Psychiatric reform in Russia

OBJECTIVE: To describe the mental health care system in Russia against the background of rapid social, economic and political change since the late 1980s. METHOD: Indicators of social stress and deteriorating population mental health and official data on service provision are presented. RESULTS: In the current system of psychiatric care dispensaries take a central position. Key issues of the discussion on mental health care include ways of coping with social stress disorders, strategies to redefine psychiatric rehabilitation in a changed social-economic context and steps towards strengthening social support networks for people with mental illness. Following political abuse of psychiatry, professionals have had to face justified and unjustified accusations, and been faced with a general challenge to their role. CONCLUSION: Tackling problems of social stress, the integration of mental health care in the general medical care system and the building-up of general hospital in-patient psychiatric units are of strategic importance.     

Perceptions of Illness, coping, and well-being in persons with mild cognitive impairment and their care partners

Despite greater attention to mild cognitive impairment (MCI), little is known about reactions to this potentially threatening diagnosis among persons with MCI (PWMCI) and their care partners. Psychologic reactions, perceptions of illness, and coping responses of 46 individuals recently diagnosed with MCI and 29 care partners were assessed with questionnaires assessing psychologic well-being, illness perceptions, coping, and perceived needs for services. Care partners and PWMCI report normal levels of psychologic well-being, showing less distress than is commonly found in Alzheimer disease (AD) caregivers. Problem-focused (eg, active coping) and emotion-focused coping strategies (eg, acceptance) were used more often than dysfunctional coping strategies (eg, self-distraction) by PWMCI and care partners. Both groups tended to minimize the likelihood of conversion to AD, and endorsed mental and physical exercise, optimism, dietary changes, and stress reduction as strategies to prevent conversion. Although PWMCI minimized their impairment, care partners reported providing an average of 24 hours per week of caregiving and reported that the PWMCI did need significant help with complex activities. Respondents reported using few formal services but they anticipate substantial future need for services. Results suggest that PWMCI and care partners are likely to minimize the threat of AD and to perceive that conversion is controllable and preventable with health promotion activities. Study implications for the development of intervention programs for PWMCI and their care partners are discussed.     

Attachment style and anxiety in carers of people with Alzheimer's disease: results from the LASER-AD study

BACKGROUND: Preliminary evidence indicates that the quality of the carer-care recipient relationship predicts those carers most at risk from anxiety. Attachment style is related to higher carer burden, psychological morbidity and increased care recipient institutionalization. We tested, for the first time, the hypothesis that carer burden and the coping strategies used mediate a relationship between attachment style and anxiety. METHODS: We interviewed 83 people with Alzheimer's disease and their family carers, originally recruited for a larger community study. Carers filled in a validated measure about their attachment style, the Hospital Anxiety and Depression Scale, the COPE to measure coping strategies, and the Zarit-Burden interview. RESULTS: More avoidant attachment (beta = 0.28) and less secure attachment (beta = -0.32) predicted anxiety. After adding coping strategies to the equation, the relationship with avoidant attachment (beta = 0.15) was no longer significant, and that with less secure attachment was reduced (beta = -0.23). A well-fitting structural equation model supported our finding that dysfunctional coping mediated the relationship between attachment style and anxiety. CONCLUSION: Carers who were less secure or more avoidantly attached reported higher anxiety. Interventions that aim to modify coping strategies have shown promise in reducing carer anxiety. Our finding that coping strategies also appear partially to explain the excess of anxiety among less securely attached carers suggests they are likely to benefit from such interventions.     

Well-being, appraisal, and coping in African-American and Caucasian dementia caregivers: findings from the REACH study

Although there has been considerable interest in racial differences in family caregiving for persons with dementia, most research to date has either ignored racial diversity or based conclusions on small numbers of caregivers drawn primarily from single site studies. The current study utilized participants from four sites of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) multi-site study to compare well-being, appraisal, and religious coping by race. African-American (n = 295) and Caucasian (n = 425) dementia caregivers from four cities (Birmingham, Memphis, Boston, and Philadelphia) were compared in their demographics, care recipient characteristics, mental and physical health, and psychosocial coping resources including appraisal and religious coping. African-American caregivers reported lower anxiety, better well-being, less use of psychotropic medications, more benign appraisals of stress and perceived benefits of caregiving, and greater religious coping and participation, than Caucasian caregivers. Self-rated health did not differ by race, but African-American caregivers reported more unhealthy behaviors than Caucasian caregivers. Some results were specific to site, possibly due to differences in recruitment strategies, inclusion/exclusion criteria, and regional differences. Adjustment for covariates, including caregiver relationship to the care recipient, gender, age, socioeconomic status, and care recipient behavioral problems, altered few of these differences. Results are discussed in terms of their relevance to psychosocial intervention programs for ethnically diverse caregivers.     

