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The condition of the families of patients with schizophrenia in Italy: burden, social network and professional support

Published online by Cambridge University Press:  11 October 2011

Lorenza Magliano ,
Claudio Malangone ,
Manuela Guarneri ,
Cecilia Marasco ,
Andrea Fiorillo ,
Mario Maj  and
Gruppo Di Lavoro
Lorenza Magliano*
Affiliation:
Istituto di Psichiatria, Università di Napoli SUN
Claudio Malangone
Affiliation:
Istituto di Psichiatria, Università di Napoli SUN
Manuela Guarneri
Affiliation:
Istituto di Psichiatria, Università di Napoli SUN
Cecilia Marasco
Affiliation:
Istituto di Psichiatria, Università di Napoli SUN
Andrea Fiorillo
Affiliation:
Istituto di Psichiatria, Università di Napoli SUN
Mario Maj
Affiliation:
Istituto di Psichiatria, Università di Napoli SUN
Gruppo Di Lavoro
Affiliation:
Lara Adinolfi, CSM di Fermo (AP); Valentina Aguglia, CSM di Palermo; Donatella Airoldi, CSM di Abbiategrasso (MI); Adriano Aletti, CSM di Cremona; Simona Laura Benzi, CSM di Tortona (AL); Marco Bertelli, CSM di Firenze; Giuliana Boine, CSM di S. Mauro Torinese (TO); Emi Bondi, CSM di Bormio (SO); Federica Bortolazzi, CSM di Portomaggiore (FE); Erica Brigidi, CSM di Ferentino (FR); Carmen Cangiano, CSM di Gragnano (NA); Anna Carniani, CSM di Castel del Piano (GR); Simona Cesano, CSM di Torino; Angelo Cucciniello, CSM di Angri (SA); Benedetto Del Vecchio, CSM di Barletta (BA); Laura Di Fazio, CSM di Livorno; Simona Fazi e Valeria Modesti, CSM di Narni (TR); Massimo Federici, CSM di La Spezia; Elisabetta Greco, CSM di Roma; Enrico La Delfa, CSM di Catania; Giovanni Marcone, CSM di Fondi (LT); Angela Martino, CSM di Pace del Mela (ME); Marco Nurra, CSM di Oristano; Gianluca Piemontese, CSM di Foggia; Flaminia Poletti, CSM di Ascoli Piceno; Antonella Sambuco, CSM di Squinzano (LE); Claudio Scuto, CSM di Como; Patrizia Thei, CSM di Milano; Alberto Trisolini, CSM di Vetralla (VT); Francesco Tuligi, CSM di Lanusei (NU)
*
Indirizzo per la corrispondenza: Dr.ssa L. Magliano, Istituto di Psichiatria, Università di Napoli SUN. Largo Madonna delle Grazie, 80138 Napoli. Fax: +39-81-5666523 E-mail: [email protected]
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Summary

Objective – This study aimed to describe: a) the interventions received by patients with schizophrenia attending Italian mental health services (MHS); b) the relatives' burden and social network and the professional support received by the families. Design – The study has been carried out in 30 MHS, randomly selected and stratified by geographic areas and population density. 25 patients with a DSM–IV diagnosis of schizophrenia and 25 relatives were recruited in each MHS. Family burden was evaluated in relation to: a) geographic area; b) interventions received by the patients; c) social and professional sup– port received by the families. Main outcome measures – a) patients: Brief Psychiatric Rating Scale (BPRS) and Disability Assessment Interview (AD); b) key-relatives: Family Problems Questionnaire (QPF) and Social Network Questionnaire (QRS); c) interventions received by the patients and their families: Scheda di Rilevazione degli Interventi – Pattern of Care Schedule (SRI). Results – Data on 709 patients and their key-relatives were collected. In the two months preceding the data collection, 35% of patients attended rehabilitative programmes; 80% of the families were in regular contact with the MHS and 8% received family psychoeducational interventions. Family burden was higher in Southern than in Central and Northern Italy. This difference disappeared when rehabilitative interventions and family support were provided. Conclusions – This study highlights that the situation of the families of patients with schizophrenia is more burdensome in Southern Italy and is greatly influenced by the type of interventions provided by the MHS.

