Caring for a family member with dementia is generally regarded as a chronically stressful process, with potentially negative physical health consequences. However, no quantitative analysis has been conducted on this literature. The authors combined the results of 23 studies to compare the physical health of caregivers with demographically similar noncaregivers. When examined across 11 health categories, caregivers exhibited a slightly greater risk for health problems than did noncaregivers. However, sex and the health category assessed moderated this relationship. Stronger relationships occurred with stress hormones, antibodies, and global reported health. The authors argue that a theoretical model is needed that relates caregiver stressors to illness and proffers moderating roles for vulnerabilities and resources and mediating roles for psychosocial distress and health behaviors.

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Is caregiving hazardous to one's physical health? A meta-analysis.

Understanding variations in the incidence of schizophrenia is a crucial step in unravelling the aetiology of this group of disorders. The aims of this review are to systematically identify studies related to the incidence of schizophrenia, to describe the key features of these studies, and to explore the distribution of rates derived from these studies. Studies with original data related to the incidence of schizophrenia (published 1965–2001) were identified via searching electronic databases, reviewing citations and writing to authors. These studies were divided into core studies, migrant studies, cohort studies and studies based on Other Special Groups. Between- and within-study filters were applied in order to identify discrete rates. Cumulative plots of these rates were made and these distributions were compared when the underlying rates were sorted according to sex, urbanicity, migrant status and various methodological features. We identified 100 core studies, 24 migrant studies, 23 cohort studies and 14 studies based on Other Special Groups. These studies, which were drawn from 33 countries, generated a total of 1,458 rates. Based on discrete core data for persons (55 studies and 170 rates), the distribution of rates was asymmetric and had a median value (10%–90% quantile) of 15.2 (7.7–43.0) per 100,000. The distribution of rates was significantly higher in males compared to females; the male/female rate ratio median (10%–90% quantile) was 1.40 (0.9–2.4). Those studies conducted in urban versus mixed urban-rural catchment areas generated significantly higher rate distributions. The distribution of rates in migrants was significantly higher compared to native-born; the migrant/native-born rate ratio median (10%–90% quantile) was 4.6 (1.0–12.8). Apart from the finding that older studies reported higher rates, other study features were not associated with significantly different rate distributions (e.g. overall quality, methods related to case finding, diagnostic confirmation and criteria, the use of age-standardization and age range). There is a wealth of data available on the incidence of schizophrenia. The width and skew of the rate distribution, and the significant impact of sex, urbanicity and migrant status on these distributions, indicate substantial variations in the incidence of schizophrenia.

/pdf/a-systematic-review-of-the-incidence-of-schizophrenia-the-4g05pk59uz.pdf

A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology.

To determine the impact of dementia on the family, we interviewed the primary care givers of 55 patients suffering from an irreversible dementia. Problems reported included disturbances of patient behavior such as catastrophic reactions, waking at night, suspiciousness, and communication disorders, some of which can be alleviated by physician-initiated intervention. Care givers also reported that they themselves had feelings of anger, depression, and fatigue, which can be treated as well. (JAMA1982;248:333-335)

https://jamanetwork.com/journals/jama/articlepdf/375756/jama_248_3_022.pdf

The Impact of Dementia on the Family

Caregiving and the experience of subjective and objective burden.