Well-being, appraisal, and coping in Latina and Caucasian female dementia caregivers: findings from the REACH study

While there has been considerable interest in studying ethnically diverse family caregivers, few studies have investigated the influence of dementia caregiving on Latino families. The current study includes participants from two sites of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) project to compare well-being, appraisal, and religiosity by ethnicity, with specific attention to levels of acculturation. Latina (n = 191) and Caucasian female (n = 229) dementia family caregivers from two regions of the United States (Miami, Florida and Northern California) were compared at baseline on demographics, care recipient characteristics, mental and physical health, and psychosocial resources, including appraisal style and religiosity. Latina caregivers reported lower appraisals of stress, greater perceived benefits of caregiving, and greater use of religious coping than Caucasian caregivers. The relationship of these variables to level of acculturation for the Latina caregivers was also explored. Implications of these results for psychosocial interventions with Latino and Caucasian family caregivers are discussed.     

Adjustment and coping in epilepsy.

Our study investigated interrelationships between problems in psychosocial adjustment, coping and epilepsy variables. Establishing the cross-cultural applicability of the Washington Psychosocial Seizure Inventory (WPSI) was an additional objective. The WPSI, Ways of Coping Scale, Modified Version, as well as scales measuring depression and anxiety were administered to 310 outpatients with epilepsy. When the scores of patients with high Lie scores were eliminated, the WPSI profiles were found to be similar to former studies, with some score elevations in emotional adjustment and interpersonal adjustment. When relationships between adjustment variables and coping were modelled, coping was found to be a mediator between the effects of interpersonal and emotional adjustment and integration to the broader social context (vocational adjustment). Family background was found to be a significant predictor of the emotional well-being and interpersonal adjustment scores of the patients. Results support the central role of coping and emotional well-being and emphasize the importance of family factors in adjustment to epilepsy. Psychotherapy and psychological interventions could support coping with illness, primarily through elimination of negative family and social effects and treatment of emotional problems.     

Social support and adjustment to caring for elder family members: A multi-study analysis

This multi-study analysis systematically examines research findings on relationships between social support and caregiver adjustment to discover whether informal support helps family caregivers. Caring for older relatives is an ongoing stressful life course event and role. Informal social support is often used as a predictor of caregiver adjustment outcomes. It is widely believed to enhance adjustment. Yet the varied research results do not necessarily support this belief. A computer-generated literature search of social sciences and medical databases produced thirty-five caregiving articles, published in refereed journals, which meet study parameters. A coding form was developed to categorize social support and adjustment variables for cross-tabular analyses. The findings show most relationships (61%) between social support and caregiver adjustment are not positively significant. Of the minority of positively significant relationships, neither perceived (available) nor received support is more important and neither instrumental nor socioemotional support is more likely to aid adjustment. Researchers and health care professionals need to explore the negative impact of social support and attributes of caregiver-care recipient relationships.     

The ability of the stress process model to explain mental health outcomes

No theory adequately explicates the relationships between stress, social support, and health. The recently developed Stress Process Model incorporates multiple levels of support and stress at the individual, family, and community level, with a focus on predicting mental health outcomes. The purpose of this study was to use an existing database to assess the predictive value of the Stress Process Model in explaining mental health outcomes in community-dwelling subjects with and without panic attacks. This study is a secondary analysis using data obtained in 1990 through 1991 for the Panic Attack Care-Seeking Threshold (PACT) study. Subjects who agreed to participate completed an in-depth interview concerning demographic features, panic characteristics, chronic medical problems, family characteristics, illness attitudes and behaviors, coping strategies, symptom perceptions, psychiatric morbidity, health care utilization, and functional status. The utility of the Stress Process Model is supported by three lines of reasoning. First, most of the relationships predicted by the model were documented in this study. Second, the model accounted for significant amounts of variance in moderating factors, primary and secondary stressors, and mental health outcomes. Finally, two of the three hypotheses were supported by this study. The integration of family and neighborhood variables into the stress process should be attractive to mental health workers in primary care and community settings.     

