding helps health professionals and researchers to identify different sources and domains of burden from a Chinese cultural perspective and take into account of these factors when planning interventions for family caregivers.

Family psychoeducational interventions for schizophrenia in routine settings: impact on patients' clinical status and social functioning and on relatives' burden and resources

This study explored the effectiveness of a psychoeducational family intervention for schizophrenia on patients' clinical status and disability and relatives' burden and perceived support. The study has been carried out in 17 mental health centres. In each of them, 2 professionals were trained in a psychoeducational intervention and applied it for six months with families of users with schizophrenia. At baseline and six months later, patients' clinical status and disability, and relatives' burden, social network and professional support were assessed by validated tools. Of the seventy-one recruited families, 48 (68%) completed the intervention. At six months, a significant improvement was found in patients' clinical status and social functioning, as well as in relatives' burden and social and professional support. In particular, the percentage of patients with poor or very poor global social functioning dropped from 50% to 27% at six months. Forty percent of patients and 45% of relatives reported a significant improvement in their social contacts over the intervention period. The results of this study confirm the hypothesis that psychoeducational family interventions may have a significant effect on social outcome and family burden in schizophrenia when provided in routine conditions.

Components and Correlates of Family Burden in Schizophrenia

Components and Correlates of Family Burden in Schizophrenia

Special Section on CATIE Baseline Data: Components and Correlates of Family Burden in Schizophrenia

Components and correlates of caregiver burden in schizophrenia were studied.The family caregivers of 623 (43 percent) of 1,460 patients with schizophrenia enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) were interviewed about resources they provided and experiences with patient behavior over the previous month. Patients were independently evaluated on symptoms, quality of life, neurocognition, medication side effects, and service use. Factor analysis reduced the caregiver data into four orthogonal factors assessing perceptions of patient problem behavior, patient impairment in activities of daily living, patient helpfulness, and resource demands and disruptions in the caregiver's personal routine.Hierarchical regression analyses demonstrated differential correlates of burden for each factor, explaining 34 percent of variance each for problem behavior and resource demands and disruption, 21 percent for impairment in activities of daily living, and 38 percent for patient helpfulness. Demographic characteristics and patient symptoms explained the greatest proportion of variance, whereas quality of life and service use explained modest variance and patient neurocognition and medication side effects were not significantly associated with burden.Results underscore the need for continued intervention with family members after the acute inpatient phase of treatment to address the impacts of symptoms as well as incorporation of skills training into consumer treatment programs to improve consumer contributions to household maintenance.

The impact of caregivers’ characteristics, patients’ conditions and regional differences on family burden in schizophrenia: a longitudinal analysis

Impact of caregiver characteristics, patient variables, and regional differences on family burden. Two hundred and eighteen schizophrenia patients and key-relatives of an urban and a rural area were examined five times over 30 months. Patients' psychopathology, service utilization; relatives' burden, coping abilities and contact duration with the patients were recorded. Effects of interpersonal differences and intrapersonal changes over time were analyzed with regression models. Interpersonal differences (patients' positive and negative symptoms, relatives' coping abilities, and patient contact) and intrapersonal changes (relatives' coping abilities, patients' negative symptoms and utilization of community care) predicted family burden. Family education programs should help caregivers to improve their coping strategies. Therapy solutions must address negative symptoms just as much as positive symptoms, as these especially impact caregivers. Intensified community-based care can reduce burden, but provision alone is not sufficient. Psychiatrists and caregivers should motivate patients to take advantage of such offers.

Burden of Care in Families of Patients with Schizophrenia

Family caregivers of persons with schizophrenia and other disorders experience high levels of burden. Most studies of family burden in schizophrenia have taken place in developed countries. The current study examined family burden and its correlates in a medium income country in South America. Forty-one relatives of patients with schizophrenia who were attending a public mental health outpatient service in the province of Arica, Chile, were assessed on Spanish versions of the Zarit Caregiver Burden Scale. All caregivers show a very high degree of burden, especially mothers, older, with low educational level, without an employment and who are taking care of younger patients. As developing country, Chile has a few national social welfare and community rehabilitation programs for relatives of psychiatric patients, especially in this part of the country. This significantly influences the high level of burden experienced by these caregivers. These results suggest a close monitoring of carer's mental health and the provision of a family intervention and psycho-social support.

