伴危险行为精神疾病患者家属心理压力和应对方式的调查

目的：调查伴危险行为精神疾病患者家属的心理压力状况和应对方式。方法选取2014年5月-12月在广州市民政局精神病院住院或门诊治疗的符合《国际疾病分类(第10版)》(ICD-10)诊断标准、存有危险行为精神疾病患者的家属50名,采用一般情况调查表、生活事件量表(LES)、特质应对方式问卷(TCSQ)和压力感受量表(PSS)对家属进行调查。结果有16名(32%)家属存在健康危险性;不同病程、住院次数的患者其家属TCSQ积极应对评分差异有统计学意义(P<0.05),不同性别患者其家属TCSQ积极应对和消极应对评分差异均有统计学意义(P<0.05)。结论伴危险行为精神疾病患者家属普遍存在着不同程度的心理压力。     

Stigma and discrimination towards people with schizophrenia and their family members

Background  

There is a scarcity of data regarding the actual stigma and discrimination experienced by schizophrenic patients and their relatives. Those experiences can vary significantly depending on the specific social group involved. We have explored such phenomena in our culture with a qualitative technique.     

Examination of grief among family members of individuals with serious and persistent mental illness

Many family members experience a profound sense of loss when a relative becomes mentally ill. The adjustment to this loss is similar to grief as a response to death. The extent of this grief may be explained by personal characteristics of family members, the severity of the illness, and the extent of social support available. A family member's emotional response to a relative's mental illness may be exacerbated by increases in both objective and subjective burden. While grief among families with a seriously mentally ill relative is the emotional response to reflecting on the loss of an emotionally healthy relative, burden reflects the present state of responsibility for the ill relative, expressed in both subjective and objective terms. In this study, family member characteristics, social support, objective burden and subjective burden contributed to explaining expressed grief among 225 family members of seriously mentally ill individuals. Mental health and family support professionals are encouraged to recognize the grief response in family members with a mentally ill relative.     

Social support and functional outcome in severe mental illness: The mediating role of proactive coping

Individuals with Severe Mental Illness (SMI) are faced with wide-spread social and occupational impairment, yet some are able to achieve a meaningful degree of functional improvement. A structural model based on Proactive Coping Theory was developed and tested in a longitudinal context to better understand: (1) the impact of proactive processes on functioning for people with SMI, and (2) the stability of the theoretical framework over time for this population. A latent path analysis examining social support, positive reappraisal, intrinsic motivation, and role functioning was tested with 148 severely mentally ill individuals receiving psychosocial rehabilitation treatment at baseline. An observed path analysis of the model was examined at six months post-baseline with 102 people. The baseline model displayed an excellent fit to the data and accounted for 54% of the variance in role functioning. Results at time 2 also suggest the empirical promise and potential longitudinal viability of the model. In line with Proactive Coping Theory and a social resources model of coping, social support may facilitate proactive coping processes to enhance role functioning, and these processes may be stable over time for people with SMI.     

The burden of mental illness on the family

ABSTRACT– As part of the WHO Collaborative Study on Strategies for Extending Mental Health Care 259 families in four developing countries (Colombia, India, Sudan and the Philippines) were screened with regard to the social burden caused by mental illness of one of its members. Levels of subsistence, previous illness, financial burden, personal relations and social acceptance were studied. The social burden was greatest in the urban areas.     

精神疾病患者家属积极应对在社会支持与焦虑间的中介作用

目的了解精神疾病患者家属的社会支持、应对方式及焦虑状况之间的相关性,探讨应对方式在社会支持与焦虑间的中介作用,为提高精神疾病患者家属心理健康水平、进一步促进患者康复提供参考。方法采用计算机随机方法选取2016年3月-6月在西南医科大学附属医院精神科住院精神疾病患者的家属50人,于患者住院期间分别采用焦虑自评量表(SAS)、简易应对方式量表(SCSQ)和社会支持评定量表(SSRS)评定家属的焦虑状况、应对方式以及社会支持情况。结果精神疾病患者家属SAS评分高于国内常模(t=9.26,P0.01),其SAS评分与SCSQ总评分及各维度评分均呈负相关(P均0.01),与SSRS总评分、主观和客观支持评分均呈负相关(P均0.01)。中介分析显示,社会支持可预测焦虑(P0.01),当积极应对进入方程后,整个方程的解释力无统计学意义(P0.05)。结论精神疾病患者家属的应对方式、社会支持和焦虑三者之间相关,积极应对在社会支持与焦虑程度间起完全中介作用,积极的应对方式可能有利于提高精神疾病患者家属心理健康水平。     

Quality of life: perspectives of people with mental illnesses and family members

Research studies that explore quality of life issues from the perspective of individuals living with mental illnesses, and from the perspective of their family members, are difficult to find in the literature. This study used qualitative strategies to assist policy makers in developing an appreciation of the perspectives of people with mental illnesses and family members on this very important topic. Results support the need for continued peer support and advocacy services; for a continued focus on promoting and supporting recovery for individuals living with mental illnesses; and for a service system that acknowledges and addresses the needs of family members.     

Psychological distress and subjective burden of caregivers of people with mental illness: the role of affiliate stigma and face concern

The present study tested the mediating role of affiliate stigma on the relationships between face concern with psychological distress and subjective burden among caregivers of people with severe mental illnesses. One hundred and eight Chinese caregivers in Hong Kong were surveyed. Based on Baron and Kenny’s (J Pers Soc Psychol 51:1173–1182, 1986) approach, affiliate stigma was found to serve as a partial mediator between face concern and caregiver distress and a full mediator between face concern and subjective burden. Cultural linkage of stigma and caregiver outcomes was identified, suggesting that researchers and practitioners should use a culturally sensitive approach to understand caregivers’ experience and alleviate their stigma.     

