Abstract
The aim of the present study is to identify the relative contribution of patient and caregiver characteristics in a sample of primary carers of patients with chronic mental disorders living in the community. As carers were recruited from caregiver organizations, mainly mothers of an adult child suffering from schizophrenia participated in the study (n = 102). Within a comprehensive transactional stress model, burden was assessed with respect to objective and subjective burden, cognitive-emotional well-being, psychological distress and subjective quality of life. Primary stressors include illness-related characteristics of the patient, and a number of personal dispositions and resources of the caregivers were included as potential moderating variables. Multiple regression analyses were separately calculated for each dimension of burden. Interaction of carers’ expressed emotion and external locus of control with the patient’s problem with family communication as well as perceived social support was most predictive for objective and subjective burden, whereas carers’ neuroticism appeared as the most relevant predictor of their well-being, psychological distress and subjective quality of life. Among the patients’ variables, regular employment contributed significantly to reduce carers’ distress and enhance their well-being. As the sample was recruited from caregiver organizations, a selection bias has to be taken into account. To reduce caregiver burden, especially mothers’ burden, the patients’ occupational abilities should be strongly enhanced at an early stage. Family interventions should improve dysfunctional interactions, enhance the carers’ social activities and focus more intensely on the carers’ own dispositions.
Similar content being viewed by others
References
Baronet AM (1999) Factors associated with caregiver burden in mental illness: a critical review of the research literature. Clin Psychol Rev 19:819–841
Barrowclough C, Parle M (1997) Appraisal, psychological adjustment and expressed emotion in relatives of patients suffering from schizophrenia. Br J Psychiatry 171:26–30
Borkenau P, Ostendorf F (1993) NEO-Fünf-Faktoren Inventar (NEO-FFI) nach Costa und McCrae. Hogrefe, Göttingen-Bern-Toronto-Seattle
Bottlender R, Jäger M, Kunze I, Groll C, Borski I, Möller H-J (2003) Negative Symptome schizophrener Patienten aus der Perspektive der Psychiater, der Patienten selbst und deren Angehörigen. Nervenarzt 74:762–766
Carter PA, Acton GJ (2006) Personality and coping: predictors of depression and sleep problems among caregivers of individuals who have cancer. J Gerontol Nurs 32:5
Chiou CJ, Chang H-Y, Chen IP, Wang HH (2009) Social support and caregiving circumstances as predictors of caregiver burden in Taiwan. Arch Herontol Geriatr 48:419–424
De Jong GM, van Sonderen D, Emmelkamp PM (1999) A comprehensive model of stress: the roles of experienced stress and neuroticism in explaining the stress-distress relationship. Psychother Psychosom 68:290–298
Derogatis LR (1977) SCL-90-R, administration, scoring and procedures. Manual for the R(evised) Version. John Hopkins University School of Medicine, Baltimore
Edwards NE, Scheetz PS (2002) Predictors of burden for caregivers of patients with Parkinson’s Disease. J Neurosci Nurs 34:184–190
Feldmann R, Buchkremer G, Minneker-Hügel E, Hornung P (1995) Fragebogen zur Erfassung der Familienatmosphäre (FEF): Einschätzung des emotionalen Angehörigenverhaltens aus der Sicht schizophrener Patienten. Diagnostica 41:334–348
Ferring D, Filipp S-H (1989) Bewältigung kritischer Lebensereignisse: Erste Erfahrungen mit einer deutschsprachigen Version der “Ways of Coping Checklist”. Zeitschrift für Differentielle und Diagnostische Psychologie 10:189–199
