Burden in Schizophrenia Caregivers: Impact of Family Psychoeducation and Awareness of Patient Suicidality

Abstract

Family caregivers of persons with schizophrenia and other psychotic disorders experience high levels of burden. Although a number of patient and caregiver predictors of burden have been identified, little research has investigated the contributions of patient depression, suicidal ideation, and substance abuse. In addition, family psychoeducation interventions have reduced patient symptoms, as well as inpatient treatment utilization; however, it is not known whether or not these interventions reduce family burden. This study investigated predictors of family burden and tested to what degree multiple family group treatment (MFGT), relative to a standard care condition, was associated with reduced family burden. Participants were 90 outpatients with a diagnosis of schizophrenia or other psychotic disorders, and their caregivers who were enrolled in a 2 year psychoeducation intervention. The best set of predictors of burden, identified by stepwise linear regression, was young patient age, awareness of patient's suicidal ideation, and family resources. These variables accounted for 32% of the total variance in burden. Findings suggest that caregiver's awareness of patient's suicidal ideation, not patient's report of suicidal ideation; and that patient age, not duration of the illness, were significant independent predictors of burden. When compared to a standard-care condition over 2 years, MFGT did not reduce family caregiver burden. Discussions focus on the relationship between burden and its predictors, and possible reasons why MFGT did not decrease burden. Modifications are proposed that may increase the impact of MFGT.

Burden of caregivers of adult patients with schizophrenia in a predominantly African ancestry population

“…Caregiving burden also includes environmental burden and is associated with stigmatization and social isolation by neighbors or other acquaintances [7]. McDonnell et al [8] reported that caregiver's awareness of patient's suicidal ideation and long-term cost implications for care contribute to the burden and were significant predictors of the burden of care. Other studies show that caregivers are at increased risk of deterioration in health and functioning [9,10].…”

Burden of Care in Families of Patients with Schizophrenia

“…It is a self-administered instrument with 22 items, which explores negative effects on the caregiver in relation to physical and mental health, social activities, and economic resources. Each question is evaluated on a Likert scale with five possible responses from ''never'' (1) to ''almost always'' (5). Total scores range from 22-110.…”

“…Demands of caregiving include paying for psychiatric treatment, supervision of the patient, dealing with societal stigma associated with mental illness, and emotional distress that may result from symptoms of family member's disorder [5].…”

Psychoeducation for Psychotic Patients

“…Some studies, however, have suggested that it is unlikely that caregivers, particularly those of patients with a long history of illness, will change their views of patients after a short PEP intervention. Further, the difficulty in engaging patients and their carers during PEP has made the outcomes of the programs inconclusive [21][22][23] . In the United States, family psychoeducation interventions are currently considered one of five evidence-based psychosocial interventions for persons with severe mental illness, particularly those with schizophrenia 24 .…”