Journal of Mental Health

ISSN: 0963-8237 (Print) 1360-0567 (Online) Journal homepage: https://www.tandfonline.com/loi/ijmh20

Psychological distress, perceived burden and

quality of life in caregivers of persons with
schizophrenia

Selwyn Stanley, Sujeetha Balakrishnan & S. Ilangovan

To cite this article: Selwyn Stanley, Sujeetha Balakrishnan & S. Ilangovan (2017) Psychological
distress, perceived burden and quality of life in caregivers of persons with schizophrenia, Journal of
Mental Health, 26:2, 134-141, DOI: 10.1080/09638237.2016.1276537

To link to this article: https://doi.org/10.1080/09638237.2016.1276537

Published online: 28 Feb 2017.

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ISSN: 0963-8237 (print), 1360-0567 (electronic)

J Ment Health, 2017; 26(2): 134–141

! 2017 Informa UK Limited, trading as Taylor & Francis Group. DOI: 10.1080/09638237.2016.1276537

ORIGINAL ARTICLE

Psychological distress, perceived burden and quality of life in caregivers

of persons with schizophrenia
Selwyn Stanley1, Sujeetha Balakrishnan2, and S. Ilangovan3
1
Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK, 2Department of Psychology, Thanjavur Medical
College, Thanjavur, India, and 3Department of Psychiatry, Thanjavur Medical College, Thanjavur, India

Abstract Keywords
Background: Caregiving in schizophrenia is a demanding and exhausting activity that Caregiving, schizophrenia, family burden,
challenges the physical and emotional resources of family caregivers. In traditional societies quality of life, psychological distress
such as India, this is further compounded by illiteracy, ignorance and religious and cultural
explanations attributed to mental illness. History
Aims: This study aimed to assess primary caregivers of persons with schizophrenia in terms of
their perceived burden, manifestation of psychological distress and quality of life (QOL). Received 10 June 2016
Methods: The study used a quantitative cross-sectional design and survey methodology to Revised 19 July 2016
collect data from caregivers in a hospital setting in Thanjavur, India. Standardized instruments Accepted 11 August 2016
were used to collect data from patients and their caregivers. Published online 24 February 2017
Results: High perceived burden and lower QOL were seen in the majority of caregivers. They also
manifested high levels of anxiety and depression. Patient characteristics such as age, gender,
symptoms and duration of illness did not influence the perceived burden of caregivers, while
positive and negative symptoms and the duration of illness were correlated with their QOL.
Conclusions: Findings indicate the need for intervention for family caregivers to enable them
cope more effectively with the demands of caregiving. Psychoeducation and participation in
peer support groups are advocated as low resource and effective outcome strategies for
caregivers in India.

Caregiving in mental illness is a demanding and exhausting charlatans who perform elaborate (and often expensive)
activity that typically involves a considerable amount of time, rituals to ‘‘cure’’ the person, and modern psychiatric treat-
energy and money over potentially long periods of time, in ment is usually the last resort (Stanley & Shwetha, 2006).
tasks that may be unpleasant or uncomfortable and could be Ignorance, illiteracy and superstition colour the perception of
psychologically stressful and/or physically exhausting (Schulz mental illness, and stigma and oppression become hard
& Martire, 2004). This could be particularly challenging in realities that families encounter in everyday life.
traditional societies such as India. The close knit family Schizophrenia is a severe mental disorder that typically
structure and lack of adequate State resources to support begins in late adolescence or early adulthood, and is
people with mental illness place the onus of care on the family characterized by profound disruption in thinking, language,
which is perceived to be the ‘‘natural’’ caregiver. Socio- perception and the sense of self, and often includes psychotic
cultural expectations see the caregiving function as typically experiences, such as hearing voices or delusions (World
being discharged by either parents, children or the spouse and Health Organisation, 2016). The volatile nature of the
as an obligation that has morally binding undertones (Stanley disorder and its accompanying debilitating consequences
et al., 2016). Religious-cultural attributions often causally pose a considerable burden on family caregivers owing to its
implicate supernatural factors in the manifestation of mental physical, social, emotional and financial implications. The
illness. Patients’ symptoms are attributed to witchcraft, burden experienced by family caregivers is a complex
ghosts, spirit intrusion, divine wrath, planetary influences phenomenon that includes many areas, such as daily life,
and bad deeds in previous life or karma (Grover et al., 2014). worries and social pressure (Ivarsson et al., 2004). Caregivers
Such beliefs frequently drive families to faith healers and are also likely to experience constraints in social activities due
to the stigma associated with mental illness that can further
their social isolation (Kuipers et al., 1989). Several studies
Correspondence: Selwyn Stanley, University of Wolverhampton, worldwide have reported high levels of burden experienced by
Senior Lecturer in Social Work, University of Wolverhampton,
caregivers of people with schizophrenia (Adeosun, 2013;
Wolverhampton, WV1 1LY, United Kingdom of Great Britain and
Northern Ireland. Tel: +441902 323385. Fax: +441902 518880. E-mail: Gutiérrez-Maldonado et al., 2005; Mitsonis et al., 2012; Ozlu
selwynstanley@gmail.com et al., 2015). Similar findings have also been attested by
DOI: 10.1080/09638237.2016.1276537 Correlates of caregiving in schizophrenia 135

