A pinboard by
Josy Thomas

PhD Student, Monash University, Melbourne


Investigate family burden and social support and compare them in schizophrenia and mood disorders.

Caregiver burden in mental illness has been the subject of research ever since the institutionalization movement that was started in the late 1960s and early 1970s. Unlike in the developed countries where community mental health programs are streamlined and have been largely successful, this movement has put enormous stress on families in non-developed countries. In India, where there are no national social welfare and medical insurance schemes, the burden of caring for patients with severe mental disorders falls largely on family members. Researches often focused on the burden of care in schizophrenia. There have been only a few studies that assessed care-giving experience in other psychiatric disorders and compared it with schizophrenia. There hasn’t been any systematic study that evaluated social support perceived by both patients and their caregivers, correlated with patient functioning and family burden, and compared these in different diagnostic groups. The present study was an attempt to assess and compare severity of illness, family burden, and social support perceived by both patients and caregivers in schizophrenia and mood disorders. 54 patients affected with schizophrenia and 58 patients with mood disorder, and one of their key relatives formed the study sample. Patient’s global functioning (severity of illness) was assessed by using the Global Assessment of Functioning (GAF) Scale from Diagnostic and Statistical Manual of Mental Disorders, 4th Edition -Text Revision (American Psychiatric Association, 2000). The patients having recovered from the acute illness and being clinically stable were administered the Social Support Questionnaire (SSQ) developed by Nehra et al. (1996) to assess their perception of social support. A key relative (primary carer) was administered the Social Support Network Inventory (SSNI) developed by Flaherty et al. (1983) and the Family Burden Interview Schedule (FBIS) developed by Pai & Kapur (1981). The patients with schizophrenia were found to be more severely ill with a longer duration of illness and perceived less social support. Consequently, caregiver burden (both objective and subjective) was significantly higher in this group. The caregivers’ perceived social support was similar in both diagnostic groups. Some significant correlations have been found among sociology-demographic and clinical characteristics, and key study variables. The implications of the study will be discussed.


Recovery and its correlates among patients with bipolar disorder: A study from a tertiary care centre in North India.

Abstract: The goal of treatment in mental illness has evolved from a symptom-based approach to a personal recovery-based approach. The aim of this study was to evaluate the predictors of personal recovery among patients with bipolar disorder.A total of 185 patients with bipolar disorder, currently in remission, were evaluated on Recovery Assessment Scale (RAS), Internalized Stigma of Mental Illness Scale (ISMIS), Brief Religious coping scale (RCOPE), Duke University Religiosity Index (DUREL), Religiousness Measures Scale, Hamilton depression rating scale (HDRS), Young Mania rating scale (YMRS) and Global Assessment of Functioning (GAF) scale.The mean age of the sample was 40.5 (standard deviation (SD), 11.26) years. Majority of the participants were male, married, working, Hindu by religion and belonged to extended/joint families of urban background. In the regression analysis, RAS scores were predicted significantly by discrimination experience, stereotype endorsement and alienation domains of ISMIS, level of functioning as assessed by GAF, residual depressive symptoms as assessed by HDRS and occupational status. The level of variance explained for total RAS score and various RAS domains ranged from 36.2% to 46.9%.This study suggests that personal recovery among patients with bipolar disorder is affected by stigma, level of functioning, residual depressive symptoms and employment status of patients with bipolar disorder.

Pub.: 07 Nov '16, Pinned: 07 Sep '17

Stigma experienced by caregivers of patients with severe mental disorders: A nationwide multicentric study.

Abstract: Stigma is very common among caregivers of patients with severe mental disorder; however, there is lack of national level data from India.To assess affiliate stigma and its correlates among caregivers of patients with severe mental disorders.For this, caregivers of patients with schizophrenia ( N = 707), bipolar disorder ( N = 344) and recurrent depressive disorder ( N = 352) were assessed on Stigma scale for Caregivers of People with Mental Illness and General Health Questionnaire.Caregivers of patients with schizophrenia reported significantly higher stigma than patients with bipolar disorder and recurrent depressive disorder. Caregiver of patients with bipolar disorder reported significantly greater stigma than the caregivers of patients with recurrent depressive disorder. Higher caregiver stigma in all the diagnostic groups was associated with higher psychological morbidity in caregivers. Higher stigma in caregivers of schizophrenia was seen when the patient had younger age of onset and longer duration of treatment. In the bipolar disorder group, higher stigma in caregivers was seen when patient had higher residual manic symptoms.This study suggests that caregivers of patients with schizophrenia experience higher stigma than the caregivers of patients with bipolar disorder and recurrent depressive disorder. Higher stigma is associated with higher psychological morbidity in the caregivers. Therefore, the clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the caregivers and plan intervention strategies to reduce stigma.

