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Introduction
Among medical diseases, psychiatric
disorders have a high prevalence and are a
signicant burden. According to the most
recentmeta‑analysis,theaverageprevalence
ofmentaldisordersintheworldis13.4%,[1]
and 30–50% of psychiatric patients (PPs)
experiencerelapse ofsymptoms inthe rst
6 months and 50–70% in the rst 5 years
afterdischargefromthehospital.[2‑4]Due to
deinstitutionalization of the treatment and
careofPPs,theroleoffamilycaregiversof
these patients is important in reducing the
number of hospital admissions.[5] Family
caregivers of PPs while being able to
manage and control the patient and their
diseaseplay a vitalroleinmaintenanceand
rehabilitation of patients.[6] Thus, family
caregivers of PPs suffer great pressure
physically, mentally, and socially in the
course of care and control of the sick
membersof the family.[7,8]
In fact, patients and their families are
constantlyaffectedby the changes resulting
from the disease and its treatment. These
changes gradually reduce the levels of
Address for correspondence:
Dr. Mousa Alavi,
Nursing and Midwifery Care
Research Center, Faculty of
Nursing and Midwifery, Isfahan
University of Medical Sciences,
Isfahan, Iran.
E‑mail: m_alavi@nm.mui.ac.ir
Access this article online
Website: www.ijnmrjournal.net
DOI: 10.4103/ijnmr.IJNMR_122_17
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Abstract
Background: Familycaregiversofpatientswithmentaldisordersplaythemostimportantroleinthe
care of psychiatric patients (PPs) and preventing their readmission. These caregivers face different
challengesindifferentcultures.Weconductedthisstudytodeterminethechallengesofcaregiversof
patientswithmentaldisordersinIran.Materials and Methods:Thisstudyisanarrativereviewwith
a matrix approach conducted by searching electronic databases, SID, IRANMEDEX, MAGIRAN,
PUBMED, SCOPUS, Web of Sciences, from February 2000 to 2017. Searched keywords include
challenges,family caregiversofpsychiatricpatient,family caregivers andpsychiatricpatient,mental
illness, families of psychiatric patient, and Iran. One thousand two hundred articles were found
in English and Farsi, and considering inclusion and exclusion criteria, 39 articles were examined.
Results:Theresultsofthestudiesshow that not meeting the needs of caregivers,burnoutandhigh
burden of care, high social stigma, low social support for caregivers, and low quality of life of
caregiverswere amongthemostimportant challengesfacedbycaregivers. Conclusions:Despitethe
effortsofauthoritiesinIran, familycaregiversofpatientswithmentaldisorders stillfacechallenges.
Therefore, the need for all‑inclusive support for family caregivers of patients with mental health
problemsis necessary.
Keywords: Caregivers, Iran, literature review, mental disorders
Challenges of Family Caregivers of Patients with Mental Disorders in Iran:
A Narrative Review
Review Article
Mohammad Akbari1,
Mousa Alavi2,
Alireza Irajpour2,
Jahangir
Maghsoudi2
1Student Research Center,
Faculty of Nursing and
Midwifery, Isfahan University of
Medical Sciences, Isfahan, Iran,
2Nursing and Midwifery Care
Research Center, Faculty of
Nursing and Midwifery, Isfahan
University of Medical Sciences,
Isfahan, Iran
How to cite this article: Akbari M, Alavi M,
Irajpour A, Maghsoudi J. Challenges of family
caregivers of patients with mental disorders in Iran:
A narrative review. Iranian J Nursing Midwifery Res
2018;23:329-37.
Received: July, 2017. Accepted: February, 2018.
performance and the ability of family
members, destruction of emotional system
and communication structures of family,
ineffective relationships among members,
emergence of nancial and economic
problems, reduced social interactions of
the family, changes in roles, reduced life
expectancy, and emergence of symptoms
such as anger, feeling guilty, grief, and
evendenial.[9,10]
Overall, mental burden of care for a
PP while reducing the quality of life of
caregivers can jeopardize their physical
and mental health, and ultimately lead to
poor care, leaving the treatment, or violent
behavior with patients and these problems
can exacerbate disorder in patients.[5,11]
Thus,ifcaregiversareleftwithoutadequate
social support, they can also be considered
ashiddenpatients.[12]
Studies show that the status of caregivers
of patients with mental disorders has
been neglected in in some countries.
