McDonell Michael G, Short Robert A, Berry Christopher M, Dyck Dennis G
Eastern Branch, The Washington Institute for Mental Illness: Research and Training, Washington State University-Spokane, 310 North Riverpoint Boulevard, P.O. Box 1495, Spokane, Washington 99210, USA.
Fam Process. 2003 Spring;42(1):91-103. doi: 10.1111/j.1545-5300.2003.00091.x.
Family caregivers of persons with schizophrenia and other psychotic disorders experience high levels of burden. Although a number of patient and caregiver predictors of burden have been identified, little research has investigated the contributions of patient depression, suicidal ideation, and substance abuse. In addition, family psychoeducation interventions have reduced patient symptoms, as well as inpatient treatment utilization; however, it is not known whether or not these interventions reduce family burden. This study investigated predictors of family burden and tested to what degree multiple family group treatment (MFGT), relative to a standard care condition, was associated with reduced family burden. Participants were 90 outpatients with a diagnosis of schizophrenia or other psychotic disorders, and their caregivers who were enrolled in a 2 year psychoeducation intervention. The best set of predictors of burden, identified by stepwise linear regression, was young patient age, awareness of patient's suicidal ideation, and family resources. These variables accounted for 32% of the total variance in burden. Findings suggest that caregiver's awareness of patient's suicidal ideation, not patient's report of suicidal ideation; and that patient age, not duration of the illness, were significant independent predictors of burden. When compared to a standard-care condition over 2 years, MFGT did not reduce family caregiver burden. Discussions focus on the relationship between burden and its predictors, and possible reasons why MFGT did not decrease burden. Modifications are proposed that may increase the impact of MFGT.
精神分裂症及其他精神障碍患者的家庭照护者负担沉重。尽管已经确定了一些与负担相关的患者及照护者预测因素，但很少有研究探讨患者抑郁、自杀意念及药物滥用的影响。此外，家庭心理教育干预已减少了患者症状及住院治疗的使用；然而，尚不清楚这些干预措施是否能减轻家庭负担。本研究调查了家庭负担的预测因素，并测试了相对于标准护理条件，多重家庭团体治疗（MFGT）在多大程度上与减轻家庭负担相关。参与者为90名被诊断患有精神分裂症或其他精神障碍的门诊患者及其照护者，他们参与了一项为期2年的心理教育干预。通过逐步线性回归确定的最佳负担预测因素组合为患者年龄小、知晓患者的自杀意念以及家庭资源。这些变量占负担总方差的32%。研究结果表明，照护者对患者自杀意念的知晓，而非患者的自杀意念报告；以及患者年龄，而非病程，是负担的重要独立预测因素。与2年的标准护理条件相比，MFGT并未减轻家庭照护者的负担。讨论集中在负担与其预测因素之间的关系，以及MFGT未减轻负担的可能原因。提出了一些可能增强MFGT效果的改进建议。