Coping effectiveness: determinants and relevance to the mental health and affect of family caregivers of persons with dementia

Family caregivers of persons with dementia (n = 141) rated their effectiveness in coping with a challenging symptom displayed by their relative, and completed measures of their ways of coping, their general (optimism) and specific (caregiving self-efficacy) outcome expectancies, their affect (positive and negative), and the mental health subscale of the SF-36. Hierarchical regression analyses revealed that coping effectiveness is more highly influenced by relatively stable outcome expectancies than by the ways of coping that are employed. In addition, optimism exerted a consistent and relatively strong impact on affect and mental health, overshadowing the influence of coping and judgments of its effectiveness. However, coping effectiveness not only had a significant main effect on the caregivers' mental health and negative affect, but also served a stress buffering function by reducing negative affect.     

Caregiver-coping in bipolar disorder and schizophrenia

BACKGROUND: The caregiving experience has been extensively investigated in some chronic/severe mental illnesses such as schizophrenia. These studies have suggested that illness variables and situational/personal characteristics of caregivers have a significant influence on how caregivers cope with mental illness. However, other similar conditions, e. g. bipolar affective disorder (BPAD), have been relatively neglected in this regard. This study attempted to compare caregiver-coping in BPAD and schizophrenia and to explore the determinants of such coping. METHOD: Illness variables and coping, burden, appraisal, perceived support, and neuroticism among caregivers were examined in 50 patients each of BPAD and schizophrenia and their caregivers. RESULTS: High levels of patient-dysfunction and caregiver-burden, low awareness of illness and low perceived control over patient's behaviour were characteristic of both BPAD and schizophrenia, with no significant differences between the two groups on these parameters. Coping patterns were also quite alike, though caregivers of patients with schizophrenia were using some emotion-focused strategies significantly more often. Caregiver's gender, patient-dysfunction and caregiver-neuroticism had a significant influence on coping patterns, but explained only a small proportion of the variance in use of different coping strategies. CONCLUSIONS: Coping and other elements of the caregiving experience in BPAD are no different from schizophrenia. The relationship between caregiver-coping and its determinants appears to be a complex one. More methodologically sound and culturally relevant investigations are required to understand this intricate area, with the hope that a better understanding will help the cause of both patients and their caregivers.     

Caregiver burden and health in bipolar disorder: a cluster analytic approach

To identify caregivers at risk for adverse health effects associated with caregiving, the stress, coping, health and service use of 500 primary caregivers of patients with bipolar disorder were assessed at baseline, 6, and 12 months. K-means cluster analysis and ANOVA identified and characterized groups with differing baseline stress/coping profiles. Mixed effects models examined the effects of cluster, time, and covariates on health outcomes. Three groups were identified. Burdened caregivers had higher burden and avoidance coping levels, and lower mastery and social support than effective and stigmatized caregivers; stigmatized caregivers reported the highest perceived stigma (p < 0.05). Effective and stigmatized groups had better health outcomes and less service use than the burdened group over time; stigmatized caregivers had poorer self-care than effective caregivers. Cluster analysis is a promising method for identifying subgroups of caregivers with different stress and coping profiles associated with different health-related outcomes.     

Stress and Personal Resource as Predictors of the Adjustment of Parents to Autistic Children: A Multivariate Model

The research validates a multivariate model that predicts parental adjustment to coping successfully with an autistic child. The model comprises four elements: parental stress, parental resources, parental adjustment and the child’s autism symptoms. 176 parents of children aged between 6 to 16 diagnosed with PDD answered several questionnaires measuring parental stress, personal resources (sense of coherence, locus of control, social support) adjustment (mental health and marriage quality) and the child’s autism symptoms. Path analysis showed that sense of coherence, internal locus of control, social support and quality of marriage increase the ability to cope with the stress of parenting an autistic child. Directions for further research are suggested.     