Althoughsomeoftheneedsandchallenges
for caregivers and family members of
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Akbari, et al.: Challenges of family caregivers of patients with mental disorders
330 Iranian Journal of Nursing and Midwifery Research ¦ Volume 23 ¦ Issue 5 ¦ September-October 2018
patients may be common with the patients, they have
unique needs with many uncertainties.[13] On the other
hand, many doctors and health care workers, particularly
psychiatric nurses, often focus their care more on the
patient and ignore the family and main caregivers of the
patient. These doctors and nurses exclude them from the
disease, treatment, and decision‑making processes and do
not consider their needs; hence, families do not have a
chance to express their concerns and needs and are at a
risk of serious problems.[14] By identifying the problems
andchallenges of the caregivers ofthe patient’sadmission
tohospital,psychiatric nurses canplanfor their issuesand
problems.
Althoughnumerousstudies have been conducted onfamily
caregiversofmentallyillpatients in Iran, acomprehensive
overview and scientic study has not been conducted
to determine their challenges. Therefore, in this study,
scientic evidences and other relevant documents were
reviewedto capture thechallengesofcaregiversofpatients
withmentalhealthproblemsintheIraniancontext.
Materials and Methods
This is a narrative review study using a matrix approach
in 2017. A review study includes a summary of previous
ndingsin the literaturereview of research on aparticular
topic.[15]Theexistenceofawealthofinformationisbothan
opportunityandachallenge.Asystematicmethodofreview
is needed for these texts to be used with full performance
toovercome this challenge. Therefore,we usedthe matrix
method[15]to achievethestudyobjectives.
Initially, a team consisting of nursing faculty members of
IsfahanUniversityofMedicalSciences,Iranandalibrarian
were arranged. Literature search was carried out by the
principal author (M.A). The extracted documents were
reviewed by other researchers independently to include
relevantand appropriatedocumentsinthestudy.
The search took place in electronic databases SID,
IRANMEDEX, MAGIRAN, Google scholar, PUBMED
SCOPUS, Web of Sciences, in English and Persian, from
2000 to 2017 with the following keywords – family
caregivers of PPs, family caregivers and PPs, family of
PPs, and Iran. A librarian helped in literature search.
Finally, 1200 published documents (i.e., 1100 papers, 45
theses, and 55 books) related to the challenges of family
caregiversof PPs inIranwereretrieved.
Relevant MeSH terms and keywords were used to
ensure selected articles included search terms pertaining
to (a) family caregiver and/or mental health disorders;
(b)challengeand/orproblem;(c)caregiverswithpsychiatric
patient; and (d) Iran. Results were combined using the
“AND”Booleanoperatortoensureinclusionofatleastone
search terms from each of the four categories. Retrieved
articleswerescreenedbasedontheinclusionandexclusion
criteria. Inclusion criteria in this study included national
studies exploring the challenges of family caregivers of
patients with mental health disorders. Participants were
family caregivers of patients with mental health disorders
of all ages. Both quantitative and qualitative studies were
included in the study. Exclusion criteria included editorial
and review articles, book chapters, preliminary or pilot
studies, and studies with the primary focus on the patient
andnotfamily caregivers.
Studies with relevant titles and abstracts were included
in the analysis. Relevant articles were then subjected to
critical appraisal which involved assessing the methods
and results sections to nd their strengths and weaknesses
as well as their relevance to the review question. After
applying inclusion and exclusion criteria, the reference
lists of the selected articles were hand searched for
related records, yielding a total of 39 articles for the nal
review[Figure 1].
All retrieved articles were read several times by one
authorandreviewedbythe second author togainadeeper
understandingofthestudies. Datawere extracted based on
the date of publication and sample setting. Core features
ofanalysis were (a)whether the studyfocused specically
onthe challenge orproblem in Iranian family caregiverof
mental health disorders; (b) whether the study was aimed
at the family caregiver or family or both; (c) outcome
measures; (d) methods; (e) content; and (f); results. Then,
based on common meanings and central issues of these
ndings, they were organized and integrated as categories
andthemes.