Pub.: 26 May '17, Pinned: 07 Sep '17

A comparison of the level of functioning in chronic schizophrenia with coping and burden in caregivers.

Abstract: A chronic mental illness such as schizophrenia is a challenging task for caregivers especially in the current era of de-institutionalization. In India, few studies have attempted to directly determine the relationship between coping mechanisms and burden; in the West, studies have found that improved coping in family members can decrease the perceived burden.To evaluate the burden and coping of caregivers in relation to the level of functioning in patients with chronic schizophrenia.The sample was 100 patients with their primary caregivers attending a Psychiatry OPD. Patients were assessed on the Global Assessment of Functioning (GAF) scale while caregivers were administered the Burden Assessment Schedule (BAS) and Mechanisms of Coping (MOC) scale.Fatalism and problem-solving were the two most preferred ways of coping. Problem-focused coping, i.e. problem-solving and expressive-action decreased the burden of caregivers, while emotion-focused coping, i.e. fatalism and passivity, increased it. As the level of functioning of the patient decreased, the significance with which the coping mechanisms influenced the burden, increased. The use of problem-solving coping by caregivers showed a significant correlation with higher level of functioning in patients.Coping mechanisms such as problem-solving can decrease the burden of illness on caregivers and may even improve the level of functioning of patients.

Pub.: 01 Jan '06, Pinned: 07 Sep '17

Collaborative community based care for people and their families living with schizophrenia in India: protocol for a randomised controlled trial.

Abstract: There is a large treatment gap with few community services for people with schizophrenia in low income countries largely due to the shortage of specialist mental healthcare human resources. Community based rehabilitation (CBR), involving lay health workers, has been shown to be feasible, acceptable and more effective than routine care for people with schizophrenia in observational studies. The aim of this study is to evaluate whether a lay health worker led, Collaborative Community Based Care (CCBC) intervention, combined with usual Facility Based Care (FBC), is superior to FBC alone in improving outcomes for people with schizophrenia and their caregivers in India.This trial is a multi-site, parallel group randomised controlled trial design in India.The trial will be conducted concurrently at three sites in India where persons with schizophrenia will be screened for eligibility and recruited after providing informed consent. Trial participants will be randomly allocated in a 2:1 ratio to the CCBC+FBC and FBC arms respectively using an allocation sequence pre-prepared through the use of permuted blocks, stratified within site. The structured CCBC intervention will be delivered by trained lay community health workers (CHWs) working together with the treating Psychiatrist. We aim to recruit 282 persons with schizophrenia. The primary outcomes are reduction in severity of symptoms of schizophrenia and disability at 12 months. The study will be conducted according to good ethical practice, data analysis and reporting guidelines.If the additional CCBC intervention delivered by front line CHWs is demonstrated to be effective and cost-effective in comparison to usually available care, this intervention can be scaled up to expand coverage and improve outcomes for persons with schizophrenia and their caregivers in low income countries.The trial is registered with the International Society for the Registration of Clinical Trials and the allocated unique ID number is ISRCTN 56877013.

Pub.: 14 Jan '11, Pinned: 27 Aug '17

Comparative study of the experience of caregiving in bipolar affective disorder and schizophrenia.

