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ABSTRACT: OBJECTIVE: The study sought to broaden the focus of research on caregivers' burden by examining caregiving rewards and their relation to coping skills. METHODS: Data from semistructured interviews with 60 family caregivers of patients with mental illness in Germany were examined by content analysis. Information was gathered with the Freiburg Questionnaire on Coping With Illness. Both t tests and regression analyses were used to analyze data. RESULTS: Caregivers made 413 statements about rewards, which were assigned to six categories. "Gratitude and affection from the patient" was the most frequently cited, and "active, problem-oriented coping" was the coping strategy most used. Three variables predicted identification of a greater number of rewards, explaining 39% of variance: "increased religiousness and searching for meaning," "caregiver's younger age," and "more statements about burden." CONCLUSIONS: To support caregivers, a shift in orientation from focusing on burden to emphasizing resources is necessary.
Psychiatric services (Washington, D.C.) 12/2012; · 2.81 Impact Factor
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ABSTRACT: Besides burden, we need to examine potential rewards of caregiving and coping strategies to determine effective means of supporting caregivers of people with mental illness. Therefore, we conducted semistructured interviews with 60 caregivers of patients with mental illness and analyzed the transcripts with a summarizing content analysis. The interviews focused on negative and positive aspects of providing care and on coping strategies; the latter was also evaluated with the Freiburg Questionnaire on Coping with Illness. The caregivers named 787 individual statements of burden and 413 individual statements of rewards. A factor analysis of the rewards identified growth in character as the main factor. The items with the highest factor loading are increase in self-confidence, inner strength, maturity, and life experience. Linear regression and regression tree analysis identified predictors for caregiver burden. To effectively reduce the burden on caregivers, we need knowledge about their concrete burdens. However, to optimize resource orientation, we must also pay much more attention to the potential rewards of caring.
The Journal of nervous and mental disease 11/2012; 200(11):928-34. · 1.77 Impact Factor
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ABSTRACT: Background: The Internet is becoming increasingly important in psychiatry and psychotherapy. Aims: The objective of this study was to evaluate if and how online self-help forums are used by patients with bipolar disorders, their relatives and treating professionals. Methods: A total of 2400 postings in two online forums were analysed qualitatively and quantitatively. Results: "Disclosure", "friendship" and "online-group cohesion" were the main self-help mechanisms. The topics most discussed were "social network", "symptoms of the illness" and "medication". Factor analyses revealed three factors concerning self-help mechanisms: "group cohesion", "emotional support" and "exchange of information", as well as three factors concerning fields of interest: "illness-related aspects", "social aspects" and "financial and legal issues". Conclusion: We infer that the main interest in participating in online forums for patients with bipolar disorders and their relatives is to share emotions and to discuss their daily struggles with the illness. Our study also reveals that social networking is very important for patients coping with bipolar disorders. Psycho-educative programmes should focus on those aspects.
Nordic journal of psychiatry 07/2012; · 0.99 Impact Factor
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ABSTRACT: The study aimed at exploring associations between inpatient suicides/attempted suicides in a psychiatric hospital and involvement of family caregivers in treatment.
Based on the German psychiatric basic documentation systems (DGPPN-BADO), we analyzed a total sample of 49,257 cases of inpatient care (1998-2007) from a large psychiatric tertiary care university hospital and as a subsample all cases of schizophrenia, depression, acute stress/adjustment disorders and personality disorders (n = 22,880). Involvement of family caregivers was evaluated according to the following variables: admission to hospital due to recommendation of caregiver, conversation between therapist and caregiver, psychoeducation of caregiver as well as psychopharmacological and/or psychotherapeutic non-compliance of patient. Descriptive and bivariate analyses were performed.