Ethical considerations
Ethical approval for this study was obtained from Isfahan
University of Medical Sciences, Isfahan Iran (ethical
approval code: IR.MUI.REC.1395.3.250). The included
studies were checked to ensure respecting the participants'
consent.
Results
Ofthe39 included studies,3were conducted before 2005,
10from2005to2010,and26from2010toFebruary2017.
Of these, 21 studies were conducted in a cross‑sectional
mannerin12provincesofIranusingconveniencesampling
with 4582 samples. Ten articles were conducted using an
interventional mode with 512 participants and 8 adopted
a qualitative approach with 170 caregivers; their ndings
could explain the conditions of caregivers of patients with
mental disorders. These studies used a variety of standard
andresearcher‑developedtools.
After completing the review process, the data were
extractedascodesof topics relevant to thereviewquestion
and were qualitatively categorized by the research team
members to nd main themes. The challenges of family
caregiversofPPs in Iran werespeciedas (a) not meeting
the needs of caregivers, (b) burnout and high burden of
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Akbari, et al.: Challenges of family caregivers of patients with mental disorders
Iranian Journal of Nursing and Midwifery Research ¦ Volume 23 ¦ Issue 5 ¦ September-October 2018 331
care, (c) high social stigma, (d) low social support for
caregivers,and (e) lowqualityoflifeofcaregivers.
Not meeting the needs of caregivers
One of the main challenges for family caregivers of PPs
is not meeting their needs. Shamsaei et al. studied the
needsoffamilycaregivers of PPs in theculturalcontextof
Iran in a qualitative study. One hundred six contents were
extracted from the statements of family caregivers of PPs
and classied in ve main themes – illness management,
consulting,economic needs, continuous care, andattention
and understanding of the society. Thus, educational,
economic, and moral supports were among the most
important unmet needs of these caregivers.[16] In another
qualitativestudybyShamsaeiet al.,theneedofcaregivers
toinformationwas oneofthemainchallenges.[17]
In the study by Zeinalian et al. (2011), four problems
and needs that most caregivers considered serious
included lack of sufcient information for the
rehabilitation of patients (98%), despair and suffering of
caregivers due to chronic disease (94%), communication
problems with patients (92%), and not enough time of
caregivers(88%).[18]
Behpajuh et al. showed that the most critical need of
caregivermotherswasinformationaboutthetrainingprocess
andparticipationin educational programsandthe treatment
of their children. Most problems of autistic children were
in the areas of speech, social interaction and emotional
problems,attentionandfocus,issuesoffamily,andcareer.[19]
Currently, the efforts of health authorities in Iran are
towardscaringforPPsathomebesidefamilymembersand
continuing treatment and care in the family environment.
Therefore,identifying and meetingtheneeds of thefamily
caregivers of PPs help the mental health care team apply
propercare interventionsto helpcaregivers andhelp them
intheir care.
Burnout and high care burden
Another important challenge of family caregivers of PPs
in Iran is burnout and high care burden. In the study by
Navidian et al., 26.4% of the caregivers had mild, 60.8%
moderate, and 12.8% high mental pressure, i.e., a total of
73.6% of family caregivers had moderate‑to‑high mental
pressure.[7] Cheemeh et al. showed that the average
burnout of caregivers of male patients was signicantly
higher than the burnout of caregivers of female patients
(24.31versus20.25). General healthscoreofcaregivers of
Figure 1: Matrix pattern of step by step review
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Akbari, et al.: Challenges of family caregivers of patients with mental disorders
332 Iranian Journal of Nursing and Midwifery Research ¦ Volume 23 ¦ Issue 5 ¦ September-October 2018
single patients was lower than the score of caregivers of
married patients, and caregivers of employed patients had
bettermental health(28.69versus.21.28).[20]
In the study by Sharif et al., the score of burden of
care of caregivers was 18.66 and reached 11.44 after
psychological intervention.[21] In a study Shamsaei et al.