Family burden,child disability,and the adjustment of mothers caring for children with epilepsy: Role of social support and coping

PurposeThis study was designed to contribute to the existing research on the coping behaviors, social support, and mental health outcomes in parents of children with epilepsy in the United States.MethodsParticipants included 152, predominantly Caucasian (89.5%), married (78.9%) women (95.4%). Via a web-based interface, mothers completed questionnaires assessing the impact of their child's disability on their family (i.e., severity of their child's disability, family burden, and personal stress), social resources (i.e., perceived social support), coping (i.e., emotion-focused and social support seeking), and adjustment (i.e., depression and anxiety).ResultsAfter controlling for demographic variables, mediational analysis revealed that mothers' perceptions of the severity of their child's disability were associated with decreased perceived social support, which was then related to higher reported levels of depression and anxiety. Similarly, low levels of perceived social support partially mediated the relation between family burden and depression, anxiety, and stress. Finally, mothers' perceptions of the severity of their children's disability and family burden were unrelated to their reports of emotion-focused or social support seeking coping. However, their use of emotion-focused and social support seeking behaviors was related to lower levels of depression.ConclusionLow levels of perceived social support may help to explain the mechanisms underlying the relation between mothers' perceptions of the severity of their child's disability and family burden on their mental health adjustment, such as depression and anxiety.     

Positive aspects of caregiving in schizophrenia: A review

Schizophrenia is a severe mental illness which is associated with significant consequences for both the patients and their relatives. Due to chronicity of the illness, the relatives of patients of schizophrenia have to bear the main brunt of the illness. Studies across the world have evaluated various aspects of caregiving and caregivers such as burden, coping, quality of life, social support, expressed emotions, and psychological morbidity. In general the research has looked at caregiving as a negative phenomenon, however, now it is increasingly recognised that caregiving is not only associated with negative consequences only, also experience subjective gains and satisfaction. This review focus on the conceptual issues, instruments available to assess the positive aspects of caregiving and the various correlates of positive aspects of caregiving reported in relation to schizophrenia. The positive aspect of caregiving has been variously measured as positive caregiving experience, caregiving satisfaction, caregiving gains and finding meaning through caregiving scale and positive aspects of caregiving experience. Studies suggests that caregivers of patients with schizophrenia and psychotic disorders experience caregiving gains(in the form of becoming more sensitive to persons with disabilities, clarity about their priorities in life and a greater sense of inner strength), experience good aspects of relationship with the patient, do have personal positive experiences. Some of the studies suggest that those who experience greater negative caregiving experience also do experience positive caregiving experience.     

A stress-coping model of mental illness stigma: II. Emotional stress responses, coping behavior and outcome

Stigma can be a major stressor for people with schizophrenia and other mental illnesses, leading to emotional stress reactions and cognitive coping responses. Stigma is appraised as a stressor if perceived stigma-related harm exceeds an individual's perceived coping resources. It is unclear, however, how people with mental illness react to stigma stress and how that affects outcomes such as self-esteem, hopelessness and social performance. The cognitive appraisal of stigma stress as well as emotional stress reactions (social anxiety, shame) and cognitive coping responses were assessed by self-report among 85 people with schizophrenia, schizoaffective or affective disorders. In addition to self-directed outcomes (self-esteem, hopelessness), social interaction with majority outgroup members was assessed by a standardized role-play test and a seating distance measure. High stigma stress was associated with increased social anxiety and shame, but not with cognitive coping responses. Social anxiety and shame predicted lower self-esteem and more hopelessness, but not social performance or seating distance. Hopelessness was associated with the coping mechanisms of devaluing work/education and of blaming discrimination for failures. The coping mechanism of ingroup comparisons predicted poorer social performance and increased seating distance. The cognitive appraisal of stigma-related stress, emotional stress reactions and coping responses may add to our understanding of how stigma affects people with mental illness. Trade-offs between different stress reactions can explain why stress reactions predicted largely negative outcomes. Emotional stress reactions and dysfunctional coping could be useful targets for interventions aiming to reduce the negative impact of stigma on people with mental illness.     

