Caregiver Reports of Patient-Initiated Violence in Psychosis

Abstract

Objective:Aggressive behaviour in psychosis is not uncommon. Community provision for people with psychosis has left informal caregivers to take on a greater role in their care. However, few studies have explored links between patient-initiated violence in mental health caregiving relationships and caregiver functioning. Our study investigated caregiver reports of aggressive acts committed by their relative with psychosis and their links to caregiver appraisals of the caregiving relationship and caregiver outcomes.Method:Caregivers of patients with a recent relapse of psychosis, recruited to a psychological therapy trial, completed the audiotaped Camberwell Family Interview at baseline. This semi-structured interview includes questions on the quality of the relationship between caregiver and patient, and patient history of violence. Seventy-two transcripts of interviews were assessed for reports of patient-initiated violence.Results:One-half of the caregiver sample (52.9%) reported an incident of patient-initiated violence during their interview; 62.2% of these involved violence toward themselves, and 24.3% toward property. Reports of patient violence were associated with caregiver ratings of hostility expressed toward patients, lower self-esteem, and emotion-focused coping. People caring on their own were more likely to report incidents of patient violence. Younger patients, males, and inpatients were more frequently identified as having a history of this kind of violence.Conclusions:Our findings suggested that caregiver reports of patient-initiated violence in psychosis are not uncommon. Mental health staff need to be aware of the risks of such violence for caregivers of people with psychosis, and consider appropriate procedures for minimizing it.Clinical Trial Registration Number: ISRCTN83557988

The last taboo: The experience of violence in first‐episode psychosis caregiving relationships

“…The results linking FEP carers’ exposure to patient violence to subjective reports of emotional burden and exhaustion, difficulties in the caregiving relationship, and stigma were consistent with existing literature (Kageyama et al ., ; Vaddadi et al . ; Onwumere et al ., ; Torrey, ). Some participants highlighted having reached their coping limit, of not feeling able to take on any more, feeling exhausted, and unable to think clearly.…”

“…Carers of people with psychosis experience a significant impact of care (Gupta, Isherwood, Jones, & Van Impe, ; Sadath, Muralidhar, Varambally, Gangadhar, & Rose, ), which carries considerable implications for their coping efforts, quality of caregiving relationship, and illness outcomes (Kuipers, Onwumere, & Bebbington, ). Lifetime rates of patient violence towards caregivers has been estimated in some studies at 50–60% (e.g., Kageyama et al ., ; Onwumere et al ., ), and approximately one‐third of carers report incidents of violence in the preceding year (Kageyama et al ., ; Wing‐Yum Chan, ). Recent data suggest that 40% of FEP patients had been physically abusive towards their parents in the 2 months prior to first presentation (Fawzi et al ., ).…”

Factors related to physical violence experienced by parents of persons with schizophrenia in Japan

“…In a previous study, family violence was associated with higher levels of caregivers' expressed hostility toward their patient relative (a component of high EE) (Onwumere et al, 2014). Negative attitudes may produce hostile and aggressive feelings that may provoke violence (Solomon et al, 2005).…”

Caring for a relative with delusional beliefs: a qualitative exploration

“…For example, in a study of interviews with 72 carers of adults with psychosis, just over half reported incidents of patient initiated violence and almost two‐thirds of incidents were towards themselves (Onwumere et al . ). Patient acts of violent behaviour towards self and others, including homicides, have been linked to persecutory delusional beliefs (Nordstrom et al .…”