Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK.
Community Transformation Project, East London NHS Foundation Trust, London, UK.
Int J Soc Psychiatry. 2022 May;68(3):600-609. doi: 10.1177/0020764021992828. Epub 2021 Feb 7.
Carers of patients experiencing first episode psychosis (FEP) are at an increased risk of mental and physical health problems themselves. However, little is known about how the psychological needs of carers may differ between those caring for an adolescent versus an adult who has FEP.
This pilot study aimed to explore any differences in the psychological needs of carers caring for adolescents versus adults with FEP.
We surveyed 254 carers of 198 FEP patients (34 carers of adolescents of 24 FEP adolescent patients). Carers completed self-report measures of anxiety, depression, burnout, subjective burden, coping, and key illness beliefs. The sample was divided according to whether the patient was under (adolescent) or over (adult) age 18, and analysed using mixed model logistic regressions.
Compared to the carers of adult patients, carers of adolescents were more than twice as likely (12% vs. 30%) to experience overall burnout syndrome (all three domains), and to develop it much quicker (19.4 vs. 10.1 months). They were also more likely to adopt behavioural disengagement avoidance as a form of coping. However, there was no difference between carers in terms of anxiety, depression, beliefs and subjective burden. For carers of adolescents, burnout was independently predicted by: a negative belief about the consequences of psychosis for the adolescent patient and an incoherent understanding of the patient's mental health.
If our findings can be replicated in a larger sample, then Rapid-Onset-Burnout-Syndrome (ROBS) is a particular problem in carers of adolescents at FEP, suggesting a need for routine screening and possible prophylactic intervention. Carers of adolescent's use of behavioural escape coping maybe also require early intervention. Theoretically, consideration could be given to the development of an adolescent sub-branch to the cognitive model of caregiving.
经历首发精神病（FEP）的患者的照顾者自身存在心理健康和身体健康问题的风险增加。然而，对于照顾 FEP 青少年和成人的照顾者的心理需求有何不同，知之甚少。
本试点研究旨在探讨照顾 FEP 青少年和成人的照顾者的心理需求是否存在差异。
我们调查了 198 名 FEP 患者的 254 名照顾者（24 名 FEP 青少年患者的 34 名照顾者）。照顾者完成了焦虑、抑郁、倦怠、主观负担、应对和关键疾病信念的自我报告量表。根据患者是否在 18 岁以下（青少年）或以上（成人）将样本分为两组，采用混合模型逻辑回归进行分析。
与照顾成年患者的照顾者相比，照顾青少年患者的照顾者更有可能经历全面倦怠综合征（所有三个领域），且发病更快（12%比 30%，19.4 个月比 10.1 个月）。他们也更有可能采取行为脱离回避作为应对方式。然而，在焦虑、抑郁、信念和主观负担方面，照顾者之间没有差异。对于照顾青少年的照顾者，倦怠独立于以下因素预测：对青少年患者精神病后果的消极信念和对患者心理健康的不一致理解。
如果我们的发现可以在更大的样本中得到复制，那么快速发病的倦怠综合征（ROBS）是 FEP 青少年照顾者的一个特殊问题，这表明需要常规筛查和可能的预防性干预。青少年照顾者采用行为逃避应对方式也可能需要早期干预。从理论上讲，可以考虑为照顾者认知模式开发一个青少年分支。
