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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.

Zaburzenia rozwojowe, takie jak autyzm dziecięcy, zespół Aspergera, upośledzenie umysłowe, mózgowe porażenie dziecięce, wydają się nieść znacznie większe emocjonalne brzemię dla bliskich niż jakiekolwiek inne zaburzenia, wymagające specjalnej opieki rodziców. Choroba o określonym początku daje nadzieje na to, że się zakończy. I zdarza się, iż przemija. W wypadku zaburzeń rozwoju dochodzi do bolesnego rozstania nie z osobą realną, ale potencjalną, obecną w marzeniach o dziecku. Wydaje się jednak, że faza żałoby po idealnym dziecku utraconym pozwala dostrzec dziecko realne, z jego ograniczeniami ale też potencjałem relacji i rozwoju. Pozwala na spokojne towarzyszenie jego odmienności. Paradoksalnie owo pozorne zaniechanie nieść może w sobie potencjał ważnej zmiany. W artykule poruszone zostały takie, dotyczące rodziców dzieci z zaburzeniami w rozwoju zagadnienia, jak: uczucia towarzyszące rodzicom w trakcie stawianiu diagnozy, podejmowane przez nich strategie zaprzeczania diagnozie, triangulacja dziecka w relację rodzicielską, trudności w procesie ko-separacji i ko-indywiduacji, egzystencjalny wymiar cierpienia dla bliskich, trudności rozwojowe rodzeństwa.

BACKGROUND: Family burden among caregivers of psychiatric patients has been reported in international researches, but in Brazil very few studies investigated this problem. OBJECTIVES: This study describes the family caregivers' objective and subjective burden and identified the most affected domains of their lives. METHODS: Descriptive study using a sample of 150 family caregiversofpsychiatricpatients,randomly selected from Cersamsin Belo Horizonte (MG), Brazil. It was applied a Family Burden Interview Schedule (FBIS-BR) and a standardized clinic and socio-demographic data questionnaire. RESULTS: Most caregivers presented high objective burden related to frequent daily assistance of patients and a high subjective burden related to worries about the patients, feeling of burden in supervising their problematic behaviors and perception of permanent impact in their social and professional lives. The daily alterations in the routine had not caused objective burden to the caregivers. The average of monthly expenses with patients was of R$ 153.5. CONCLUSIONS: Results confirmed data from international research with the same target population and from Brazilians studies with caregivers of old patients with depression or dementia. Results obtained in the present research indicated that it is necessary to develop intervention programs for information, support and orientation of family caregivers. CONTEXTO: Pesquisas internacionais constataram sobrecarga em familiares cuidadores de pacientes psiquiátricos, mas no Brasil há poucos estudos nesta área. OBJETIVOS: Descrever a sobrecarga objetiva e subjetiva de uma amostra de familiares e os aspectos mais afetados de suas vidas. MÉTODOS: Estudo descritivo com 150 familiares de pacientes psiquiátricos selecionados aleatoriamente nos Cersams de Belo Horizonte (MG). Utilizou-se a Escala de Sobrecarga dos Familiares de Pacientes Psiquiátricos (FBIS-BR) e um questionário sociodemográfico e clínico. RESULTADOS: A maioria dos cuidadores apresentou elevada sobrecarga objetiva relativa à alta freqüência de ajuda aos pacientes nas tarefas cotidianas e elevada sobrecarga subjetiva, referente às preocupações com os pacientes, ao elevado grau de incômodo ao supervisionar seus comportamentos problemáticos e à percepção de mudanças permanentes na vida social e profissional dos familiares. As alterações diárias na rotina não acarretaram sobrecarga objetiva aos cuidadores. A média de gastos mensais com os pacientes foi de R$ 153,57. CONCLUSÕES: Os resultados confirmaram dados de estudos internacionais com cuidadores de pacientes psicóticos e de estudos nacionais com cuidadores de pacientes idosos com depressão e demência. Os resultados da presente pesquisa mostram a necessidade de desenvolver programas de informação, orientação e apoio aos familiares dos pacientes psiquiátricos.

