Bowman Siann, Alvarez-Jimenez Mario, Wade Darryl, Howie Linsey, McGorry Patrick
Department of Occupational Therapy, School of Allied Health, La Trobe University, MelbourneVIC, Australia.
The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, MelbourneVIC, Australia.
Front Psychol. 2017 May 23;8:730. doi: 10.3389/fpsyg.2017.00730. eCollection 2017.
The impact of first episode psychosis (FEP) upon parents' experience of caregiving has been well-documented. However, the determinants and nature of this remain poorly understood in siblings. It is hypothesized that siblings of young people with FEP are also impacted by caregiving and burden. This study aimed to characterize the experience of caregiving for siblings of young people with FEP. Survey methodology was used to explore the experience of 157 siblings in the first 18 months of their brother or sister's treatment for FEP. Participants reported on their appraisal of the negative and positive aspects of caregiving as measured by the Experience of Caregiving Inventory (ECI). Descriptive statistics were used to establish the results for the total sample as well as for gender and birth order differences. A series of multivariate regression analyses were conducted to determine the relationships between illness characteristics and siblings' experience of caregiving. Older brothers reported the lowest scores for negative experiences in caregiving and younger sisters reported the highest. Negative experiences in caregiving resulted in less warmth within the sibling relationship and impacted negatively upon quality of life. When the young person with FEP had attempted suicide and/or been physically violent, siblings experienced more caregiver burden. Multivariate analysis showed that female gender was a significant factor in explaining the impact of illness related variables on the experience of caregiving. Suicide attempts and a history of violence resulted in higher caregiving burden for siblings regardless of whether they lived with the young person experiencing FEP or not. Female siblings are at higher risk of negative experiences from caregiving resulting in a reduced quality of life and a changed sibling relationship. Suicide attempts and violence are indicators for intensive case management to improve outcomes for the individual with FEP which may in turn reduce the burden experienced by the sibling. Clinicians can use these findings to identify siblings, assertively intervene and provide increased psychological support, psychoeducation and practical problem solving to reduce the burden. The caregiving role that they already play for their ill brother or sister should be recognized.
首发精神病（FEP）对父母照顾体验的影响已有充分记录。然而，在兄弟姐妹中，其决定因素和本质仍知之甚少。据推测，患有FEP的年轻人的兄弟姐妹也会受到照顾和负担的影响。本研究旨在描述患有FEP的年轻人的兄弟姐妹的照顾体验。采用调查方法探讨了157名兄弟姐妹在其兄弟姐妹接受FEP治疗的前18个月中的体验。参与者通过照顾体验量表（ECI）报告了他们对照顾的消极和积极方面的评价。使用描述性统计来确定总样本以及性别和出生顺序差异的结果。进行了一系列多元回归分析，以确定疾病特征与兄弟姐妹照顾体验之间的关系。哥哥在照顾中的负面体验得分最低，妹妹得分最高。照顾中的负面体验导致兄弟姐妹关系中缺乏温暖，并对生活质量产生负面影响。当患有FEP的年轻人试图自杀和/或有身体暴力行为时，兄弟姐妹会承受更多的照顾负担。多元分析表明，女性是解释疾病相关变量对照顾体验影响的一个重要因素。自杀未遂和暴力史导致兄弟姐妹的照顾负担更高，无论他们是否与患有FEP的年轻人住在一起。女性兄弟姐妹面临因照顾产生负面体验的风险更高，这会导致生活质量下降和兄弟姐妹关系改变。自杀未遂和暴力是强化个案管理的指标，以改善患有FEP的个体的结局，这反过来可能会减轻兄弟姐妹所承受的负担。临床医生可以利用这些发现来识别兄弟姐妹，积极干预并提供更多的心理支持、心理教育和实际问题解决方法，以减轻负担。应该认可他们已经为生病的兄弟姐妹所扮演的照顾角色。