Abstract: Bipolar affective disorder and schizophrenia are disabling illnesses and place a considerable degree of burden on the caregivers. Many studies from India have measured the burden of care in schizophrenia and some studies have measured the burden experienced by the caregivers of bipolar affective disorder. Few studies have compared this variable in these disorders. Experience of caregiving is a broader concept that takes into consideration both the negative and positive appraisal of the caregiving. However, no study from India has compared the experience of caregiving in bipolar affective disorder and schizophrenia.To study the experience of caregiving in a group of caregivers of bipolar patients and compare the same with caregivers of patients with schizophrenia.Seventy patients with a diagnosis of bipolar affective disorder and 70 with a diagnosis of schizophrenia were selected for the present study. Patients were assessed on the Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Positive and Negative Syndrome Scale depending upon their diagnosis. They were also assessed on the Global Assessment of Functioning (GAF) scale. Caregivers of the patients were assessed on the General Health Questionnaire (GHQ) and the Experience of Caregiving Inventory (ECI).The maximum ECI score was seen in the domain of handling 'difficult behaviour' in both the groups. Compared to caregivers of patients with bipolar affective disorder, caregivers of patients with schizophrenia had overall more positive and negative appraisal of caregiving experience while caring for their ill relatives. The difference reached significant levels for all domains but for the domains of 'effects on family', 'need for back-up' and 'good aspect of relationship'. There were significant differences too for the total positive personal experience sub-score. There was a significant positive correlation between the negative and positive caregiving experience score for both schizophrenia and bipolar groups.The caregivers of both bipolar affective disorder and schizophrenia appraise the caregiving negatively, while at the same time appraising some positive aspects of it. Caregivers of schizophrenia patients appraise caregiving more negatively than those of bipolar affective disorder patients.

Pub.: 30 Aug '11, Pinned: 27 Aug '17

Positive aspects of caregiving in schizophrenia: A review.

Abstract: Schizophrenia is a severe mental illness which is associated with significant consequences for both the patients and their relatives. Due to chronicity of the illness, the relatives of patients of schizophrenia have to bear the main brunt of the illness. Studies across the world have evaluated various aspects of caregiving and caregivers such as burden, coping, quality of life, social support, expressed emotions, and psychological morbidity. In general the research has looked at caregiving as a negative phenomenon, however, now it is increasingly recognised that caregiving is not only associated with negative consequences only, also experience subjective gains and satisfaction. This review focus on the conceptual issues, instruments available to assess the positive aspects of caregiving and the various correlates of positive aspects of caregiving reported in relation to schizophrenia. The positive aspect of caregiving has been variously measured as positive caregiving experience, caregiving satisfaction, caregiving gains and finding meaning through caregiving scale and positive aspects of caregiving experience. Studies suggests that caregivers of patients with schizophrenia and psychotic disorders experience caregiving gains (in the form of becoming more sensitive to persons with disabilities, clarity about their priorities in life and a greater sense of inner strength), experience good aspects of relationship with the patient, do have personal positive experiences. Some of the studies suggest that those who experience greater negative caregiving experience also do experience positive caregiving experience.

Pub.: 22 Jun '12, Pinned: 27 Aug '17

Outcomes that matter: a qualitative study with persons with schizophrenia and their primary caregivers in India.

Abstract: Involving persons with schizophrenia and their families in designing, implementing and evaluating mental health services is increasingly emphasised. However, there is little information on desired outcomes from the perspectives of these stakeholders from low and middle income countries (LMIC).To explore and define outcomes desired by persons with schizophrenia and their primary caregivers from their perspectives.In-depth interviews were held with 32 persons with schizophrenia and 38 primary caregivers presenting for care at one rural and one semi-urban site in India. Participants were asked what changes they desired in the lives of persons affected by the illness and benefits they expected from treatment. Data was analysed using thematic and content analysis.Eleven outcomes were desired by both groups: symptom control; employment/education; social functioning; activity; fulfilment of duties and responsibilities; independent functioning; cognitive ability; management without medication; reduced side-effects; self-care; and self-determination. Social functioning, employment/education and activity were the most important outcomes for both groups; symptom control and cognitive ability were more important to persons with schizophrenia while independent functioning and fulfilment of duties were more important to caregivers.Interventions for schizophrenia in India should target both clinical and functional outcomes, addressing the priorities of both affected persons and their caregivers. Their effectiveness needs to be evaluated independently from both perspectives.

Pub.: 18 Sep '12, Pinned: 27 Aug '17

Relationship of quality of life with coping and burden in primary caregivers of patients with schizophrenia.