O entendimento do formato da Intervenção Familiar citada pelos ensaios clínicos controlados na condição esquizofrenia foi o foco de nossa investigação aqui relatada. Procedemos a uma busca sistemática na base de dados MedLine e elaboramos a compreensão da fundamentação teórica das práticas descritas para avaliar a heterogeneidade clínica das intervenções que são objeto de estudo dos ensaios que resgatamos. Descrevemos um modelo denominado "pragmático", que apresenta fragmentos de técnicas, sem princípios de base ou técnicas derivadas de teorias; outro modelo cuja ênfase do trabalho é na mudança comportamental; e por fim um modelo cognitivo comportamental, que privilegia a abordagem cognitiva. Fazemos considerações sobre os conceitos de Emoção Expressa (EE) e Sobrecarga Familiar, subjacentes aos modelos comportamental e cognitivo comportamental na Intervenção Familiar para Portadores de Esquizofrenia. Consideramos que esse modelo, que privilegia um maior entendimento do familiar acerca da esquizofrenia, com a devida adequação devido às especificidades culturais nacionais, deve ser investigado para a utilização nos CAPS do Brasil. The understanding of the format of the Family Intervention mentioned by the clinical trials controlled in the condition schizophrenia it was the focus of our investigation here told. We proceeded to the one systematic search in MedLine and we elaborated for the understanding of the theoretical foundation of the described practices to evaluate the clinical heterogeneity of the interventions that are object of study of the trials that we rescued. We described a model denominated "pragmatic", that presents fragments of techniques, without base beginnings or derived techniques of theories; another model whose emphasis of the work is in the change comportamental; and finally a model cognitive comportamental, that privileges the cognitive approach. We make considerations on the concepts of Expressed Emotion (EE) and Family Burden, underlying to the models comportamental and cognitive comportamental in the Family Intervention for Bearers of Schizophrenia.

The recent trend towards community psychiatry appears to have shifted much of the burden of care of the chronically mentally ill from the institutions to the family. The objective of this study was to assess the implication of psychopathology in forty five schizophrenic patients on burden experience by their primary caregivers. Patients' psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS) and the burden on caregivers was measured using Burden on Family Interview Schedule (BFS). The prevalence of burden was extensive with 40% reported severe subjective burden. The greatest objective burden was treatment expenses affecting 35.6% of primary caregivers. Schizophrenic patients' psychopathology (particularly delusion, hostility and hallucinatory behaviour) was found to be significantly correlated with the amount of burden experienced by primary caregivers. Grandiosity and stereotyped thinking were the least burdensome symptoms imposed on the caregivers.

AIMS: To describe in a sample of 646 relatives of patients with physical long-term illnesses: a) the relatives' burden of care; b) the relatives' attitudes towards the patients; c) the social and professional support received by the families. METHODS: The study has been carried out in 30 Italian geographic areas randomly selected taking into account geographic location and population density. The sample has been consecutively recruited in 139 specialised units for the treatment of chronic heart, brain, diabetes, kidney, and lung diseases. Family burden was evaluated in relation to: a) family's socio-demographic variables and patients' clinical variables; b) relatives' attitudes toward the patient; c) social and professional support; d) geographic area and population density. OUTCOME MEASURES: Family Problems Questionnaire, physical illness version (QPF-O) and Social Network Questionnaire (QRS). RESULTS: The consequences of caregiving most frequently reported were constraints in social and recreational activities, and feelings of loss. Burden was more marked in relatives of patients with higher physical disabilities, with neurological illnesses, and in relatives with lower support by their social network. CONCLUSIONS: These data highlight the need to provide psychological and practical support to caregivers of patients with long-term physical diseases on the basis of the evaluation of their needs for care.