Of the 22,880 cases in the subsample, 31 inpatient suicides and 198 attempted inpatient suicides were recorded. We could not find any significant associations of caregiver involvement variables with inpatient suicide. In contrast, for the total sample (n = 49,257), attempted suicide was associated with more conversation between therapists and caregivers (χ(2) = 3.863, df = 1, p = 0.049) and with psychopharmacological (χ(2) = 4.822, df = 1, p = 0.028) and psychotherapeutic (χ(2) = 13.041, df = 1, p = 0.000) non-compliance of the patients.
Further research is needed regarding the influence of caregivers on suicidal behavior of mentally ill inpatients.
International Journal of Psychiatry in Clinical Practice 07/2012; 16(3):238-42. · 0.43 Impact Factor
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ABSTRACT: Our study investigated the association of aggression and suicidal behavior in schizophrenic inpatients. Eight thousand nine hundred one admissions for schizophrenia (1998-2007) to a psychiatric university hospital were included. Schizophrenic suicides (n = 7)/suicide attempters (n = 40) were compared to suicides (n = 30)/suicide attempters (n = 186) with other diagnoses and to schizophrenic non-attempters regarding aggression. Logistic regression analysis was performed to explore risk factors for attempted suicide. Schizophrenic suicides/suicide attempters did not differ from other suicides/suicide attempters or from schizophrenic non-attempters with regard to aggression. Risk of inpatient suicide attempt was increased for patients with attempted suicide at admission, high school graduation, and disorganized subtype. Aggression could not be found to be a predictor of attempted suicide. Aggression seems to have a minor role for suicidal behavior in schizophrenia.
Suicide and Life-Threatening Behavior 02/2011; 41(2):171-9. · 1.33 Impact Factor
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ABSTRACT: Thirty-two problem-oriented interviews with caregivers of patients with bipolar affective disorders were analyzed using content analysis. The 722 statements of caregivers about their experiences of subjective burden because of the illness of their family members were summarized in 49 global statements and correlated by factor analysis to 10 types of burden. In particular, patients' noncompliance as well as the helplessness of the caregivers in interaction with the (changing) depressive and manic symptoms of the ill family members emerged as serious burdens on the caregivers. Whereas female caregivers suffered more from problems regarding quality of relationship with the patient, male caregivers experienced more constraints on their own autonomy, uncertainty concerning their judgment of patients' capacity, and uncertainty because of the changing symptoms of illness. The findings of this study highlight that an appreciation of caregivers' own consternation and information about how best to handle the (uncooperative) behavior of the patient should be taken into account in psychoeducational groups as well as in the daily work routine of professionals.
American Journal of Orthopsychiatry 01/2011; 81(1):139-48. · 1.29 Impact Factor
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ABSTRACT: The study aimed to investigate the expectations of patients in a general psychiatric hospital regarding an "ideal" doctor.
60 problem centred interviews with psychiatric in-patients were analysed by using a summarizing content analysis.
Analysis of interview data showed three fundamental areas, which are important for patients: doctors' personality, physician-patient-interaction and treatment as well as doctors' treatment environment. The "ideal" doctor 1. is reachable and takes his time (75%), 2. is friendly and congenial (63%), 3. shows commitment and interest (60%), 4. is an understanding and sensitive contact person (60%), 5. is responsive to needs of patients (55%).
For that reason, optimal time management and social competence is necessary and should be a part of medical students' and doctors' education. Focusing on patients' expectations can positively influence their treatment satisfaction.
Psychiatrische Praxis 09/2010; 37(6):279-84. · 1.64 Impact Factor
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ABSTRACT: Objective. The situation of caregivers of psychiatric patients is mostly focussed on burdens of parents or spouses of patients. The burden of siblings due to the illness, however, is mostly underestimated and disregarded. Methods. Thirty-seven narrative interviews with siblings of schizophrenia inpatients were analysed by using a summarizing content analysis. The founded global statements were quantitatively analysed. Regression-analysis as well as regression trees were used to evaluate the data linked with sociodemographic and disease-related variables of the patient and siblings. Results. The results showed a high proportion of siblings engaged in caregiving activities. A total of 492 individual statements were summarized in 26 global types of statements. The three most often reported burdens by the healthy siblings are: “Handling the symptoms of illness” (100%), “Emotional burden due to the illness of the sibling” (100%) and “Uncertainty in judging what amount of stress the patient can cope with” (81.1%). Linear regression and regression tree analysis show predictors for higher burdened siblings. Conclusion. Siblings of schizophrenia patients are burdened in various aspects and in a specific matter. Their special needs will therefore have to be recognised before they can receive appropriate intervention.
