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Purpose: Health-related quality of life (HRQoL) can be reduced in parents with mental illness (mental illness) who face the dual demands of disabling symptoms and their impact on family, social, and occupational life. This study aimed at analyzing the influence of various factors on HRQoL in parents with mental illness.Method: Baseline data of the German randomized controlled multicenter project CHIMPS (children of parents with mental illness) was used for analyses. The final sample consisted of n = 208 parents with mental illness and n = 197 children and adolescents aged 8–18 years. HRQoL was assessed with the EQ-5D.Results: Parents with mental illness reported significantly lower global and specific HRQoL than the German reference population. They were least satisfied with aspects that relate to anxiety and depression followed by usual activities, pain and discomfort. Better global HRQoL was primarily associated with self-reported physical and mental health, as well as adaptive coping behavior. Associations with mobility, self-care, usual activity, pain and discomfort, anxiety and depression were analyzed and discussed.Conclusions: HRQoL in parents with mental illness is reduced. Clinical interventions should focus on the alleviation of mental health symptoms and probably somatic symptoms and promote adaptive coping skills.

Objective This study aims to investigate the burden of family caregivers of patients with schizophrenia, and its influencing factors Methods A total of 105 patients with schizophrenia and their caregivers were investigated using the positive and negative symptom scale (PANSS) and family burden scale of disease (FBS) Results There was a strong correlation between the patient's recovery and family burden, especially between positive and negative symptoms and family financial burden, family daily activities, family recreational activities, and family relationship Conclusion There is a strong correlation between the patient's recovery and family burden, and this is especially correlated to family economic burden, family daily activities, family recreational activities, and family relationship. Medical staff should pay attention to the psychological characteristics of patients and fully understand and avoid the adverse effects of family burden on the rehabilitation of patients., There is a strong correlation between the patient's recovery and family burden, and this is especially correlated to family economic burden, family daily activities, family recreational activities and family relationship. Medical staff should pay attention to the psychological characteristics of patients, and fully understand and avoid the adverse effects of family burden on the rehabilitation of patients.

espanolSe analizan las diferencias de genero en problemas de conducta y su relacion con la carga familiar en trastornos mentales graves. El Inventario de Problemas de Conducta (BPI) y dos items relativos a la carga familiar ("?Se siente usted capaz de sobrellevar la enfermedad o trastorno y los problemas que ocasiona?" y "?Con que frecuencia se ve usted desbordado/a por estos problemas de comportamiento/enfermedad?") se administraron a 235 informantes clave de pacientes en tratamiento en una unidad de Salud Mental Comunitaria. Los hombres presentaban mayores problemas de conducta y carga familiar, existiendo diferencias significativas en descontrol de impulsos y en problemas de comportamiento graves. Se halla una correlacion positiva entre problemas de comportamiento y carga familiar, siendo la dimension inactividad/aislamiento social la mejor predictora de carga familiar. Respecto a la carga familiar, es la dimension inactividad/aislamiento social la que posee mayor capacidad explicativa en hombres y mujeres. EnglishGender differences in behavior problems and their relationship with family burden in severe mental disorders were analyzed. The Behavior Problems Inventory (BPI) and two items related to family burden (FB 1: "Do you feel able to endure the illness or disorder and the problems it causes?" and FB 2: "How often are you overwhelmed by these behavior/illness problems?") were administered to 235 key informants under treatment in a community mental health unit. The results show that men presented more behavior problems and family burden, with significant differences in impulse dyscontrol and severe behavior problems. A positive correlation was found between behavior problems and family burden, where the inactivity/social withdrawal dimension was the best predictor of family load for men and women. We conclude that men have more behavior problems and that the inactivity/social withdrawal dimension has the most explanatory power for family burden in both men and women.

BACKGROUND Mental and behavioural disorders have a large impact on individuals, family and communities. There is a paucity of studies on burden and cost of illness of Bipolar Affective Disorder both internationally and in India. Such studies are important for clinical management and policy decisions. Aim of the study - The aim of the present study is to assess the magnitude of the cost of illness and family burden of Bipolar Affective Disorder and Schizophrenia and to find out the difference in the burden of the caregivers for both the groups. MATERIALS AND METHODS The study was conducted in the outpatient department of Institute of Mental Health, Chennai. Sixty patients in each group were included by stratified sampling. Caregivers living with patients for atleast one year are included in the study, and those with any comorbid illness, were excluded from the study. ICD -10 diagnostic and research criteria were used for diagnosis of BPAD and Schizophrenia, Questionnaire for Assessment of Cost of Illness was used to assess cost of illness and Family Burden Interview Schedule was used to assess burden of caregivers. RESULTS Schizophrenia patients are mostly from urban, nuclear family. The illness characters & sociodemographic profile of caregivers are comparable. Lifetime costs and loss of income over lifetime was more in schizophrenia. Loss of income in the past year was similar. The burden was comparable for caregivers of both groups in disruption of family routine, interaction with family members, effect on mental health. CONCLUSION Burden of both diseases were comparable except schizophrenics experience more financial burden.

Introduction: Children with autism will be a stressor to their family. This research aims to describe about family grieving process and family burden when taking care of their children with autism at Special Needs School Bangun Bangsa, Surabaya.Method: This research used descriptive phenomenology design with indepth interview method. The participant of this research was six member of a family who plays role as the main caregiver for autism child. This study employs the purposive sampling method. The data is gathered through interviews and fi eld notes that is then analyzed with the Collaizi technique. This research generated three themes.Result: The results illustrate families display the grieving process as a cycle. They feel a deep, permanent and long period of grief through in to five stages of grief: denial, anger, depression, bargaining and acceptance. The Grieving is come from the caregiver and the autism child. Large amounts of grief cause families in grief for a long period and this causes family burden. There are six family burden, psychological burden, physical burden, financial burden, social burden, time burden and thought burden.Conclusion: Finding of the research would hopefully be beneficial to professional health staff, especially psychiatric nurses to complete their ability in minimizing various negative impacts that the family may suffer from while taking care their autism children with autism through nursing care plans designs development, researches about family empowerment in burden managements and also a research to improve the Family Psycho-education Therapy and a specific Supportive Group Therapy modules for family with autism children.

