Level Of Family Burden Research Articles

Psychoeducational family intervention for bipolar I disorder: medium and long-term efficacy

IntroductionBipolar disorder (BD) is associated to high personal and social burden, impaired social functioning and high levels of disability. Recent studies have showed that relapse rates are significantly reduced in those patients whose families receive psychoeducational interventions. Even though most of available evidences are related to the short-term efficacy of psychoeducational family interventions (PFI). No evidence is available on medium and long-term efficacy.ObjectivesThis study aims to assess the efficacy after one and five years of PFI in BD in terms of: 1) improvement of patients’ symptoms and global functioning; 2) improvement of relatives’ objective and subjective burden and coping strategies.MethodsA multicenter, controlled, outpatient trial has been conducted in BD patients and their key relatives, recruited in 11 Italian mental health centers. Patient’s clinical status, social and personal functioning, burden of illness, and relative’s burden and coping strategies were assessed with specific instruments at baseline, after 1 year and after 5 years.Results137 families were recruited, 70 allocated to the experimental intervention. After one year, an increasing positive effect on patients’ clinical status, global functioning and objective and subjective burden was found. Moreover, were observed a reduced number of relapses and of hospitalizations after five years, compared to the control group. A reduction in the levels of family burden and an improvement of their coping strategies were also observed.ConclusionsPositive effects of the experimental intervention persist over the mid and long-term period. PFI should be provided in mental health centres to patients with BD and their relatives.DisclosureNo significant relationships.

T243. RESOURCE GROUP-ACT: RELATIVES’ PERSPECTIVES

BackgroundRelatives often take on great responsibility for helping the patient in his or her daily life, and many relatives experience lack of support from health care services. Cooperation with relatives is a central component in Resource groups Assertive Community Treatment (R-ACT). This person-centered model has been found to decrease symptoms, increase level of function, and strengthen well-being in patients with psychotic disorders. However, little is known about relatives’ experiences of the model.AimTo examine relatives experiences of R-ACT. Further, to compare relatives’ experiences of treatment and feelings of being alienated from care services in relatives’ with and without experience of R-ACT. We hypothesize higher levels of family burden, and family stigma and lower quality of life in relatives without R-ACT.DesignCross-sectional study focusing on relatives of persons with psychotic disorders during the period of October 1, 2017 – May 31, 2018.ParticipantsRelatives of next of kin suffering from psychotic disorders, treated in health care clinics with and without R-ACT in Västra Götaland County in Sweden.MeasurementsThe postal questionnaire includes four self-reported instruments: the Family Involvement and Alienation Questionnaire, the Burden Inventory for Relatives of Persons Psychotic Disturbances, the Inventory of Stigmatizing Experiences (family version), and RAND-36.ResultsRecruitment is ongoing. Preliminary results will be presented at the conference.DiscussionIncreased knowledge about relatives’ experiences of psychosis care can inform the development of R-ACT, a care model that focuses on participation of both patients and their relatives.

Relationship between the levels of family burden in caring for older people with the incidence of mistreatment

Caring for older people can be a burden for the family that led to mistreatment. To determine the relationship between the levels of family burden in caring for older people with the occurrence of mistreatment incidence. A cross sectional study design was conducted with 135 older people who live with their family as respondents. 135 families with older people at Kelurahan/Village of Harjamukti area, Kecamatan/ District of Cimanggis, Depok city. This study applied probability sampling technique with multistage cluster sampling. Family characteristics show that almost half of older people were caring by family members (caregivers) who were aged 20-39 years, nearly all caregivers were women, family income mostly less than UMK, families mostly monosyllabic nation Betawi and caregivers mostly were their own child. Most of the families stated that no expense in caring for the older people (89.6%), but there are still families who feel the burden of caring. The highest type of mistreatmet of the older people is psychological mistreatments. From the statistical test obtained by p value equals to 0.553, it was concluded there was no correlation between the incidences of any family burden with mistreatment.

Efficacy of Psychoeducational Family Intervention in Bipolar I Disorder: Results From a Multicenter, Randomized, Controlled Trial

Introduction Psychoeducational family intervention (PFI) has been proposed to supplement pharmacotherapy in order to improve the clinical outcome of people with bipolar I disorder. Only a few studies have been carried out on the efficacy of PFI on patients' social functioning and on relatives' burden. Objectives to improve patients' social functioning and to reduce the level of family burden in relatives of people with bipolar I disorder. Aims to improve clinical outcome and social functioning of patients with bipolar I disorder, and to reduce family burden, in those receiving the experimental intervention compared with treatment as usual (TAU) group. Methods A multicentre, real-world, randomized, controlled, outpatient trial was carried out in 11 Italian mental health centres. Enrolled patients and key-relatives were consecutively allocated either to receive PFI and TAU or to a waiting list receiving TAU alone. Results 70 families were allocated to the experimental group and 67 to the control group. At the end of the intervention, a significant improvement in patients' clinical status and social functioning was found in the experimental group compared to TAU, as well as a significant reduction in the levels of relatives' subjective and objective burden. The effect of the intervention remained significant also after controlling for several confounding patient's socio-demographic and clinical factors. Conclusions PFI is effective in improving the clinical and social outcomes of patients with bipolar I disorder and of their relatives.

