Skip to main content

Advertisement

Log in

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

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baronet AM (1999) Factors associated with caregiver burden in mental illness: a critical review of the research literature. Clin Psychol Rev 19:819–841

    Article  PubMed  CAS  Google Scholar 

  2. Barrowclough C, Parle M (1997) Appraisal, psychological adjustment and expressed emotion in relatives of patients suffering from schizophrenia. Br J Psychiatry 171:26–30

    Article  PubMed  CAS  Google Scholar 

  3. Borkenau P, Ostendorf F (1993) NEO-Fünf-Faktoren Inventar (NEO-FFI) nach Costa und McCrae. Hogrefe, Göttingen-Bern-Toronto-Seattle

    Google Scholar 

  4. Bottlender R, Jäger M, Kunze I, Groll C, Borski I, Möller H-J (2003) Negative Symptome schizophrener Patienten aus der Perspektive der Psychiater, der Patienten selbst und deren Angehörigen. Nervenarzt 74:762–766

    Article  PubMed  CAS  Google Scholar 

  5. Carter PA, Acton GJ (2006) Personality and coping: predictors of depression and sleep problems among caregivers of individuals who have cancer. J Gerontol Nurs 32:5

    PubMed  Google Scholar 

  6. Chiou CJ, Chang H-Y, Chen IP, Wang HH (2009) Social support and caregiving circumstances as predictors of caregiver burden in Taiwan. Arch Herontol Geriatr 48:419–424

    Article  Google Scholar 

  7. De Jong GM, van Sonderen D, Emmelkamp PM (1999) A comprehensive model of stress: the roles of experienced stress and neuroticism in explaining the stress-distress relationship. Psychother Psychosom 68:290–298

    Article  PubMed  Google Scholar 

  8. Derogatis LR (1977) SCL-90-R, administration, scoring and procedures. Manual for the R(evised) Version. John Hopkins University School of Medicine, Baltimore

  9. Edwards NE, Scheetz PS (2002) Predictors of burden for caregivers of patients with Parkinson’s Disease. J Neurosci Nurs 34:184–190

    Article  PubMed  Google Scholar 

  10. Feldmann R, Buchkremer G, Minneker-Hügel E, Hornung P (1995) Fragebogen zur Erfassung der Familienatmosphäre (FEF): Einschätzung des emotionalen Angehörigenverhaltens aus der Sicht schizophrener Patienten. Diagnostica 41:334–348

    Google Scholar 

  11. Ferring D, Filipp S-H (1989) Bewältigung kritischer Lebensereignisse: Erste Erfahrungen mit einer deutschsprachigen Version der “Ways of Coping Checklist”. Zeitschrift für Differentielle und Diagnostische Psychologie 10:189–199

  12. Folkman S, Lazarus RS (1989) An analysis of coping in a middle-aged community sample. J Health Soc Behav 21:219–239

    Article  Google Scholar 

  13. Gallant MP, Connel CM (1997) Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses. J Aging Health 9:373–395

    Article  PubMed  CAS  Google Scholar 

  14. Garretero S, Garcés J, Ródenas F, Sanjosé V (2009) The informal caregiver′s burden of dependent people: theory and empirical review. Arch Gerontol Geriatr 49:74–79

    Article  Google Scholar 

  15. Gosh S, Greenberg J (2009) Aging fathers of adult children with schizophrenia: the toll of caregiving on their mental and physical health. Psychiatr Serv 60:982–984

    Article  Google Scholar 

  16. Harvey K, Burns T, Fahy T, Manley C, Tattan T (2001) Relatives of patients with severe psychotic illness: factors that incluence appraisal of caregiving and psychological distress. Soc Psychiatry Psychiat Epidemiol 36:456–461

    Article  CAS  Google Scholar 

  17. Ho BC, Flaum M, Hubbard W, Arndt S, Andreasen NC (2004) Validity of symptom assessment in psychotic disorders: information variance across different sources of history. Schizophr Res 68:299–307

    Article  PubMed  Google Scholar 

  18. Hooker K, Frazier LD, Monahan DJ (1994) Personality and coping among caregivers of spouses with dementia. Gerontologist 34:386–392

