|Year : 2016 | Volume
| Issue : 3 | Page : 273-278
Factors associated with family burden in schizophrenia
Sateesh Rangarao Koujalgi1, Raghavendra B Nayak2
1 Department of Psychiatry, J.N. Medical College, KLE University, Belagavi, Karnataka, India
2 Associate Professor of Psychiatry, Dharwad Institute of Mental Health and Neuro Science, Dharwad, India
|Date of Web Publication||21-Dec-2016|
Dr. Sateesh Rangarao Koujalgi
Department of Psychiatry, J.N. Medical College, KLE University, Nehru Nagar, Belagavi - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Family burden affects the health of both patient and caregivers. Identifying determinants of family care burden in patients with schizophrenia has significant psychosocial implications.
Aim: To investigate the sociodemographic factors associated with caregiver burden in patients with schizophrenia.
Materials and Methods: A series of one hundred schizophrenia within the age group of 18–47 and above and having more than 2 year's history of illness and 100 caregivers of such a patient have been taken up for the study, within the age group of 18–63 and above. To identify the primary care givers of the above patients, Pollack and Perlick scale was used. The International Classification of Disease-10 – Diagnostic Criteria for Research were used for psychiatric diagnosis. Patient and caregivers of the patients were assessed on self-developed sociodemographic pro forma. Pearson correlation coefficient test was used to study the correlation between patient, caregivers, and family burden.
Results: Family care burden has statistically significant correlation with patients advanced age (r = 0.239, P< 0.017), duration of illness (r = 0.210, P< 0.036), and patient income (r = 0.202, P< 0.044). The correlation analysis also correlated positively with family care burden and caregivers advanced age (r = 0.226, P< 0.034), low education level (r = −0.215, P< 0.032), poor family income (r = 0.205, P< 0.043), and length of contact with patients (r = 0.242, P< 0.021).
Conclusion: Patient advanced ages, duration of illness, poor patient income, caregivers' advanced ages, low education level, poor family income, and length of contact with patients were the factors most likely associated with family care burden in schizophrenia.
Keywords: Caregivers, factors associated with family care burden, schizophrenia
|How to cite this article:|
Koujalgi SR, Nayak RB. Factors associated with family burden in schizophrenia. Indian J Health Sci Biomed Res 2016;9:273-8
| Introduction|| |
Schizophrenia is a continuous, lifetime major psychiatric disorder that may affect children, adolescents, and adults. The patient exhibits odd behaviors and more often harmful to themselves and others. Being a chronic disease, relapse is more common during the treatment process. Therefore, patients required frequent acute care hospitalization and to reduce negative impacts long-term care may be indicated.
Family members play a potent role in providing care to the ill patient. These caregivers not only provide care but also abide to emotional support to the patient. Hence, the patient may become dependent on the family members, and ultimately this affects caregivers quality of life. , Continuous caregiving for longer time, especially to the schizophrenics, can pose burden which leads to negative consequences.,,,
Studies revealed that depression is more commonly seen in caregivers of mentally ill than noncaregivers. Caregivers depressed mood may adversely affect their health and self–well-being.
Harvey et al. study revealed that demographic factor that is age of the patient has predicted family burden. Yet another study by Byford et al. expressed determinants of family care burden in severe psychiatric illness. The study revealed the age of the patient and the duration of the illness were the predominant determinants. Shah et al. reported odd behaviors occupational impairments, suicidal behavior, and cognitive impairments were the determinants of family care burden in severe mental illness. Li et al. evaluated the predictors of family care burden and quality of life of individual with schizophrenia. The study assessed the level of family burden and quality of life, its correlation with demographic variable of caregivers and the good predictors of family burden and quality of life. The study concluded that caregiver experiences a higher degree of burden while providing care for their schizophrenia patient. A significant correlation was found between the burden and their level of education and good predictors were family caregiver's physical health and household income.
