Social Psychiatry and Psychiatric Epidemiology

, Volume 25, Issue 6, pp 289–297 | Cite as

Objective and subjective dimensions of family burden

Towards an integrative framework for research
  • A. H. Schene


In this article the consequences for those in close contact with a severely disturbed psychiatric patient, the burden of the family, are elaborated within an integrative framework. Burden areas are described and their objective and subjective dimensions are distinquished. The framework comprises three approaches: the systems approach, role theory and the stress process. An outline of the more important burden instruments developed up to now and suggestions for further research are given.


Public Health System Approach Close Contact Psychiatric Patient Integrative Framework 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Barrett J, Kurionsky J, Gurland B (1972) Community tenure following emergency discharge. Am J Psychiatry 128: 958–964Google Scholar
  2. Billings AG, Moos RH (1982) Psychosocial theory and research on depression: an integrative framework and review. Clin Psychol Rev 2: 213–237Google Scholar
  3. Brown GW, Carstairs GM, Topping G (1958) Post-hospital adjustment of chronic mental patients. Lancet II: 685–689Google Scholar
  4. Brown GW, Rutter M (1966a) The measurement of family activities and relationships. Hum Relat 19: 239–263Google Scholar
  5. Brown GW, Bone M, Dalison BH, Wing JK (1966b) Schizophrenic and social care. A comparative follow-up study of 339 schizophrenic patients (Maudsley Monographs No 17). Oxford University Press, OxfordGoogle Scholar
  6. Brown GW, Birley JLT, Wing JK (1972) Influence, of family life on the course of schizophrenic disorder: a replication. Br J Psychiatry 121: 241–258Google Scholar
  7. Cobb S (1976) Social support as a moderator of life stress. Psychosom Med 38: 300–314Google Scholar
  8. Coyne JC, Kessler RC, Tal M, Turnbull J, Wortman CB, Greden JF (1987) Living with a depressed person. J Consult Clinical Psychology 55: 347–352Google Scholar
  9. Creer C, Wing JK (1974) Schizophrenia at home. Institute of Psychiatry, LondonGoogle Scholar
  10. Creer C, Sturt E, Wykes T (1982) The role of relatives In: Wing JK (ed) Longterm Community care experience in a London borough. Psychol Med Monogr [Suppl 2]: 29–39Google Scholar
  11. Deykin E (1961) The reintegration of the chronic schizophrenic patient discharged to his family and community as perceived by the family. Ment Hygiene 45: 235–246Google Scholar
  12. El Islam MF (1979) A better outlook for schizophrenics living in extended families. Br J Psychiatry 135: 343–347Google Scholar
  13. El Islam MF (1982) Rehabilitation of schizophrenics by the extended family. Acta Psychiatr Scand 65: 112–119Google Scholar
  14. Engel GL (1980) The clinical application of the biopsychosocial model. Am J Psychiatry 137: 535–544Google Scholar
  15. Fadden GB (1984) The relatives of patients with depressive disorders: a typology of burden and strategies of coping. M. Phil Thesis. Institute of Psychiatry, University of LondonGoogle Scholar
  16. Fadden G, Bebbington P, Kuipers L (1987) Caring and its burdens. A study of the spouses of depressed patients. Br J Psychiatry 151: 660–667Google Scholar
  17. Freeman HE, Simmons OG (1958) Mental patients, in the community. Family settings and performance level. Am Sociol Rev 22: 147–154Google Scholar
  18. Freeman HE, Simmons OG (1959) Social class and posthospital performance levels. Am Sociol Rev 24: 345–451Google Scholar
  19. Gibbons JS, Horn SH, Powell JM, Gibbons JL (1984) Schizophrenic patients and their families: a survey in p psychiatric service based on a DGH unit. Br J Psychiatry 144: 70–77Google Scholar
  20. Giel R, Arongo MV de, Hafeiz Babikir A (1983) The burden of mental illness on the family. Acta Psychiatr Scand 68: 186–201Google Scholar
  21. Grad J, Sainsbury P (1963) Mental illness and the family. Lancet I: 544–547Google Scholar
  22. Grad J, Sainsbury P (1968) The effects that patients have on their families in a community care and a control psychiatric service. Br J Psychiatry 114: 265–278Google Scholar
  23. Gubman GD, Tessler RC, Willis G (1987) Living with the mentally ill: factors affecting household complaints. Schizophr Bull 13: 727–736Google Scholar
  24. Herz MI, Endicott J, Spitzer RL (1977) Brief hospitalization: a two-year follow-up. Am J Psychiatry 134: 502–507Google Scholar
  25. Hoenig J, Hamilton MW (1966a) The schizophrenic patient in the community and the effect on the household. Int J Soc Psychiatry 26: 165–176Google Scholar
  26. Hoenig J, Hamilton MW (1966b) The burden on the household in an extramural psychiatric service. In: Freeman HL, Farndale WAJ (eds) New aspects of the mental health services. Pergamon. Oxford, pp 612–635Google Scholar
  27. Hoenig J (1968) The de-segregation of the psychiatric patients. Proc R Soc Med 61: 115–120Google Scholar
  28. Jacob M, Frank E, Kupfer DJ, Carpenter LL (1987) Recurrent depression: an assessment of family burden and family attitudes. J Clin Psychiatry 44: 395–400Google Scholar