Background: Dissociative disorder is a stress-related disorder usually present in adolescent and younger age group. It is also accompanied with significant impairment in activity of daily living and family relationship. Family environment plays important role in initiation and maintenance of symptoms and this put significant burden on family. Aim and Objective: To study presence of stressor, family environment, and assessment of family burden in dissociative disorder patients. Material and Method: This was a cross-sectional observational study in which 100 dissociatives disorder patients were included after fulfilling inclusion criteria from both inpatients and outpatient department of psychiatry. Results: In our study major part of the sample were women 60 (60%), among them most of were housewife and educated up to primary school. According to a stressor, 63 (63%) patients had family stress/problem and out of them, 35 (58.4) were women. Seventy-four (74%) patients had dissociative convulsion and out of them, 45 (75%) were women. The dissociative disorder patients cause a considerable degree of burden over other family members in both men and women. There is a significant difference found in the family environment in term of personal growth dimension, relationship dimension in both men and women. Conclusion: Present study concludes that dissociative disorder patients cause a considerable degree of burden over other family members in term of leisure, physical, mental, financial, and routines family interrelationship domains. The family environment in term of personal growth dimension, relationship dimension has a casual effect on symptoms of dissociative disorder patients.

Introduction: The main caregivers of people with mental disorders are their family members. Families as the caregivers of people with mental disorders is associated with a significant burden. This systematic review aims to identify and summarize the main focus based on the scientific evidence about family burden as the caregivers of people with mental disorders. Methods: The databases used were Scopus, Science Direct and Sage Journal with the keywords ‘burden’, ‘family’, ‘caregiver’, ‘mental’, ‘health’, ‘illness’, ‘disorder’ and they were limited to 2014 – 2018 from within nursing and health science journals. One hundred and four full text articles were reviewed. The 14 articles that fulfilled the inclusion criteria were analyzed using narrative synthesis followed the Joanna Briggs Methodology model for the Qualitative Systematic Review to find the main themes of each article. Results: Seven main themes were found to be related to family burden as the caregivers of a family member with mental disorders. The 7 themes were knowledge, emotional burden, physical burden, medication, financial burden, social burden, health services and government support. Conclusion: The findings suggest that the family burden on the caregivers was diverse and that this has an effect on the ability of the family to care for patients with mental disorders. Family burden has become an important indicator for the provision of mental health services.

Perinatal depression (PD) is a severe and disabling condition impacting negatively on children in terms of adverse neonatal outcomes and on the well-being of women and their families. All pregnant women attending the unit of Gynecology and Obstetrics Service of the University of Campania "L. Vanvitelli" will be screened for PD using the Edinburgh Postpartum Depression Scale (EPDS). Women with a score ≥10 at the EPDS will be invited to receive a full psychiatric assessment. The required sample size is of 126 women with PD which will be randomly allocated to either an experimental group, receiving a uni-familiar psychoeducational intervention, or to a control group, receiving the Best Treatment Option (BTO). Patients will be evaluated through several assessment instruments: Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), Manchester Short Assessment of Quality of Life (MANSA), Family Assessment Device (FAD), Family Coping Questionnaire (FCQ), and Pattern of Care Schedule (PCS). Patients will be evaluated at baseline, 3, 6, 9, and 12 months post-randomization. The severity of depressive symptoms at the HAM-D scale has been selected as primary outcome. Other outcome measures include improvement in the severity of anxiety symptoms, of global and personal functioning, an improvement in family members' coping strategies and in the level of quality of life. It has been highlighted the importance of developing screening and treating programs for PD, and our study will use rigorous study design to evaluate the efficacy of the adaption of a well-known family psychoeducational model to the treatment of PD. The aims of present trial are to: (1) develop an informative package for pregnant women with PD; (2) promote a screening programme for PD; (3) identify those (socio-demographic and pregnancy-related environmental) factors associated with a higher risk to develop a perinatal or postnatal depression; (4) evaluate the efficacy of a new experimental psychoeducational intervention in reducing the depressive symptoms during pregnancy compared to the BTO.

