Predictors of Burden and Infectious Illness in Schizophrenia Caregivers

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
Psychosomatic Medicine (Impact Factor: 3.47). 07/1999; 61(4):411-9. DOI: 10.1097/00006842-199907000-00001
Source: PubMed


The objective of the study was to test predictive models of schizophrenia caregiver burden and infectious illness episodes for caregivers who had regular contact with their mentally ill family members.
A nurse interviewer, blind to the patient's symptoms, caregiver burden, and psychosocial status, administered the Health Review to 70 caregivers. A second family interviewer, blind to caregiver health status and patient symptoms, assessed caregiver resources (eg, active coping and social support), vulnerabilities (eg, anger expression and passive coping) and burden. Concurrently, independent patient raters, blind to caregiver health and psychosocial status, assessed caregiver stressors. The Brief Psychiatric Rating Scale and the Modified Scale for the Assessment of Negative Symptoms were used to assess the severity of positive (eg, hallucinations and delusions) and negative (eg, anhedonia and asociality) symptoms, respectively.
Predictive models, including measures of stressors, resources, and vulnerability factors for caregiver burden and for presence of infectious illness, were each highly significant, accounting for 40% and 29% of the variance, respectively. However, the specific measures that predicted burden and infectious illness differed. Greater burden was predicted by more severe patient negative symptoms (stressor), greater anger control and blame self-coping (vulnerability), and decreased tangible social support (resource). Presence of infectious illness episodes was predicted by more severe patient positive symptoms (stressor) and less satisfaction with social support while controlling for the frequency of reporting on the Health Review. When scores from the Brief Psychiatric Rating Scale (stressors) were categorized into quartiles, it was found that the frequency of infectious illness in the highest quartile was four times that in the lowest quartile. Other results indicated that even though burden was not associated with infectious illness, it was associated with "continuing health problems," perceived stress, and depression.
These data indicate that although schizophrenia caregiver burden and infectious illness are predicted by measures of patient stressors, vulnerabilities, and resources, the specific measures predicting these outcomes differ. The results also call attention to the powerful influence of patient symptoms as a predictor of burden and the presence of infectious illness among caregivers.

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    • "In addition, prior research has identified a number of factors which may impact the subjective burden experienced by caregivers. For example, there is evidence to suggest that (i) specific clusters of schizophrenia symptoms may have a differential impact on caregiver burden [11] [45] [46] and high levels of symptomology have a significant impact on caregiver burden [47] [48] [49] [50]; (ii) there are differences in the concept of caregiver burden in terms of ethnicity (with white caregivers more likely to report high levels of caregiver burden than African Americans) [42] [51] [52]; (iii) the gender of the person receiving the care (males with schizophrenia are more frequently associated with high levels of caregiver burden) [47] [53] and the person providing the care (female caregivers experiencing higher levels of burden than male caregivers) [11] [54] can influence caregiver burden; (iv) the caregiver relationship to the person with schizophrenia (e.g., mother-daughter and father-daughter) and living situation (living with person or not) can affect the degree of caregiver burden [55]; (v) age of the person receiving care [56, 57] and age of the caregiver [58] may both have an independent effect on reported rates of caregiver burden (studies suggesting that younger people with schizophrenia and older caregivers experience higher levels of burden); (vi) educational attainment may predict levels of caregiver burden, with those of lower educational backgrounds experiencing higher levels of caregiver burden [59]. "
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    • "Psychosis is a life-changing event for patients and families alike (Lester et al., 2005), and the carer role of these relatives is often demanding and may be associated with considerable personal costs (Kuipers et al., 2010). More than one third of such family caregivers experience significant levels of distress and perceived burden (Awad and Voruganti, 2008; Barrowclough et al., 1996; Birchwood and Cochrane, 1990; Magliano et al., 2000; Oldridge and Hughes, 1992; Parabiaghi et al., 2007; Roick et al., 2007; Schene et al., 1998; Szmukler et al., 1996; Winefield and Harvey, 1993), including considerable rates of depression (Dyck et al., 1999). "
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    • "Given the immunomodulatory influence of cortisol (Elenkov 2004), atypical patterns of cortisol and associated alterations in immune efficacy, might underlie the positive relationship between problem behaviours of the care recipient and incidences of commonly occurring ailments in their caregivers reported here. Indeed, CAR dysfunction (De Vugt et al. 2005), alterations in the immune response (Gallagher et al. 2009) and greater episodes of infectious illness (Dyck et al. 1999) have been observed in caregivers experiencing more problems with patients' behaviours. Quality of life for the care recipient is contingent on the health and happiness of the care provider (Burgess & Gutstein 2007). "
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