Burden, interdependence, ethnicity, and mental health in caregivers of patients with schizophrenia.

Caring for a patient with schizophrenia often results in high levels of perceived burden and poorer overall mental health. Using a sample of 176 caregivers of patients with schizophrenia, the present study examined how two components of burden (objective and subjective) interacted with interdependence and ethnicity to influence relatives' overall mental health. In line with study hypotheses, and with the stress-appraisal-coping model developed by Lazurus and Folkman (1984), we found that subjective burden mediated the relationship between objective burden and mental health. In other words, subjective appraisals of caregiving appeared to partially underlie the association between the concrete costs of caregiving and psychological outcomes in schizophrenia caregivers. Also as hypothesized, we found that interdependence, or the perceived interconnectedness of individuals within a group, moderated the relationship between objective burden and subjective burden. In other words, when levels of interdependence were high, the objective components of burden appeared to have a weaker relationship with subjective burden. When interdependence was low, on the other hand, objective burden was more likely to be associated with subjective burden. This finding suggests that helping caregivers to value harmony and connection with others over individual self-interests may reduce the likelihood that objective stressors (which are often inevitable in schizophrenia) will result in subjective distress. On the basis of prior research, we also tested several hypotheses regarding the role of ethnicity and its association with burden, interdependence, and mental health. However, contrary to expectations, no ethnic patterns were observed.

Neurocognition and cognitive biases in schizophrenia.

Individuals with schizophrenia have been found to exhibit a number of information processing biases that may play a role in the development and exacerbation of symptoms and may impair overall functioning. However, little is known about the factors that are associated with these cognitive biases. Recently, researchers have begun to consider whether neurocognitive deficits, common in schizophrenia, may be risk factors for the development of cognitive biases. In the present study, we assessed neurocognition (verbal learning, delayed verbal recall memory, and verbal recognition memory) and cognitive biases (knowledge corruption and impaired cognitive insight) in 72 individuals with schizophrenia or schizoaffective disorder. As hypothesized, poorer delayed verbal recall memory was associated with increased knowledge corruption. Contrary to expectations, verbal learning and verbal memory were not associated with cognitive insight. These findings suggest that an inadequate recall memory system may put patients with schizophrenia at greater risk for cognitive distortions.

Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: a review of the literature.

The aim of this article is to critically review the literature on expressed emotion (EE), communication deviance (CD), and culture in families of patients with schizophrenia. There is growing evidence that EE and CD are highly linked. Yet the two constructs together predict the development of schizophrenia and the associated symptoms better than either construct alone. In this article, the authors review data indicating that both the expression and the levels of high EE and CD vary by ethnicity. It may be especially difficult for family members to communicate coherently and in a less critical manner when focusing on patients' inability to sustain particular cultural norms and values that are endorsed by their family and ethnic background. The authors propose that more attention to the role of culture in EE and CD and greater focus on the proper assessment of these variables would further enhance our understanding of these constructs.

Expressed emotion and interdependence in White and Latino/Hispanic family members of patients with schizophrenia.

This study examined associations among ethnicity, expressed emotion (EE) and interdependence in a sample of 41 Latino/Hispanic and White family members of patients with schizophrenia. EE was assessed using both the Camberwell Family Interview (CFI) and the Five Minute Speech Sample (FMSS). These measures were found to be highly concordant for rating EE. However, the CFI appears to identify high EE more often than does the FMSS. Whites were designated as high EE significantly more often than were Latinos/Hispanics, regardless of assessment method. Using the interdependence subscale of the Self-Construal Scale, we found a strong trend for Latino/Hispanics to report a more interdependent self-construal than did Whites. However, contrary to expectations, interdependence was not found to mediate the relationship between ethnicity and EE. EE and interdependence may both play a role in the better course of illness observed for patients from traditional cultures. However, these two constructs may relate to patient functioning through different mechanisms.