Family functioning in first-episode psychosis: a systematic review of the literature

The influential role of family in the outcome of chronic schizophrenia is well documented. However, there has been relatively little research on the intrafamilial relationships of people experiencing their first episode of psychosis (FEP), a point in time when most of the changes in family dynamics are observed. The aim of this article is to present a review of the literature focusing on the family environment of FEP patients. We carried out a computerized literature search on MEDLINE and PsycINFO (1990-2013), and a manual search of references of pertinent articles. In total, 27 studies investigating expressed emotion (EE) and family burden (FB) in FEP were identified and fulfilled the inclusion criteria. Similar to chronic patients, a high prevalence of high-EE in carers of FEP patients was reported. High-EE status appears to be independent of the patient's illness-related characteristics, but dependent of relatives' attributions. In contrast to chronic patients, low levels of FB and psychological distress among family members of FEP patients were observed indicating that in the early stages of the illness family involvement is not yet associated with significant disruption in their lives. Studies assessing FB in chronic patients have found a well-established link of FB with patient's illness-related factors, but in FEP patients the families' appraisal of FB is more closely associated with their coping mechanisms. Further studies evaluating family functioning in terms of cohesion and adaptability will shed light on the intrafamilial relationships in FEP patients which may be associated with the long-term outcome of this chronic illness.

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.

Identifying factors contributing to child and family outcome 30 months after traumatic brain injury in children

Objective: To examine the contributions of injury severity, physical and cognitive disability, child and family function to outcome 30 months after traumatic brain injury (TBI) in children. Design: A prospective,...

Predictors of Acute Child and Family Outcome following Traumatic Brain Injury in Children

Objective: To examine the relative contributions of injury severity, level of physical and cognitive disability, child behavior and family function to short-term outcome 6 months following traumatic brain injury (TBI) in children. Design: Prospective, longitudinal, between-group design, comparing preinjury and postinjury measures of functional outcome across three levels of injury severity. Subjects: One hundred and twelve children, aged 2–12 years admitted to the Royal Children’s Hospital, Melbourne, with a diagnosis of TBI. The sample was divided into three groups, according to injury severity: mild TBI (n = 31), moderate TBI (n = 52) and severe TBI (n = 29). Children with a history of neurologic, developmental and psychiatric disorder were excluded from participation. Main Outcome Measures: Levels of postinjury functioning in the following domains: physical function, cognitive ability (incorporating intellect, memory and attention), behavioral and family functioning, and level of family burden. Results: A clear dose-response relationship for physical and cognitive outcomes was found, with severe TBI associated with greater impairment of physical, intellectual, memory and attentional function. For psychosocial outcome, results were less clearly linked to injury severity. Preinjury behavioral and family functioning were closely related to postinjury function in these domains, with an interaction identified between family function and child behavior at 6 months postinjury. Family functioning remained unchanged postinjury, although level of burden was high, and predicted by injury severity, functional impairment and postinjury behavioral disturbance. Conclusions: These results suggest ongoing functional problems for the child and significant family burden 6 months following TBI. The nature and severity of physical and cognitive problems are most closely related to injury severity, with family functioning and child behavior better predicted by psychosocial and premorbid factors.

Family burden of schizophrenia and depressive illness. Specifying the effects of ethnicity, gender and social ecology.

The burdens experienced by relatives of mentally ill persons are substantial. To study the relationship between family burden and sociocultural context. A comparative study of Euro-Americans and Latinos ascertained whether dimensions of family response are (a) non-specific to diagnostic groups; and/or (b) variable across cultural settings. Regardless of diagnosis or ethnicity, patient misery was found most burdensome and distressing. However, considerable difference in shades of meaning and nuance across groups appears in relation to what is classed similarly as 'misery'. Only gender was significantly associated with social performance (males reported to have greater deficits). A complex cultural ecological effect was observed among the Latino-schizophrenia group. Findings suggest similarities and differences in levels of family burden in relation to socio-cultural factors across cultural and diagnostic groups. The specificity of results by objective and subjective measures, types of burden, gender, ethnicity, diagnosis, and living situation confirm the importance of context and heterogeneity in understanding family burden and distress.

Is It Ever Too Late to Learn? Information Provision to Relatives of Long-term Schizophrenia Sufferers

This pilot study describes the provision of information tailored to meet the needs of families caring for a chronic schizophrenic member. An existing education package (Smith and Birchwood, 1987) was adapted to give greater emphasis to negative symptoms, myths/stereotypes and “quality of life” issues. A range of outcome measures revealed that the “original” education package promoted a greater reduction in the level of family burden whereas the “modified” package tended to promote greater belief in the efficacy of medication. Both educational programmes were associated with significant gains in knowledge per se (but not in “functional knowledge”) and significant positive changes in families' beliefs about their own role in the treatment process. The implications of these findings are discussed.

Relationship between expressed emotion and family burden in psychotic disorders: an exploratory study

This study explored the relationship between level of expressed emotion (EE) and level of family burden in 20 families of individuals with psychotic disorder. Results indicated that a relationship between EE and family burden did exist, but it appeared to be strongly influenced by demographic and illness-related variables. The usefulness of the 5-min speech sample method of assessing EE was limited by the aversion of some family members to being videotaped and by denial of patient symptoms by some relatives. Other methodological weaknesses are discussed. The relationship between demographic and illness-related variables and level of EE needs further exploration.