Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-24T11:08:08.788Z Has data issue: false hasContentIssue false
  • English
  • Français

Family burden in schizophrenia: effects of socio-environmental and clinical variables and family intervention

Published online by Cambridge University Press:  11 October 2011

Lorenza Magliano ,
Andrea Fiorillo ,
Claudio Malangone ,
Adriano Aletti ,
Giosue Belotti ,
Paola Bevilacqua ,
Anna Luisa Delle Femine ,
Gianmichele Fontana ,
Francesca Maucioni  and
Michele Travi
...Show all authors
Lorenza Magliano*
Affiliation:
Istituto di Psichiatria, Università di Napoli SUN
Andrea Fiorillo
Affiliation:
Istituto di Psichiatria, Università di Napoli SUN
Claudio Malangone
Affiliation:
Istituto di Psichiatria, Università di Napoli SUN
Adriano Aletti
Affiliation:
Dipartimento di Salute Mentale di Cremona
Giosue Belotti
Affiliation:
Dipartimento di Salute Mentale di Zogno (BG)
Paola Bevilacqua
Affiliation:
Dipartimento di Salute Mentale di Cortona (Arezzo)
Anna Luisa Delle Femine
Affiliation:
Dipartimento di Salute Mentale di Salerno
Gianmichele Fontana
Affiliation:
Dipartimento di Salute Mentale di S. Vito al Tagliamento (Pordenone)
Francesca Maucioni
Affiliation:
Dipartimento di Salute Mentale di Polla (Salerno)
Michele Travi
Affiliation:
Dipartimento di Salute Mentale di Arezzo
Paola Zanus
Affiliation:
Dipartimento di Salute Mentale di Trieste
Andrea Rossi
Affiliation:
Eli-Lilly Italia, Firenze
Mario Maj
Affiliation:
Istituto di Psichiatria, Università di Napoli SUN
*
Indirizzo per la corrispondenza: Dr.ssa L. Magliano, Istituto di Psichiatria, Università di Napoli SUN, Largo Madonna delle Grazie, 80138 Napoli. Fax +39 — 081-566.6523. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Objective Description of burden, attitudes and received professional support in a sample of relatives of patients with schizophrenia, recruited in 8 Italian Mental Health Sservices (MHS), stratified by geographic areas and population density.Design - Cross-sectional study on key-relatives of clinically stable patients with a DSM-IV diagnosis of schizophrenia. Evaluation of: a) relationships of family burden with patient's clinical characteristics, family's sociodempgraphic variables, relative's attitudes toward the patient, professional and social support received by the family; b) differences in the levels of burden, attitudes and support received by the family with respect to geographical area and population density.Setting - 8 Italian MHS stratified by geographic areas (Northern, Central, Southern Italy) and population density (urban vs. rural areas).Main outcome measures - Patient's clinical status and social functioning: BPRS and ADC. Family burden, attitudes and support received by the family: FPQ.Results - Data on 144 patients and their key-relatives were collected. Higher levels of burden were found among relatives referring to Southern MHS. The burden was found positively correlated with the levels of patients' BPRS positive and manic/hostility symptoms and disability, and with the number of daily hours spent by the relative in contact with the patient, and negatively correlated with the levels of professional support received by the family. Conclusions - The results of this study highlight the need to provide rehabilitative programmes for patients with schizophrenia as well as informative and psychoeducational interventions for their families.