The available literature reveals several factors related to burden. These were patient's psychopathology, demographic variables of caregiver, such as economic status, gender, employment, and duration of care given. It is so, because that schizophrenia is a chronic and major psychiatric illness., Predominantly, the nature of illness. Therefore, these patients were required acute care hospitalized and usually need long-term care and treatment. With this, it may assume that mostly caregiver of schizophrenia feels burden.
However, the studies have not concentrated on determinants of family care burden in schizophrenia and how they contribute for family care burden. This study focuses on care givers of individuals with schizophrenia because schizophrenia is an increasing public health concern worldwide. The Western studies reported existence of family care burden in patients with schizophrenia. In India, there is a lack of data on factors associated with family care burden in schizophrenia. Hence, this study was intended to address these issues. Most often, family burden is associated with patient's and caregiver's characteristics. The variables include duration of care, severity of illness, age, employment, education, and economic status. Hence, understanding regarding these variables becomes more important for mental health professional, which may help in psychosocial management. Therefore, the study was undertaken to explore determinants of family care burden in schizophrenia. This study may bring baseline data and enable mental health worker to reduce family care burden in schizophrenia and may promote quality of life of patients and caregiver. The objective of this study was to describe the determinants of family care burden in schizophrenia.
| Materials and Methods|| |
It was a cross-sectional, descriptive, and correlation study. The study sample consisted of two groups that were 100 patients with schizophrenia and 100 schizophrenia patients' caregivers. The data were collected from the psychiatry outpatient and inpatient department by adopting the stratified sample random sampling technique. Patients fulfilling The International Classification of Disease-10 – Diagnostic Criteria for Research for schizophrenia (all type) were included as samples of the study. Patients within the age group of 18–47 and above and having more than 2 year's history of illness were taken up for the study after ensuring confidentiality. To identify the primary care givers of above patients, Pollack and Perlick scale was used. Caregivers within the age group of 18 to above 63 years of age were included in the study. Informed consent was obtained for such cases. Caregivers were excluded from the study if they were found to have organic mental disorder or other co-morbid psychiatric disorder. Factors related to burden on family caregiver were grouped into: (1) patient factors included age, sex, marital status, religion, educational status, occupation, family status, history of mental illness in the family, patient income, and domicile (2) caregiver factors included age, sex, educational status, occupation, family income, duration of contact with patient, and relationship with patient. Pearson co-relation coefficient test was used to study the correlation between patient, caregivers and family burden. Family Burden Interview Schedule includes 24 items classified into six categories, viz., financial burden, and disruption of routine family activities, family leisure, family interactions, and effect on physical and mental health of others. Ratings are carried out on a three-point scale and schedule has a separate category to rate “subjective” burden. The validity and reliability of the scale was reported satisfactory. All the items were reliable, which was reported more than 0.78 by the authors of the schedule. This interview schedule is used to compare different treatment situation for same disorders or in comparing the treatment effect on families of various types of illness. The other part of the study will not be detailed here, because it has been published in another journal (Indian Journal of Psychological Medicine/Jul-Sep 2013/Vol. 35/Issue3/Page no. 251-255). Data were analyzed using the SPSS version 17 software (SPSS Inc. Chicago, IL). Pearson's co-relation coefficient test was used for the analysis.
| Results|| |
Correlations for the impact of patient demographical factors on caregiver burden
The results in [Table 1] show that among variables examined, patient age, duration of illness, and patient income were positively correlated with family care burden.
|Table 1: Correlation among various patient sociodemographic variables with family care burden in patient with schizophrenia (n=100)|
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There was a statistically significant correlation between age of patient and family burden at the 0.05 level of significance.
Duration of illness
There was a statistically significant correlation between duration of illness and family burden at the 0.05 level of significance.
There was a statistically significant correlation between patient income and family burden at the 0.05 level of significance.
Correlations for the impact of caregiver demographical factors on family burden
The results in [Table 2] show that among variables examined, caregivers' age, family income, length of contact with patients were positively correlated with burden, whereas caregivers' education level was negatively correlated with burden.
|Table 2: Correlations between family burden and caregiver sociodemographical factors in patient with schizophrenia (n=100)|
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There was a statistically significant correlation between age and family burden at the 0.05 level of significance.