10/2009; 13(4):326-337.
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ABSTRACT: The published literature reflects differences between the sexes in the help-seeking behavior of individuals with depression. Professional mental health services reach men to a lesser extent than women. Internet forums are considered an option to better reach males specifically.
We investigated gender differences in the active use of the Internet to access English- and German-language information on depression.
Analysis differentiated contributors' sex for 200 threads (clusters of responses related to one person seeking advice) followed on 2 Internet forums, www.defeatdepression.org, originating from the United Kingdom, and www.verrueckt.de, originating from Germany. From the qualifying date of January 3, 2007, the investigated threads retrospectively reached 149 days. Using 2 variables, "sex ratio of regular Internet users" and "epidemiologically expected sex ratio," we calculated a hypothetical value for the female-to-male (F:M) ratio of requests for help of 1.23 for the United Kingdom and 1.16 for Germany. Then we compared the actual versus the estimated gender distributions with a 2-sided chi 2 test.
We included 89 queries from www.defeatdepression.org and 97 queries from www.verrueckt.de. On the English-language forum, 46 (52%) of the queries were from women and 43 (48%) from men. On the German-language forum, 67 (69%) of the queries were from women and 30 (31%) from men. The German forum had a significantly higher F:M ratio of contributors compared with the English forum (2.23 vs 1.07, respectively; chi 2 = 5.885; P = 0.015). The actual F:M ratio of contributors for the English forum was similar to the expected calculation (1.07 actual vs 1.23 expected; chi 2 = 0.230; P = 0.652), but was significantly lower than the actual versus the expected F:M ratio of contributors for the German forum (2.23 actual vs 1.16 expected; chi 2 = 4.891; P = 0.027).
Possible reasons for the German Internet forum having a higher F:M ratio of contributors compared with the English Internet forum are the differences in presentation style, language, and cultural context between the 2 Web sites.
Gender Medicine 07/2008; 5(2):181-5. · 2.10 Impact Factor
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ABSTRACT: The number of medical liability court cases in Germany has more than trebled over the past 30 years. In almost every case of a therapeutic failure, the accusation is one of insufficient medical information. It was investigated which requirements information for patients has to meet in the field of psychiatry and psychotherapy.
The supreme court jurisdiction relating to patient information and consent in medicine was analysed. Legal and medical documents on the topic were also evaluated.
Doctors' legal duty to provide information includes the areas of therapeutic information, enabling information for the patient, and information relating to costs. The burden of proof is always on the doctor, and the documentation needs to be legally safe.
The legal basis relating to patient information and consent is consistent with the objectives of patient oriented psychiatry and psychotherapy. However, many legal requirements are exaggerated and far removed from medical practice. The specialist societies are called on to develop guidelines on how to provide information during the medical consultation.
Psychiatrische Praxis 06/2008; 35(4):163-9. · 1.64 Impact Factor
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ABSTRACT: The study aimed to evaluate if and how online self-help forums are used by patients with bipolar affective disorders.
Within a six-months period 1200 postings of 135 users in two German language forums were analysed with respect to fields of interest and self-help mechanisms.
The topics most discussed were social network of the patients, symptoms of the illness, and medication. Disclosure, online-group cohesion as well as empathy and support were the main self-help mechanisms.
Our study reveals that the social network is very important for patients coping with bipolar affective disorders. We infer that the main interest in participating in online forums for bipolar affective disorders is to share emotions. Attention to those aspects should be given also in psychoeducative programs.