examined the meaning of health from the perspective of
family caregivers of patients with bipolar disorder. In
data analysis, six main themes –living hell, psychological
burnout, self‑neglect, need for support, condemned to
isolation, and shame – were extracted. All participants
reportedfeelingsofsadness, internal suffering,lackofjoy,
despair,andemptinessintheirexperiences.[22]
Saleh et al. (2014) obtained a moderate score of social
healthofcaregiversofveterans,12.59.Moreover,18.8%of
thesecaregivers havehad veryhigh socialhealth –22.6%
high,17.6% moderate, 21.6%low,and15.5%verylow.[23]
Abdollahpour et al. obtained the average care burden of
family caregivers caring for patients with dementia (55.2),
implying that the burden of care providers in more than
50%ofthecaregiversofthesepatients(scoreof burden of
care58–116)wasmoderatetosevere.[24]
In their study, Navidian et al. mentioned the burden of
caring of 73.6% of caregivers of PPs as moderate to
severe.[25] In another study, Shamsaei et al. examined
the burden of caring of caregivers of patients with
schizophrenia in Iran; 7.6% of the caregivers had no
burdenofcareorhadverymildformofit,23.5%hadmild
to moderate, 41.8% moderate to severe, and 27.1% had
severeburdenofcare.[26] Hosseini et al.foundthat35% of
caregivershad a scoreofGHQ>23.[27]
As studies showed care pressure of caregivers of mentally
ill patients is high, and it is possible that these pressures
reducethelevelofpatientcareand jeopardize the physical
andmentalhealthofthecaregiver.
High social stigma
Stigma is considered as one of the major challenges of
caregivers. Vagei et al. (2015) obtained the mean (SD)
score of stigma in families of patients with schizophrenia
42.6 (9.2) (out of 68), where the highest mean was for
withdrawalfrom society 12.4 (3.3) and the lowestwas for
loneliness 9.8 (3).[28] In the qualitative study of Shamsaei
et al., experiences of family caregivers of mentally ill
patients in Iran were in three main themes – negative
judgment, shame, stigma and social isolation.[29]
Sadeghi et al. (2004) showed that 49% of caregivers for
schizophrenia, 30% of people from major depressive
disorder (MDD) group, and 50.5% of bipolar group were
complaining about discrimination and ridicule because of
PPsinthe family.[30]
In their study, Shah et al. concluded that 45% of the
caregivers of schizophrenic patients and 32.5% of
depression group were ridiculed and discriminated
against.[31]
Families and those without mental illness (especially at
an early age, particularly at the school level) should be
awareof howcompassionate kindnessleads tostigma and
discrimination and pose obstacles among caregivers and
familyof PPs.
Low social support for caregivers
Social support for caregivers of patients with mental
disorders can be evaluated in four areas, including social
support, information support, moral support, and support
forfamily caregiversofwarveterans.
Social support
One of the very important issues and important
responsibilities of all members of society is social support
of these caregivers because studies show that the social
support for this group is low. Saleh et al. (2014) showed
that 6.8% of these caregivers have very high social
protection, 38.5% high, 21.5% moderate, 18.5% low, and
15%very low.[23]
Beirami et al (2014) showed that social support score
in women taking care of their spouses with post
traumatic stress disorder (PTSD) (28.16) is than normal
people(33.28).[32]
Information support
Other studies in Iran show information support for
these caregivers. In other words, these caregivers have
insufcient information about self‑care and patients.