Folkman S, Lazarus RS (1989) An analysis of coping in a middle-aged community sample. J Health Soc Behav 21:219–239
Gallant MP, Connel CM (1997) Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses. J Aging Health 9:373–395
Garretero S, Garcés J, Ródenas F, Sanjosé V (2009) The informal caregiver′s burden of dependent people: theory and empirical review. Arch Gerontol Geriatr 49:74–79
Gosh S, Greenberg J (2009) Aging fathers of adult children with schizophrenia: the toll of caregiving on their mental and physical health. Psychiatr Serv 60:982–984
Harvey K, Burns T, Fahy T, Manley C, Tattan T (2001) Relatives of patients with severe psychotic illness: factors that incluence appraisal of caregiving and psychological distress. Soc Psychiatry Psychiat Epidemiol 36:456–461
Ho BC, Flaum M, Hubbard W, Arndt S, Andreasen NC (2004) Validity of symptom assessment in psychotic disorders: information variance across different sources of history. Schizophr Res 68:299–307
Hooker K, Frazier LD, Monahan DJ (1994) Personality and coping among caregivers of spouses with dementia. Gerontologist 34:386–392
Hooker K, Monahan DJ, Bowman SR, Frazier LD, Shifren K (1998) Personality counts for a lot: predictors of mental and physical health of spouse caregivers in two disease groups. J Gerontol B Psychol Sci Soc Sci 53:73–85
Idler El, Benyamini J (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38:21–37
Idler EL, Kasl S (1991) Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol 46:55–65
Janke W, Erdmann G (1997) Streßverarbeitungsfragebogen. Hogrefe, Göttingen-Bern-Toronto-Seattle
Koukia E, Madianos MG (2005) Is psychosocial rehabilitation of schizophrenic patients preventin family burden? A comparative study. J Psychiatr Ment Health Nurs 12:415–422
Krampen G (1991) Fragebogen zu Kompetenz- und Kontrollüberzeugungen (FKK). Hogrefe, Göttingen-Toronto-Zürich
Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, Watson P, Hardy A, Garety P (2006) Influence of carer expressed emotion and affect on relapse in non-affective psychosis. Br J Psychiatry 188:173–179
Lazarus RS, Folkman S (1984) Stress, appraisal, coping. Stringer, New York
Maercker A, Langner R (2001) Persönliches Wachstum (Personal Growth) durch Belastungen und Traumata: Validierung zweier deutschsprachiger Fragebogenversionen. Diagnostica 47:153–162
Magana SM, Ramirez Garcia JI, Hernandez MG, Cortez R (2007) Psychological distress among Latino family caregivers of adults with schizophrenia: the roles of burden and stigma. Psychiatr Serv 58:378–384
Magliano L, Fadden G, Economou M, Held T, Xavier M, Guarneri M, Malangone C, Marasco C, Maj M (2000) Family burden and coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol 35:109–115
Möller-Leimkühler AM (2005) Burden of relatives and predictors of burden. Baseline results from the Munich 5-yeat-follow up study on relatives of first hospitalized patients with schizophrenia or depression. Eur Arch Psychiatry Clin Neurosci 255:223–231
Möller-Leimkühler AM (2006) Multivariate prediction of realtives’ stress outcome one year after first hospitalization of schizophrenic and depressed patients. Eur Arch Psychiatry Clin Neurosci 256:122–130
Möller-Leimkühler AM, Mädger F (2010) Personality factors and mental health outcome of caregivers of first hospitalized schizophrenic and depressed patients. Eur Arch Psychiatry Clin Neurosci 261:165–172
Möller-Leimkühler AM, Obermeier M (2008) Predicting caregiver burden in first admission psychiatric patients. Eur Arch Psychiatry Clin Neurosci 258:406–413
Möller-Leimkühler AM, Jandl M (2010) Expressed and perceived emotion over time: does the patients′ view matter for caregivers′ burden? Eur Arch Psychiatry Clin Neurosci Dec 21 [Epub ahead of print]
