May 09, 2005

Caregiver Coping in Schizophrenia

Caregiver strategies in schizophrenia (and bipolar)

This is a paper that is looking at what it is like for a caregiver of someone with a chronic mental illness. They cite many references about papers regarding the caregiver role in schizophrenia or dementia, but in this paper they focus more on bipolar affective disorder. Specifically, the authors wanted to compare and contrast the coping styles of people who took care of people with bipolar vs. people with schizophrenia. They also looked at demographic characteristics to see what factors impacted the styles of care given by the person responsible.

The authors looked at 50 patients with schizophrenia and 50 with bipolar disorder. They asked questions of both the patient and the caregiver. They wanted to assess the level of functioning of the patient and the extent to which they needed care. Caregivers were defined as people with whom the patients lived and they had to have some responsibility with respect to the patient’s treatment but also to their daily living needs. They looked at several stressors including financial, family structure, and physical health demands amongst many others. As the study was conducted in India, the investigators created many of their own scales or adapted English assessments and translated them into Hindi for more widespread understanding. Patients were also assessed for level of psychopathology using common rating scales (PANSS and YMRS/HDRS).

The researchers assessed care giving style by asking if the caregiver remembered ever using particular techniques for coping. The most common techniques used were consulting with physicians, consulting family/friends and other supportive people. Over 96% of caregivers mentioned utilizing these types of resources in both the bipolar and schizophrenia groups. Approximately 80% of caregivers in both groups “hoped for miracles/prayed for good times” as a coping strategy. Nearly all caregivers utilized a mixture of techniques that were considered both adaptive and some more maladaptive. For the most part, the groups coped similarly but in the schizophrenia caregiver group there was a significantly greater proportion of caregivers that coped by “trying to take one’s mind off things by smoking/drinking/taking pills to relax” and also that used coercion to achieve what they wanted. There were differences noticed in coping styles between men and women with women more likely to use “problem-focused” strategies though it was a small difference between the groups. Women were also more likely to seek social support for their issues and were less likely to use the maladaptive avoidant behaviors.

There are a few methodological limitations to this study. The populations studied were very similar to each other and were both chronic patients with a long history of illness behind them. Their caregivers had been with the patients generally for a long time and many were spouses. There was a high proportion of married patients in this study as well. Because the patients were of such a chronic nature, the findings may not necessarily be applicable to a population of more recently diagnosed patients in which the coping of caregivers may be more difficult as they adjust to the changes in their loved ones. It should also be noted that caregivers tend to change their coping techniques over time and this study focused on a snapshot in time. Therefore, it may not necessarily predict how people cope over the length of their care giving. Ultimately, more long term and longitudinal research designs will be helpful to ascertain the coping strategies people use over the many years they take care of patients. Ultimately, this type of research can be helpful in finding out the useful and less useful ways that people cope and that way more specific recommendations can be make to help people who are involved in the difficult work of taking care of the chronically mentally ill.

Nehra R, Chakrabarti S, Kulhara P, Sharma R.
Caregiver-coping in bipolar disorder and schizophrenia: A re-examination.
Soc Psychiatry Psychiatr Epidemiol. 2005 Apr;40(4):329-36.

Click here to access this article on PubMed


Post a comment

Please enter this code to enable your comment -
Remember Me?
(you may use HTML tags for style)
* indicates required