There was a statistically significant correlation between education status and family burden at the 0.05 level of significance.
There was a statistically significant correlation between family income and family burden at the 0.05 level of significance.
Length of contact
There was a statistically significant correlation between length of caregiver contact with patient and family burden at the 0.05 level of significance.
| Discussion|| |
Caregiver factor associated with family care burden in patient with schizophrenia
Sociodemographic details and family care burden of the study group were published in the other article. Results from this study revealed that caregivers' age was positively correlated with family burden. This is consistent with the previous study carried out by Li et al., who investigated association between demographic characteristic of caregivers burden when providing care for a member with schizophrenia. Results revealed that the age of caregiver was positively correlated to burden of caregiver. When caregiver becomes older, they are worried about who will take care of their ill relative in the future. Even older caregiver also cannot provide adequate care to the ill relative. In addition, younger age of caregiver which has to provide caring for ill member, results in increasing sense of life is worth living. [Table 3] and [Table 4] indicates objective and subjective dimensions of family burden care in schizophrenia. The old age caregivers not only have to take care of their ill relative but they also have to look after their own health, which may result in a higher burden they perceived.
With regard to education, the study showed that education level had a negative relationship with burden. The study findings are consistent with previous studies which found that caregivers who had higher level of education, reported less burden., A possible reason for the negative relationship between education level and caregiver burden may be explained by a view that caregivers with higher educational background may have higher knowledge of the illness and are able to find and access to social and financial resources. These characteristics allow them to obtain better care and treatment for their ill relative. [Table 3] and [Table 4] indicates objective and subjective dimensions of family burden care in schizophrenia. Li et al. reported that the education level has negative correlation with caregivers burden. It was assumed that higher the level of education, higher the salary would be. High salary will minimize financial strain related to providing care for their ill relative. Even more education level of the caregiver also tends to have adequate knowledge to handle stressful life event. Therefore caregivers' education status influences burden of the caregiver.
Results from this study revealed that caregivers' family income was positively correlated with burden. Lower income may be a stressor that influence stress feeling during the caring process. Beside caregivers providing care for their ill relative, they also had to solve financial problem and find out source of money. From this data, it is apparent that family income plays a key role in predicting caregivers' level of burden. The reason may be low income is a stressor which influences the feelings during the caring process. Besides caregivers may have financial strains in finding out sources of money. Srinivasan and Thara  revealed that the highest challenges experienced by Indian families in caring for persons of psychiatric illness are financial and social isolation. The growing socioeconomic changes, industrialization, minimal job opportunities, and facilities have driven the agrarian sectors of our economy to difficulty. Therefore, family income associated with burden in schizophrenia disorder caregivers.
Regarding duration of time spent to look after patient, the present study results indicated that length of contact positively correlated with burden in families of schizophrenia. The higher the duration of contact for taking care of their ill relative, the greater burden the caregivers experienced. The present study results were consistent with previous studies.,, When a caregiver spends time with their ill relative, it may result in having less time for themselves in terms of attending to their own daily routine activities. Approximately 60–80% of impaired people are cared by the family member Clement et al. Usually these people require assistance in performing activities of daily living, such as bathing, grooming, medication management and routine follow-up. It is obvious when care is provided for a longer duration of time particularly for patient of schizophrenia caregivers may experience burden. Hence, this marked negative effect may predict family care burden in patient with schizophrenia.
Individual factors related to burden on family caregivers caring for patients with schizophrenia
The correlation between age and burden shows that there is a significant relation between the age of the patient and burden, i.e., the older the patient the greater the burden. Li et al. reported that there was correlation between patient age and family burden. Younger age group patients with schizophrenia are unable to take care of themselves, which may be due to the early stage of illness. Therefore, caregivers felt burden while providing care to the younger patient in long time period. Yet another study found that caregivers of schizophrenia patient displayed a very high degree of burden, especially while taking care of younger patients. The younger patients might require intensive caregiving, therefore the caregiver needs to spend more time with patient.