Stigma-related stress,shame and avoidant coping reactions among members of the general population with elevated symptom levels

BackgroundIt is unclear whether mental illness stigma affects individuals with subthreshold syndromes outside clinical settings. We therefore investigated the role of different stigma variables, including stigma-related stress and shame reactions, for avoidant stigma coping among members of the general population with elevated symptom levels.MethodsBased on a representative population survey, general stress resilience, stigma variables, shame about having a mental illness as well as avoidant stigma coping (secrecy and social withdrawal) were assessed by self-report among 676 participants with elevated symptom levels. Stigma variables and resilience were examined as predictors of avoidant stigma coping in a path model.ResultsIncreased stigma stress was predicted by lower general stress resilience as well as by higher levels of perceived stigma, group identification and perceived legitimacy of discrimination. More shame was associated with higher perceived legitimacy. Lower resilience as well as more perceived stigma, group identification and perceived legitimacy predicted avoidant coping. Stigma stress partly mediated effects of resilience, perceived stigma and group identification on avoidant coping; shame partly mediated effects of perceived legitimacy on coping. Stigma stress and shame were also directly and positively related to avoidant stigma coping. Analyses were adjusted for symptoms, neuroticism and sociodemographic variables.ConclusionsStigma may affect a larger proportion of the population than previously thought because stigma variables predicted secrecy and withdrawal among members of the general population with elevated, but overall mild symptom levels. Avoidant stigma coping likely has harmful effects, potentially exacerbating pre-existing psychological distress and undermining social networks. This highlights the need to reduce public stigma as well as to support individuals with subthreshold syndromes in their coping with stigma stress and shame reactions.     

Depression in the Caregiving Mothers of Adult Schizophrenics: A Test of the Resource Deterioration Model

The predictive validity of the resource deterioration model was tested with a sample of 100 Black, elderly, low-income, unmarried, caregiving mothers of adult schizophrenic sons and/or daughters. Stressors consisted of three social variables (burden of care, economic strain, undesirable life events) and one physical variable (poor physical health). Stress mediators consisted of coping and social support resources; the outcome variable was defined as depression. The results indicated support for the resource deterioration model with regard to a physical stressor and coping resources, but not for social stressors and social support resources.     

Behavioral and psychiatric comorbidities in pediatric epilepsy: toward an integrative model

It is well recognized that children with epilepsy are at heightened risk for developing behavior problems and psychiatric disorders. Studies identifying factors associated with child behavior were reviewed and findings were placed into two broad categories for review and critique: illness-related variables and psychosocial variables. Illness-related variables were seizure frequency and seizure control, type of epilepsy, age of onset, duration of illness, and antiepileptic drugs. Psychosocial variables were reviewed using a family stress framework: stressors, perceptions, adaptive resources, coping, and family adjustment. After the literature on each category is reviewed, an integrated heuristic model that includes key illness-related and psychosocial variables is presented.     

Predictors of the stage of residential planning among aging families of adults with severe mental illness

OBJECTIVE: This study identified predictors of the extent of residential planning carried out by aging families of adults with severe mental illness according to the conceptual framework of the Double ABCX model of family coping and adaptation. METHODS: Mail surveys were completed by 157 mothers (mean age, 67 years) from 41 states who lived with and provided care to offspring with serious mental disorders (mean age, 38 years). Seventy-six percent of the offspring were men (N=120). Sixty percent of the offspring had been given a diagnosis of schizophrenia or schizoaffective disorder (N=94), 20 percent had multiple diagnoses (N=31), and 16 percent had bipolar disorder (N=25). RESULTS: Higher stages of planning were associated with use of avoidance as a means of coping, discussion of plans with the offspring with a disability, the desire to have family members assume future care responsibilities, lower subjective burden of providing care, and more self-perceived adverse age-related change. The model accounted for 20 percent of the variance in residential planning; over half of this variance was associated with coping behaviors and appraisals of the caregiving context. CONCLUSIONS: In addition to providing relevant information and alleviating feelings of intense burden that undermine residential planning, service providers can best assist older parents by encouraging them to recognize age-related changes in themselves that signal the need to plan and by helping them to involve the entire family in the planning process.     

Caregiving types and psychosocial well-being of caregivers of people with mental illness in Finland

The burden on caregivers of the mentally ill and their need for information and support have been well documented. The present study aimed to describe how different types of caregivers cope with the demands imposed by a family member's mental illness. Five distinct types of caregivers were identified according to the caregiving dimensions: supervising, anxious, coping, resigned, and activating. The results of this study show that mental health professionals should be aware of the caregiving consequences, personal meaning in caregiving, and coping strategies used in order to be able to offer appropriate interventions that optimally meet caregivers' needs.