Mami et al. carried out a program of psycho‑education
supportfor familiesof PPs,which ledto increased mental
health, social functioning, reduced anxiety, and depressive
symptoms; however, the program had no signicant effect
ondecreasing the physicalsymptomsofcaregivers.[33]
The results of Sheikh al‑Islami et al. illustrates that the
average score of psychological well‑being before training
was 224 and after training was 373, i.e. training the skills
of dealing with stress affects the familial mental health of
familiesof people withmentaldisorder.[34]
In two studies, Karamlou et al. (2010) showed that
psycho‑education of families of people with severe
mental disorders has no positive effects on their family
environment. Family psycho‑education increases
expressiveness, mental state, and family solidarity, but it
doesnot change theconictcomponent.[35]
Inastudy,Sharifet al.reportedthatpsychological training
program for families of PPs has a signicant impact on
psychological symptoms (score 4.78 versus. 3.13) and
care burden (score 18.66 versus. 11.45).[36] Studies by
Pahlavanzadeh,Mottaghipour,andKoolaeereportedsimilar
results.[37‑39]
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Akbari, et al.: Challenges of family caregivers of patients with mental disorders
Iranian Journal of Nursing and Midwifery Research ¦ Volume 23 ¦ Issue 5 ¦ September-October 2018 333
In the study by Omranifard et al., average score of the
pressureimposedon family intheintervention and control
groupsinnone of thethreeperiods,atthebeginningofthe
intervention,3monthsaftertheintervention,and 6 months
after the intervention, had no signicant differences.
Nevertheless, the quality of life in the intervention
group 6 months after the intervention had signicantly
increased.[40]
According to these studies, low information of family
caregivers of patients with mental disorders in Iran is
evident.Comprehensivesupportofcaregiversisoneofthe
requirements and one of the main tasks of all individuals
andorganizationsinIran.
Spiritual support
Another aspect of the protection of these caregivers is
spiritual support and some texts have referred to them.
Shariet al.studied the relationship between the religious
commitment of family caregivers of Iranian context and
consequencesofcare.Positivereligiouscoping(tendencyto
religion),indicatingasense of spirituality,saferelationship
with God, belief meaningfulness of life, and spiritual
relationship with others, has positive outcomes such as
higher self‑esteem, better quality of life, psychological
adjustment, and more spiritual growth in relation to
tension. However, negative religious coping (turning away
from religion) represents less safe relationship with God
and an uncertain and pessimistic view of the world and
has negative consequences such as depression, emotional
distress, and lack of physical health, low quality of life,
andweakproblem solving.[41]
Although Iranian society has entered industrialization,
alongwiththesechanges,religiousbeliefsandvalueshave
preserved their character. Thus, caregivers with greater
moral support have higher mental health that should be
consideredby authorities insupportofcaregivers.
Support for family caregivers of mental veterans of war
Some studies have been conducted on caregivers of
mental veterans in Iran. Noghani et al. (2016) conducted
a study on PTSD veterans’ wives and found perceived
socialsupport,severity of PTSD ofthespouse, and family
economic status as factors affecting (64%) the quality of
lifeofthe caregivers.[42]
Salehet al.obtainedtheaveragescoreofsocialsupportfor
caregiversofveterans(21.2);themostimportantsourcesof
social support were family members followed by relatives
andfriends.Ofthesecaregivers,6.8%haveveryhighsocial
support,38.5%high,21.2%moderate,18.5%low,and15%
verylow.[23]Beiramiet al.showedthatsocialsupportscore
in the women taking care of husbands with PTSD (28.16)
waslessthan thatofnormalpeople(33.28).[32]
However, family caregivers of mental veterans still have
problems and challenges because the sanctity and culture
of sacrice are supported more than other caregivers by
bothofcial and nonofcialsources.
Low quality of life
Aali et al. showed that the mean scores of developmental
functioning of families of autistic children is less than
that of normal children (67.06 versus 80.65). In addition,
regarding interest and attraction to human relationships,
solving common social problem, logical thinking, and
discipline, their ndings showed signicant differences
betweendevelopmentalfunctioningofthefamilyofautistic
children and developmental functioning of the family of
healthychildren.[43]
Toubaeiet al.showed thatthefamiliesofdepressedpeople
have more satisfaction, physical health, and mental health
thanfamilies with otherpsychiatricdisorders.[44]
The study by Peyman et al. showed that 23.9% of
householdshave agreattendencytoaccepttheirpatientsat
home,53.8 have amoderate tendency,and 22.3%have no
tendency.[45]
Keigobadiet al.showedthattheaveragescoreofqualityof
lifeof caregiverswas4.49outof10. Overall,inthisstudy,
the quality of life for caregivers was 17% unfavorable,
76.5% somewhat favorable, and 5.9% favorable. From the
economicviewpoint, 41.7%were weak,50% average,and
8.3%good.[46]Noghaniet al.showedthatthequalityoflife
ofthesecaregiversinallaspectsislowerthantheothers.[42]
Finally, Sharif showed that weak quality of life in women
showstheneedformoreattentiontotreatmentinterventions
ofandsocial support forpromotingwell‑being and quality
oflifein thisgroupofcaregivers.[47]
As seen from the results of this study, carers of mental
patients in Iran have several challenges. Authorities must
resolve these challenges with the proper management of
caregivers.
