Prosocial Family Processes and the Quality of Life of Persons With Schizophrenia

Abstract

Objectives-Research on the family's contribution to the quality of life of persons with serious mental illness has largely focused on negative family interactions associated with poorer client outcomes. The purpose of this naturalistic study of aging mothers and adults with schizophrenia was to investigate prosocial family processes that potentially enhance, rather than detract from, the life satisfaction of persons with serious mental illness.Methods-The data were drawn from a longitudinal study of aging parents caring for a son or daughter with schizophrenia. This report is based on 122 mother-adult child dyads who participated in the third wave of the study. Mothers completed an in-home interview and questionnaire that included measures of the quality of the relationship between the mother and adult child, maternal warmth, and maternal praise of the adult child. The adult with schizophrenia completed a life satisfaction questionnaire.Results-The adults with schizophrenia had higher life satisfaction when their mothers expressed greater warmth and praise of their son or daughter with schizophrenia and when their mothers reported the quality of their relationship as being close and mutually supportive.Conclusions-Past research has emphasized changing families, most typically by lowering expressed emotion, with little emphasis on the families' strengths, in particular, prosocial family processes that may enhance the life satisfaction of their loved one. As a recovery orientation focuses on the strengths of adults with mental illness, it also should focus equally on the supportive presence of families in the lives of clients.Research on the family's contribution to the quality of life of persons with serious mental illness has focused largely on negative family interactions associated with poorer outcomes. The concept of expressed emotion has received the most attention, with an emphasis on the family's role in relapse through criticism of and overinvolvement in the life of the relative with mental illness. However, many families play a supportive role and serve as a safety net, because the demand for mental health services far exceeds their availability (1).Yet little is known about the types of family behaviors that enhance rather than detract from the quality of life of persons with schizophrenia. Lopez and colleagues (2) have begun to identify prosocial family processes, such as the expression of warmth and positive remarks, that support clients on their road to recovery. However, research on adults with schizophrenia has been limited to studying the relationship of these prosocial behaviors to relapse (3)(4)(5). The This article is part of a special section honoring the memory of three leaders in the psychosocial treatment of patients with severe and persistent mental disorders: Wayne S. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript purpose of this cross-sectional analysis of data drawn from a longitudinal study of families and adults with schizophrenia was to build upon ...

Are the Effects of Duration of Untreated Psychosis Socially Mediated?

“…This finding appears consistent with the considerable body of research showing that expressed emotion (which includes indices of criticism and hostility) is directly related to likelihood of relapse and other aspects of treatment outcome, 58 and more recent research implicating expressions of positive thoughts and feelings from others as being particularly important in predicting social adjustment and likelihood of relapse. [64][65][66] Long periods of active psychosis will likely have impacts on support received from others. Perhaps changes in some domains will differ from trajectories in other areas.…”

Directions for Future Patient-Centered and Comparative Effectiveness Research for People With Serious Mental Illness

“…Greenberg et al 147 approached their study of family members' contribution to the QOL of consumers with serious mental illnesses from the perspective that most prior research has focused on the negative impact of family member participation on client outcomes. Past research focused on lowering expressed emotion among family members with little attention to the potential benefits that might result from prosocial family processes such as support, warmth, and affection.…”

“…Past research focused on lowering expressed emotion among family members with little attention to the potential benefits that might result from prosocial family processes such as support, warmth, and affection. Greenberg et al 147 examined longitudinal data from aging parents who were caring for an adult child with schizophrenia, finding that the adult children demonstrated higher life satisfaction when their mothers expressed greater warmth and praise and when their mothers reported the quality of their relationship as being close and mutually supportive. The authors noted that a recovery orientation focused on the strengths of adults with mental illness should focus equally on the supportive presence of their families.…”

“…The authors noted that a recovery orientation focused on the strengths of adults with mental illness should focus equally on the supportive presence of their families. 147 Family-based services were reviewed as part of the Schizophrenia Patient Outcomes Research Team. 148 While the studies reviewed were not focused specifically on assessing family needs and preferences, the authors identified ways in which family member involvement facilitates positive outcomes.…”

“…Nevertheless, a distinct advantage of these measures is that they have been used as measures of treatment outcomes across a wide variety of interventions and have thus been linked to various service programs and packages. These include CCMs, 361,369 integrated care models, 297 supported housing programs, 485 approaches to improving relationships with providers, 52 use of a recovery orientation that addresses families' needs and preferences, 147 and efforts to reduce coercion. 79 Several comprehensive reviews of these measures are available, [627][628][629][630][631][632] but little is known about how well they represent consumer preferences or values.…”