Duration of illness and clinical symptoms may have an influence on caregivers' burden. Positive symptoms may be associated with caregivers' burden more than the negative symptom., Other factor associated with burden of caregiver is the severity of patient symptoms. A symptom caused by illness is associated with disability, which influences the patients behavior and capacity to carry out activity of daily living. Hence, all these cause patients dependence on caregiver. Moreover, in case of chronic illness, caregiver may feel burden in caregiving due to symptoms of disease of the patient and illness, which need long-term care.
Correlations analysis to determine the associations of family burden indicate that low income emerged as a significant factor of family care burden. Symptoms of illness affect working ability of the patient. Fujino and Okamura  found that the patient disability in daily life was related to family care burden. It may result dependency of patients on caregiver to carry out their daily activities. It may be due to the fact that schizophrenia is considered as a chronic and major psychiatric disorder. The patients of schizophrenia may experience impairment in thought process that influences their behavior. More often, their behaviors are odd  or harmful to others. In addition, the illness may recur during the phase of treatment and recovery. Patients with schizophrenia may have impairment in independent living skills which may lead to poor or loss of functional outcome. Impaired levels of functioning are mainly in the areas of loss of learned skills and the failure to learn new ones. This affects the patient's productivity. This may contribute to family care burden both in terms of patient's dependence on social and economic factors., Maurin and Boyd  found that low employment of patient may lead to increased dependence on the caregivers for meeting basic needs, which results in burden on relatives. Mueser et al. show that poor occupational functioning is considered as a universal feature of schizophrenia, with employment rate of range 10–20% and this population fall under the age group of 26–30 years. Due to these entire factors patient become less productive. Hence, it directly correlated the family care burden.
The associations of burden in schizophrenia disorder have implications for psychosocial social management. More focus must be given to those caregivers who are more prone to a great degree of burden. Hence, periodical burden assessment should be made available in psychiatric services. The mental health worker should be considered on such variables, which impact on caregiver burden in schizophrenia. The mental health worker needs to educate family members about presence and absence of these factors that may pose caregivers at risk of unbearable burdens. Hence, psychosocial intervention may erode family burden. Moreover, it will assist in enhancing caregiver sense of coherence of their patient. Over all, it would result in increasing emotional support and strengthens the patient's functioning. Hence, mental health worker should provide psycho-educational family therapy to the caregivers in order to handle the patient problems which caregivers may face in daily routine activities. Ultimately, this may improve the patient's quality of life and minimizes family burden.
| Conclusion|| |
The study revealed, significant relationship between caregivers' age, education status, family income, and length of contact with patient and family burden in patient with schizophrenia. Greater burden was reported by caregivers with patient advanced ages, low patient income, and longer duration of illness.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Pompili M, Lester D, Grispini A, Innamorati M, Calandro F, Iliceto P, et al
. Completed suicide in schizophrenia: Evidence from a case-control study. Psychiatry Res 2009;167:251-7.
Bostrom AC, Boyd MA. Schizophrenia. In: Boyd MA, editor. Psychiatric Nursing: Contemporary Practice. Philadelphia, New York: Lippincott William and Wilkins; 2005. p. 265-310.
Singleton N, Maung NA, Cowie J. Mental Health of Carers. London: Office for National Statistics; 2002.
Amirkhanyan AA, Wolf DA. Caregiver stress and noncaregiver stress: Exploring the pathways of psychiatric morbidity. Gerontologist 2003;43:817-27.
Danhauer SC, McCann JJ, Gilley DW, Beckett LA, Bienias JL, Evans DA. Do behavioral disturbances in persons with Alzheimer's disease predict caregiver depression over time? Psychol Aging 2004;19:198-202.
Caqueo-Urízar A, Gutiérrez-Maldonado J. Burden of care in families of patients with schizophrenia. Qual Life Res 2006;15:719-24.
Grandón P, Jenaro C, Lemos S. Primary caregivers of schizophrenia outpatients: Burden and predictor variables. Psychiatry Res 2008;158:335-43.