Riassunto

Scopo – Questo studio ha inteso documentare: a) gli interventi che i pazienti con schizofrenia ricevono nei Servizi di Salute Mentale (SSM); b) il carico e la rete sociale dei familiari nonché il sostegno professionale che essi ricevono dai servizi. Disegno – Lo studio è stato condotto in 30 CSM selezionati in maniera randomizzata e stratificati per area geografica e densita di popolazione sull'intero territorio nazionale. In ciascun CSM selezionato, sono stati consecutivamente reclutati 25 pazienti con diagnosi DSM-IV di schizofrenia in fase di compenso clinico e altrettanti familiari-chiave. Il carico dei familiari è stato esplorato in relazione alia zona geografica, agli interventi ricevuti dai pazienti e al sostegno professionale e sociale prestato ai loro familiari. Principal misure utilizzate – a) paziente: Brief Psychiatric Rating Scale (BPRS) e intervista per 1'Accertamento delta Disabilita (AD); b) familiare-chiave: Questionari auto-compilati sui Problemi Familiari (QPF) e sulla Rete Sociale (QRS); c) interventi: Scheda di Rilevazione degli Interventi (SRI). Risultati – Sono stati raccolti dati relativi a 709 pazienti e altrettanti familiari-chiave. Nei due mesi precedenti la rilevazione dei dati, il 35% dei pazienti aveva partecipato a programmi riabilitativi, l'80% dei familiari era stato in contatto regolare con i CSM e P8% aveva ricevuto un intervento psicoeducativo familiare. I livelli di carico familiare erano maggiori al Sud. Tale differenza veniva meno quando la presa in ca-rico comprendeva interventi psico-riabilitativi e di sostegno familiare. Conclusioni – Questo studio mette in evidenza che la situazione delle famiglie dei pazienti con schizofrenia è attualmente più difficile al Sud, ed è sensibilmente influenzata dai tipo di presa in carico.

Keywords

schizofreniacarico familiarerete socialeinterventischizophreniafamily burdensocial networkinterventions
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 10 , Issue 2 , June 2001 , pp. 96 - 106
Copyright
Copyright © Cambridge University Press 2001