researchers from India (Gururaj et al., 2008; Jagannathan Instruments

et al., 2014; Kate et al., 2013).
(1) The Positive and Negative Syndrome Scale (PANSS) by
Mirowsky and Ross (2002) define psychological distress
Kay et al. (1987) is a 30-item instrument. Of these,
as a state of emotional suffering characterized by symptoms
7 items constitute a Positive Scale (symptoms such as
of depression (e.g. loss of interest, sadness and hopeless-
delusions, hallucinations, grandiosity), 7 items a
ness) and anxiety (e.g. restlessness, feeling tense). It is
Negative Scale (symptoms such as blunted affect,
known that the caregiving experience takes a toll on the
stereotyped thinking, emotional withdrawal), and the
mental health of the caregiver (Harvey et al., 2001; Martens
remaining 16 a General Psychopathology Scale (symp-
& Addington, 2001), and this is an issue not adequately
toms such as anxiety, depression, guilt). Items for
addressed in the Indian literature on caregiving in mental
component scales are rated from 1 to 7 according to
illness. Studies from elsewhere indicate that depression has
symptom severity from 1 for ‘‘absent’’ to 7 for
been frequently reported by caregivers of people with
‘‘extreme’’. This instrument was administered only to
mental disorders (Magliano et al., 2007). Caregiver stress
the person with schizophrenia.
has also been associated with anxiety, psychiatric disorders
(2) The Schizophrenia Caregiver Quality of Life question-
and poor mental and physical health (Etters et al., 2008;
naire (S-CGQoL) is a self-administered, multidimen-
Lavela & Ather, 2010). It is important to understand the
sional instrument developed by Richieri et al. (2011). It
mental health status of caregivers, as care recipients
contains 25 items describing seven dimensions
experience positive health outcomes when their carers do
(Psychological and Physical Well-Being; Psychological
not feel burdened or depressed (Liu et al., 2015). Caregiver
Burden and Daily Life; Relationships with Spouse;
depression can influence their behaviour towards the
Relationships with Psychiatric Team; Relationships
recipient by resulting in physical (MacNeil et al., 2010)
with Family; Relationships with Friends; and Material
or verbal abuse (Smith et al., 2011).
Burden). Items are rated using a 6-point Likert scale,
Although studies have been conducted on specific issues in
with options scored from ‘‘Never’’ to ‘‘Always’’ for each
caregiving such as burden and coping, not much has been
of the seven dimensions as well as a cumulative QOL
done to explore quality of life (QOL) issues in caregivers of
score.
people with schizophrenia. It is seen from the literature that
(3) The Zarit Burden Interview (ZBI) by Zarit et al. (1980), a
these caregivers are at risk of having a lower QOL due to
popular caregiver self-report measure that contains 22
mental health problems and higher caregiver burden (Chen &
items and assesses the perceived burden of rendering
Greenberg, 2004). Those who experience high levels of
care, using a 5-point scale. Response options range from
distress are more likely to have a lower QOL (Geriani et al.,
0 (Never) to 4 (Nearly Always). A cumulative burden
2015; Li et al., 2007). This is particularly so when they
score has been used in this study. Though the instrument
experience restricted roles and activities, and increased
was initially developed to assess caregiver burden in
psychosomatic, anxious or depressive symptoms (Awad &
dementia, it has been used extensively in relation to
Voruganti, 2008; Schulz & Beach, 1999).
mental illness (e.g. Adeosun, 2013; Hanzawa et al.,
This study was framed to understand the caregiving
2010).
experience with regard to the mental health status of the
(4) The Depression, Anxiety and Stress Scale (DASS-21)
caregiver, their QOL and the extent and nature of burden
consists of three self-report scales developed by
perceived by them in caring for a family member having a
Lovibond and Lovibond (1995), and was used to assess
diagnosis of schizophrenia. We were also interested in
psychological distress with regard to the emotional states
ascertaining whether patient symptoms did influence any of
of depression, anxiety and stress. Each of the three scales
these key variables of the study.
contains seven items, and scores for each scale are
calculated by summing the scores for the relevant items.
Methods
Respondents
Design
Data were collected from 75 caregivers who were caring for a
A quantitative cross-sectional survey design was used to
family member diagnosed (according to ICD-10) and
assess respondents utilizing standardized self-report instru-
undergoing treatment for schizophrenia as inpatients in
ments to elicit data pertaining to the key variables.
the Department of Psychiatry of the Medical College.
Respondents were chosen consecutively on inpatient admis-
Setting of the study sion based on their willingness to participate.
Thanjavur (also known as Tanjore) is a temple town in
Tamilnadu state in South India. Data for the study were
Ethical considerations
collected at the Thanjavur Medical College Hospital which
is a multi-speciality teaching cum treatment centre estab- The study received ethical clearance from the Ethics Review
lished in 1964. It has a bed-strength of 678 and caters to Panel of the medical college. Participation was voluntary, and
people predominantly from the adjoining rural districts. It informed consent was obtained from the patients and their
offers treatment in 18 specialisms including the caregiver. They were told that they had the option to drop out
Department of Psychiatry, where data for this study were of the study at any point without any implications in terms of
collected. the treatment being availed of.
136 S. Stanley et al. J Ment Health, 2017; 26(2): 134–141