Amaç:Bu çalışmada şizofreni ya da şizoaffektif bozukluğu olan hastaların aile üyelerinin yaşadığı yük ile kendini damgalama ve diğer etmenler arasındaki ilişkinin araştırılması amaçlandı.Yöntem:DSM-V tanı ölçütlerine göre şizofreni veya şizoaffektif bozukluk tanısı alan hastaların kendilerine bakmakla yükümlü olan yakınlarından (beraber yaşayan anne, baba, kardeş, akraba) oluşan 102 kişi çalışmaya dahil edildi. Onam veren hasta yakınlarına öncelikle nüfus bilgi formu, Kendini Damgalama Ölçeği- Aile (KDÖ-A), Zarit Aile Yük Ölçeği (ZAYÖ), Beck Depresyon Ölçeği (BDÖ) ve klinisyen tarafından hastalara Klinik Genel İzlenim-Şiddet (KGİ-Ş) ve İşlevselliğin Genel Değerlendirilmesi (İGD) uygulandı.Verilertanımlayıcı istatistiksel yöntemler, Spearman korelasyon analizi, Mann-Whitney U testi ve Linear Regresyon analizi ile değerlendirildi. Bulgular:Hastaların %67'si erkek, yaş ortalaması 35±8 ve eğitim ortalaması 11±3 yıl idi. %74'ü bekâr, %68'i işsiz ve %73'ü anne-babası ile yaşayan hastalardan oluştu. Hasta yakınlarının %52'si kadın, yaş ortalaması 52±13 ve eğitim ortalaması 9±4 yıl idi. %35'i baba olmasına rağmen, kadın bakım verenler çoğunluktaydı. Çalışmamızda hasta yakınlarının ZAYÖ ölçeğinden ortalama 41±14 puan aldığı görüldü. Hasta yakınlarında orta-şiddetli düzeyde yük algıladıkları görüldü. Hastaların nüfus verilerinden yalnızca özkıyım girişimi ile ZAYÖ arasında anlamlı ilişki bulundu. Hastanede yatış sayısı ile ZAYÖ arasında pozitif bir bağıntı vardı.ZAYÖ ile BDÖ, KDÖ-A arasında düşük düzeyde pozitif bir ilişki bulundu. İkili karşılaştırmalarda ZAYÖ ile ilişkili bulunan değişkenler regresyon analizine alındığında [X2=4,543, df=5, p=0.000, R2=0,191] KDÖ-A toplam puan düzeyinin aile yükü ile daha güçlü ilişki gösterdiği belirlendi. Sonuç: Hasta yakınlarının aile yükünü belirleyen önemli etmenlerden birininde kendini damgalaması olduğu görülmektedir. Kendini damgalama yaşantıları onların sıkıntısını ve yükünü artıran önemli bir açmaz olmaktadır.Anahtar Sözcükler: Şizofreni, Aile Yükü, Kendini Damgalama Objective:The aim of this study was to investigate the relationship between the burden of family members of patients with schizophrenia or schizoaffective disorder and their self-stigma and other factors..Method:A total of 102 patients (relatives, parents, siblings, relatives) who were responsible for taking care of the patients diagnosed with schizophrenia or schizoaffective disorder according to DSM-V criteria were included in the study.Firstly, the sociodemographic information form, Self-Stigma Inventory for Families (SSI-F),Zarit Caregiver Burden Scale (ZCBS), Beck Depression Inventory (BDI), and Clinical Global Impression – Severity of Illness (CGI-SI), and Global Assessment of Functioning (GAF) was assessed. The data were analyzed by using descriptive statistical analysis methods, Spearman's correlation analysis, Mann-Whitney U test and linear regression analysis.Results: 67% of the patients were male, the average age was 35±8 years and the mean education was 11±3 years. 74% were single, 68% were unemployed and 73% were living with their parents. 52% of the patients' relatives were female, the mean age was 52±13 and the average education was 9±4 years. Although 35% of the father, female caregivers were the majority.İt was seen that the relatives of the self stigma an average of 41±14 points.The patients were found to have moderate to severe load. Only a significant relationship was found between suicidal attempts and the patients with ZCBS. There is a positive correlation between the number of hospitalizations and ZCBS.A positive relationship was found between BDI and SSI-F and ZCBS.In the pairwise comparisons, when the variables that were found to be related to ZCBS were subjected to regression analysis [X2 = 4.543, df = 5, p = 0.000, R2 = 0.191], it was found that self stigma had stronger relationships with the family burden. Conclusions:It is seen that the relatives of the patients are stigmatizing themselves in one of the important factors that determine the family burden. Self-stigma experiences become an important dilemma that increases their distress and burden.Keywords:Schizophrenia, Family Burden, Self-stigma 52

The goal of this study was to determine if family burden experienced by the families of individuals with a recent-onset of schizophrenia is associated with whether the individual is able to work or attend school during the first year of treatment. Forty-one participants with a recent first episode of schizophrenia and their families enrolled in two NIMH-funded protocols through the UCLA Aftercare Research Program completed a measure of family burden at baseline. Amount of work during this time was also recorded. Baseline family burden was associated with work status (no work, part-time work, or full-time work) at both the six-month, r = −0.321, p = .04, and one-year time point, r = − 0.47, p = .002. Family burden was also associated with hours participated in work/school hours at the six-month time point, r = −0.390, p = .012, and at the one-year time point, r = −0.492, p = .01. Further exploration into the family burden measure shows that family perceived limited opportunities resulting from the individual's psychiatric disorder was associated with worse functional outcome at all three time points beyond psychiatric symptoms and baseline functioning. Missed opportunities due to a family member's illness may reduce the level of support provided to the individual and thus impact their psychosocial functioning. Our findings suggest that this dimension of family burden is highlighting the importance of and need for more balanced family support to boost functional outcome.

