Psychological impact on caregivers traumatized by the violent behavior of a family member with schizophrenia.

BACKGROUND: A combination of factors such as substance abuse problems, medication noncompliance, and insufficient insight are generally known to increase the risk of violent behavior. However, little is known regarding the psychological impact on caregivers who are traumatized by the violent behavior of a family member with schizophrenia. Therefore, we carried out an investigation to measure this impact. METHOD: A questionnaire was given to 116 caregivers of individuals with schizophrenia in family support groups in Seoul and Daegu, Korea. Their responses were then evaluated using the 22-item version of the Impact of Event Scale-Revised (IES-R), the 8-item short version of the Zarit Caregiver Burden Interview (ZBI-8), and the 15-item version of the Mental Illness and Disorder Understanding Scale (MIDUS). RESULTS: The mean (SD) IES-R score was 26.69 (17.83) (range, 1-84). Multiple regression analysis showed that the psychological impact of traumatic experiences was significantly associated with the following factors: medical non-adherence (P<0.01), living without the patient (P<0.01), and caregiver burden (P<0.05). CONCLUSION: Our results from the present study suggest that even when family caregivers live apart from the patient, they still experience the harmful psychological impact of trauma from the patient's violent behavior. The psychological impact continued as a result of the huge caregiver burden and the medication non-adherence of the family member with schizophrenia in spite of receiving long-term treatment and multiple hospitalizations. The present findings suggest the need for improved community-based service for preventive long-term care, including medication adherence, for outpatients with schizophrenia instead of multiple hospitalizations.

Study of understanding the internalized stigma of schizophrenia in psychiatric nurses in Japan.

AIM: 'Internalized stigma' is a construct that reflects the degree to which a person accepts beliefs endorsed by society about mental illness. Among people with schizophrenia spectrum disorders, internalized stigma has been found to moderate the associations between insight and social function, hope, and self-esteem. Among families of patients with schizophrenia, internalized stigma may not only hinder help-seeking but also result in the families attempting to provide care themselves, without assistance from mental health services. Little is known about internalized stigma among service providers, especially psychiatric nurses in Japan. Therefore, we investigated the correlation between internalized stigma and 'beliefs about the most appropriate form of hospitalization' among psychiatric nurses. METHODS: The subjects were 215 psychiatric nurses employed in psychiatric hospitals who completed the personal stigma scale, perceived stigma scales, and Difficulty of Community Living Scale (DCLS) with respect to a chronic schizophrenia case vignette. RESULTS: Internalized stigma was positively correlated with greater 'beliefs about the most appropriate form of hospitalization' among psychiatric nurses. We also showed that stronger 'beliefs about the social disadvantages of schizophrenia patients in the community' was positively correlated with stronger 'beliefs about the most appropriate form of hospitalization'. CONCLUSION: The present findings suggest that the psychiatric nurses employed at Japanese psychiatric hospitals have a pessimistic view of the community living of people with schizophrenia and their families. And these psychiatric nurses' beliefs were related to their understanding of the deeply dependent relationship between patients and families, and was related to the Confucian ideal.

Caregiver burden and coping strategies for patients with schizophrenia: comparison between Japan and Korea.

AIM: With the current shift to community-centered mental health services, considerable research on the family burden of caring for patients with schizophrenia has been conducted in developed countries. However, there has been no investigation of families with Japanese or Korean sociocultural backgrounds. Therefore, the present study compared the caregiver burden and coping strategies of families of patients with schizophrenia in Japan and Korea in order to elucidate similarities and differences in the sociocultural factors that affect the care experience of families in Northeast Asia. METHODS: A total of 99 Japanese (Nagasaki) and 92 Korean (Seoul, Daegu) family members of patients with schizophrenia were surveyed in regards to caregiver burden, coping strategies, and nursing awareness of the caregiver role regarding the patient with schizophrenia. RESULTS: Analysis revealed the following: (i) although no difference in caregiver burden and coping strategy was observed between the countries, the nursing awareness of families' caregiver role was significantly higher in Japan than in Korea; (ii) caregiver burden was significantly associated with the patient's social functioning and care needs in both countries; and (iii) caregiver burden was significantly associated with reduction of social interests, coercion, avoidance, resignation, and nursing awareness of caregiver role in both countries. CONCLUSION: Although the nursing awareness of families' roles in caring for patients with schizophrenia differed between Japan and Korea, similar trends were observed for the causes of caregiver burden. These findings suggest that in order to provide effective support for reducing caregiver burden, the necessity of such support must be emphasized in both countries.

Burden and coping strategies in mothers of patients with schizophrenia in Japan.

AIM: The present study was conducted to identify factors contributing to burden of care in 57 mothers caring for patients with schizophrenia. METHODS: Members of the Federation of Families of People with Mental Illness in Nagasaki Prefecture were evaluated using well-validated scales to evaluate burden of care (eight-item short version of the Japanese version of the Zarit Caregiver Burden Interview), general health status (General Health Questionnaire 12-item version), difficulty in life, coping strategies, emotional support, and understanding of mental illness and disorders. RESULTS: Burden of care was significantly associated with general health status and difficulty in life. CONCLUSION: On multiple regression it was found that 'social interests' and 'resignation', both of which are the subscales of coping strategies, exerted significant and independent effects with respect to burden of care.