Perlick Deborah A, Rosenheck Robert A, Kaczynski Richard, Swartz Marvin S, Cañive José M, Lieberman Jeffrey A
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
Psychiatr Serv. 2006 Aug;57(8):1117-25. doi: 10.1176/ps.2006.57.8.1117.
Components and correlates of caregiver burden in schizophrenia were studied.
The family caregivers of 623 (43 percent) of 1,460 patients with schizophrenia enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) were interviewed about resources they provided and experiences with patient behavior over the previous month. Patients were independently evaluated on symptoms, quality of life, neurocognition, medication side effects, and service use. Factor analysis reduced the caregiver data into four orthogonal factors assessing perceptions of patient problem behavior, patient impairment in activities of daily living, patient helpfulness, and resource demands and disruptions in the caregiver's personal routine.
Hierarchical regression analyses demonstrated differential correlates of burden for each factor, explaining 34 percent of variance each for problem behavior and resource demands and disruption, 21 percent for impairment in activities of daily living, and 38 percent for patient helpfulness. Demographic characteristics and patient symptoms explained the greatest proportion of variance, whereas quality of life and service use explained modest variance and patient neurocognition and medication side effects were not significantly associated with burden.
Results underscore the need for continued intervention with family members after the acute inpatient phase of treatment to address the impacts of symptoms as well as incorporation of skills training into consumer treatment programs to improve consumer contributions to household maintenance.
研究精神分裂症患者照料者负担的构成要素及其相关因素。
对参与干预有效性临床抗精神病药物试验(CATIE)的1460例精神分裂症患者中的623例(43%)的家庭照料者进行访谈,了解他们在前一个月提供的资源以及患者行为方面的经历。对患者的症状、生活质量、神经认知、药物副作用和服务使用情况进行独立评估。因子分析将照料者数据归纳为四个正交因子,分别评估对患者问题行为的认知、患者日常生活活动能力受损情况、患者的帮助程度以及资源需求和照料者个人日常生活的干扰。
分层回归分析表明每个因子的负担相关因素存在差异,问题行为和资源需求及干扰各解释了34%的方差变异,日常生活活动能力受损解释了21%的方差变异,患者的帮助程度解释了38%的方差变异。人口统计学特征和患者症状解释的方差变异比例最大,而生活质量和服务使用解释的方差变异适中,患者的神经认知和药物副作用与负担无显著关联。
结果强调在治疗的急性住院期之后需要继续对家庭成员进行干预,以应对症状的影响,同时将技能培训纳入患者治疗项目,以提高患者对家庭维持的贡献。