Differences among families coping with serious mental illness: a qualitative analysis

Families of 180 people with serious mental illness, representing various socioeconomic and ethnic groups, were interviewed about their understanding of their family member's illness, coping with problems caused by the illness, sources of support, effects of medication and substance abuse, and dealing with mental health professionals. Several significant areas of concern emerged, and are explored with attention to differences based on gender, ethnic group, socioeconomic status, and role of the family member.     

Insight into mental illness, self-stigma, and the family burden of parents of persons with a severe mental illness

Background

Parents of persons with severe mental illness (SMI) often experience burden due to the illness of their daughter or son. In the present study, the possibility that parents' self-stigma moderates the relationship between the parents' insight into a daughter's or son's illness and the parents' sense of burden was investigated.

Methods

Levels of insight into a daughter's or son's mental illness, parent self-stigma, and parent burden of 127 parents of persons with an SMI were assessed. Regression analysis was used to test the putative moderating role of parents' self-stigma.

Results

Self-stigma was found to mediate rather than moderate the relationship between insight and burden. Accordingly, parent insight into the mental illness of a daughter or son appears to increase parent burden because it increases parent self-stigma.

Conclusions

The implications of these findings for practice, theory, and future research are discussed.     

The prevalence of religious coping among persons with persistent mental illness

OBJECTIVE: The purpose of this study was to examine the prevalence of religious coping among persons with persistent mental illness and to gain a preliminary understanding of the relationship between religious coping and symptom severity and overall functioning. METHODS: A total of 406 individuals who were diagnosed as having a mental illness and who were patients at one of 13 Los Angeles County mental health facilities completed a survey consisting of the Religious Coping Index, the Symptom Checklist 90-R (SCL-90), the Global Assessment of Functioning (GAF) scale, and a 48-item demographic questionnaire. RESULTS: More than 80 percent of the participants used religious beliefs or activities to cope with daily difficulties or frustrations. A majority of participants devoted as much as half of their total coping time to religious practices, with prayer being the most frequent activity. Specific religious coping strategies, such as prayer or reading the Bible, were associated with higher SCL-90 scores (indicating more severe symptoms), more reported frustration, and a lower GAF score (indicating greater impairment). The amount of time that participants devoted to religious coping was negatively related to reported levels of frustration and scores on the SCL-90 symptom subscales. CONCLUSIONS: The results of the study suggest that religious activities and beliefs may be particularly compelling for persons who are experiencing more severe symptoms, and increased religious activity may be associated with reduced symptoms. Religion may serve as a pervasive and potentially effective method of coping for persons with mental illness, thus warranting its integration into psychiatric and psychological practice.     

Caregiver burden in chronic mental illness: the role of patient and caregiver characteristics

The aim of the present study is to identify the relative contribution of patient and caregiver characteristics in a sample of primary carers of patients with chronic mental disorders living in the community. As carers were recruited from caregiver organizations, mainly mothers of an adult child suffering from schizophrenia participated in the study (n = 102). Within a comprehensive transactional stress model, burden was assessed with respect to objective and subjective burden, cognitive-emotional well-being, psychological distress and subjective quality of life. Primary stressors include illness-related characteristics of the patient, and a number of personal dispositions and resources of the caregivers were included as potential moderating variables. Multiple regression analyses were separately calculated for each dimension of burden. Interaction of carers’ expressed emotion and external locus of control with the patient’s problem with family communication as well as perceived social support was most predictive for objective and subjective burden, whereas carers’ neuroticism appeared as the most relevant predictor of their well-being, psychological distress and subjective quality of life. Among the patients’ variables, regular employment contributed significantly to reduce carers’ distress and enhance their well-being. As the sample was recruited from caregiver organizations, a selection bias has to be taken into account. To reduce caregiver burden, especially mothers’ burden, the patients’ occupational abilities should be strongly enhanced at an early stage. Family interventions should improve dysfunctional interactions, enhance the carers’ social activities and focus more intensely on the carers’ own dispositions.     

An examination of stress and coping among adults diagnosed with severe mental illness

The present study explored the types of major life and chronic stressors that people with severe mental illness experience, and the coping strategies that are used in response to them. Twenty-eight adults with severe mental illness completed qualitative interviews focused on stress and coping in the prior six months. Participants reported experiencing disruptive major life events including the sudden death of a loved one, loss of housing, and criminal victimization, as well as chronic stressors such as psychiatric symptoms and substance abuse issues, substandard living conditions, legal problems, and health concerns. Results suggested that persons with severe mental illness frequently use problem-centered coping strategies in response to most types of stressors, including major life events, although this occurred after the initial application of avoidant coping strategies. Future research should explore whether or not the identified stressors and the coping strategies used in response to them are unique to this population.     

The role of culture and family in mental illness

A case is presented of a 25-year-old Oriental man who shocked his family by revealing his homosexuality, choosing atheism over his family's traditional Christian religion, and attempting suicide. The discussant examines the cultural implications of the family's reactions to the patient's clinical picture.     

Psychopathology and subjective burden amongst primary caregivers of people with mental illness in South-Western Nigeria

Background  

Most mentally ill persons reside with family members in sub-Saharan Africa with the primary caregiver having to cater for the patients’ needs. The burden of this care giving may be associated with psychopathology in the carer.     

Beyond coping with mental illness: toward personal growth

This study focused on the active attempts of individuals with severe mental illness to make sense of their disorders and initiate processes of personal growth. The findings are based on bimonthly comprehensive assessments conducted over a 1-year period with 43 persons who were hospitalized for schizophrenia and related disorders. Results reveal that living with severe mental illness may also generate processes of growth and change. Clinical and theoretical implications of these results are discussed.