The Context of Caretaking in Rural Areas: Family Factors Influencing the Level of Functioning of Seriously Mentally Ill Patients Living at Home

Abstract

After the deinstitutionalization of psychiatric hospitals, many families became primary caregivers for seriously mentally ill individuals. Mental health services became further reduced with the advent of managed care and reductions in health and mental health care. The dearth of community-care options often results in psychiatric patients being quickly stabilized in hospital units and discharged to live with their families. The lack of community resources is particularly acute in rural areas. Given these realities the current study sought to determine if family caretaking variables are related to patient outcomes. Family factors including the perception of burden, expressed emotion (EE), and primary caregivers' social support were tested in a model of caretaking that examines the relationship between these factors and patients' symptom expression and social and occupational functioning. The sample includes 49 predominantly African American families living in a rural area and with a chronically ill family member who had been previously diagnosed with a psychotic disorder. Primary caregivers and patients were interviewed using adapted measures of burden, EE, and social support. Patients were administered a revised version of the Brief Psychiatric Rating Scale. Results suggest less perceived burden, increased caregiver support and, to a lesser extent, EE explain approximately one-fifth of the variance in patient functioning. These results support previous research demonstrating the importance of family factors for seriously mentally ill patient outcomes. Results are discussed in terms of implications for assisting families in the current era of diminished resources.

Resilience in Family Members of Persons with Serious Mental Illness

“…21 Some demographic features of family caregivers may increase their vulnerability to compromised health, including age 22,23 and level of education. 23 The studies suggested that older 3 Zauszniewski, Bekhet & Suresy family members and those who have less education may be more prone to health problems and disruptions in family functioning.…”

Factors Affecting the Sense of Burden Felt by Family Members Caring for Patients With Mental Illness

“…Factors that have been reported to potentially affect the sense of burden felt by family members caring for persons with mental illness at home are (a) the demographic characteristics of the families (e.g., whether the caregiver is a female or a spouse; Ostman, Wallsten, & Kjellin, 2005;Wittmund, Wilms, Mory, & Angermeyer, 2002), (b) the severity of the psychiatric symptoms and the patients' ability for social adaptation (including problematic behaviors; Kohn-Wood, & Wilson, 2005), (c) psychosocial factors (including the family's ability to cope with the needs of the patient, the time spent providing care, the duration of care, and economic problems; Schmid, Spiessl, Vukovich, & Cording, 2003;Stengård, 2002;Wilms et al, 2004;Wittmund, Nause, & Angermeyer, 2005), and (d) awareness of family members about psychiatric illnesses (Schmid, Spiessl, & Cording, 2005). As regards the relationship between the sense of burden and the sense that "life is worth living," that is, finding life worth living, on the part of family caregivers, Kramer (1997) pointed out that the sense that "life is worth living" felt by caregivers has many conceptual similarities with the positive views of the caregivers about caring for family members with illness.…”

Relationships Among Perceived Burden, Depressive Cognitions, Resourcefulness, and Quality of Life in Female Relatives of Seriously Mentally Ill Adults

“…This means many families must take care of their mentally ill family members (Chang & Horrocks, 2006;Chien & Norman, 2003). Two thirds (57-69%) of family caregivers of persons with SMI are women (Kohn-Wood & Wilson, 2005;Tung & Gillett, 2005) and studies have shown that these family members are at high risk of developing a depressive disorder (Wittmund, Wilms, Mory, & Angermeyer, 2002).…”