Villalobos Bianca T, Ullman Jodie, Krick Tracy Wang, Alcántara Darcy, Kopelowicz Alex, López Steven R
University of Arkansas, Fayetteville, Arkansas, USA.
California State University, San Bernardino, California, USA.
Br J Clin Psychol. 2017 Sep;56(3):273-285. doi: 10.1111/bjc.12137. Epub 2017 May 2.
This study tested an attribution model of help-giving in family caregivers of persons with schizophrenia as it relates to caregivers' reported burden. We hypothesized (a) that caregivers' attributions of their ill relatives' responsibility for their symptoms would be associated with more negative and less positive affective reactions, (b) that affective reactions would be related to perceptions of administered support, and (c) that support would in turn predict greater burden.
We examined 60 family caregivers of Mexican origin living in Southern California. Mexican Americans were chosen because of their high degree of contact with their ill relative, thereby facilitating the examination of help-giving and burden. Contrary to past studies, caregivers' attributions and affective stance were assessed independently, the former based on self-report and the latter based on codes drawn from the Camberwell Family Interview. Caregiver burden was assessed at baseline and one year later.
Path analyses showed partial support for the attribution model of help-giving. Specifically, attributions of responsibility negatively predicted caregiver's warmth, which in turn predicted more administered support. Contrary to hypotheses, attributions were not associated with caregiver criticism, and criticism was positively related to administered support. In addition, caregiver support was not related to burden at either baseline or a year later. Criticism was a significant predictor of burden at follow-up through burden at baseline.
The emotional stance of caregivers predicts burden independent of the help they provide. Caregiver criticism not only predicts negative patient outcomes but can predict negative caregiver outcomes as well.
Positive clinical implications In family treatment, it is important to address caregiver criticism not only because of its relationship to poor clinical outcomes of ill relatives but also because of its relationship to greater caregiver burden. Integrating a balanced rationale for family interventions - to improve ill relatives' and caregivers' outcomes - may promote further engagement of both parties as some caregivers may be additionally motivated to improve their own well-being, and some ill relatives may appreciate more equitably distributing the treatment focus. Limitations The caregiver sample was in general low in criticism; therefore, the findings may not be generalizable to families with a higher degree of criticism. There was a 35% sample attrition at the one-year follow-up.
本研究检验了精神分裂症患者家庭照料者的帮助给予归因模型，及其与照料者报告的负担之间的关系。我们假设：（a）照料者对患病亲属症状责任的归因会与更多负面且更少正面的情感反应相关；（b）情感反应会与所提供支持的感知相关；（c）支持反过来会预测更高的负担。
我们研究了60名居住在南加州的墨西哥裔家庭照料者。选择墨西哥裔美国人是因为他们与患病亲属的接触程度高，从而便于对帮助给予和负担进行研究。与过去的研究相反，照料者的归因和情感立场是独立评估的，前者基于自我报告，后者基于从坎伯韦尔家庭访谈中得出的编码。在基线和一年后评估照料者负担。
路径分析显示对帮助给予归因模型有部分支持。具体而言，责任归因负面预测照料者的热情，而照料者的热情反过来又预测更多所提供的支持。与假设相反，归因与照料者批评无关，且批评与所提供的支持呈正相关。此外，照料者支持在基线或一年后均与负担无关。批评是随访时负担的显著预测因素，通过基线时的负担起作用。
照料者的情感立场独立于他们提供的帮助来预测负担。照料者批评不仅预测患者的负面结果，也能预测照料者的负面结果。
积极的临床意义 在家庭治疗中，处理照料者批评很重要，不仅因为它与患病亲属不良临床结果的关系，还因为它与更高的照料者负担的关系。整合家庭干预的平衡理由——以改善患病亲属和照料者的结果——可能会促进双方进一步参与，因为一些照料者可能会更有动力改善自身福祉，一些患病亲属可能会更认可更公平地分配治疗重点。局限性 照料者样本总体批评程度较低；因此，研究结果可能不适用于批评程度较高的家庭。一年随访时有35%的样本流失。