Discussion
We conducted this study to examine the challenges of
familycaregiversofmentallyillpatientsinIran.Theresults
indicatedthat the challenges faced byfamily caregiversof
mentally ill patients in Iran include not meeting the needs
of caregivers, burnout and high care burden, high social
stigma,lowsocialsupportofcaregivers,andqualityoflife.
The results of the included studies with others conducted
outside Iran show similarities and differences in the
needs of family caregivers of these patients in Iran and
other countries. Ploeg et al. in Canada concluded that
caregivers of PPs need social life, tool support, emotional
support, information support, and telephone access to the
professionaltreatmentteamaswellasaccesstoexperienced
counterparts.[48] Wancata et al. in Austria showed that
relieving social isolation is among the components with a
high percentage among caregivers’ needs, and the fear of
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334 Iranian Journal of Nursing and Midwifery Research ¦ Volume 23 ¦ Issue 5 ¦ September-October 2018
labeling and discrimination has the lowest percentage,[49]
which is justied by cultural differences. Altruism is
consideredoneoftheancient Persian cultures. Iraniansare
notindifferenttothe family andtheirneighbors and social
view is dominant in Iran. Thus, social isolation has no
placeinIran.Another pointisthatexpression of the needs
and problems and caring for PPs are under the inuence
of culture. In Asian countries, unlike European countries,
duetoissues suchashonor,people refrain fromexpressing
theseproblems and hidethem that eventuallyleads toloss
ofsocialsupport.[50]
Interms ofperceivedstigma,familiesofPPs havemedium
and higher levels of stigma.[30,31,51] In the study by Yin
et al.,majorityoffamilycaregiverswerehidingthedisease
of their family members suffering schizophrenia and did
nothavesupportof their friends.[52] InthestudybySanden
et al.,familiesofpatientswithsocialproblemshadlimited
their social relationships with friends due to stigma.[53]
The study of stigma in patients with mental disorders in
IranandSweden showed that Iranians,incomparison with
Swedish,hadfewerstigmasinlonelinessthatcanbedueto
theIslamicbeliefs oftheIranians.[54]
In connection with the burden of caring for PPs, many
studies showed that not only in Iran but also in other
countries the burden of caring for PPs is signicant, and
the psychological and mental health of these caregivers
have many challenges and they often experience a high
percentage of anxiety and depression.[55,56] In a study
on Jamaican Africans, Alexander et al. showed that the
burden of family caregiving is moderate in patients with
schizophrenia.[57]CaregiversofPPsinZimbabweexperience
signicant burden of care,[58] while this is moderate to
severe in Iran. Chien showed that in China care burden of
caregiversof patientswithschizophreniaishigh.[59]
Padierna showed a very high burden of care for patients
witheating disordersinSpain,[60]buttheburdenofcarefor
schizophrenic patients in Iran is more than other patients’
care burden. The ndings of this study show low level of
education of family caregivers of patients was associated
withanincreasedburdenofcare.ZahidandPahlavanzadeh
showed a signicant relationship between high level
of education and burden of care. It is likely that rising
educational levels leads to increased accountability and
understanding of the complexity of their patient care.[61,62]
Gafari et al. showed that education is insufcient for
informalcaregivers’of multiplesclerosispatients.[63]
In the eld of social support of family caregivers of PPs,
it should be stated that Iranian society is sensitive to the
problemsoftheirfellowandhasagreatdesiretoovercome
them, and people unofcially support these caregivers.