Psychiatrische Praxis 02/2008; 35(1):28-32. · 1.64 Impact Factor
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ABSTRACT: Sociotherapy is an approved method in the treatment of mental disorders. The present study aimed at evaluating the role of sociotherapy in a scientific journal during the last 20 years.
A systematic analysis of all papers published in the "Psychiatrische Praxis" in the years 1985/1986, 1995/1996 and 2005/2006 was carried out.
During the last two decades the proportion of papers with sociotherapeutic topics has decreased significantly. 20 years ago one out of four articles dealt with sociotherapy, currently only one out of ten. In addition, the spectrum of themes is diminished, only the topics work rehabilitation and relatives are represented in the latest issues of the journal.
In contrast to its clinical value, sociotherapy has lost importance in psychiatric research. Multidisciplinary collaboration is required to enhance sociotherapy in mental health care research.
Psychiatrische Praxis 12/2007; 34(8):395-9. · 1.64 Impact Factor
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Psychiatrische Praxis 12/2007; 34(8):365-6. · 1.64 Impact Factor
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The Lancet 11/2007; 370(9595):1310. · 38.28 Impact Factor
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The Lancet 08/2007; 370(9581):28. · 38.28 Impact Factor
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Psychiatrische Praxis 04/2007; 34(2):53-4. · 1.64 Impact Factor
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ABSTRACT: The aim of this case study is to show how a monozygotic twin perceives the schizophrenic disorder of his twin brother and how these experiences affect his own handling and coping after the beginning of his own schizophrenic disorder.
A 46-year-old patient with a first episode of schizophrenia who took care of his twin brother with a disease history of 25 years of schizophrenia.
In this case the little knowledge the patient had of his schizophrenic disorder and his lasting lack accessing his illness in the context of a defensive mechanism were striking. Concurrently, the patient overestimated his loading capacity.
A long time of caregiving of a schizophrenic twin brother does not necessarily facilitate the coping with a schizophrenic illness of one's own. Defensive mechanisms could inhibit the implementation of constructive coping strategies with the illness.
Psychiatrische Praxis 12/2006; 33(8):395-7. · 1.64 Impact Factor
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ABSTRACT: The interrelation of subjective concepts to quality of life has been mainly separately explored so far.
Beside quality of life (WHOQOL-BREF) of 117 schizophrenic inpatients coping (FKV-LIS), locus of control (KKG), subjective well-being under medication (SWN-K), patient satisfaction (ZUF-8), caregiver burden (FBA) as well as sociodemographic and disease-related variables (German Basic Documentation System, BADO) were analysed using Pearsonian correlation and regression analyses.
Predictors of quality of life were physical well-being, social and occupational integration, active problem-focused coping, less minimization of illness, voluntary admission to hospital, high satisfaction with treatment and life, being aware of positive changes as a consequence of illness and low-rated caregiver burden. In contrast, locus of control, sociodemographic and disease-related variables as well as medication (conventional or atypical antipsychotics) had no significant influence.
Active problem-focused coping, social and occupational integration and physical well-being play an important role for schizophrenic patients' quality of life and should be considered in treatment regimens.
Psychiatrische Praxis 11/2006; 33(7):337-43. · 1.64 Impact Factor
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ABSTRACT: There are only some reports about discharge letters addressed to patients. By a case report benefits and potential of letters to patients should be shown.
The presented case report describes the hospital stay of a 19 year old patient suffering from schizophrenia.
The case report indicates that letters to patients provide a useful source of information and can help the patient to understand the nature of his illness. Furthermore, letters to patients are important to increase confidence and can lead to an open atmosphere in the therapeutic process.
Letters to patients enhance the role of patients as self-responsible partners in health care. In single cases a personal addressed letter to the patient is feasible in psychiatric hospitals despite shortness of time.
Psychiatrische Praxis 10/2006; 33(6):296-8. · 1.64 Impact Factor
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Schizophrenia Research 06/2006; 84(1):185-6. · 4.75 Impact Factor
