Browsing by Subject "Family functioning"

Background: With the increasing burden of mental health disorders worldwide, strategies are needed to identify salient issues related to mental health and to locally validate mental health screening measures in order to ultimately inform and improve mental illness prevention and treatment. This is particularly the case in regions such as Sub-Saharan Africa, where the burden of illness caused by mental health and substance use disorders is putting increased pressure on an already severely under-resourced healthcare system with few mental health professionals. This study had two aims: (1) to validate items assessing general mental health distress in a Kenyan sample and (2) to identify salient family-level influences on caregiver mental health in Kenyan families.

Methods: This study used a mixed-methods approach with cross-sectional data collected from a sample of 33 caregivers from two communities in Kenya. Each caregiver participated in a survey and a semi-structured interview. Based on the interview data, presence of emotional problems in each study participant was determined such that each participant was designated a mental health “case” or “non-case.” For Aim 1, individual mental health survey items were evaluated for their ability to discriminate between mental health case status groups. For Aim 2, a mixed-methods approach was used to examine relationships between family functioning domains and individual mental health using survey and interview data.

Results: Survey items found to discriminate between individuals with and without emotional problems included 23 items adapted from existing measures of mental health, as well as 5 new items developed for the cultural context. Positively-worded items tended to have poor discrimination between individuals with and without emotional problems. Through examination of quantitative and qualitative data, both family functioning and couple functioning were found to be associated with individual mental health. Satisfaction with roles in terms of provision for family needs was a particularly salient issue affecting individual mental health, as corroborated by the qualitative data. Religiosity was also found to be an important factor in the population, with generally high religiosity among all participants and some differences in use of religion for coping with stressors between individuals with and without emotional problems.

Conclusions: Integration of both adapted and locally-developed mental health screening items should be considered to fully capture the construct of mental health in a given setting, and both content and structure of questions should be considered when developing measures. Both family functioning and couple functioning domains were found to be important, with implications for areas of focus for future research and interventions. Future contextually-sensitive research is needed to comprehensively validate measures of mental health and to further identify predictors of individual mental health in the Kenyan setting.

Caregivers of survivors of pediatric cancer face ongoing social, emotional and financial challenges that may result in enduring illness- and caregiving-related distress. After patients complete treatment there are challenges that persist. Indeed, emerging physical and cognitive "late effects," resulting from the disease and treatment, require families to adapt to a new normal state that may require significant long-term follow-up and care by the survivor and their primary caregiver. This study compares the psychological adjustment of caregivers of pediatric cancer survivors with caregivers of healthy children. In addition, this study evaluates individual factors, such as family functioning and coping style, which may be associated with poorer adjustment among caregivers of pediatric cancer survivors. Caregivers of pediatric cancer survivors (n = 64) and caregivers of healthy children (n = 64) were recruited during regularly scheduled clinic visits to complete questionnaires including a demographic and illness questionnaire and measures of psychosocial functioning. A series of multivariate analyses of covariance were conducted to assess for differences in caregiver distress by group. Caregivers of survivors reported significantly more child-specific parenting stress and somatization than caregivers of healthy children. Hierarchical regression modeling revealed that Escape-avoidance coping and Supportive family functioning predicted 25-40% of the variance in parenting-related psychological adjustment among caregivers of survivors. Caregivers of pediatric cancer survivors face unique challenges that contribute to ongoing distress, particularly related to the parenting role. This population may benefit from interventions aimed at reducing avoidance based coping and improving family functioning.

Background: Deinstitutionalization of persons with schizophrenia has led to families providing the majority of care and carrying the bulk of burden. There is a need to identify factors that influence caregiver burden in order to properly address the needs of caregivers. This is particularly important in low-resource settings, where psychiatric services are scarce and interventions for schizophrenia could be most effective if targeted to the affected individual and their caregiver. This study seeks to examine the association between family functioning and perceived burden in informal caregivers of individuals with schizophrenia in Tanzania and identify socio-demographic and illness-related factors that may be associated with caregiver burden in the study population.Methods: This study analyzed cross-sectional data from 65 dyads of individuals with schizophrenia and their informal caregivers in Dar es Salaam and Mbeya, Tanzania. Caregiver burden was measured using the Burden Assessment Scale (BAS). Univariable and multivariable regression analyses were performed to determine the relationship between perceived caregiver burden and family functioning and explore correlates of burden among caregivers. Results: Sixty-three percent of caregivers in our study reported experiencing high burden as a result of caring for a relative with schizophrenia. Multivariable regression analyses revealed that poor family functioning was a significant correlate of high caregiver burden (OR = 4.79; 95% CI = 1.19, 19.32). Additionally, caregiver having worked in the past 3 months was associated with high caregiver burden (OR = 4.80; 95% CI = 1.14, 20.23), while higher levels of hope in the caregiver were associated with low caregiver burden (OR = 0.82; 95% CI = 0.70, 0.95). Although not included in the multivariable regression model, another factor that was linked to high caregiver burden was caring for a woman with schizophrenia (OR = 3.91; 95% CI = 1.13, 13.50). Conclusions: We found that poor family functioning, caregiver having worked in the past 3 months, lower levels of hope in the caregiver, and caring for a woman with schizophrenia were correlates of high caregiver burden. Future interventions aiming to reduce caregiver burden may benefit from improving family functioning and nurturing hope among caregivers of individuals living with schizophrenia. We must pay special attention to the needs of caregivers that work in addition to providing care for a relative with schizophrenia in order to better support them.