However, ofcially, the Deputy of Department of Medical
University nationwide covers acute patients, and welfare
organization covers the treatment of chronic PPs, and
FoundationofMartyrs and Veteranscovers PTSDveterans
andtheirfamilycaregivers.Theseorganizationsare mostly
responsiblefor economic andhealthcaresupport.
Another type of support in Iran is spiritual support.
Perception of caregivers of their care responsibility as
punishmentfromGodorthefeelingthatGodhasabandoned
them is associated with higher levels of symptoms of
depression,whereasfeelingGod’spresenceinthelivesand
preserving religious beliefs and faith could increase their
adaptability by changing caregivers’ perception of care
burden.[54] In general, religion and spirituality can affect
people’s adaptability to stressful situations by providing
a framework for understanding the meaning and cause of
negative events as well as providing a hopeful vision of
life. In fact, religious commitment acts as a buffer against
stress and moderates negative effects of care on health of
caregivers.
Studies in Iran showed that families with PPs have lower
qualityoflife. This ndingisconsistent with otherstudies
on the signicant effects of patient care, especially those
withmentaldisorders.Boyeret al.showedthattheselected
samples from Chile and France were of poor quality of
life.[64] In this regard, Wong et al. concluded that the
stress of caring for a relative with a mental illness could
reduce their quality of life.[65] Hayes et al. considered
the quality of life of caregivers in Australia low as well.
Boyer et al. consider the reason of low quality of family
life in what these families do today for their patients that
was the responsibility of psychiatric centers in the past.
Thus,socialservicesavailabledonotsupply these changes
sufciently.[64]
Overall, caregivers of patients with mental disorders not
onlyinIranbutalsoinmostcountrieshavemanyproblems
andchallengesin coping with mentalillness.Theobjective
and subjective burnout of family increases in cases where
patients with mental disorders are unable to function, are
dependent, or have not learned social skills. Thus, family
members, especially caregivers, due to using energy and
time to provide the care needed, are in danger of reduced
quality of life. They experience great emotional stress
associated with supporting patient, lack of enjoyable
activities, housekeeping problems, feeling of being
unwanted, participation in care, uncertain prognosis, and
lack of access to social support needed. Nurses can offer
training needed such as identifying sources of support,
self‑efcacy techniques, and empowerment to the family,
especiallythe main caregivers.
A literature review in Iran and this study have some
limitations, especially in using standard search terms in
national databases that provide the majority of citations
in national prevalence studies. To overcome this problem,
we used all synonyms of search terms separately in both
Persian and English languages. Another major limitation
was the lack of good coverage in searching universities
researchprojects and student’sthesis.
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Akbari, et al.: Challenges of family caregivers of patients with mental disorders
Iranian Journal of Nursing and Midwifery Research ¦ Volume 23 ¦ Issue 5 ¦ September-October 2018 335
Conclusion
Resultsof this studyshowed that familycaregivers ofPPs
facemany challengesin Iran. Uncertainties in meeting the
needsofcaregivers and thelackoftheirprovision,burnout
andhighcareburden,highsocialstigma,lowsocialsupport
fromcaregivers,andlowqualityoftheirlifewerethemost
important challenges in the literature. Three key elements
inrelationtothesefamiliesshouldneverbeforgotten:rst,
every member of society should respect and pay attention
to the vital role caregivers play, and this can reduce a lot
of stress these caregivers experience. Second, members of
professionalhealthteam should provide moreopportunities
totrainpropercare,supportresourcesinsociety,andproper
communication skills not only for caregivers but also for
membersofthe community byimprovinginterprofessional
approach. Third, ofcials and policymakers can consider
the problems and challenges of these caregivers and by
adopting appropriate legislation facilitate the path of
solving the problems of these caregivers. Therefore, the
need for all‑inclusive support of family caregivers of
patientswith mentalhealthproblemsseemsnecessary.
Acknowledgement
This study is derived from a PhD thesis of Nursing
sponsored by the Isfahan University of Medical Sciences.
The authors are thankful to the Vice‑chancellor for the
approvalof this researchproject(code:395250).
Financial support and sponsorship
IsfahanUniversityof MedicalSciences,Iran.
Conicts of interest
Nothingto declare.
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