Roick C, Heider D, Toumi M, Angermeyer MC. The impact of caregivers' characteristics, patients' conditions and regional differences on family burden in schizophrenia: A longitudinal analysis. Acta Psychiatr Scand 2006;114:363-74.
Hou SY, Ke CL, Su YC, Lung FW, Huang CJ. Exploring the burden of the primary family caregivers of schizophrenia patients in Taiwan. Psychiatry Clin Neurosci 2008;62:508-14.
Canadian Study of Health and Aging Working Group. Canadian study of health and aging: Study methods and prevalence of dementia. Can Med Assoc J 1994;150:899-913.
Lu YY, Austrom MG. Distress responses and self- care behaviours in dementia family caregivers with high and low depressed mood. J Am Psychiatr Nurses Assoc 2005;11:231-40.
Harvey K, Burns T, Fahy T, Manley C, Tattan T. Relatives of patients with severe psychotic illness: Factors that influence appraisal of caregiving and psychological distress. Soc Psychiatry Psychiatr Epidemiol 2001;36:456-61.
Byford S, Barber JA, Fiander M, Marshall S, Green J. Factors that influence the cost of caring for patients with severe psychotic illness: Report from the UK 700 trial. Br J Psychiatry 2001;178:441-7.
Shah AJ, Wadoo, Latoo J. Psychological distress in carers of people with mental disorders. Br J Med Pract 2010;3:a327-33.
Li J, Lambert CE, Lambert VA. Predictors of family caregivers' burden and quality of life when providing care for a family member with schizophrenia in the People's Republic of China. Nurs Health Sci 2007;9:192-8.
Vevera J, Hubbard A, Veselý A, Papezová H. Violent behaviour in schizophrenia. Retrospective study of four independent samples from Prague, 1949 to 2000. Br J Psychiatry 2005;187:426-30.
Fujino N, Okamura H. Factors affecting the sense of burden felt by family members caring for patients with mental illness. Arch Psychiatr Nurs 2009;23:128-37.
Chien WT, Chan SW, Morrissey J. The perceived burden among Chinese family caregivers of people with schizophrenia. J Clin Nurs 2007;16:1151-61.
Cook JA, Lefley HP, Pickett SA, Cohler BJ. Age and family burden among parents of offspring with severe mental illness. Am J Orthopsychiatry 1994;64:435-47.
Srinivasan TN, Thara R. Beliefs about causation of schizophrenia: Do Indian families believe in supernatural causes? Soc Psychiatry Psychiatr Epidemiol 2001;36:134-40.
Chang HY, Chiou CJ, Chen NS. Impact of mental health and caregiver burden on family caregivers' physical health. Arch Gerontol Geriatr 2010;50:267-71.
Chiou CJ, Chang HY, Chen IP, Wang HH. Social support and caregiving circumstances as predictors of caregiver burden in Taiwan. Arch Gerontol Geriatr 2009;48:419-24.
Koukia E, Madianos MG. Is psychosocial rehabilitation of schizophrenic patients preventing family burden? A comparative study. J Psychiatr Ment Health Nurs 2005;12:415-22.
Clement S, Gerber D, McGuire SL. Comprehensive Community Health Nursing: Family Aggregate and Community Practice. St. Louis, MO: Mosby; 1995.
Tang VW, Leung SK, Lam LC. Clinical correlates of the caregiving experience for Chinese caregivers of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2008;43:720-6.
Lefley HP. Impact of mental illness in families of mental health professionals. J Nerv Ment Dis 1987;175:613-9.
Lefley HP. Family burden and family stigma in major mental illness. University of Miami School of medicine. Am Psychol 1989;44:556-60.
Maurin JT, Boyd CB. Burden of mental illness on the family: A critical review. Arch Psychiatr Nurs 1990;4:19-28.
Mueser KT, Corrigan PW, Hilton DW, Tanzman B, Schaub A, Gingerich S, et al.
Illness management and recovery: A review of the research. Psychiatr Serv 2002;53:1272-84.
[Table 1], [Table 2], [Table 3], [Table 4]