Moor C, Zimprich D, Schmitt M, Kliegel M (2006) Personality, aging self-perceptions, and subjective health: a mediation model. Int J Aging Hum Dev 63:241–257
Navaie-Waliser M, Spriggs A, Feldman PH (2002) Informal caregiving: differential experiences by gender. Med Care 40:1249–1259
Pai S, Kapur RL (1981) The burden on the family of a psychiatric patient: development of an interview schedule. Br J Psychiatry 138:332–335
Papastavrou W, Charalambous A, Tsangari H, Karayiannis G (2010) The cost of caring: the relative with schizophrenia. Scand J Caring Sci 24:817–823
Perlick DA, Rosenheck RA, Miklowitz DJ, Chessik C, Wolff N, Kaczynski R, Ostacher M, Patel J, Desai R, the STEP-BR (2007) Prevalence and correlates of burden among caregivers of patients with bipolar disorder enrolled in the systematic treatment enhancement program for bipolar disorder. Bipolar Disord 9:262–273
Pohl JM, Given CW, Collins CE, Given BA (1994) Social vulnerability and reactions to caregiving in daughters and daughters-in-law caring for disabled aging parents. Health Care Women Int 15:385–395
Pot AM, Deeg DJH, van Dyck R (2000) Psychological distress of caregivers: moderator effects of caregiver resources? Patient Educ Cons 41:235–240
Priebe S, Gruyters T, Heinze M, Hoffmann C, Jäkel A (1995) Subjektive Evaluationskriterien in der psychiatrischen Versorgung–Erhebungsmethoden für Forschung und Praxis. Psychiat Prax 22:140–144
Pruchno RA, Resch NL (1989) Mental health of caregiving spouses: coping as mediator, moderator, or main effect? Psychol Aging 4:454–463
Ray JJ, Still LV (1987) Maximizing the response-rate in surveys may be a mistake. Pers Individ Dif 8:573–574
Reichhart T, Pischel-Walz G, Kissling W, Bäuml J, Schuster T, Rummel-Kluge C (2010) Gender differences in patient and caregiver psychoeducation for schizophrenia. Eur Psychiatry 25:39–46
Russo J, Vitaliano PP, Brewer DD, Katon W, Becker J (1995) Psychiatric disorders in spouse caregivers of care recipients of Alzheimer’s disease and matched controls: a diathesis-stress model of psychopathology. J Abnorm Psychol 104:197–204
Scazufca M, Kuipers E (1996) Links between expressed emotion and burden of care in relatives of patients with schizophrenia. Br J Psychiatiry 168:580–587
Sha AJ, Wadoo O, Latoo J (2010) Psychological distress in carers of people with mental disorders. BJMP 3:a327
Sommer G, Frydrich T (1989) Soziale Unterstützung: diagnostik, Konzepte, F-SOZU. Dt. Ges. für Verhaltenstherapie, Tübingen
Tedeschi RG, Calhoun LG (1996) The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress 9:455–471
Van Os J, Park SB, Jones PB (2001) Neuroticism, life events and mental health: evidence for person-environment correlation. Br J Psychiatry Suppl 40:72–77
Wancata J, Freidl M, Krautgartner M, Friedrich F, Matschnig T, Unger A, Gössler R, Frühwald S (2008) Gender aspects of parents’ needs of schizophrenia patients. Soc Psychiatry Psychiatr Epidmiol 43:968–974
Wiedemann G, Rayki O, Feinstein E, Hahlweg K (2002) The family questionnaire: development and validation of a new self-report scale for assessing expressed emotion. Psychiatr Res 109:265–279
Yee JL, Schulz R (2000) Gender differences in psychiatric morbidity among family caregivers: a review and analysis. Gerontologist 40:147–164
von Zerssen D (1976) Die Befindlichkeitsskala: parallelformen Bf-S und Bf-S’. Beltz-Test, Göttingen
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Möller-Leimkühler, A.M., Wiesheu, A. Caregiver burden in chronic mental illness: the role of patient and caregiver characteristics. Eur Arch Psychiatry Clin Neurosci 262, 157–166 (2012). https://doi.org/10.1007/s00406-011-0215-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00406-011-0215-5