The first objective of the study was to describe the changes in the psychic state and functioning of two groups of patients’ suffering from severe acute mental disorders. The experimental group (n = 40) was treated in a psychosis team and the control group (a historical control group: n = 40) in conventional psychiatric special care (hospital and non-institutional) before the beginning of the work of the psychosis team. Another objective was to describe the patients’ use of services, especially psychiatric hospital treatment during the two-year follow-up. The third objective was to examine the changes in family burden and expressed emotion (EE) and the differences between the experimental group and the control group both on an individual and on a family level. The last objectives were to describe how the functioning of each patients’ family was reflected on an individual level and in the use of psychiatric hospital treatment, and how the psychosis team and conventional psychiatric special care differ in structure and contents as regards clinical work in practice. The study was conducted in Kainuu in 1992–1996. On an individual level, there was positive development in both groups between 0–9 months. After that the positive development continued in the experimental group, stopping in the control group. During the follow-up the experimental group used psychiatric hospital treatment less than the control group: between 0–2 years there were 713 days of treatment (17.8 days per person) in the experimental group and 2759 days (68.9 days per person) in the control group. The number of patients using hospital treatment was 12 (30%) in the experimental group and 30 (75%) in the control group. There was no difference between the groups in the number of non-institutional psychiatric special care meetings. During the follow up the expenses caused by psychiatric special care were 1.572.000 marks in the experimental group and 3.175.200 marks in the control group. In both groups the burden of the families sank in the time period of 0–9 months. After that, the positive development continued in the experimental group, stopping in the control group. The number of families with a high EE-index at the beginning of the treatment was 18 (75%) in the experimental group and 13 (72%) in the control group, after two years the figures being 15 (62%) and 10 (56%) respectively. Cases with a high or low family EE-index did not differ from each other in the amount of psychiatric hospital treatment. The positive development in psychic state and functioning was related to the better functioning of the family. During the first month of treatment, therapy meetings were held more often for the experimental group (experimental group: n = 202; control group: n = 147), and family members or other close people participated in the meetings more often in the experimental group (experimental group: n = 370; control group: n = 122). Working in the psychosis team was on an individual level at least as profitable as conventional psychiatric special treatment. Family burden decreased in both groups between 0–9 months and continued to decrease in the experimental group between 9 months – 2 years, but stopped in the control group. Treatment in the psychosis team was cheaper than conventional treatment. As a whole, the work of the psychosis team was more profitable and economical than conventional psychiatric special treatment. Tiivistelmä Tutkimuksen tarkoituksena oli kuvata psykoosityöryhmässä hoidettujen (koeryhmä: n = 40) ja ennen psykoosityöryhmän toiminnan alkamista tavanomaiseen tapaan psykiatrisessa erikoissairaanhoidossa sekä sairaala- että avohoidossa hoidettujen (historiallinen kontrolliryhmä: n = 40) äkillisistä vaikeista mielenterveyshäiriöistä kärsivien potilaiden psyykkisen tilan ja toimintakyvyn muutoksia ja palveluiden, erityisesti psykiatrisen sairaalahoidon käyttöä noin kahden vuoden seuranta-aikana. Tarkoituksena oli myös seurata lähiomaisten kuormittuneisuuden (family burden) ja perheen tunneilmapiirin (expressed emotion; EE) muutoksia ja koe- ja kontrolliryhmien välisiä eroja sekä yksilö- että perhetason ominaisuuksien suhteen. Tarkoituksena oli edelleen kuvata kunkin potilaan perheen toimintakyvyn heijastumista yksilötasolla ja psykiatrisen sairaalahoidon käytössä ja kuvata psykoosityöryhmätyyppisen ja tavanomaisen psykiatrisen erikoissairaanhoidon rakenteellisia ja sisällöllisiä eroja käytännön kliinisessä työssä. Tutkimus toteutui Kainuussa vuosina 1992–1996. Yksilötasolla molemmissa ryhmissä tapahtui myönteistä kehitystä psyykkisessä tilassa ja toimintakyvyssä aikavälillä 0–9 kuukautta. Aikavälillä 9 kuukautta – 9 vuotta myönteinen kehitys jatkui koeryhmässä, mutta pysähtyi kontrolliryhmässä. Koeryhmä käytti psykiatrista sairaalahoitoa seuranta-aikana huomattavasti kontrolliryhmää vähemän: hoitopäiviä aikavälillä 0–2 vuotta oli koeryhmässä 713 (17.8 päivää henkilöä kohti) ja kontrolliryhmässä 2759 (68.9 päivää henkilöä kohti). Sairaalahoitoa käyttäneitä potilaita oli koeryhmässä 12 (30 %) ja kontrolliryhmässä 30 (75 %). Psykiatrisen erikoissairaanhoidon avohoitokäyntien määrässä ei ryhmien välillä ollut eroa. Psykiatrisen erikoissairaanhoidon kustannukset seuranta-aikana olivat koeryhmässä 1.572.000 markkaa ja kontrolliryhmässä 3.175.200 markkaa. Lähiomaisten subjektiivinen ja objektiivinen kuormittuneisuus laskivat molemmissa ryhmissä aikavälillä 0–9 kk. Tämän jälkeen myönteinen kehitys jatkui koeryhmässä, mutta pysähtyi kontrolliryhmässä. Korkean EE-indeksin saaneita perheitä oli koeryhmässä hoidon alussa 18 (75 %) ja kontrolliryhmässä 13 (72 %) ja kahden vuoden kuluttua koeryhmässä 15 (62 %) ja kontrolliryhmässä 10 (56 %). Tapaukset, joissa oli mitattu perheen korkea tai matala EE- indeksi eivät eronneet psykiatrisen sairaalahoidon määrän suhteen toisistaan. Psyykkisen tilan ja toimintakyvyn myönteinen kehitys liittyi perheen parempaan toimintakykyyn. Hoitokokousten ja yksilötapaamisten kokonaismäärässä ei ryhmien välillä ollut eroa. Ensimmäisen kuukauden aikana hoitokokouksia järjestettiin koeryhmässä enemmän kuin kontrolliryhmässä (koeryhmä: n = 202; kontrolliryhmä: n = 147) ja omaisten tai läheisten osallistuminen hoitokokouksiin oli koeryhmässä tavallisempaa (koeryhmä: n = 370; kontrolliryhmä: n = 122). Saatujen tulosten perusteella psykoosityöryhmätyöskentely oli vaikeissa mielenterveyshäiriöissä yksilötasolla vähintäänkin yhtä tuloksellista kuin tavanomainen erikoissairaanhoito. Etenkin aikavälillä 9 kuukautta – 2 vuotta psykoositöryhmässä hoidetut selviytyivät tavanomaista hoitoa saaneita paremmin. Perheen kuormittuneisuus laski molemmissa ryhmissä aikavälillä 0–9 kuukautta ja lasku jatkui koeryhmässä aikavälillä 9 kuukautta – 2 vuotta, mutta pysähtyi kontrolliryhmässä. Hoito psykoosityöryhmässä oli tavanomaista hoitoa halvempaa. Kokonaisuutena psykoosityöryhmän työskentely oli tavanomaista psykiatrista erikoissairaanhoitoa tuloksellisempaa ja taloudellisempaa.