    Google Scholar 

  19. Hooker K, Monahan DJ, Bowman SR, Frazier LD, Shifren K (1998) Personality counts for a lot: predictors of mental and physical health of spouse caregivers in two disease groups. J Gerontol B Psychol Sci Soc Sci 53:73–85

    Article  Google Scholar 

  20. Idler El, Benyamini J (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38:21–37

    Article  PubMed  CAS  Google Scholar 

  21. Idler EL, Kasl S (1991) Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol 46:55–65

    Google Scholar 

  22. Janke W, Erdmann G (1997) Streßverarbeitungsfragebogen. Hogrefe, Göttingen-Bern-Toronto-Seattle

    Google Scholar 

  23. Koukia E, Madianos MG (2005) Is psychosocial rehabilitation of schizophrenic patients preventin family burden? A comparative study. J Psychiatr Ment Health Nurs 12:415–422

    Article  PubMed  CAS  Google Scholar 

  24. Krampen G (1991) Fragebogen zu Kompetenz- und Kontrollüberzeugungen (FKK). Hogrefe, Göttingen-Toronto-Zürich

    Google Scholar 

  25. Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, Watson P, Hardy A, Garety P (2006) Influence of carer expressed emotion and affect on relapse in non-affective psychosis. Br J Psychiatry 188:173–179

    Article  PubMed  CAS  Google Scholar 

  26. Lazarus RS, Folkman S (1984) Stress, appraisal, coping. Stringer, New York

    Google Scholar 

  27. Maercker A, Langner R (2001) Persönliches Wachstum (Personal Growth) durch Belastungen und Traumata: Validierung zweier deutschsprachiger Fragebogenversionen. Diagnostica 47:153–162

    Article  Google Scholar 

  28. Magana SM, Ramirez Garcia JI, Hernandez MG, Cortez R (2007) Psychological distress among Latino family caregivers of adults with schizophrenia: the roles of burden and stigma. Psychiatr Serv 58:378–384

    Article  PubMed  Google Scholar 

  29. Magliano L, Fadden G, Economou M, Held T, Xavier M, Guarneri M, Malangone C, Marasco C, Maj M (2000) Family burden and coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol 35:109–115

    Article  PubMed  CAS  Google Scholar 

  30. Möller-Leimkühler AM (2005) Burden of relatives and predictors of burden. Baseline results from the Munich 5-yeat-follow up study on relatives of first hospitalized patients with schizophrenia or depression. Eur Arch Psychiatry Clin Neurosci 255:223–231

    Google Scholar 

  31. Möller-Leimkühler AM (2006) Multivariate prediction of realtives’ stress outcome one year after first hospitalization of schizophrenic and depressed patients. Eur Arch Psychiatry Clin Neurosci 256:122–130

    Article  PubMed  Google Scholar 

  32. Möller-Leimkühler AM, Mädger F (2010) Personality factors and mental health outcome of caregivers of first hospitalized schizophrenic and depressed patients. Eur Arch Psychiatry Clin Neurosci 261:165–172

    Google Scholar 

  33. Möller-Leimkühler AM, Obermeier M (2008) Predicting caregiver burden in first admission psychiatric patients. Eur Arch Psychiatry Clin Neurosci 258:406–413

    Article  PubMed  Google Scholar 

  34. Möller-Leimkühler AM, Jandl M (2010) Expressed and perceived emotion over time: does the patients′ view matter for caregivers′ burden? Eur Arch Psychiatry Clin Neurosci Dec 21 [Epub ahead of print]

  35. Moor C, Zimprich D, Schmitt M, Kliegel M (2006) Personality, aging self-perceptions, and subjective health: a mediation model. Int J Aging Hum Dev 63:241–257

    Article  PubMed  Google Scholar 

  36. Navaie-Waliser M, Spriggs A, Feldman PH (2002) Informal caregiving: differential experiences by gender. Med Care 40:1249–1259

    Article  PubMed  Google Scholar 

  37. Pai S, Kapur RL (1981) The burden on the family of a psychiatric patient: development of an interview schedule. Br J Psychiatry 138:332–335

    Article  PubMed  CAS  Google Scholar 

  38. Papastavrou W, Charalambous A, Tsangari H, Karayiannis G (2010) The cost of caring: the relative with schizophrenia. Scand J Caring Sci 24:817–823