Riassunto

Scopo - Descrizione del carico, degli atteggiamenti e degli interventi ricevuti da un campione di familiari di pazienti con schizofrenia reclutati in otto DSM stratificati per area geografica e per densità di popolazione. Disegno - Studio trasversale di familiari-chiave di pazienti con diagnosi DSM-IV di schizofrenia in fase di compenso clinico. Valutazione delle: a) relazioni tra carico e caratteristiche cliniche del paziente, socio-demografiche del nucleo familiare, atteggiamenti del familiare nei confronti del paziente, sostegno professionale e sociale ricevuto dalla famiglia; b) differenze nei carico, negli atteggiamenti e nell'aiuto professionale in relazione all'area geografica e alia densità di popolazione. Setting - 8 DSM stratificati per area geografica (Nord, Centro, Sud) e densità di popolazione (urbana vs. rurale).Principali misure - a) dello stato clinico e del funzionamento sociale del paziente: BPRS e ADC; b) del carico, degli atteggiamenti e del sostegno ricevuto: QPF.Risultati - Sono stati raccolti dati relativi a 144 pazienti con schizofrenia e altrettanti familiari. Il carico è risultato correlato positivamente con i livelli di disabilita e di sintomi BPRS positivi e di mania/ostilita, e con il numero di ore trascorse dal familiare a contatto quotidiano col paziente, e negativamente con il livello di aiuto professionale ricevuto dalla famiglia. Il carico è risultato maggiore tra i familiari reclutati nei due centri meridionaii. Gli interventi offerti ai familiari dei pazienti sono piu frequenti e differenziati al Nord e al Centro rispetto al Sud. Solo una minima parte dei familiari ha ricevuto interventi psicoeducativi.Conclusioni - 1 risultati di questo studio sottolineano la necessita di assicurare un'assistenza psichiatrica integrata per i pazienti con schizofrenia che comprenda sia programmi riabilitativi per gli utenti sia interventi informativi e psicoeducativi per le loro famiglie.

Keywords

carico familiareschizofreniavariabili socio-ambientaliinterventi familiarifamily burdenschizophreniasocio-environmental variablesfamily interventions
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 7 , Issue 3 , December 1998 , pp. 178 - 187
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

