A review of the information and support needs of family carers of patients with chronic obstructive pulmonary disease.

AIMS AND OBJECTIVES: The objectives of this narrative review were to identify: (1) The information and support needs of carers of family members with chronic obstructive pulmonary disease; (2) appropriate interventions to support carers in their caregiving role; (3) information on carers' needs as reported in studies of patients living with COPD in the community. BACKGROUND: Chronic obstructive pulmonary disease is a major health problem in the UK resulting in significant burden for patients, families and the health service. Current National Health Service policies emphasise, where medically appropriate, early discharge for acute exacerbations, hospital-at-home care and other models of community care to prevent or reduce re-hospitalisations of people with chronic conditions. Understanding carers' needs is important if health care professionals are to support carers in their caregiving role. DESIGN: A narrative literature review. METHODS: Thirty five papers were reviewed after searching electronic databases. RESULTS: Few studies were identified which addressed, even peripherally, carers' needs for information and support, and no studies were found which described and evaluated interventions designed to enhance caregiving capacity. Several studies of hospital-at-home/early discharge, self care and home management programmes were identified which included some information on patients' living arrangements or marital status. However, there was little or no detail reported on the needs of, and in many cases, even the presence of a family carer. CONCLUSIONS: This review highlights the dearth of information on the needs of carers of chronic obstructive pulmonary disease patients and the need for future research. RELEVANCE TO CLINICAL PRACTICE: There is little research based knowledge of the needs of carers of chronic obstructive pulmonary disease patients and interventions to assist them in providing care. This knowledge is critical to ensure that carers receive the information they need to carry out this role while maintaining their own physical and emotional health.

Patterns of maternal responding in postpartum mothers with schizophrenia.

Little is known about how schizophrenia might affect how a mother responds to her infant, such as whether responding is reduced or impaired. The aim was to identify, from brief videotaped interactions, whether the responses of mothers with schizophrenia were fewer, less positive, more negative, and more 'abnormal' than mothers with affective disorder, and whether their infants (mean age: 15 weeks) lacked activity or initiation to which mothers could respond. Mothers with schizophrenia (N=14) were as responsive as mothers with affective disorder (N=31), but they showed markedly low positive responsiveness. Only the schizophrenia group exhibited non-responses as a result of being psychologically withdrawn from the interaction, and abnormal behaviors. Inconsistent to our hypothesis, infants in both groups showed similar levels of activity, initiative and negativity. The findings highlight the need for further research to examine the contribution of maternal response impairments to the developmental vulnerability of this genetically high-risk group.

Content and style of speech from mothers with schizophrenia towards their infants.

Schizophrenia can affect verbal communication and relational processes, but how it might disrupt maternal infant-directed (ID) speech is unknown. Maternal speech characteristics were coded, blind to clinical information, from brief videotaped mother-infant interactions of 14 mothers with schizophrenia and 36 mothers with similar hospitalisation but with other clinical diagnoses. Compared with the non-schizophrenia group, the speech of mothers with schizophrenia was less infant-focused. Infant-focused content was also predicted by maternal age, but not by duration of hospitalisation or infant gender. Mothers with schizophrenia also used significantly fewer songs or rhymes than the comparison group, and showed a trend towards fewer negative comments. Speech prosody/content deviations were rarely observed in either group, and no differences were found in speech rate or structure. The marked lack of ID speech content of mothers with schizophrenia reflects low maternal sensitivity, perhaps due to 'theory of mind' impairment and blunted affect, and may contribute to the early developmental vulnerability of their children.

Smoking cessation interventions in chronic obstructive pulmonary disease and the role of the family: a systematic literature review.

