Dyck D G, Short R, Vitaliano P P
The Washington Institute for Mental Illness, Research and Training, Washington State University and Eastern State Hospital, Spokane 99201-3899, USA.
Psychosom Med. 1999 Jul-Aug;61(4):411-9. doi: 10.1097/00006842-199907000-00001.
The objective of the study was to test predictive models of schizophrenia caregiver burden and infectious illness episodes for caregivers who had regular contact with their mentally ill family members.
A nurse interviewer, blind to the patient's symptoms, caregiver burden, and psychosocial status, administered the Health Review to 70 caregivers. A second family interviewer, blind to caregiver health status and patient symptoms, assessed caregiver resources (eg, active coping and social support), vulnerabilities (eg, anger expression and passive coping) and burden. Concurrently, independent patient raters, blind to caregiver health and psychosocial status, assessed caregiver stressors. The Brief Psychiatric Rating Scale and the Modified Scale for the Assessment of Negative Symptoms were used to assess the severity of positive (eg, hallucinations and delusions) and negative (eg, anhedonia and asociality) symptoms, respectively.
Predictive models, including measures of stressors, resources, and vulnerability factors for caregiver burden and for presence of infectious illness, were each highly significant, accounting for 40% and 29% of the variance, respectively. However, the specific measures that predicted burden and infectious illness differed. Greater burden was predicted by more severe patient negative symptoms (stressor), greater anger control and blame self-coping (vulnerability), and decreased tangible social support (resource). Presence of infectious illness episodes was predicted by more severe patient positive symptoms (stressor) and less satisfaction with social support while controlling for the frequency of reporting on the Health Review. When scores from the Brief Psychiatric Rating Scale (stressors) were categorized into quartiles, it was found that the frequency of infectious illness in the highest quartile was four times that in the lowest quartile. Other results indicated that even though burden was not associated with infectious illness, it was associated with "continuing health problems," perceived stress, and depression.
These data indicate that although schizophrenia caregiver burden and infectious illness are predicted by measures of patient stressors, vulnerabilities, and resources, the specific measures predicting these outcomes differ. The results also call attention to the powerful influence of patient symptoms as a predictor of burden and the presence of infectious illness among caregivers.
本研究的目的是针对那些与患有精神疾病的家庭成员有定期接触的照料者，测试精神分裂症照料者负担及感染性疾病发作的预测模型。
一名对患者症状、照料者负担及心理社会状况不知情的护士访谈者，对70名照料者进行健康评估。另一名对照料者健康状况及患者症状不知情的家庭访谈者，评估照料者的资源（如积极应对和社会支持）、易损性（如愤怒表达和消极应对）及负担。同时，对照料者健康及心理社会状况不知情的独立患者评估者，评估照料者的压力源。简明精神病评定量表和改良阴性症状评定量表分别用于评估阳性症状（如幻觉和妄想）及阴性症状（如快感缺失和社交障碍）的严重程度。
预测模型，包括压力源、资源及照料者负担和感染性疾病存在的易损性因素测量指标，均具有高度显著性，分别解释了40%和29%的方差变异。然而，预测负担和感染性疾病的具体测量指标有所不同。更严重的患者阴性症状（压力源）、更强的愤怒控制及自责应对（易损性）和实际社会支持的减少（资源）可预测更高的负担。在控制健康评估报告频率的情况下，更严重的患者阳性症状（压力源）及对社会支持的更低满意度可预测感染性疾病发作的存在。当简明精神病评定量表（压力源）得分被分为四分位数时，发现最高四分位数组的感染性疾病频率是最低四分位数组的四倍。其他结果表明，尽管负担与感染性疾病无关，但它与“持续健康问题”、感知压力及抑郁有关。
这些数据表明，虽然精神分裂症照料者负担和感染性疾病可通过患者压力源、易损性及资源的测量指标进行预测，但预测这些结果的具体测量指标有所不同。研究结果还提醒人们注意患者症状作为照料者负担及感染性疾病存在的预测因素所产生的强大影响。