Gaia Sampogna,1 Mario Luciano,1 Valeria Del Vecchio,1 Claudio Malangone,1,2 Corrado De Rosa,1 Vincenzo Giallonardo,1 Giuseppina Borriello,1 Benedetta Pocai,1 Micaela Savorani,1 Luca Steardo Jr,1 Debora Lampis,3 Franco Veltro,4 Francesco Bartoli,5 Francesco Bardicchia,6 Anna Maria Moroni,7 Giusy Ciampini,8 Emanuele Orlandi,9 Silvia Ferrari,10 Silvia Biondi,11 Sonia Iapichino,11,12 Enrico Pompili,13 Massimiliano Piselli,14 Alfonso Tortorella,15 Giuseppe Carrà,5,16 Andrea Fiorillo1 1Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, 2Mental Health Centre of Ravello, Mental Health Unit, Ravello, 3Mental Health Centre of Lanusei, Mental Health Unit, Lanusei, 4Mental Health Department of Campobasso, Campobasso, 5Department of Medicine and Surgery, University of Milano Bicocca, Monza, 6Mental Health Centre of Grosseto, Mental Health Unit, Grosseto, 7Niguarda Hospital, Department of Psychiatry, Milan, 8Mental Health Centre of Lanciano, Mental Health Unit, Lanciano, 9Mental Health Centre of Sassuolo, Mental Health Unit, Sassuolo, 10University of Modena and Reggio Emilia, Department of Psychiatry, Reggio Emilia, 11Mental Health Centre of Montecatini, Mental Health Unit, Montecatini, 12Auditor Psychiatrist, for the activities of Clinical Risk Management and safety of treatments, Tuscany Region, 13Mental Health Centre of Rome, Mental Health Unit, Rome, 14Mental Health Centre of Foligno, Mental Health Unit, Foligno, 15Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy; 16Division of Psychiatry, University College of London, London, UK Background: Psychoeducational family intervention (PFI) has been proven to be effective in improving the levels of family burden and patients’ personal functioning in schizophrenia and bipolar disorders (BDs). Less is known about the impact of PFI on relatives’ coping strategies in BD. Methods: A multicenter, controlled, outpatient trial funded by the Italian Ministry of Health and coordinated by the Department of Psychiatry of the University of Campania “Luigi Vanvitelli” has been conducted in patients with bipolar I disorder (BD-I) and their key relatives consecutively recruited in 11 randomly selected Italian community mental health centers. We aim to test the hypothesis that PFI improves problem-oriented coping strategies in relatives of BD-I patients compared to the Treatment As Usual (TAU) group. Results: The final sample was constituted of 123 patients and 139 relatives. At baseline assessment (T0), the vast majority of relatives already adopted problem-oriented coping strategies more frequently than the emotion-focused ones. At the end of the intervention, relatives receiving PFI reported a higher endorsement of adaptive coping strategies, such as “maintenance of social interests” (odds ratio [OR]=0.309, CI=0.04–0.57;p=0.023), “positive communication with the patient” (OR=0.295, CI=0.13–0.46;p=0.001), and “searching for information” (OR=0.443, CI=0.12–0.76;p=0.007), compared to TAU relatives, after controlling for several confounders. As regards the emotion-focused coping strategies, relatives receiving the experimental intervention less frequently reported to adopt “resignation” (OR=-0.380, CI=-0.68 to -0.08; p=0.014) and “coercion” (OR=-0.268, CI=-0.46 to -0.08;p=0.006) strategies, compared to TAU relatives. Conclusion: PFI is effective in improving the adaptive coping strategies of relatives of BD-I patients, but further studies are needed for evaluating the long-term benefits of this intervention. Keywords: coping strategies, family burden, psychoeducation family intervention, bipolar disorder, social functioning

Introduction: This study explores burden and social and professional support in families of young patients with muscular dystrophies (MDs) in Italy. Methods: The study was carried out on 502 key relatives of 4‐ to 25‐year‐old patients suffering from Duchenne, Becker, or Limb‐Girdle MD who were living with at least 1 adult relative. Results: A total of 77.1% of relatives reported feelings of loss, 74.0% had feelings of sadness, and 59.1% had constraints in leisure activities. Burden was higher among relatives of patients with higher disability and who spent more daily hours in caregiving. Practical difficulties were higher among relatives who perceived lower help in patient emergencies and less practical support by their social network. Psychological burden was higher in those relatives who were unemployed, those with poorer support in emergencies, and those with lower social contacts. Conclusions: Caring for patients with MDs may be demanding for relatives even in the early stages of these disorders, especially when social support is poor and the patient's disability increases. Muscle Nerve 52: 13–21, 2015

Background This study assessed the efficacy of the Falloon model of psychoeducational family intervention (PFI), originally developed for schizophrenia management and adapted to bipolar I disorder. The efficacy of the intervention was evaluated in terms of improvement of patients׳ social functioning and reduction of family burden. Methods This was a multicentre, real-world, controlled, outpatient trial carried out in 11 randomly recruited Italian mental health centres. Enroled patients and key-relatives were consecutively allocated either to receive PFI and Treatment As Usual (TAU) or to a waiting list receiving TAU alone. The efficacy of the intervention was evaluated in terms of improvement in patients׳ social functioning (primary outcome) and reduction of family burden (secondary outcome). Results Of the 137 recruited families, 70 were allocated to the experimental group and 67 to the control group. At the end of the intervention, significant improvements in patients׳ social functioning and in relatives׳ burden were found in the treated group compared to TAU. This effect of the intervention remained also after controlling for several confounding patient׳s socio-demographic and clinical factors. The experimental intervention had an impact also on other outcome measures, such as patients׳ clinical status and personal burden. Limitations Lack of an active control group. Conclusions The results of this study clearly show that the psychoeducational family intervention according to the Falloon model is effective in improving the social outcome of patients with bipolar I disorder.

The diagnosis of cancer is a family experience that changes the lives of all its members, bringing an immense amount of stress and many challenging situations. The daily routine, common activities and distribution of duties all have to change. Family members follow the phases of the disease, very often suffering comparable or greater distress than the patient. They use various coping methods which aim at helping both the sick relative and themselves. These methods, together with emotional responses, change over time according to the phase of the disease. Cancer puts the family at risk since it imposes an alternation in the relations among family members. It affects the couple's relationship, their sex life, and it can also be a cause of major trauma among their children and adolescents. The diagnosis of cancer brings also individual risks for the family members in terms of psychological and physical health impairment. Family caregivers often feel overloaded with the additional obligations and roles they have to pick up. They find it increasingly burdening to care full-time for the household and provide emotional support for the patient. The family's problems and the way family members regard the disease may be also a result of the family system they are in. This article describes the nature of caregiving to a patient with cancer and the biggest concerns for the family.