Com a reformulação dos modelos de prestação de cuidados em psiquiatria e saúde mental, tem-se verificado um aumento do número de doentes com perturbações mentais graves a viver com a família, cujos membros passam a estar assim potencialmente sujeitos a uma sobrecarga psicológica significativa. Dado o papel central dos familiares na prestação de cuidados informais, é de extrema relevância avaliar de forma padronizada as suas dificuldades, nomeadamente quanto à necessidade de intervenções de tipo psicoeducacional. Nos últimos anos têm sido elaborados vários instrumentos especificamente para a avaliação da sobrecarga familiar: neste trabalho, os autores descrevem o desenvolvimento da versão portuguesa do "Family Problem Questionnaire-FPQ". Após tradução e retroversão, foi feita a administração do FPQ a uma amostra de conveniência de 160 familiares de indivíduos com diagnóstico de esquizofrenia: numa análise preliminar, os resultados demonstraram boa aceitação e propriedades psicométricas satisfatórias. Este instrumento parece, pois, conter boas potencialidades de aplicação em actividades de investigação e monitorização de qualidade de cuidados prestados nos serviços de saúde mental, nomeadamente em intervenções psicoeducacionais. Probably due to the shift from institutional care to community care, the research has shown that informal carers (eg, family members) of patients with severe and long-term mental illness may experience an important psychological and emotional burden. Given that the family members are becoming such valuable resources as carers, it is crucial to assess their difficulties and needs, namely for the proposal of a psycho-educational intervention. In order to achieve this goal, several instrument focused on family burden assessment have been developed in the last years: in this paper, the authors report the development of the portuguese version of the "Family Problem Questionnaire-FPQ". After the back-translation procedures, a sample of 160 informal caregivers of patients with schizophrenia was evaluated using the FPQ: on a preliminar analysis, the results showed good acceptance and satisfactory psychometric properties. Thus, the FPQ seems to be potentially useful in a wide range of research and practical settings, including clinical and quality of care assessments, as well on the monitoring of psychoeducational interventions.

