OBJECTIVES: Pediatric chronic physical illness and adult psychiatric disorders are substantial sources of burden for family care-takers, but little attention has been paid to parental burden resulting from children's or adolescents' psychiatric disorders. This paper describes the predictors of perceived parental burden and its impact on the use of specialty mental health and school services. METHODS: A representative general population sample of 1015 9-, 11-, and 13-year-olds and their parents completed structured psychiatric diagnostic interviews and the Child and Adolescent Burden Assessment. RESULTS: Weighted estimates indicated that 10.7% of parents in the general population perceived burden resulting from their children's symptomatology. Significant predictors of perceived burden were levels of child symptomatology and impairment and parental mental health problems. Children's depressive and anxiety disorders were associated with less burden than other diagnoses. The effects of child disorder severity on specialty mental health service use appeared to be mediated by the level of burden induced. CONCLUSIONS: Substantial levels of parental burden resulted from child psychiatric disorders and were a major reason for specialist mental health service use.

Perceived parental burden and service use for child and adolescent psychiatric disorders.

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Perceived Parental Burden andService UseforChild andAdolescent Psychiatric Disorders

Schizophrenia is a severe mental illness, which is stressful not only for patients, but also for family members. Numerous studies have demonstrated that family caregivers of persons with a severe mental illness suffer from significant stresses, experience moderately high levels of burden, and often receive inadequate assistance from mental health professionals. Effective family functioning in families with schizophrenia may be influenced by a variety of psychosocial factors. The purpose of this article was to present a review of the social science literature related to families living with schizophrenia that has been published during the last three decades. There is general agreement in the literature that a multitude of variables affect families with a severe mental illness, such as schizophrenia. Therefore, this literature review examined the most frequently investigated variables (coping, psychological distress and caregiver burden, social support, caregiver resiliency and depression, and client behavioral problems) as they are related to families and schizophrenia.

Families Living with Severe Mental Illness: A Literature Review

Early research has established that burden exists and has identified certain behaviours of mentally ill relatives that family members find most distressing Further research has confirmed the accuracy of the early work and has focused on the severity of mental illness Recent research has stressed the importance of social support in the study of caregiver burden This paper explores the research literature that covers the concept of caregiver burden in the area of mental illness and also presents developed instruments for the study of caregiver burden

Family burden in chronic mental illness: a review of research studies

The goals of the study were to describe (1) the tasks undertaken by people who care for a relative with chronic schizophrenia, according to their level of contact with the patient; and (2) any needs for further help that these caregivers might experience. Interviews and standardized questionnaires were used to collect information from 121 family caregivers whose relatives had been diagnosed an average of 14 years previously. Burden in the sense of interference in caregivers' daily lives was most marked for caregivers in high contact with the patients. Patients whom the caregivers regarded as enjoyable to live with had greater self-care and communication skills. Caregivers preferred that patients low in these skills or high in disruptive behavior live in supervised settings. Caregivers expressed particular support for earlier professional intervention in episodes of illness, information about how to lobby politicians for resources, and information about schizophrenia. These results can be used to plan interventions to reduce caregiver stress.

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Needs of Family Caregivers in Chronic Schizophrenia

Eighty-six family caregivers participated in small group interviews about their experience of burden in caring for mentally ill relatives. Families experienced profound burdens as a result of their interactions with the mental health care system, particularly in negotiating crisis situations; acting as patient advocates and case managers; obtaining adequate community resources, continuity of care, and information; dealing with legal barriers; and communicating with mental health professionals. Recommended methods of reducing family burden and improving the care of the mentally ill who reside in the community are family education, inclusion of the family in treatment decisions, changes in current mental health laws, redirection in professional training, and development of mobile crisis teams.

D P Gray

Papers

Families' perceptions of burden of care for chronic mentally ill relatives