Objective: This randomized-controlled experimental study was conducted to determine the effects of psychoeducation in the inpatient clinic and regular telepsychiatric follow-up (via telephone) after discharge on emotional expression, depression and family burden of primary caregivers of the schizophrenic patients. Methods: This study was performed on 62 caregivers of the schizophrenic patients, assigned to experiment (n=32) and control (n=30) groups, from 1 st July 2010 to 31 st May 2011. The Scales for Expressed Emotion, the Beck Depression and the Zarit Family Burden were applied for the caregivers in experiment and control groups before education, after education and after 6-months telephone follow-up. Results: The mean scores of the caregivers in experiment group on family burden, emotional expression and depression were decreased after education and after telephone follow-up and difference was significant (p < 0.001). Conclusions: Psychoeducation and telepsychiatric follow-up via telephone induced decrease in family burden, emotional expression and depressive symptoms for their caregivers and was a support for the family in the patient care.

PURPOSE: When someone has a mental illness, family members may share the experience of stigma. Past research has established that family members' experiences of stigma by association predict psychological distress and lower quality-of-life.METHODS: The present study, conducted with 503 family members of people with mental illness examined the prevalence of 14 different coping strategies. Of greater importance, we examined the role of these coping strategies as mediators of the relationships between stigma by association and family burden, on the one hand, and outcomes, such as psychological distress and quality-of-life, on the other.RESULTS: The results showed that both perceived stigma by association and family burden are associated with greater psychological distress and lower quality-of-life, and that most coping strategies mediate these relationships.CONCLUSIONS: Adaptive coping strategies were related to reduced negative outcomes, while most maladaptive coping strategies were related to enhanced negative outcomes. Implications for intervention development are discussed.

Objectives: To investigate the determinants of family burden in a sample of patients with schizophrenia and their caregivers. Methods: Thirty-one stable patients with schizophrenia and their main caregivers were recruited. Sociodemographic variables were assessed in a semi-structured interview, and positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Cognitive performance was assessed with the Schizophrenia Cognition Rating Scale (SCoRS). Levels of burden on caregivers were assessed with the Family Burden Interview Schedule (FBIS). Interactions among variables were analyzed using Pearson correlations and linear regression analysis. Results: Objective and subjective FBIS scores were 1.9 (standard deviation [SD] = 0.5) and 2.4 (SD = 0.6) respectively. Objective burden correlated positively with positive and negative symptoms, and cognitive impairment. Subjective burden correlated positively with positive symptoms and negatively with mean age of disease onset. Positive, negative and cognitive symptoms accounted for 47.6% of the variance of objective burden, with negative symptoms accounting independently for 30.3%. Age of onset, parents as caregivers and positive symptoms accounted for 28% of the variance of subjective burden, with age of onset independently explaining 20.3%. Conclusion: Patients' clinical and sociodemographic variables are important determinants of family burden in schizophrenia. Objective burden is predicted by symptoms, particularly negative ones. Subjective burden is predicted by symptoms and sociodemographic variables, particularly age of disease onset. Resumo Objetivo: Investigar os determinantes de sobrecarga familiar numa amostra de pacientes com esquizofrenia e seus cuidadores. Métodos: Trinta e um pacientes com esquizofrenia e seus principais cuidadores participaram do estudo. Variáveis sociodemográficas foram analisadas por meio de uma entrevista semiestruturada, e sintomas positivos e negativos foram quantificados através da Positive and Negative Syndrome Scale (PANSS). O desempenho cognitivo foi mensurado pela Schizophrenia Cognition Rating Scale (SCoRS). A Escala de Avaliação da Sobrecarga dos Familiares (FBIS) avaliou os níveis de sobrecarga entre os cuidadores. As interações entre as variáveis foram verificadas por meio do coeficiente de correlação de Pearson e de análise de regressão linear. Resultados: Os escores objetivos e subjetivos da FBIS foram 1,9 [desvio padrão (DP) 0,5] e 2,4 (DP 0,6), respectivamente. Sobrecarga objetiva se correlacionou positivamente com sintomas positivos e negativos, e com prejuízos cognitivos. A sobrecarga subjetiva se correlacionou positivamente com sintomas positivos, e negativamente com a idade de início da doença. Os sintomas positivos e negativos e os prejuízos cognitivos contribuíram com 47,6% da variância da sobrecarga objetiva, sendo que sintomas negativos foram responsáveis independentemente por 30,3%. A idade de início da doença, os pais na posição de cuidadores e os sintomas positivos contribuíram com 28% da variância da sobrecarga subjetiva, sendo que a idade de início da doença contribuiu independentemente com 20,3%. Conclusões: Variáveis sociodemográficas e clínicas dos pacientes são importantes determinantes de sobrecarga familiar na esquizofrenia. A sobrecarga objetiva pode ser predita por sintomas, especialmente os negativos. A sobrecarga subjetiva pode ser predita por sintomas e características sociodemográficas, particularmente a idade de início da doença.

OBJECTIVE: To identify and compare caregiver burden and expressed emotion (EE) in adult substance use disorder (SUD) patients with and without co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). To examine possible differences in correlations between caregiver burden and EE across patient groups. DESIGN AND METHODS: Cross-sectional study with measures of perceived burden (Involvement Evaluation Questionnaire: IEQ), subjective stress (General Health Questionnaire: GHQ) and perceptions of expressed emotion (Level of Expressed Emotion: LEE) in informal caregivers for patients with SUD, SUD+ADHD or SUD+ASD. FINDINGS: No differences in caregiver burden or expressed emotion when caregivers for patients with SUD were compared to caregivers for patients with SUD+ADHD. A moderate but non-significant difference for caregivers of patients with SUD versus SUD+ASD, which disappeared when the number of contact hours between patient and caregiver for the SUD only group was controlled for. The IEQ sum scores also substantially correlated with the LEE sum scores. CONCLUSION: Informal caregivers for patients with only SUD show higher levels of burden and EE than informal caregivers for patients with SUD and a co-occurring ASD. This difference was largely explained by the higher number of contact hours between patient and caregiver in the SUD only group. ispartof: International Journal of Mental Health and Addiction vol:14 issue:1 pages:49-63 ispartof: location:United States status: published

