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Do needs, symptoms or disability of outpatients with schizophrenia influence family burden?

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Abstract

Background

Most needs of outpatients with schizophrenia are met by the family. This could cause high levels of family burden. The objective of this study is to assess the relationship between the patients’ needs and other clinical and disability variables and the level of family burden.

Method

A total sample of 231 randomly selected outpatients with schizophrenia was evaluated with the Camberwell Assessment of Needs, Positive and Negative Syndrome Scale, Global Assessment of Functioning and Disability Assessment Scale. A total of 147 caregivers also answered the objective and subjective family burden questionnaire (ECFOS-II). Correlations between total number of needs and family burden, t tests between presence or absence of need for each domain of family burden and regression models between family burden and needs, symptoms, disability and sociodemographic variables were computed.

Results

The number of patients’ needs was correlated with higher levels of family burden in daily life activities, disrupted behaviour and impact on caregiver’s daily routine. The patients’ needs most associated with family burden were daytime activities, drugs, benefits, self-care, alcohol, psychotic symptoms, money and looking after home. In a regression model, a higher number of needs, higher levels of psychopathology and disability, being male and older accounted for higher levels of family burden.

Conclusion

Patients with schizophrenia with more needs cause greater family burden but not more subjective concerns in family members. The presence of patients’ needs (daytime activities, alcohol and drug), severity of psychotic symptoms and disability are related to higher levels of family burden.

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References

  1. Addington J, Collins A, Mc Cleery A, et al. (2005) The role of family work in early psychosis. Schizophr Res 1; 79(1):77–83

    Article  Google Scholar 

  2. Berglund N, Valhne JO, Edman A (2003) Family intervention in schizophrenia-impact on family burden attitude. Soc Psychiatry Psychiatr Epidemiol 38(3):116–121

    Article  PubMed  Google Scholar 

  3. Dyck DG, Short R, Vitaliano PP (1999) Predictors of burden and infectious illness in schizophrenia caregivers. Psychosom Med 61(4):411–419

    PubMed  CAS  Google Scholar 

  4. Endicott J, Spitzer RL, Fleiss JL, et al. (1976) The global assessment scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33:766–771

    PubMed  CAS  Google Scholar 

  5. Fadden G, Bebbington P, Kuipers L (1987) The burden of care: the impact of functional psychiatric illness on the patient’s family. Br J Psychiatry 150:285–292

    Article  PubMed  CAS  Google Scholar 

  6. Fallon IRM, Roncone R, Held T, et al. (2001) An international overview of family interventions: developing effective treatment strategies and measuring their benefits for patients, carers and communities. In: Lefles HP, Johnson DL (eds) Family intervention in mental illness: international perspectives. Praeger, Greenwood

    Google Scholar 

  7. Foldemo A, Gullberg M, Ek AC, et al. (2005) Quality of life and burden in parents of outpatients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 40:133–138

    Article  PubMed  Google Scholar 

  8. Garcia J, Vazquez-Barquero J (1999) Deinstitutionalization and psychiatric reform in Spain. Actas Esp Psiquiatr 27(5):281–291

    PubMed  CAS  Google Scholar 

  9. González-Torres MA, et al. (2007) Stigma and discrimination towards people with schizophrenia and their family members. A qualitative study with focus group. Soc Psychiatry Psychiatr Epidemiol 42(1):14–23

    Article  PubMed  Google Scholar 

  10. Gutierrez-Maldonado J, Caqueo-Urizar A, Kavanagh DJ (2005) Burden of care and general health in families of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 40(11):899–904

    Article  PubMed  Google Scholar 

  11. Hazel NA, McDonell MG, Short RA, et al. (2004) Impact of multiple family groups of outpatients with schizophrenia on caregivers’ distress and resources. Psychiatr Serv 55(1):35–41

    Article  PubMed  Google Scholar 

  12. Hoening J, Hamilton M (1966) The schizophrenic patient and his effect on household. Int J Soc Psychiatry 12:165–176

    Article  Google Scholar 

  13. Hogarty GE, Anderson CM, Reiss DJ, et al. (1991) Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. II. Two-year effects of a controlled study on relapse and adjustment. Environmental-personal indicators in the course of schizophrenia (EPICS) research group. Arch Gen Psychiatry 48(4):340–347

    PubMed  CAS  Google Scholar 

  14. Janca A, Kastup M, Katchming H, et al. (1996) The world health organisation short disability assessment schedule (WHO-DAS-S): a tool for the assessment of difficulties in selected areas of functioning of patients with mental disorders. Soc Psychiatry Psychiatr Epidemiol 31:349–354