Abstract: Very few studies have evaluated the quality of life (QOL) of caregivers of schizophrenia patients. The aim of this paper is to study the QOL, including the spirituality, religiousness and personal beliefs (SRPB) facets, of primary caregivers of patients with schizophrenia using the WHOQOL-BREF and WHOQOL-SRPB scales. Additionally an attempt was made to study the relationship between QOL with coping and burden in caregivers.One hundred primary caregivers of patients with schizophrenia completed the WHOQOL-BREF and WHOQOL-SRPB scales. They were also assessed on the Family Burden Interview Schedule and Coping Checklist.There were no significant associations of clinical variables and perceived burden with any of the WHOQOL-BREF domains and various WHOQOL-SRPB facets. There was a significant positive correlation between WHOQOL-BREF and various facets of WHOQOL-SRPB. There was a significant negative correlation between coercion as a coping strategy and the spiritual strength facet of WHOQOL-SRPB. Seeking social support as a coping strategy had a negative correlation with all domains of WHOQOL-BREF, whereas avoidance and use of problem-focused coping had no correlation with any of the domains of WHOQOL-BREF. Collusion as a coping skill had a negative correlation with the domains of physical health, social relationships and environment and the total WHOQOL-BREF score. Coercion as a coping strategy had a negative correlation with the general health and environment domains of WHOQOL-BREF.Findings of the present study suggest that there is a positive correlation between WHOQOL-BREF domains and WHOQOL-SRPB facets, which indicates that SRPB forms an integral component of the concept of QOL. Further, the QOL of caregivers is influenced by the coping skills used to deal with stress arising due to a patient's illness.

Pub.: 08 Jan '13, Pinned: 27 Aug '17

Clinicians' versus caregivers' ratings of burden in patients with schizophrenia and bipolar disorder.

Abstract: Only a few studies have evaluated the similarities and differences between clinicians' and caregivers' rating of burden of caring for a person with chronic mental illness.To compare clinician-rated and caregiver-rated burden in a population of patients with either schizophrenia or bipolar disorder, using two different scales to measure caregiver burden.Caregivers of patients with schizophrenia (n = 65) or bipolar disorder (n = 57) completed the Hindi version of the Involvement Evaluation Questionnaire (Hindi-IEQ) by themselves. Clinicians rated the burden on the Family Burden Interview Schedule (FBI) based on semi-structured interview with the same caregivers.Both total objective and subjective burden on the FBI (clinician ratings) demonstrated significant positive correlations with the total Hindi-IEQ (caregiver ratings) scores. Most areas of burden on the FBI correlated positively with the tension and the worrying-urging II subscales, as well as the total Hindi-IEQ scores. According to clinicians, a significantly higher percentage of caregivers of patients with schizophrenia were experiencing a moderate to severe degree of subjective burden; objective burden in this group was also significantly higher in the domains of effect on the mental health of caregivers. Contrastingly, caregivers of patients with bipolar disorder judged burden to be higher in this group than schizophrenia.There were many areas of agreement as well as some significant discrepancies between clinicians' and caregivers' assessment of burden in this population of patients. This suggests that a comprehensive evaluation of burden should include assessments by both clinicians and caregivers of patients.

Pub.: 22 Jun '13, Pinned: 27 Aug '17

Comparative study of cost of care of outpatients with bipolar disorder and schizophrenia.