OBJECTIVE: (a) To explore burden related to caregiving and support received from professionals and social network in relatives of patients with schizophrenia in Northern, Central and Southern Italy; and (b) to test whether a higher level of family burden is associated with a lower level of professional and social network support. METHOD: Seven hundred and nine patients with schizophrenia and their key-relatives were consecutively recruited in 30 Italian mental health departments. Data were collected on: (a) patients' clinical status and levels of disability; (b) relatives' burden, social and professional support; (c) interventions received by patients and their families. RESULTS: Family burden was found lower in Northern Italy. However, after controlling for psychosocial interventions, differences in family burden among the three geographical areas disappeared. Family burden was associated with patients' levels of disability and manic/hostility symptoms, and with professional and social network support received by the family. CONCLUSION: Professional and social network support represent crucial resources to reduce family burden in schizophrenia.

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.

Objective We compared the effects of two brief psychoeducation programs and social skills training on the negative attitudes of mothers with a son who has schizophrenia. Methods 15 mothers with strong negative feelings towards a sons with schizophrenia were assigned by convenience to participate in one of three brief (5 session) group programs at an outpatient clinic: lecture-based psychoeducation, video-based psychoeducation, or social skills training. Assessments using the Patient Rejection Scale were conducted with the mothers at post-treatment, and 3-, 6-, and 9-months later. Results Mothers in the three groups demonstrated significantly different patterns of changes in their negative attitudes following treatment. Whereas the mothers who received the two psychoeducation interventions showed reductions in rejecting attitudes immediately following the program, their scores gradually increased at the subsequent follow-up assessments. In contrast, the mothers in the social skills training group showed reductions in negative attitudes that were sustained across all of the follow-up assessments. Conclusion Brief social skills training may be more effective than psychoeducation in reducing negative attitudes of parents who have an offspring with schizophrenia.

Accelerated atherosclerosis and vascular calcification, with oxidative stress, endothelial dysfunction, and other factors causing the arterial stiffness, increases cardiovascular morbidity and mortality in patients on peritoneal dialysis. The aim of this paper is to assess changes in intima media thickness (IMT) at common carotid arteries (CCA) in patients with stable continuous ambulatory peritoneal dialysis (PD) and examine the relationship of these changes and other risk factors on the occurrence of atherosclerosis. The study was conducted on 35 stable PD patients (25 type 2 diabetic patients), aged 58.6 +/- 10.6 years. CCA-IMT was assessed using ultrasound B-mode technique, bilaterally. Other risk factors for the occurrence of atherosclerosis were monitored through regular laboratory control. One atheromatous plaque was found in 19 patients (54.3%). Among 25 type 2 diabetic patients, vascular calcifications were found in 80% patients. In all PD patients, CCA-IMT is 0.77 +/- 0.23, in PD patients with vascular calcifications CCA-IMT is 1.05 +/- 0.2 mm, while in group without vascular calcifications the value of this parameter is 0.56 +/- 0.09 (p0.01 ). Significant differences were found between PD patients with and without vascular calcifications on CCA in patients age (p0.001), as well as values of systolic blood pressure (p=0.001), serum phosphorus (p=0.017), product calcium and phosphorus (p=0.021), CRP (p=0.039), triglycerides (p0.05) and lipoprotein (a) values (p=0.044). Our results suggest an important determination of common carotid arteries intima media thickness and its relation to other risk factors for the occurrence and progression of atherosclerosis in patients undergoing peritoneal dialysis.

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. …

This study explored the burden in parents and healthy siblings of 4-17 year-old patients with Duchenne (DMD) and Becker (BMD) muscular dystrophies, and whether the burden varied according to clinical aspects and social resources. Data on socio-demographic characteristics, patient's clinical history, parent and healthy children burden, and on parent's social resources were collected using self-reported questionnaires administered to 336 parents of patients with DMD (246) and BMD (90). Parents of patients with DMD reported higher burden than those of patients with BMD, especially concerning feeling of loss (84.3% DMD vs. 57.4% BMD), stigma (44.2% DMD vs. 5.5% BMD) and neglect of hobbies (69.0% DMD vs. 32.5% BMD). Despite the burden, 66% DMD and 62.4% BMD parents stated the caregiving experience had a positive impact on their lives. A minority of parents believed MD has a negative influence on the psychological well-being (31.0% DMD vs. 12.8% BMD), and social life of unaffected children (25.7% vs. 18.4%). In the DMD group, burden correlated with duration of illness and parent age, and burden was higher among parents with lower social contacts and support in emergencies. In DMD, difficulties among healthy children were reported as higher by parents who were older, had higher burden and lower social contacts. In both groups, burden increased in relation to patient disability. These findings underline that the psychological support to be provided to parents of patients with MD, should take into account clinical features of the disease.

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.