    Article  PubMed  CAS  Google Scholar 

  15. Joseph R, Birchwood M (2005) The national policy reforms for mental health services and the story of early intervention services in the United Kingdom. J Psychiatry Neurosci 30(5): 362–365

    PubMed  Google Scholar 

  16. Kay SR, Opler LA, Fiszbein A (1986) The positive and negative symptom scale (PANSS). Rating manual. Soc Behav Sci Doc 17:28–29

    Google Scholar 

  17. Koukia E, Madianos MG (2005) Is psychosocial rehabilitation of schizophrenic patients preventing family burden? A comparative study. J Psychiatr Ment Health Nurs 12(4):415–422

    Article  PubMed  CAS  Google Scholar 

  18. Leff J (1994) Working with the families of schizophrenic patients. Br J Psychiatry 164(Suppl 23):71–76

    Google Scholar 

  19. Lehman AF, Steinwachs DM (1998) Translating research into practice: the schizophrenia patient outcomes research team (PORT) treatment recommendations. Schizophr Bull 24(1):1–10

    PubMed  CAS  Google Scholar 

  20. Lowick B, De Hert M, Peeters E, Wampers M, Gilis P, Peuskens J (2004) A study of the family burden of 150 family members of schizophrenic patients. Eur Psychiatry 19(7):395–401

    Article  Google Scholar 

  21. Magliano L, Fadden G, Economou M, et al. (2000) Family burden and coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol 35(3):109–115

    Article  PubMed  CAS  Google Scholar 

  22. Magliano L, Malangone C, Guarneri M, et al. (2001) The condition of families of patients with schizophrenia in Italy: burden, social network and professional support. Epidemiol Psichiatr Soc 10(2):96–106

    PubMed  CAS  Google Scholar 

  23. Magliano L, Fiorillo A, Rosa C, et al. (2006) Family burden and social network in schizophrenia vs. physical diseases: preliminary results from an Italian national study. Acta Psychiatr Scand Suppl 429:60–63

    Article  PubMed  Google Scholar 

  24. Mc Crone P, Leese M, Thornicroft G, et al. (2000) Reliability of the Camberwell assessment of need-European version. Br J Psychiatry 177(39):s34–s40

    Article  Google Scholar 

  25. Meier K, Schene A, Koeter M, et al. (2004) Needs for care of outpatients with schizophrenia and the consequences of their informal caregivers. Results from the EPSILON multi centre study on schizophrenia. Soc Psychiatry Psychiatr Epidemiol 39:251–258

    Article  Google Scholar 

  26. Middelboe T, Mackeprang T, Hansson L, et al. (2001) Nordic Study of patients with schizophrenia who live in community. Eur Psychiatry 16:207–215

    Article  PubMed  CAS  Google Scholar 

  27. Möller-Leimkükhler AM (2005) Burden of relatives and predictors of burden. Baseline results from the Munich 5-year-follow-up study on relatives of first hospitalised patients with schizophrenia and depression. Eur Arch Psychiatr Clin Neurosci 225:223–231

    Article  Google Scholar 

  28. Moreno Kustner B, Jimenez Estevez JF, Godoy Garcia JF, et al. (2003) Assessment of needs for care of a schizophrenic patient sample from the Granada Sur Mental Health Care Area. Actas Esp Psiquiatr 31(6):325–330

    PubMed  CAS  Google Scholar 

  29. Norusis M (1993) SPSS para Windows. Versión 11.0 Guía del usuario, Madrid

  30. Ochoa S, Usall J, Haro JM, et al. (2001) Estudio comparativo de las necesidades de las personas con esquizofrenia en función del género. Actas Esp Psiquiatr 29(3):165–171

    PubMed  CAS  Google Scholar 

  31. Ochoa S, Haro JM, Autonell J, et al. (2003) Met and unmet needs of Patients with schizophrenia in Spanish sample. Schizophr Bull 29(2):201–210

    PubMed  CAS  Google Scholar 

  32. Penn DL, Mueser KT (1996) Research update on the psychosocial treatment of schizophrenia. Am J Psychiatry 153(5): 607–617

    PubMed  CAS  Google Scholar 

  33. Peralta V, Cuesta JM (1994) Validación de la escala de síndromes positivo y negativo (PANSS) en una muestra de esquizofrénicos españoles. Actas Esp Psiquiatr 22:171–177

    Google Scholar 

  34. Perlick DA, Rosenheck RA, Kaczynski R, Swartz MS, Canive JM, Lieberman JA (2006) Components and correlates of family burden in schizophrenia. Psychiatr Serv 57(8):1117–1125

    Article  PubMed  Google Scholar 

  35. Phelan M, Slade M, Thornicroft G, et al. (1995) The Camberwell Assessment of Need (CAN): the validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry 167:589–595