BIBLIOGRAFIA

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). American Psychiatric Association: Washington DC.Google Scholar
Bebbington, P. & Kuipers, L. (1994). The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychological Medicine 24, 707–718.CrossRefGoogle ScholarPubMed
Brown, G.W., Birley, J.L.T. & Wing, J.K. (1972). Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry 121, 241–258.CrossRefGoogle ScholarPubMed
Brown, G.W., Bone, M., Dalison, B. & Wing, J.K. (1966). Schizophrenia and Social Care. Oxford University Press: Oxford.Google Scholar
Buchanan, J. (1995). Social support and schizophrenia: a review of the literature. Archives of Psychiatric Nursing 2, 68–76.CrossRefGoogle Scholar
Clausen, J.A. & Yarrow, M.R. (1955). The impact of mental illness on the family. Journal of Social Issues 11, 3–64.CrossRefGoogle Scholar
Fadden, G., Bebbington, P. & Kuipers, L. (1987). The burden of care: the impact of functional psychiatric illness on the patients' family. British Journal of Psychiatry 150, 285–297.CrossRefGoogle Scholar
Gibbons, J.S., Horn, S.H., Powell, J.M. & Gibbons, J.L. (1984). Schizophrenic patients and their families: a survey in a psychiatricservice based on a DGH unit.British Journal of Psychiatry 144, 70–77.CrossRefGoogle Scholar
Goldstein, J.M. & Miklowitz, D.J. (1995). The effectiveness of psychoeducational family therapy in the treatment of schizophrenicdisorders.Journal of Marital and Family Therapy 21, 361376.CrossRefGoogle Scholar
Hoenig, J. & Hamilton, M. (1966). The schizophrenic patient in the community and its effect on the household. International Journal of Social Psychiatry 12, 165–176.CrossRefGoogle ScholarPubMed
Jackson, H.J., Smith, N. & McGregory, P. (1990). Relationship between Expressed Emotions and family burden in psychotic disorders:an exploratory study.Acta Psychiatrica Scandinavica 82, 242–249.CrossRefGoogle ScholarPubMed
Kavanagh, D.J., Piatkowska, O., Clark, D., O'Halloran, P., Manicavasagar, V., Rosen, A. & Tennant, C. (1993). Application of cognitive-behavioural family intervention for schizophrenia in multidisciplinary teams: what can the matter be? Australian Psychology 28, 181–188.CrossRefGoogle Scholar
Lukoff, D., Nuechterlein, K.H. & Ventura, J. (1986). Manual for the expanded Brief Psychiatriic Rating Scale (BPRS). Schizophrenia Bulletin 12, 594–602.Google Scholar
Magliano, L., Guarneri, M., Marasco, C., Veltro, F. & Morosini, P.L. (1993). Studio di riproducibilita di un'intervista semistrutturata per l'Accertamento della Disabilita sociale e del Carico familiare (A.D.C.).Rivista di Riabilitazione Psichiatrica e Psicosociale, 1, 49–52.Google Scholar
Magliano, L., Veltro, F., Guarneri, M. & Marasco, C. (1995). Clinical and socio-demographic correlates of coping strategies in relatives of schizophrenic patients. European Psychiatry 10, 155–158.CrossRefGoogle ScholarPubMed
Magliano, L., Fadden, G., Madianos, M., Caldas de Almeida, J.M., Held, T., Guarneri, M., Marasco, C., Tosini, P. & Maj, M. (1998a). Burden on the families of patients with schizophrenia:results of the BIOMED I study.Social Psychiatry and Psychiatric Epidemiology(in press).CrossRefGoogle Scholar
Magliano, L., Fadden, G., Economou, M., Xavier, M., Held, T., Guarneri, M., Marasco, C., Tosini, P. & Maj, M. (1998b). Social and clinical factors influencing the choice of coping strategies in relatives of patients with schizophrenia: results of the BIO-MED I study.Social Psychiatry and Psychiatric Epidemiology (in press).CrossRefGoogle Scholar
Maurin, J.T. & Boyd, C.B. (1990). Burden on mental illness on the family: a critical review. Archives of Psychiatric Nursing 4, 99–107.CrossRefGoogle ScholarPubMed
McFarlane, W.R., Lukens, E., Link, B., Dushay, R., Deakins, S.A., Newmark, M., Dunne, E.J., Horen, B. & Toran, J. (1995). Multiple family group and psychoeducation in the treatment of schizophrenia.Archives of General Psychiatry 52, 679–687.CrossRefGoogle ScholarPubMed
Morosini, P.L., Veltro, F., Cerreta, A., Gaio, R., Palomba, U. & Ventra, C. (1988). Disabilita sociale e carico familiare. Studio di riproducibilita di un nuovo strumento di valutazione. Rivista Sperimentale di Freniatria 3, 541–563.Google Scholar
Morosini, P.L., Roncone, R., Veltro, F., Palomba, U. & Casacchia, M. (1991). Routine assessment pool in psychiatry: the questionnaire of family attitudes and burden. Italian Journal of Psychiatry and Behavioural Sciences 1, 95–101.Google Scholar
Platt, S., Weyman, A. & Hirsch, S. (1983). Social Behaviour Assessment Scale (SBAS). NFER-Nelson: Berks.Google Scholar
Raj, L., Kulhara, P. & Avasthi, A. (1991). Social burden of positive and negative schizophrenia. International Journal of Social Psychiatry 37, 242–250.CrossRefGoogle ScholarPubMed
Solomon, P. & Draine, J. (1995). Subjective burden among family members of mentally ill adults: relation to stress, coping, and adaptation. American Journal of Ortopsychiatry 65, 419–427.CrossRefGoogle ScholarPubMed
Veltro, F., Magliano, L., Lobrace, S. & Morosini, P.L. (1990). Nuovo studio di riproducibilita di un'intervista semi-strutturata per l'Accertamento della Disabilita sociale e del Carico familiare(A.D.C.). Neurologia. Psichiatria e Scienze Umane 5, 813–820.Google Scholar
Veltro, F., Magliano, L., Lobrace, S., Morosini, P.L. & Maj, M. (1994). Burden on key-relatives of patients with schizophrenia vs. neurotic disorders: a pilot study. Social Psychiatry and Psychiatric Epidemiology 29, 66–70.CrossRefGoogle ScholarPubMed
Wing, J.K., Monck, E., Brown, G.W. & Carstairs, G.M. (1964). Morbidity in the community of schizophrenic patients discharged from London mental hospitals in 1959. British Journal of Psychiatry 110, 10–21.CrossRefGoogle ScholarPubMed
World Health Organisation (1988).Psychiatric Disability Assessment Schedule (DAS). WHO: Geneva.Google Scholar