Background and Objectives: To evaluate the utility of the constructs functioning and disability (F & D) and dependency for case-mix and subtyping of patients with schizophrenia by psychosocial, clinical, use of services and attention received from informal carers. Methods: A randomly selected total of 205 people with schizophrenia, and their careers were evaluated through PANSS, DAS-sv, Objective and Subjective Burden Scale (ECFOS-II) and use of services. Results: Two groups and Four profiles were identified according to levels of Dependency: The non-dependent group was made of two profiles: independent (I), and persons with disability in the community (DiC). The dependent group included persons with dependency in the community (DeC) and persons with dependency in hospital care (DeH). There are clinical and psychosocial differences between these profiles being the dependent the most severe. Regarding use of services, DeC use the most resources, with the exception DeH (more hospitalization resources). The DeC profile generate greater family burden in the following areas; taking medication, being accompanied to appointments, and management than the DiC, despite both groups showing a high need for support. Conclusions: Dependency is a relevant construct for case-mix and subtyping in schizophrenia, and it is related to severity both at the social and clinical level. DeC generate more family burden than the other profiles, followed by DiC (patients with schizophrenia with disability but non-dependent).

CONTEXTO: A presença de sobrecarga em familiares cuidadores resultante do auxílio/cuidado prestado pode comprometer a saúde deles, implicar deterioração de relacionamentos e manutenção ou agravamento do quadro do enfermo. OBJETIVOS: Avaliar graus de sobrecarga, objetiva e subjetiva, de familiares de indivíduos com transtorno obsessivo-compulsivo (TOC) em amostras na rede pública e privada. MÉTODOS: Estudo descritivo-analítico constituído de: caracterização do sujeito com TOC (N = 30) e de seu familiar cuidador (N = 30), em amostras da rede pública (N = 30) e privada (N = 30), por meio de questionários sociodemográficos; confirmação diagnóstica (TOC) com uso do Mini International Neuropsychiatric Interview (MINI); aplicação da Escala de Avaliação da Sobrecarga de Familiares (FBIS-BR). RESULTADOS: Foram detectadas significância estatística entre as amostras na dimensão objetiva, com maiores graus de sobrecarga na amostra da rede pública, e significância na dimensão subjetiva apenas na questão relativa à "realização de tarefas de casa", com maiores graus na amostra da clínica privada. CONCLUSÃO: O estudo constatou graus de sobrecarga diferentes em familiares de sujeitos com TOC em tratamento, em amostras na rede pública e privada de assistência em psiquiatria. BACKGROUND: The burden present in family members caretakers that results of the care given, could jeopardize their health, provoke the decay of relationships, as well as maintain or worsen the patient's condition. OBJECTIVES: Evaluate the levels of objective and subjective burden in family members of individuals with obsessive-compulsive disorder (OCD) in samples from the public and private network. METHODS: This is a descriptive-analytical study that characterizes the individual with OCD (N = 30) and their family caretakers (N = 30), in samples of public net (N = 30) and private net (N = 30), with use of standardized socio-demographic data questionnaire; diagnosis confirmation (OCD) by using Mini International Neuropsychiatric Interview (MINI); the Family Burden Interview Schedule (FBIS-BR) was applied. RESULTS: A statistical significance has been detected among the samples through an objective point of view, with higher levels of burden in the sample of public net; the significance through a subjective point of view was only perceived regarding "doing housework", with higher levels in the private practice. DISCUSSION: The study has verified different levels of burden in family members of individuals with OCD under treatment in samples from the public and private network of psychiatric assistance.

OBJECTIVE: Psychiatric deinstitutionalization resulted in greater involvement of families in daily care of patients. Family caregivers burden has been described by international researches. In Brazil very few studies investigated family burden with validated scales, perhaps due to the restrict availability of scales to measure this construct. The present study examined the reliability of the Brazilian version of the Family Burden Interview Schedule. METHOD: Scale reliability was assessed through its internal consistency and temporal stability. A sample of 243 family caregivers of psychiatric patients attending public outpatient services were interviewed with the scale. Socio-demographic data were collected with a standardized form. A sub-sample of 42 relatives participated in a re-test, after 3 weeks, for assessment of the scale temporal stability. RESULTS: Cronbach alpha coefficients ranged from 0.58 to 0.90 for global and domains scores. Pearson correlation coefficients and intra-class correlation coefficients for test and retest ranged from 0.54 to 0.90. DISCUSSION: Results for internal consistency were similar to the original scale. Four subscales presented alpha coefficients superior to the original ones. The temporal stability cannot be compared because this analysis was not performed for the original scale. CONCLUSION: The Brazilian version of the scale had good psychometric properties of temporal stability and internal consistency. OBJETIVO: A desinstitucionalização psiquiátrica resultou em maior envolvimento das famílias nos cuidados diários dos pacientes. Pesquisas internacionais constataram a sobrecarga dos familiares, mas, no Brasil, poucas pesquisas a investigaram utilizando escalas validadas, talvez devido à carência de instrumentos de medida deste construto. Este estudo avaliou a confiabilidade da versão brasileira da escala Family Burden Interview Schedule. MÉTODO: Avaliou-se a confiabilidade, em termos da consistência interna e estabilidade temporal. Foram entrevistados 243 familiares cuidadores de pacientes psiquiátricos de serviços públicos de saúde mental. Os dados sociodemográficos foram obtidos por questionário padronizado. Uma subamostra de 42 familiares foi entrevistada novamente, após três semanas, para avaliação da estabilidade temporal teste-reteste. RESULTADOS: Os coeficientes alfa de Cronbach para os escores globais e domínios variaram de 0,58 a 0,90. Os coeficientes de correlação de Pearson e de correlação intraclasse para o teste-reteste foram positivos e significativos, variando de 0,54 a 0,90. DISCUSSÃO: Os resultados da consistência interna foram semelhantes aos da escala original, mas quatro subescalas apresentaram valores de alfa superiores. A estabilidade não pode ser comparada, pois esta não foi avaliada para a escala original. CONCLUSÃO: A versão brasileira da escala apresentou boas propriedades psicométricas de estabilidade temporal e consistência interna.