    Article  PubMed  CAS  Google Scholar 

  36. Provencher HL, Mueser KT (1997) Positive and negative symptom behaviors and caregiver burden in the relatives of persons with schizophrenia. Schizophr Res 25; 26(1):71–80

    Article  CAS  Google Scholar 

  37. Roick C, Heider D, Toumi M, Angermeyer MC (2006) The impact of caregivers’ characteristics, patients’ conditions and regional differences on family burden in schizophrenia: a longitudinal analysis. Acta Psychiatr Scand 114(5):363–374

    Article  PubMed  CAS  Google Scholar 

  38. Rosales C, Torres F, Luna J, et al. (2002) Fiabilidad del instrumento de evaluación de necesidades Camberwell (CAN). Actas Esp Psiquiatr 30(2):99–104

    Google Scholar 

  39. Rosenfarb IS, Bellack AS, Aziz N (2006) A sociocultural stress, appraisal, and coping model of subjective burden and family attitudes toward patients with schizophrenia. J Abnorm Psychol 115(1):157–165

    Article  PubMed  Google Scholar 

  40. Smith GC (2003) Patterns and predictors of service use and unmet needs among aging families of adults with severe mental illness. Psychiatr Serv 54(6):817–817

    Article  Google Scholar 

  41. Tessler RT, Gamache GM (1995) Toolkit for evaluation family experience with severe mental illness. Human Services Research Institute, Cambridge

    Google Scholar 

  42. Tucker C, Barker A, Gregorie A (1998) Living with schizophrenia: caring for a person with a severe mental illness. Soc Psychiatry Psychiatr Epidemiol 33:305–309

    Article  PubMed  CAS  Google Scholar 

  43. Vilaplana M, Ochoa S, Martínez A, et al. (2007) Validación en población española de la entrevista de carga familiar objetiva y subjetiva (ECFOS-II) para familiares de personas con esquizofrenia. Actas Esp Psiquiatr 35(6):372–381

    PubMed  CAS  Google Scholar 

  44. Villalta-Gil V, Vilaplana M, Ochoa S, et al. (2006) Four symptom dimensions in schizophrenia outpatients. Compr Psychiatry 47(5):384–388

    Article  PubMed  Google Scholar 

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Acknowledgements

This project has received the financial help of the Spanish “Fondo de Investigaciones Sanitarias” (FIS 97/1275); RIRAG Network (RETICS FIS G03/061); the Spanish Ministry of Health, Instituto de Salud Carlos III, CIBER-SAM, and the Fundació Marató de TV3 (013610).

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Authors and Affiliations

  1. Unitat de Recerca i Desenvolupament de Sant Joan de Déu-SSM (Research Unit) CIBER-SAM, C/ Pujades, 42, 08330, Sant Boi de Llobregat, Barcelona, Spain

    Susana Ochoa PhD, Miriam Vilaplana MSC, Josep Maria Haro PhD, Victoria Villalta-Gil PhD, Francisco Martínez MSC, Mari Cruz Negredo BA, Pilar Casacuberta BA, Elena Paniego BA, Judith Usall PhD, Montserrat Dolz MD & Jaume Autonell MD

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  1. Susana Ochoa PhD
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  2. Miriam Vilaplana MSC
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  3. Josep Maria Haro PhD
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  4. Victoria Villalta-Gil PhD
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  5. Francisco Martínez MSC
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  10. Montserrat Dolz MD
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the NEDES Group

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Correspondence to Susana Ochoa PhD.

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The NEDES group is a multidisciplinary group of researchers from Sant Joan de Déu, which includes: S. Araya; P. Asensio; J. Autonell; A. Benito; E. Busquets; C. Carmona; P. Casacuberta; M. Castro; N. Díaz; M. Dolz; A. Foix; J. M. Giralt; A. Gost; J. M. Haro; M. Marquez; F. Martínez; R. Martínez; J. Miguel; M. C. Negredo; S. Ochoa; Y. Osorio; E. Paniego; L. Pantinat; A. Pendàs; C. Pujol; J. Quilez; J. Ramon; M. J. Rodríguez; B. Sánchez; A. Soler; F. Teba; N. Tous; J. Usall; M. Valdelomar; J. Vaquer; E. Vicens; M. Zamora.

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Ochoa, S., Vilaplana, M., Haro, J.M. et al. Do needs, symptoms or disability of outpatients with schizophrenia influence family burden?. Soc Psychiat Epidemiol 43, 612–618 (2008). https://doi.org/10.1007/s00127-008-0337-x

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  • DOI: https://doi.org/10.1007/s00127-008-0337-x

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