AIM: This paper is a report of a systematic review to assess the effectiveness of family-focused smoking cessation interventions for people with chronic obstructive pulmonary disease and to determine what data on families are documented in studies of smoking cessation interventions. BACKGROUND: Chronic obstructive pulmonary disease is a major public health problem and cigarette smoking is the most important factor contributing to its development and progression. However, smoking cessation rates are low and relapse is common. The role of families in smoking cessation efforts has received little attention. METHODS: All studies were included in the review that (i) addressed an evaluation of a psycho-social/educational smoking cessation intervention for people with chronic obstructive pulmonary disease, (ii) addressed some information on the family (i.e. living arrangements, marital status, smoking history of family members, support for quitting) and/or included the family as part of the intervention and (iii) were published between 1990 and 2006. Electronic data sources, existing systematic reviews of smoking cessation interventions and the grey literature were reviewed. RESULTS: Seven studies were included. Six studies (11 papers) included data on marital status, smoking status of household members, support for quitting smoking and related variables. In two of the studies, the variable on the family was used to analyse smoking cessation outcomes. One additional study met the inclusion criterion of an evaluation of a smoking cessation intervention, which also included a family focus in the intervention. CONCLUSION: No conclusions about the effectiveness of a family-focused smoking cessation intervention could be drawn from this review. Further research is needed to determine if a more family-focused intervention, in conjunction with pharmacological and counselling approaches, would lead to improved smoking cessation outcomes.

What predicts poor mother-infant interaction in schizophrenia?

BACKGROUND: Poor clinician-rated parenting outcome and observed interactive deficits in mothers with schizophrenia admitted to a psychiatric mother and baby unit (MBU) reflect continuing concerns over the parenting capacity of this group. However, little is known about whether interaction deficits are accounted for by severity of illness or adverse social circumstances typically experienced by these mothers. METHOD: Thirty-eight women with severe perinatal illness (schizophrenia n=13; affective disorders n=25) and their infants were observed in play interaction a week prior to MBU discharge. Clinical and sociodemographic data were also obtained. RESULTS: Mothers with schizophrenia and their infants were rated to have poorer interactive behaviour than the affective disorders group. Infant avoidance of the mother was associated with a lack of maternal sensitivity and responsiveness. The deficits in mother-infant interaction found in the schizophrenia group could not be accounted for by our measures of illness severity or factors relating to adverse social circumstances. CONCLUSIONS: The results replicate and extend previous findings showing poor interactive behaviours in mothers with schizophrenia, their infants, and in the dyad, in a range of areas following clinical recovery. The findings suggest that factors other than illness duration, dose of medication, marital status and occupational status are explanatory for the interactive deficits associated with maternal schizophrenia. Parenting interventions that aim to improve maternal sensitivity need to be developed specifically for this group.

Prevalence and predictors of parenting outcomes in a cohort of mothers with schizophrenia admitted for joint mother and baby psychiatric care in England.

OBJECTIVES: Most women with schizophrenia have children. Schizophrenia has been identified as an independent predictor of poor parenting outcome following joint mother and baby psychiatric admission. We aimed to describe the characteristics of these women postnatally and to estimate the prevalence of, and identify independent predictors of, parenting outcomes. METHOD: Clinical and psychosocial data from consecutive joint psychiatric admissions of mothers and infants between September 1996 and September 2002 were collected. Diagnoses were based on ICD-10 criteria (N = 239 schizophrenia; N = 693 affective disorders). The prevalence of each parenting outcome at discharge, assessed according to social services intervention and staff-rated measures of parenting ability, was estimated. Factors associated with poor parenting outcomes and independent predictors were identified using "modified" Poisson regression, and prevalence of these parenting outcomes was estimated in subgroups of mothers stratified by combinations of protective/risk factors. RESULTS: Mothers with schizophrenia were characterized as having more complex clinical and psychosocial problems and were considerably more likely to experience all types of poor parenting outcomes, compared to mothers with affective disorders. Mothers with schizophrenia reporting supportive marital and other relationships, those whose partners were well, and those of higher social class showed the best parenting outcomes. CONCLUSIONS: Mothers with schizophrenia who experience better parenting outcomes may be protected by certain factors. Successful parenting is related, partly, to stability within the family and access to financial and social resources. The nature of the relationship between identified predictors and parenting outcomes in this group is unclear but may suggest that parenting outcome varies with clinical outcome in schizophrenia. Future research and service development should focus on potential protective factors that may encourage successful parenting outcomes in this vulnerable group.