Jean-Pierre Lépine1, Mike Briley21Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris Unité INSERM 705 CNRS UMR 8206, Université Paris Diderot, Paris, France; 2NeuroBiz Consulting and Communication, Castres, FranceAbstract: Recent epidemiological surveys conducted in general populations have found that the lifetime prevalence of depression is in the range of 10% to 15%. Mood disorders, as defined by the World Mental Health and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, have a 12-month prevalence which varies from 3% in Japan to over 9% in the US. A recent American survey found the prevalence of current depression to be 9% and the rate of current major depression to be 3.4%. All studies of depressive disorders have stressed the importance of the mortality and morbidity associated with depression. The mortality risk for suicide in depressed patients is more than 20-fold greater than in the general population. Recent studies have also shown the importance of depression as a risk factor for cardiovascular death. The risk of cardiac mortality after an initial myocardial infarction is greater in patients with depression and related to the severity of the depressive episode. Greater severity of depressive symptoms has been found to be associated with significantly higher risk of all-cause mortality including cardiovascular death and stroke. In addition to mortality, functional impairment and disability associated with depression have been consistently reported. Depression increases the risk of decreased workplace productivity and absenteeism resulting in lowered income or unemployment. Absenteeism and presenteeism (being physically present at work but functioning suboptimally) have been estimated to result in a loss of $36.6 billion per year in the US. Worldwide projections by the World Health Organization for the year 2030 identify unipolar major depression as the leading cause of disease burden. This article is a brief overview of how depression affects the quality of life of the subject and is also a huge burden for both the family of the depressed patient and for society at large.Keywords: epidemiology, DALY, mortality risk, economic burden, family burden, depression

Background: There are few studies that describe differences in measures of burden and participation in care relating to whether the relatives live with or apart from the person with a mental illness.Aim: To investigate different aspects of family burden, need for support and participation in care situations specifically considering whether the relative and the patient are living together or apart.Method: 162 relatives (73 relatives of committed patients and 89 relatives of voluntarily admitted patients) answered a semi-structured questionnaire concerning their situation as a relative of a severely mentally ill person.Results: There was increased experienced family burden in several aspects due to the relative and patient living together. However, relatives who lived with the patient were less likely to believe that the patient would be better off dead, experienced more participation in the patient’s treatment and more often viewed the psychiatric services as being of good quality than those relatives who did not live with the patient.Conclusion: Persons with a severe mental illness who are admitted to inpatient units are in need of different aspects of intensive psychiatric care. Some of these needs are supplied by relatives in everyday life, often without any support. In providing for the needs of relatives, in relieving their burden, the psychiatric services needs to implement different methods according to whether the relatives live with or apart from the patient.

The burden, the coping strategies and the social network of a sample of 236 relatives of patients with schizophrenia, living in five European countries, were explored by well-validated assessment instruments. In all centres, relatives experienced higher levels of burden when they had poor coping resources and reduced social support. Relatives in Mediterranean centres, who reported lower levels of social support, were more resigned, and more often used spiritual help as a coping strategy. These data indicate that family burden and coping strategies can be influenced by cultural factors, and suggest that family interventions should have also a social focus, aiming to increase the family social network and to reduce stigma.

SummaryThis study aimed to explore the burden on the key-relatives of a sample of patients with obsessive-compulsive disorder and a control sample of patients with major depression. The level of burden of relatives of obsessive-compulsive patients was moderate to severe in most of the explored situations, and did not differ significantly from that of the relatives of depressives. Social relationships were compromised in 74% of cases, and feelings of depression were recorded in 84% of cases. The level of subjective burden changed according to the relatives' sex, age and position in the family. The degree of objective burden correlated with the level of patients' disability, whereas that of subjective burden correlated with the severity of patients' obsessive-compulsive symptomatology.

The burden perceived by the key relatives of 27 schizophrenics and 19 patients with neurotic disorders, both with at least a minimal degree of personal/social disability and a current exacerbation of symptoms, was assessed by a self-administered questionnaire. Only modest quantitative and qualitative differences between the two samples of key relatives were found. The burden perceived by the relatives of schizophrenics was more closely related to the patients' personal/social disability than that reported by the relatives of neurotic patients. The psycho-pathological features of schizophrenic patients that were perceived as the most burdensome were “negative” symptoms, whereas the burden reported by the relatives of neurotic patients was predominantly related to obsessive/compusive and anxiety symptoms.

BACKGROUND: To date, only few data are available on how family burden in schizophrenia changes over time. In addition, no study has explored how such factors as coping styles and social support influence burden over time. This paper presents the 1-year follow-up data from the BIOMED I study on family burden and coping strategies in schizophrenia. METHODS: A sample of 159 relatives of patients with schizophrenia living in five European countries was followed up prospectively for 1 year with regard to burden and coping strategies, using validated questionnaires. RESULTS: In the sample as a whole, the burden was stable. A reduction of family burden over time was found among relatives who adopted less emotion-focused coping strategies and received more practical support from their social network. In addition, family burden decreased in relation to the improvement of patient's social functioning. CONCLUSIONS: When relatives of patients with schizophrenia are able to improve their coping strategies, it is possible for burden to be reduced even after several years. This points to the necessity to provide families of chronic psychotic patients with psychoeducational interventions emphasising the adoption of an effective coping style.