Abstract: To assess and compare the average annual the cost of illness of outpatients with bipolar disorder and schizophrenia.Cost of illness in 75 out-patients with bipolar disorder and 53 out-patients with schizophrenia was assessed over a 9-month period by using bottom-up approach. The cost of 9 months was annualized by dividing the 9 months cost by 3 and then multiplying the obtained figure with 4.Total average annual costs of care of bipolar disorder was Indian rupees 32,759 (US $ 655.18) and that of schizophrenia was Indian rupees 48,059 (US $ 961.18) and there was no significant difference between the two groups. In both the groups, indirect costs (bipolar disorder-64.0%; Schizophrenia-77.6%) were higher than direct costs (bipolar disorder-36%; Schizophrenia-22.4%). Cost of medications was high. Patient and their families bore the main brunt of financial burden (95.4-96% of the total cost). In Bipolar disorder total treatment costs were significantly higher in those who had lower level of functioning. In bipolar disorder group number of visits to the hospital correlated with total cost, indirect cost and provider's cost, whereas in schizophrenia group total number of visits correlated with provider's cost only. Only a small proportion (13.7%) of the total cost of bipolar disorder was predicted by presence or absence of alcohol dependence and number of visits. In the schizophrenia group, only positive symptom score as per the rating on PANSS appeared as a significant predictor of total cost, explaining 15.6% of the total cost.Costs for outpatients with bipolar disorder are similar to the cost of outpatients with schizophrenia. Costs are higher in patients of bipolar disorder with lower level of functioning. Findings of the study suggests that reducing the number of visits to the hospital by providing care at the doorsteps, focusing on reduction of substance use and improving the level of functioning of the patients can reduce the cost of care of bipolar disorder.

Pub.: 24 Sep '14, Pinned: 27 Aug '17

Experiences of stigma and discrimination of people with schizophrenia in India.

Abstract: Stigma contributes greatly to the burden of schizophrenia and is a major obstacle to recovery, yet, little is known about the subjective experiences of those directly affected in low and middle income countries. This paper aims to describe the experiences of stigma and discrimination of people living with schizophrenia (PLS) in three sites in India and to identify factors influencing negative discrimination. The study used mixed methods and was nested in a randomised controlled trial of community care for schizophrenia. Between November 2009 and October 2010, data on four aspects of stigma experienced by PLS and several clinical variables were collected from 282 PLS and 282 caregivers and analysed using multivariate regression. In addition, in-depth-interviews with PLS and caregivers (36 each) were carried out and analysed using thematic analysis. Quantitative findings indicate that experiences of negative discrimination were reported less commonly (42%) than more internalised forms of stigma experience such as a sense of alienation (79%) and significantly less often than in studies carried out elsewhere. Experiences of negative discrimination were independently predicted by higher levels of positive symptoms of schizophrenia, lower levels of negative symptoms of schizophrenia, higher caregiver knowledge about symptomatology, lower PLS age and not having a source of drinking water in the home. Qualitative findings illustrate the major impact of stigma on 'what matters most' in the lives of PLS and highlight three key domains influencing the themes of 'negative reactions' and 'negative views and feelings about the self', i.e., 'others finding out', 'behaviours and manifestations of the illness' and 'reduced ability to meet role expectations'. Findings have implications for conceptualising and measuring stigma and add to the rationale for enhancing psycho-social interventions to support those facing discrimination. Findings also highlight the importance of addressing public stigma and achieving higher level social and political structural change.

Pub.: 03 Dec '14, Pinned: 27 Aug '17

A comparative study of caregivers' perceptions of health-care needs and burden of patients with bipolar affective disorder and schizophrenia.

Abstract: Although many studies in schizophrenia have evaluated health-care needs, there is a lack of data on the needs of patients with bipolar affective disorder (BPAD), with only occasional studies evaluating them, and no study has evaluated the relationship of health-care needs of patients with caregiver's burden.To study the relationship of caregiver's burden and needs of patients as perceived by caregivers of patients with BPAD and schizophrenia.Caregivers of patients with BPAD and schizophrenia were assessed using the Camberwell Assessment of Needs - Research version (CAN-R) and Supplementary Needs Assessment Scale (SNAS), the Family Burden Interview schedule (FBI) and the Involvement Evaluation Questionnaire (IEQ).Mean total needs of patients on CAN-R were 7.54 (SD 3.59) and 7.58 (SD 4.24) for BPAD and schizophrenia respectively. Mean total needs for SNAS were 7.24 (SD 3.67) and 7.68 (SD 5.02) for BPAD and schizophrenia groups, respectively. Total objective and subjective burden as assessed on FBI was significantly more for the schizophrenia group. Caregivers of patients with BPAD perceived significantly less disruption of routine family activities and lower impact on the mental health of others. On IEQ, the mean score on the domain of supervision was significantly higher for the BPAD group. In the schizophrenia group, positive correlations were seen between the total number of unmet and total (met and unmet) needs and certain aspects of burden, but no such correlations emerged in the BPAD group.There is no correlation between number of needs and burden in the BPAD group; however, in the schizophrenia group the number of needs correlated with the perceived burden. Accordingly, orienting services to address needs of patients with schizophrenia can lead to reduction in burden among caregivers.