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References

REFERENCES

Abramowitz, I. & Coursey, R. (1989). Impact of an educational support group on family participants who take care of their schizophrenic relatives. Journal of Consulting and Clinical Psychology 57, 232–236.CrossRefGoogle ScholarPubMed
Barrowclough, G, Tarrier, N. & Johnston, M. (1996). Distress, expressed emotion and attributions in relatives of schizophrenic patients. Schizophrenia Bulletin 22, 691–701.CrossRefGoogle Scholar
Birchwood, M. & Cochrane, R. (1990). Family's coping with schizophrenia: coping styles, their origins and correlates. Psychological Medicine 20, 857–865.CrossRefGoogle ScholarPubMed
Brewin, C.R. (1994). Changes in attribution and expressed emotion among the relatives of patients with schizophrenia. Psychological Medicine 24, 905–911.CrossRefGoogle ScholarPubMed
Brooker, C, Falloon, I., Butterworth, A., Goldberg, D., Graham-Hole, V. & Hillier, V. (1992). The outcome of training community psychiatric nurses to deliver psychosocial interventions. British Journal of Psychiatry 165, 222–230.CrossRefGoogle Scholar
Brugha, D. (1989). Attitudes towards mental illness, a review of the literature. Acta Psychiatrica Scandinavica 80, 1–12.Google Scholar
Buchanan, J. (1995). Social support and schizophrenia: a review of the literature. Archives Psychiatry Nursing 2, 68–76.CrossRefGoogle Scholar
Clausen, J.A. & Yarrow, M.R. (1955). The impact of mental illness on the family. Journal of Social Issues 11, 3–64.CrossRefGoogle Scholar
Cook, J.A., Heller, T. & Pickett-Schenk, S.A. (1999). The effect of support group participation on caregiver burden among parents of adults offspring with severe mental illness. Family Relations 48, 405–410.CrossRefGoogle Scholar
Dixon, L.B. & Lehman, A.F. (1995). Family interventions for schizophrenia. Schizophrenia Bulletin 21, 631–643.CrossRefGoogle ScholarPubMed
Doornbos, M.M. (1997). Problems and coping methods of caregivers of young adults with mental illness. Journal of Psychosocial Nursing 35, 22–26.Google ScholarPubMed
Fadden, G., Bebbington, P. & Kuipers, L. (1987). The burden of care: the impact of functional psychiatric illness on the patients' family. British Journal of Psychiatry 150, 285–297.CrossRefGoogle Scholar
Gibbons, J.S., Horn, S.H., Powell, J.M. & Gibbons, J.L. (1984). Schizophrenic patients and their families: a survey in a psychiatric service based on a DGH unit. British Journal of Psychiatry 144, 70–77.CrossRefGoogle Scholar
Greenberg, J.S., Greenley, J.R. & Kim, H.W. (1995). The provision of mental health services to family of persons with serious mental illness. Research in Community and Mental Health 8, 181–204.Google Scholar
Greenley, J.R. & Vilhjalmsson, R. (1995). Societal reaction to mental disorder: a test of theoretical propositions. Research in Community and Mental Health 8, 41–62.Google Scholar
Grella, C.E. & Grusky, O. (1989). Families of seriously mentally ill and their satisfaction with services. Hospital and Community Psychiatry 40, 831–835.Google ScholarPubMed
Hoenig, J. & Hamilton, M. (1966). The schizophrenic patient in the community and its effect on the household. International Journal of Social Psychiatry 12, 165–176.CrossRefGoogle ScholarPubMed
Jackson, H.J., Smith, N. & McGregory, P. (1990). Relationship between Expressed Emotions and family burden in psychotic disorders: an exploratory study. Acta Psychiatrica Scandinavica 82, 242–249.CrossRefGoogle ScholarPubMed
Jed, J. (1989). Social support for caretakers and psychiatric rehospitalization. Hospital and Community Psychiatry 40, 1297–1299.Google ScholarPubMed
Johnson, D.L. (1995). Current issues in family research: can the burden of mental illness be relieved? Research in Community and Mental Health 8, 309–328.Google Scholar
Lefley, H.P. (1989). Family burden and family stigma in major mental illness. American Psychologist 44, 556–560.CrossRefGoogle ScholarPubMed
Lukoff, D., Nuechterlein, K.H. & Ventura, J. (1986). Manual for the expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin 12, 594–602.Google Scholar
Magliano, L., Guarneri, M., Marasco, C, Veltro, F. e Morosini, P.L. (1993). Studio di riproducibilita di un'intervista semi-strutturata per l'Accertamento della Disability sociale e del Carico familiare (A.D.C.). Rivista di Riabilitazione Psichiatrica e Psicosociale 1, 49–52.Google Scholar
Magliano, L., Veltro, F., Guarneri, M. & Marasco, C. (1995). Clinical and socio-demographic correlates of coping strategies in relatives of schizophrenic patients. European Psychiatry 10, 155–158.CrossRefGoogle ScholarPubMed
Magliano, L., Fadden, G., Madianos, M., Caldas de Almeida, J.M., Held, T., Guarneri, M., Marasco, C, Tosini, P. & Maj, M. (1998a). Burden on the families of patients with schizophrenia: results of the BIOMED I study. Social Psychiatry and Psychiatric Epidemiology 33, 405–412.CrossRefGoogle ScholarPubMed