Schizophrenia is a disabling, chronic psychiatric disorder that poses numerous challenges in its management and consequences. It extols a significant cost to the patient in terms of personal suffering, on the caregiver as a result of the shift of burden of care from hospital to families, and on society at large in terms of significant direct and indirect costs that include frequent hospitalizations and the need for long-term psychosocial and economic support, as well as life-time lost productivity. ‘Burden of care’ is a complex construct that challenges simple definition, and is frequently criticized for being broad and generally negative. Frequently, burden of care is more defined by its impacts and consequences on caregivers. In addition to the emotional, psychological, physical and economic impact, the concept of ‘burden of care’ involves subtle but distressing notions such as shame, embarrassment, feelings of guilt and self-blame. The early conceptualization of ‘burden of care’ into two distinct components (objective and subjective) has guided research efforts until the present time. Objective burden of care is meant to indicate its effects on the household such as taking care of daily tasks, whereas subjective burden indicates the extent to which the caregivers perceive the burden of care. Research contributions in later years (1980s to the present) have added more depth to understanding of the construct of burden of care by exploring important determinants and factors that likely contribute or mediate the caregiver’s perception of burden of care. Several studies examined the role of gender, and reported that relatives of male patients with schizophrenia frequently experience more social dysfunction and disabilities than those of female patients. Similarly, a number of other studies documented the contribution of ethnicity and cultural issues to subjective burden of care. Although there is no complete agreement on whether a specific cluster of psychotic symptoms has the most impact on a caregiver’s burden of care, there is agreement that the severity of symptoms increases it. An extensive literature concerning family interventions in schizophrenia has demonstrated the positive impact of various family interventions in improving family environment, reducing relapse and easing the burden of care. Although the evidence of such positive impact of family interventions in schizophrenia is well documented, such interventions are neither widely used nor appropriately integrated in care plans, and are frequently underfunded. Although the cost of caregiving is considered to be significant, there are no reliable estimates of the costs associated with such care. The majority of available literature categorized the cost of burden of care among the indirect costs of schizophrenia in general. In recent years, attempts to compare the costs of caregiving in several countries have been reported in the evolving literature on this topic. ‘Burden of care’ as a complex construct certainly requires the development of appropriate methodology for its costing. In achieving a balance between the patients’ and caregivers’ perspectives, caregivers have to be included in the care plan and adequate information and support extended to the family and caregivers. Access to better treatment for patients, including medications, psychosocial interventions and rehabilitation services, are important basic elements in easing the burden on caregivers. Other measures such as availability of crisis management, provision of legally mandated community treatment to avert hospitalization, and well informed and balanced advocacy are also important. Although research efforts have been expanded in the last 3 decades, an urgent need exists for enhancing such efforts, particularly in the development and evaluation of effective family interventions strategies. There is also a need for continued improvement in the delivery of psychiatric services to the severely psychiatrically ill and their families. As there is a lack of reliable cost information about the family burden of care specific to schizophrenia, there is an urgent need to develop reliable approaches that can generate data that can inform in policy making and organization of services.

The burden of schizophrenia on caregivers: a review.

Mental illness and the family

A cohort of patients treated in two psychiatric services with differing admission policies was followed-up for two years and the effects of the patients on their families was measured and compared at the beginning and end of the period. All the measures used showed that the community service which favoured extra-mural care left the patient's families more heavily burdened.

However, this did not apply when those families whose patients had been the most severe burden at referral were considered separately. These families were helped equally in both services even though significantly fewer patients were admitted in the community one. Similarly, the families of all patients over 65 years and of all patients who were never admitted to hospital were not adversely affected to a significantly greater extent in the community care service after two years, although there was an unmistakable trend in that direction.

When the differences between the services in family burden was examined in more detail, the higher ratings obtained in the community service were found to be due to the effects on the family of a discrete group of patients. These were the younger, mainly psychoneurotic, patients who had had at least one admission and who had never been a severe burden, but who continued to cause their families problems after two years. The community service was not providing as much social support to the families of this group as was the control service.

The Effects that Patients Have on their Families in a Community Care and a Control Psychiatric Service—A Two Year Follow-up

The social relations of suicide. The value of a combined epidemiological and case study approach.

The annual rates of referral to two differently organized comprehensive psychiatric services in separate but demographically similar areas are presented for various demographic social and clinical categories In Part 1 the rates are examined for similarities both between the two areas and with findings from other studies in order to obtain pointers to factors affecting the inception of psychiatric disorders In Part 2 an attempt is made to evaluate an aspect of the community service Differences between the rates in the two areas are discussed with a view to identifying those variables that selectively affect referral to a community service

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700007200

Incidence of referred mental illness in Chichester and Salisbury

'The long habit of living', Sir Thomas Browne wrote, 'indisposeth us for dying'. Yet this habitual indisposition is strangely contradicted by suicide; accordingly it mystifies and disturbs us. Suicide also affronts society; opting out with such apparent scorn is seen as a vote of no confidence in the social order. Consequently from man's social beginnings to the present day, suicide has been hemmed in by moral prohibition and cant; attitudes which continue to obscure the problem and hinder an objective examination of it. In this paper I want to consider, in the light of present evidence, some recently canvassed opinions about suicide which are, I suspect, rooted in such attitudes.

Peter Sainsbury

Papers

Mental illness and the family

The Effects that Patients Have on their Families in a Community Care and a Control Psychiatric Service—A Two Year Follow-up

The social relations of suicide. The value of a combined epidemiological and case study approach.

Incidence of referred mental illness in Chichester and Salisbury

Suicide: opinions and facts.