We present here an exploratory descriptive investigation about the needs of the caregivers of patients with severe mental illness (SMI) referring to a mental health service of a Southern Italian city. Twelve caregivers were queried, as experienced contacts, about their own emotional involvement and their relationship with the patient by means of a semi-structured interview. Interviews were subjected to a qualitative thematic-categorical analysis. The results reveal painful experiences of anguish and feelings of inadequacy stemming from care-giving which gravely impact the caregivers' personal well-being and family relations. Keywords: Family Burden, Communication of Diagnosis, Severe Mental Illness, Sense-Making Process, Qualitative Research A diagnosis of severe mental illness (SMI) prompts, within the family, organizational efforts aimed at treatment and support which end up inevitably involving the whole family group. (Dice et al., 2015). It is a critical moment in the medical activity and its understanding can allow transforming steps in the comprehension of illness in the patient and his/her family (De Luca Picione & Freda, 2016a, 2016b, 2016c; De Luca Picione, Dice, & Freda, 2015). In this paper we intend to observe processes of signification attributed, in the family context, to the psychiatric diagnosis and the consequent possibilities of decline in daily life. As health providers, we consider these aspects as a central point for the doctor-patient relationship, in order to implement best practices for taking care patients and support their families (Freda & Dice, 2017; Dice, Dolce, & Freda, 2016; Martino & Freda, 2016a; De Luca Picione, Dice, & Freda, 2015; Freda et al., 2014; Martino et al., 2013). In fact, it is becoming an increasingly frequent observation that a specific individual (e.g., a parent or sibling) tends to take on him- or herself most of the duties related to the care of his/her dependent (Hermanns & Mastel-Smith, 2012; Jeanty & Hibel, 2011). Chiu et al. (2013) recently showed how the role of caregiver is often tied to a large amount of emotional work such as meeting patients' emotional needs. These individuals are called on every day to care for their dependents, who often hold no job and require daily assistance to satisfy their needs (Furlong & McGilloway, 2012; Jagannathan et al., 2011; Kate et al., 2013; Wheeler, 2010). Chiu et al. (2013) also showed that relatives of patients with SMI frequently suffer from some kind of emotional disorder. This suggests that the heavy family burden associated with caregiving responsibilities might be a psycho-social risk factor (Van Parys et al., 2014); indeed, several studies show that the role of the caregiver is often associated with anxiety, depression, fears and worries, feelings of guilt or loss, psychosomatic complaints, as well as experiences related to social stigma. Moreover, the caregivers of psychiatric patients often experience emotions pertaining to secretiveness, loneliness, fear, pain, and anger, as well as overwhelming guilt for having borne a child with SMI (Kate et al., 2013). In light of this scenario, it is generally recognized that family-targeted interventions can improve the relatives' emotional well-being, and support the caregivers in their undoubtedly important role to their dependents. It becomes necessary to focus carefully on the caregiver's emotional state (Caqueo-Urizar et al., 2011; Furlong & McGilloway, 2012; Kate et al., 2013) lest his/her health deteriorate and symptoms should emerge triggered by the inordinate burden of caregiving. This, in turn, will bear beneficially on the treatment of the patient. This is the reason why mental health service providers often include well-being and quality of family relations as indicators of the standard of care provided (Asmal et al., 2014; Caqueo-Urizar et al., 2011; Hansen & Buus, 2013; Kate et al., 2013), and why paramount importance is attributed to the emotional consequences on relatives of living together with and constantly caring for a patient with SMI (Howe et al. …

Background The difference of burden between caregivers of acute patients with schizophrenia and bipolar disorder has not been well studied in China, a culture where family responsibility has a very high value. Our aim is to compare family burden in these two categories diagnosis and to identify predictors of family burden in a large psychiatric hospital in China. Methods Two hundred forty-three schizophrenic patients and 200 bipolar patients were enrolled in a cross-sectional study. Patients were independently evaluated on symptoms, insight, attitudes toward medication, quality of life during the first week of their admissions. The prime caregiver for each patient was also evaluated with a standard measure of family burden within 1 week of patients’ admission. Results Caregiver perceptions of violent behavior and suicidal risk among patients with bipolar disorder were significantly greater than among families of those with schizophrenia. Hierarchical regression analyses demonstrated differential correlates of burden for all predictive factors with R2 values ranging from 0.14 to 0.27 in the five burden factors in schizophrenia families; and from 0.12 to 0.24 in bipolar disorder families. Symptoms severity explained the greatest proportion of variance, whereas patient and caregiver demographic variables explained much less variance. Conclusion Family burden, especially the caregiver perceptions of violent and suicidal behaviors were greater in care givers of acute bipolar disorder patients than among caregivers of schizophrenia patients in the present sample. However, in families of patients with both disorders clinical features were the strongest predictor of caregiver burden.

Background The economic and moral implications of family burden are well recognised. What is less understood is whether or how family health and family burden relate to personal mental health. This study examines family health and perceived family burden as predictors of personal mental health, taking personal and sociodemographic factors into consideration. Methods Data used was from the National Comorbidity Study Replication (NCS-R), namely the random 30% of participants (N = 3192) to whom the family burden interview was administered. Measures of family burden and mental health were considered for analysis. Results Binary logistic regressions were used as means of analyses. Perception of family burden was associated with an increased vulnerability to personal mental health problems, as was the presence of mental health difficulties within the family health profile. Which member of the family (kinship) was ill bore no relation to prediction of personal mental health. Personal and socio-demographic factors of sex, age, marital status, education and household income were all predictive of increased vulnerability to mental health problems over the last 12 months. Conclusions Certain elements of family health profile and its perceived burden on the individuals themselves appears related to risk of personal incidence of mental health problems within the individuals themselves. For moral and economic reasons, further research to understand the dynamics of these relationships is essential to aid developing initiatives to protect and support the mental health and wellbeing of relatives of ill individuals.