    Google Scholar 

  39. Perlick DA, Rosenheck RA, Miklowitz DJ, Chessik C, Wolff N, Kaczynski R, Ostacher M, Patel J, Desai R, the STEP-BR (2007) Prevalence and correlates of burden among caregivers of patients with bipolar disorder enrolled in the systematic treatment enhancement program for bipolar disorder. Bipolar Disord 9:262–273

    Article  PubMed  Google Scholar 

  40. Pohl JM, Given CW, Collins CE, Given BA (1994) Social vulnerability and reactions to caregiving in daughters and daughters-in-law caring for disabled aging parents. Health Care Women Int 15:385–395

    Article  PubMed  CAS  Google Scholar 

  41. Pot AM, Deeg DJH, van Dyck R (2000) Psychological distress of caregivers: moderator effects of caregiver resources? Patient Educ Cons 41:235–240

    Article  CAS  Google Scholar 

  42. Priebe S, Gruyters T, Heinze M, Hoffmann C, Jäkel A (1995) Subjektive Evaluationskriterien in der psychiatrischen Versorgung–Erhebungsmethoden für Forschung und Praxis. Psychiat Prax 22:140–144

    CAS  Google Scholar 

  43. Pruchno RA, Resch NL (1989) Mental health of caregiving spouses: coping as mediator, moderator, or main effect? Psychol Aging 4:454–463

    Article  PubMed  CAS  Google Scholar 

  44. Ray JJ, Still LV (1987) Maximizing the response-rate in surveys may be a mistake. Pers Individ Dif 8:573–574

    Google Scholar 

  45. Reichhart T, Pischel-Walz G, Kissling W, Bäuml J, Schuster T, Rummel-Kluge C (2010) Gender differences in patient and caregiver psychoeducation for schizophrenia. Eur Psychiatry 25:39–46

    Article  PubMed  CAS  Google Scholar 

  46. Russo J, Vitaliano PP, Brewer DD, Katon W, Becker J (1995) Psychiatric disorders in spouse caregivers of care recipients of Alzheimer’s disease and matched controls: a diathesis-stress model of psychopathology. J Abnorm Psychol 104:197–204

    Article  PubMed  CAS  Google Scholar 

  47. Scazufca M, Kuipers E (1996) Links between expressed emotion and burden of care in relatives of patients with schizophrenia. Br J Psychiatiry 168:580–587

    Article  CAS  Google Scholar 

  48. Sha AJ, Wadoo O, Latoo J (2010) Psychological distress in carers of people with mental disorders. BJMP 3:a327

    Google Scholar 

  49. Sommer G, Frydrich T (1989) Soziale Unterstützung: diagnostik, Konzepte, F-SOZU. Dt. Ges. für Verhaltenstherapie, Tübingen

    Google Scholar 

  50. Tedeschi RG, Calhoun LG (1996) The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress 9:455–471

    Article  PubMed  CAS  Google Scholar 

  51. Van Os J, Park SB, Jones PB (2001) Neuroticism, life events and mental health: evidence for person-environment correlation. Br J Psychiatry Suppl 40:72–77

    Article  Google Scholar 

  52. Wancata J, Freidl M, Krautgartner M, Friedrich F, Matschnig T, Unger A, Gössler R, Frühwald S (2008) Gender aspects of parents’ needs of schizophrenia patients. Soc Psychiatry Psychiatr Epidmiol 43:968–974

    Article  Google Scholar 

  53. Wiedemann G, Rayki O, Feinstein E, Hahlweg K (2002) The family questionnaire: development and validation of a new self-report scale for assessing expressed emotion. Psychiatr Res 109:265–279

    Article  Google Scholar 

  54. Yee JL, Schulz R (2000) Gender differences in psychiatric morbidity among family caregivers: a review and analysis. Gerontologist 40:147–164

    Article  PubMed  CAS  Google Scholar 

  55. von Zerssen D (1976) Die Befindlichkeitsskala: parallelformen Bf-S und Bf-S’. Beltz-Test, Göttingen

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anne Maria Möller-Leimkühler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Möller-Leimkühler, A.M., Wiesheu, A. Caregiver burden in chronic mental illness: the role of patient and caregiver characteristics. Eur Arch Psychiatry Clin Neurosci 262, 157–166 (2012). https://doi.org/10.1007/s00406-011-0215-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-011-0215-5

Keywords

Navigation