Kohn-Wood Laura P, Wilson Melvin N
Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, Michigan 48109-1043, USA.
Am J Community Psychol. 2005 Sep;36(1-2):1-13. doi: 10.1007/s10464-005-6229-2.
After the deinstitutionalization of psychiatric hospitals, many families became primary caregivers for seriously mentally ill individuals. Mental health services became further reduced with the advent of managed care and reductions in health and mental health care. The dearth of community-care options often results in psychiatric patients being quickly stabilized in hospital units and discharged to live with their families. The lack of community resources is particularly acute in rural areas. Given these realities the current study sought to determine if family caretaking variables are related to patient outcomes. Family factors including the perception of burden, expressed emotion (EE), and primary caregivers' social support were tested in a model of caretaking that examines the relationship between these factors and patients' symptom expression and social and occupational functioning. The sample includes 49 predominantly African American families living in a rural area and with a chronically ill family member who had been previously diagnosed with a psychotic disorder. Primary caregivers and patients were interviewed using adapted measures of burden, EE, and social support. Patients were administered a revised version of the Brief Psychiatric Rating Scale. Results suggest less perceived burden, increased caregiver support and, to a lesser extent, EE explain approximately one-fifth of the variance in patient functioning. These results support previous research demonstrating the importance of family factors for seriously mentally ill patient outcomes. Results are discussed in terms of implications for assisting families in the current era of diminished resources.
精神病医院去机构化之后，许多家庭成为了严重精神疾病患者的主要照料者。随着管理式医疗的出现以及健康和精神卫生保健的缩减，精神卫生服务进一步减少。社区护理选择的匮乏常常导致精神病患者在医院病房迅速得到稳定治疗，然后出院回家与家人一起生活。社区资源的匮乏在农村地区尤为严重。鉴于这些现实情况，当前的研究试图确定家庭照料变量是否与患者的治疗结果相关。在一个照料模型中，对包括负担感、表达性情绪（EE）和主要照料者的社会支持等家庭因素进行了测试，该模型考察了这些因素与患者症状表现以及社会和职业功能之间的关系。样本包括49个主要为非裔美国人的家庭，这些家庭居住在农村地区，家中有一名长期患病且先前被诊断患有精神障碍的家庭成员。使用经过调整的负担感、EE和社会支持测量方法对主要照料者和患者进行了访谈。对患者进行了修订版的简明精神病评定量表测试。结果表明，较低的负担感、增加的照料者支持以及在较小程度上的EE解释了患者功能约五分之一的变异。这些结果支持了先前的研究，证明了家庭因素对严重精神疾病患者治疗结果的重要性。将根据在当前资源减少的时代协助家庭的意义来讨论研究结果。