Pub.: 01 May '15, Pinned: 27 Aug '17

Stigma and its correlates in patients with schizophrenia attending a general hospital psychiatric unit

Abstract: Aakanksha Singh, Surendra K Mattoo, Sandeep Grover Indian Journal of Psychiatry 2016 58(3):291-300 Background: Very few studies from India have studied stigma experienced by patients with schizophrenia. Aim of the Study: To study stigma in patients with schizophrenia (in the form of internalized stigma, perceived stigma and social-participation-restriction stigma) and its relationship with specified demographic and clinical variables (demographic variables, clinical profile, level of psychopathology, knowledge about illness, and insight). Materials and Methods: Selected by purposive random sampling, 100 patients with schizophrenia in remission were evaluated on internalized stigma of mental illness scale (ISMIS), explanatory model interview catalog stigma scale, participation scale (P-scale), positive and negative syndrome scale for schizophrenia, global assessment of functioning scale, scale to assess unawareness of mental disorder, and knowledge of mental illness scale. Results: On ISMIS scale, 81% patients experienced alienation and 45% exhibited stigma resistance. Stereotype endorsement was seen in 26% patients, discrimination experience was faced by 21% patients, and only 16% patients had social withdrawal. Overall, 29% participants had internalized stigma when total ISMIS score was taken into consideration. On P-scale, 67% patients experienced significant restriction, with a majority reporting moderate to mild restriction. In terms of associations between stigma and sociodemographic variables, no consistent correlations emerged, except for those who were not on paid job, had higher participation restriction. Of the clinical variables, level of functioning was the only consistent predictor of stigma. While better knowledge about the disorder was associated with lower level of stigma, there was no association between stigma and insight. Conclusion: Significant proportion of patients with schizophrenia experience stigma and stigma is associated with lower level of functioning and better knowledge about illness is associated with lower level of stigma.

Pub.: 12 Oct '16, Pinned: 27 Aug '17

Experiences of stigma and discrimination faced by family caregivers of people with schizophrenia in India.

Abstract: Stigma associated with schizophrenia significantly affects family caregivers, yet few studies have examined the nature and determinants of family stigma and its relationship to their knowledge about the condition. This paper describes the experiences and determinants of stigma reported by the primary caregivers of people living with schizophrenia (PLS) in India. The study used mixed methods and was nested in a randomised controlled trial of community care for people with schizophrenia. Between November 2009 and October 2010, data on caregiver stigma and functional outcomes were collected from a sample of 282 PLS-caregiver dyads. In addition, 36 in-depth-interviews were conducted with caregivers. Quantitative findings indicate that 'high caregiver stigma' was reported by a significant minority of caregivers (21%) and that many felt uncomfortable to disclose their family member's condition (45%). Caregiver stigma was independently associated with higher levels of positive symptoms of schizophrenia, higher levels of disability, younger PLS age, household education at secondary school level and research site. Knowledge about schizophrenia was not associated with caregiver stigma. Qualitative data illustrate the various ways in which stigma affected the lives of family caregivers and reveal relevant links between caregiver-stigma related themes ('others finding out', 'negative reactions' and 'negative feelings and views about the self') and other themes in the data. Findings highlight the need for interventions that address both the needs of PLS and their family caregivers. Qualitative data also illustrate the complexities surrounding the relationship between knowledge and stigma and suggest that providing 'knowledge about schizophrenia' may influence the process of stigmatisation in both positive and negative ways. We posit that educational interventions need to consider context-specific factors when choosing anti-stigma-messages to be conveyed. Our findings suggest that messages such as 'recovery is possible' and 'no-one is to blame' may be more helpful than focusing on bio-medical knowledge alone.

Pub.: 19 Feb '17, Pinned: 27 Aug '17

Caregiver burden and coping: a prospective study of relationship between burden and coping in caregivers of patients with schizophrenia and bipolar affective disorder.