Burden of care and general health in families of patients with schizophrenia

De-institutionalization of psychiatric patients has led to a greater emphasis on family management in the community, and family members are often overwhelmed by the demands that caring for a patient with schizophrenia involves. Most studies of family burden in schizophrenia have taken place in developed countries. The current study examined family burden and its correlates in a regional area of a medium income country in South America. Sixty-five relatives of patients with schizophrenia who were attending a public mental health out-patient service in the province of Arica, Chile, were assessed on Spanish versions of the Zarit Caregiver Burden Scale and SF-36 Health Survey (SF-36). Average levels of burden were very high, particularly for mothers, carers with less education, carers of younger patients and carers of patients with more hospitalisations in the previous 3 years. Kinship and number of recent hospitalisations retained unique predictive variance in a multiple regression. Burden was the strongest predictor of SF-36 subscales, and the prediction from burden remained significant after entry of other potential predictors. In common with families in developed countries, family members of schizophrenia patients in regional Chile reported high levels of burden and related functional and health impact. The study highlighted the support needs of carers in contexts with high rates of poverty and limited health and community resources.

The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy.

(a) To explore burden related to caregiving and support received from professionals and social network in relatives of patients with schizophrenia in Northern, Central and Southern Italy; and (b) to test whether a higher level of family burden is associated with a lower level of professional and social network support. Seven hundred and nine patients with schizophrenia and their key-relatives were consecutively recruited in 30 Italian mental health departments. Data were collected on: (a) patients' clinical status and levels of disability; (b) relatives' burden, social and professional support; (c) interventions received by patients and their families. Family burden was found lower in Northern Italy. However, after controlling for psychosocial interventions, differences in family burden among the three geographical areas disappeared. Family burden was associated with patients' levels of disability and manic/hostility symptoms, and with professional and social network support received by the family. Professional and social network support represent crucial resources to reduce family burden in schizophrenia.

Family burden and coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study.

To date, only few data are available on how family burden in schizophrenia changes over time. In addition, no study has explored how such factors as coping styles and social support influence burden over time. This paper presents the 1-year follow-up data from the BIOMED I study on family burden and coping strategies in schizophrenia. A sample of 159 relatives of patients with schizophrenia living in five European countries was followed up prospectively for 1 year with regard to burden and coping strategies, using validated questionnaires. In the sample as a whole, the burden was stable. A reduction of family burden over time was found among relatives who adopted less emotion-focused coping strategies and received more practical support from their social network. In addition, family burden decreased in relation to the improvement of patient's social functioning. When relatives of patients with schizophrenia are able to improve their coping strategies, it is possible for burden to be reduced even after several years. This points to the necessity to provide families of chronic psychotic patients with psychoeducational interventions emphasising the adoption of an effective coping style.

Family burden and coping strategies in schizophrenia: are key relatives really different to other relatives?

Subjective and objective burden, psychiatric symptoms and coping strategies in a sample of 90 key relatives and other relatives of patients with schizophrenia, living in two European countries, were explored by means of well-validated questionnaires. The levels of burden on key relatives did not differ significantly from those on other relatives. Moreover, the risk of developing psychiatric symptoms was similar in the two subject groups at both centres. Significant correlations were found between key relatives and other relatives concerning the adoption of emotion-focused coping strategies. These data contrast with the current belief that family burden in schizophrenia is mainly a burden of key relatives, and they emphasize the need to provide supportive interventions for as many relatives as possible.

Family burden in schizophrenia: effects of socio-environmental and clinical variables and family intervention

Description of burden, attitudes and received professional support in a sample of relatives of patients with schizophrenia recruited in 8 Italian Mental Health Services (MHS), stratified by geographic areas and population density. Cross-sectional study on key-relatives of clinically stable patients with a DSM-IV diagnosis of schizophrenia. Evaluation of: a) relationships of family burden with patient's clinical characteristics, family's socio-demographic variables, relative's attitudes toward the patient, professional and social support received by the family; b) differences in the levels of burden, attitudes and support received by the family with respect to geographical area and population density. 8 Italian MHS stratified by geographic areas (Northern, Central, Southern Italy) and population density (urban vs. rural areas). Patient's clinical status and social functioning: BPRS and ADC. Family burden, attitudes and support received by the family: FPQ. Data on 144 patients and their key-relatives were collected. Higher levels of burden were found among relatives referring to Southern MHS. The burden was found positively correlated with the levels of patients' BPRS positive and manic/hostility symptoms and disability, and with the number of daily hours spent by the relative in contact with the patient, and negatively correlated with the levels of professional support received by the family. The results of this study highlight the need to provide rehabilitative programmes for patients with schizophrenia as well as informative and psychoeducational interventions for their families.