Evaluating a model of caregiving for people with psychosis

Abstract.

Background: The caregiving experience has been conceptualised as distress or satisfaction attributed to various factors in the carer's external and internal world. Aims: The aim of this study was to test how such factors relate to one another in the framework of a ‘stress-coping’ model using data from a group of carers of people with psychosis. Method: Standard univariate analyses and graphical modelling techniques were applied to baseline and follow-up interview data available from a clinical trial of a support package offered to 77 carers in contact with a community psychiatric service. Results: Results at baseline were consistent with a stress-coping model. Carer distress was most strongly associated with coping. In turn, coping was associated with two sets of factors – one related to appraisal and caregiving difficulty, the other to social support. Using a small sample of longitudinal data (n = 38), most individual measures were predictable from baseline. However, there was again a strong association between carer distress and current coping. Support from confidants assumed an important relationship to effective coping. The level of effective coping increased over time while caregiving difficulty decreased, but carer appraisal and distress did not change. Conclusions: The findings provide some support for an interactive, stress-coping model of caregiving in psychosis. Effective coping in caregivers may improve with support from confidants. Carer distress may not change while caregiving continues.