  29. Knights A, Hirsch SR, Platt SD (1980) Clinical change as a function of brief admission to hospital in a controlled study using the Present State Examination. Br J Psychiatry 137: 170–180Google Scholar
  30. Kreisman D, Joy V (1974) Family response to the illness of a relative. A review of the literature. Schizophr Bull 1: 34–57Google Scholar
  31. Lazarus RS, Cohen JB (1977) Environmental stress. In: Altman I, Wohlwill JF (eds) Human behaviour and the environment: current theory and research, vol 1. Plenum, New York pp 90–121Google Scholar
  32. Lazarus RS (1981) The stress and coping paradigm. In: Eisdorfer C, Cohen A, Kleinman A, Maxim P (eds) Theoretical basis for psychopathology, Spectrum, New York, pp 177–214Google Scholar
  33. Mandelbrote B, Folkard S (1961) Some factors related to outcome and social adjustment in schizophrenia. Acta Psychiatr Scand 37: 223–235Google Scholar
  34. Methorst GJ (1985) Mannen en vrouwen van psychiatrische patienten, Thesis, WageningenGoogle Scholar
  35. Noh S, Turner RJ (1987) Living with psychiatric patients: implications for the mental health of family members. Soc Sci Med 25: 263–271Google Scholar
  36. Noh S, Avison WR (1988) Spouses of discharged psychiatric patients: factors associated with their experience of burden. J Marriage Fam 50: 377–389Google Scholar
  37. Pai S, Kaipur RL (1981) The burden on the family of a psychiatric patient; development of an interview schedule. Br J Psychiatry 138: 332–335Google Scholar
  38. Pai S, Kaipur RL (1982) Impact of treatment intervention of the relationship between dimensions of clinical psychopathology, social dysfunction and burden on the family. Psychol Med 12: 651–658Google Scholar
  39. Pasamanick B, Scarpitti FR, Dinith S (1967) Schizophrenics in the community; an experimental study in the prevention of hospitalization. Appleton Century Crofts, New YorkGoogle Scholar
  40. Pearlin LI, Schooler C (1978) The structure of coping. J Health Soc Behav 19: 2–21Google Scholar
  41. Pearlin LI, Lieberman MA, Managhan EG, Mullan JT (1981) The stress process. J Health Soc Behav 22: 337–356Google Scholar
  42. Platt S (1981) Social adjustment as a criterion of treatment success: just what are we measuring? Psychiatry 44: 95–112Google Scholar
  43. Platt S (1985) Measuring the burden of psychiatric illness on the family; an evaluation of some rating scales. Psychol Med 15: 383–393Google Scholar
  44. Platt S, Weyman A, Hirsch S, Hewett S (1980) The Social Behaviour Assessment Schedule (SBAS); rationale, contents, scoring and reliability of a new interview schedule. Soc Psychiatry 15: 43–55Google Scholar
  45. Platt S, Weyman A, Hirsch S (1983) Social Behaviour Assessment Schedule (SBAS), 3rd edn. Windsor, Berkshire: NFER-NelsonGoogle Scholar
  46. Rabkin J (1972) Opinions about mental illness, a review of the literature. Psychol Bull 77: 153–171Google Scholar
  47. Raymond ME, Slaby AE, Lieb J (1975) Familial response to mental illness. Soc Casework 56: 492–498Google Scholar
  48. Sainsbury P, Grad J (1962) Evaluation of treatment and services. In: The burden on the community. A symposium. Oxford University Press, LondonGoogle Scholar
  49. Sainsbury P, Grad J (1966) Evaluating the community psychiatric service in Chichester. Aims and methods of research. Milbank Q 44: 231–242Google Scholar
  50. Schene AH (1986) Thuis bezorgd; een literatuurstudie naar het verschijnsel “Burden on the family”. NcGv, UtrechtGoogle Scholar
  51. Schene AH (1987) The burden on the family scale. Department of Ambulatory and Social Psychiatry, University of Utrecht, UtrechtGoogle Scholar
  52. Spitzer RL, Giboon M, Endicott J (1971) Family evaluation form. New York State Department of Mental Hygiene, New YorkGoogle Scholar
  53. Tessler RC, Killian LM, Gubman GD (1987) Stages in family response to mental illness; an ideal type. Psychosoc Rehabil J 10: 3–16Google Scholar
  54. Tessler R, Fisher G, Gamache G (1989) A role strain approach to the measurement of family burden: the properties and utilities of a new scale. Paper presented at the Annual meeting of the Eastern Sociological Society, BaltimoreGoogle Scholar
  55. Treudley MB (1946) Mental illness and family routines. Ment Hygiene 15: 407–418Google Scholar
  56. Turner RJ (1983) Direct, indirect and moderating effects of social support on psychological distress and associated conditions. In: Kaplan HB (ed) Psychosocial stress, trends in theory and research. Academic, New York, pp 105–156Google Scholar
  57. Waalker VN, MacBriddle A, Vachon MLS (1977) Social support networks and the crisis of bereavement. Soc Sci Med 11: 35–41Google Scholar
  58. Wing JK, Monck E, Brown GW, Carstairs GM (1964) Morbidity in the community of schizophrenic patients discharged from London Mental Hospitals in 1959. Br J Psychiatry, 110: 10–21Google Scholar
  59. Yarrow M, Schwarz C, Murphy H, Deasy L (1955) The psychological meaning of mental illness in the family. J Soc Issues 11: 12–24Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • A. H. Schene
    • 1
  1. 1.Department of Ambulatory and Social PsychiatryUniversity of UtrechtUtrechtThe Netherlands

Personalised recommendations