Abstract: Caregivers of patients of schizophrenia and bipolar affective disorder (BAD) experience considerable burden while caring their patients. They develop different coping strategies to deal with this burden. Longitudinal studies are required to assess the relationship between caregiver burden and coping.The present study was conducted to assess relationship between burden and coping in caregivers of clinically stable patients with schizophrenia and BAD.One hundred patients each of schizophrenia and BAD attending a psychiatric outpatient setting and their caregivers were followed up for a period of 6 months. Burden and coping strategies were assessed in the caregivers at baseline, and after 3 and 6 months using the Burden Assessment Schedule (BAS) and Ways of Coping Checklist - Hindi Adaptation (WCC - HA).Burden remained stable over 6 months and was comparable in the two groups of caregivers. Caregivers from both the groups were found to use problem focused coping strategies more often than seek social support and avoidance strategies. Scores on avoidance type of coping showed a positive correlation with the total burden scores and a number of burden factors.Caregivers of patients of schizophrenia and BAD face similar levels of burden and use similar types of coping methods to deal with it. Relationship between caregiver burden and coping is quite complex.

Pub.: 19 Aug '07, Pinned: 27 Aug '17

Relationship of caregiver burden with coping strategies, social support, psychological morbidity, and quality of life in the caregivers of schizophrenia.

Abstract: To evaluate the relationship of caregiver burden as assessed by using Hindi Involvement Evaluation Questionnaire (IEQ) with coping strategies, social support, psychological morbidity, and quality of life of caregivers of patients with schizophrenia. Additionally, the relationship of caregiver-burden with sociodemographic variables, and clinical variables, including severity of psychopathology and level of functioning of patients, was studied.The study included 100 patients with schizophrenia and their caregivers recruited by purposive random sampling.Among the four domains of IEQ, highest number of correlations emerged with tension domain. Tension domain had positive correlation with the caregiver being single, time spent in caregiving per day, and use of avoidance, collusion, and coercion as coping strategies. Additionally, tension domain was associated with poor quality of life in all the domains of WHO-QOL Bref and was associated with higher psychological morbidity. Worrying urging-I domain of IEQ correlated with frequency of visits, higher use of problem focused coping and poor physical health as per the WHO-QOL Bref. Worrying urging-II domain of IEQ had positive correlation with higher level of positive symptoms, lower level of functioning of the patient, younger age of caregiver, caregiver being unmarried, and higher use problem focused and seeking social support as coping strategies. Supervision domain of IEQ correlated positively with lower income, being an unmarried caregiver, from an urban locality and non-nuclear family. Supervision domain was associated with poor physical health as assessed by WHO-QOL Bref.Caregiving burden, especially tension is associated with use of maladaptive coping strategies, poor quality of life and higher level of psychological morbidity in caregivers.

Pub.: 10 Sep '13, Pinned: 27 Aug '17

Predictors of family caregiver burden in schizophrenia: Study from an in-patient tertiary care hospital in India.

Abstract: Family caregivers experience significant burden in taking care of their patients with schizophrenia. Research on predictors of caregiver burden in India, where families are the primary caregivers of schizophrenia patients, is lacking.To study the predictors of burden experienced by the family caregivers of first admission in-patient schizophrenia patients in India.Family caregivers of 137 schizophrenia patients admitted to an in-patient facility of a hospital in south India were interviewed using the Burden Assessment Schedule. The coping, knowledge about schizophrenia, perceived social support of the caregivers and illness severity, psychopathology and disability experienced by the patients were also assessed.Bivariate correlation and multivariate regression analysis were used to study the association of different factors on burden.Duration of illness and levels of psychopathology and disability had significant direct correlation with total burden score; perceived social support had significant inverse correlation with total burden score. There was a high correlation between psychopathology and disability (p<0.001). Two separate regression analyses, each including total PANSS score (psychopathology) or total IDEAS score (disability) showed that duration of illness and perceived social support were significant predictors of burden in addition to psychopathology and disability.During the first hospitalization, in addition to symptom reduction and disability limitation, focus should be on enhancing social support in order to reduce caregiver burden among family members of schizophrenia patients.

Pub.: 25 Mar '14, Pinned: 27 Aug '17