Magliano, L., Fiorillo, A., Malangone, G, Aletti, A., Belotti, G., Bevi-Iacqua, P., Delle Femine, A.L., Fontana, G., Maucioni, F., Travi, M., Zanus, P., Rossi, A., & Maj, M. (1998b). Carico familiare nella schizofrenia: effetto delle variabili cliniche e socio-ambientali e degli interventi familiari. Epidemiologia e Psichiatria Sociale 7, 178–187.CrossRefGoogle Scholar
Magliano, L., Fadden, G., Economou, M., Xavier, M., Held, T., Guarneri, M., Marasco, C, Tosini, P. & Maj, M. (1998c). Social and clinical factors influencing the choice of coping strategies in relatives of patients with schizophrenia: results of the BIOMED I study. Social Psychiatry and Psychiatric Epidemiology 33, 413–419.CrossRefGoogle ScholarPubMed
Magliano, L., Fadden, G., Fiorillo, A., Malangone, C, Sorrentino, D., Robinson, A. & Maj, M. (1999). Family burden and coping strategies in schizophrenia: are key-relatives really different to other relatives? Acta Psychiatrica Scandinavica 99, 10–15.CrossRefGoogle ScholarPubMed
Magliano, L., Fadden, G., Economou, M., Xavier, M., Held, T., Guarneri, M., Malangone, C, Marasco, C. & Maj, M. (2000a). Family burden and coping strategies in schizophrenia: 1-year follow-up data from the B10MED I study. Social Psychiatry and Psychiatric Epidemiology 35, 109–115.Google ScholarPubMed
Magliano, L., Fiorillo, A., Malangone, C, Guarneri, M., Marasco, C, Maj, M. & Lavoro, Gruppo di (2000b). Cause e conseguenze psicosociali della schizofrenia: le opinioni dei familiari dei pazienti. Epidemiologia e Psichiatria Sociale 9, 113–125.CrossRefGoogle Scholar
Maurin, J.T. & Boyd, C.B. (1990). Burden of mental illness on the family: a critical review. Archives of Psychiatric Nursing 4, 99–107.CrossRefGoogle ScholarPubMed
Morosini, P.L., Veltro, F., Cerreta, A., Gaio, R., Palomba, U. & Ventra, C. (1988). Disability sociale e carico familiare. Studio di riproducibilita di un nuovo strumento di valutazione. Rivista Sperimentale di Freniatria 3, 541–563.Google Scholar
Morosini, P.L., Roncone, R., Veltro, F., Palomba, U. & Casacchia, M. (1991). Routine assessment pool in psychiatry: the questionnaire of family attitudes and burden. Italian Journal of Psychiatry and Behavioural Sciences 1, 95–101.Google Scholar
Noh, S. & Turner, R.J. (1987). Living with psychiatric patients: implications for the mental health of family members. Social Science and Medicine 25, 263–271.CrossRefGoogle ScholarPubMed
Platt, S., Weyman, A. & Hirsch, S. (1983). Social Behaviour Assessment Scale (SBAS). NFER-Nelson: Berks.Google Scholar
Raj, L., Kulhara, P. & Avasthi, A. (1991). Social burden of positive and negative schizophrenia. International Journal of Social Psychiatry 37, 242–250.CrossRefGoogle ScholarPubMed
Reinhard, S. C. (1994). Living with mental illness: effects of professional support and personal control on caregiver burden. Research in Nursing & Health 17, 79–88.CrossRefGoogle ScholarPubMed
Robinson, E.A.R. (1996). Causal attributions about mental illness: relationship to family functioning. American Journal of Orthopsychiatry 66, 282–295.CrossRefGoogle ScholarPubMed
Scazufca, M. & Kuipers, E. (1996). Links between expressed emotion and burden of care in relatives of patients with schizophrenia. British Journal of Psychiatry 168, 580–587.CrossRefGoogle ScholarPubMed
Scazufca, M. & Kuipers, E. (1998). Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients' social functioning. Psychological Medicine 28, 453–461.CrossRefGoogle ScholarPubMed
Schene, A.H., van Wijngaarden, B. & Koeter, M.W.J. (1998). Family caregiving in schizophrenia: domains and distress. Schizophrenia Bulletin 24, 609–618.CrossRefGoogle ScholarPubMed
Solomon, P. (1996). Moving from psychoeducation to family education for families of adults with serious mental illness. Psychiatric Services 47, 1364–1370.Google ScholarPubMed
Solomon, P. & Draine, J. (1995a). Subjective burden among family members of mentally ill adults: relation to stress, coping and Actaptation. American Journal of Orthopsychiatry 65, 419–427.CrossRefGoogle Scholar
Solomon, P. & Draine, J. (1995b). Actaptive coping among family members of persons with serious mental illness. Psychiatric Services 46, 1156–1160.Google ScholarPubMed
Struening, E.X., Stueve, A., Phyllis, V., Kreisman, D.E., Link, B.G. & Herman, D.B. (1995). Factors associated with grief and depressive symptoms in caregivers of people with serious mental illness. Research in Community and Mental Health 8, 91–124.Google Scholar
Veltro, F., Magliano, L., Lobrace, S., Morosini, P.L. (1990). Nuovo studio di riproducibilita di un'intervista semi-strutturata per I'Accertamento della Disabilita sociale e del Carico familiare (A.D.C.). Neurologia, Psichiatria e Scienze Umane 5, 813–820.Google Scholar
Winefield, H.R. & Harvey, E.J. (1993). Determinants of psychological distress in relatives of people with chronic schizophrenia. Schizophrenia Bulletin 19, 619–625.CrossRefGoogle ScholarPubMed
Wing, J.K., Monck, E., Brown, G.W. & Carstairs, G.M. (1964). Morbidity in the community of schizophrenic patients discharged from London hospitals in 1959. British Journal of Psychiatry 110, 10–21.CrossRefGoogle ScholarPubMed
World Health Organisation (1988). Psychiatric Disability Assessment Schedule (DAS). WHO: Geneva.Google Scholar