Statistical analysis (positive or negative) in relation to the other. Frequencies

plotted for the composite scale reveal that the majority of care
SPSS version 20 (Statistical Package for Social Sciences;
recipients (68%) had a predominance of positive symptoms
IBM Software, Armonk, NY) was used for data analysis and
over negative symptoms (32%).
for generating the results of this study. Independent t tests
were used to compare caregivers on background factors (such
DASS profile of caregivers
as patient’s gender) and caregivers’ characteristics (gender,
relationship to patient) in terms of the manifestation of the Table 2 depicts the DASS profile of the caregivers in terms of
key variables of the study. Pearson’s correlation coefficients the severity of the manifestation of its respective components,
were obtained to examine the relationship among the key graded according to the norms provided by the authors of the
variables and also with background factors. A multiple scale. It is seen that while the majority of caregivers
regression analysis was finally executed to identify predictor experienced a ‘‘moderate’’ level of stress, in terms of
variables that influence the manifestation of caregiver burden. depression and anxiety, they have been classified as being
‘‘severe’’ and ‘‘extremely severe’’, respectively.
Results
Burden and QOL profile of caregivers
Respondents’ profile
This profile was generated by using the median to classify
All caregivers were married and their age ranged from 28 to
respondents into ‘‘low’’ and ‘‘high’’ groups in terms of their
60 years (mean ¼ 49.4). The majority of them were men
burden and QOL scores. It is seen from Table 3 that the
(62.5%) and Hindus by religion (88%). They came from a
majority of respondents have been rated as being ‘‘high’’ on
rural setting and were predominantly farmers (73%) with a
the burden perceived by them. It is worth mentioning that
monthly income up to Rs. 4000 (82%) (about $60).
according to scoring instructions, scores above 60 are
Educational background was low with most having attended
classified as ‘‘severe burden’’ and that all caregivers in this
school at various levels. The family size for the majority was
study met this criterion. It is also seen that based on the
two or three members (60%) (mean family size ¼ 3.6). They
median, with regard to the total QOL score as well as all the
provided care in their capacity of either being parents (72%)
seven dimensions of the S-CGQoL, that the majority have
or the spouse (28%) of the person undergoing treatment for
been classified as being ‘‘low’’.
schizophrenia.
Comparisons based on background factors
Care recipients’ profile
In order to compare the relationship status of the caregivers
The persons undergoing treatment for schizophrenia were on the key domains, t tests were carried out. No significant
between 17 and 54 years of age (mean ¼ 31.4), and the difference was seen based on parent/spouse status in terms of
majority were unmarried (59.7%) men (63.6%). They had a the ZBI scores (t ¼ 0.64; p ¼ 0.43) and the total QOL scores
low level of education at different levels of school; 45.5% (t ¼ 1.18; p ¼ 0.24) except for the psychological burden and
were unemployed and 18.2% said they were housewives. The daily life component of the QOL scale (t ¼ 2.78; p ¼ 0.01).
others mentioned working as farmers, tailors, weavers,
mechanics and being engaged in small trades. About 63.6%
Table 1. Distribution of care recipients by PANSS profile.
did not have an income and those who did, earned up to Rs.
3000 per month (about $45). The duration of their illness
Positive Negative General
ranged from 5 to 15 years (mean ¼ 5.67). They had all been in Score symptoms symptoms psychopathology
treatment previously and said that the illness had an insidious
11–20 14 (19.2) 49 (64.7) –
onset and was progressive in nature with deterioration of 21–30 60 (79.5) 6 (8.8) –
symptoms over time. 31–40 – 17 (22.6) 38 (49.9)
41–50 1 (1.3) 3 (3.9) 36 (48.8)
51–60 – – 1 (1.3)
PANSS profile of care recipients Total 75 (100) 75 (100) 75 (100)
Mean 24.9 21.9 40.2
The majority of patients scored up to 30 (maximum score 49) SD 5.5 10.4 4.7
on the positive symptoms scale, much lower than the other Range 14.0–41.0 14.0–55.0 32.0–60.0
two domains of the PANSS.
Figures in parentheses are percentages.
Table 1 shows that scores for the negative scale are
distributed at all levels with the majority having scored up to
40 out of a maximum possible 49. Table 2. DASS profile of caregivers.
The third PANSS domain constitutes a general psycho-
pathology scale and the majority have scored between 31 and Severity Depression Anxiety Stress
50 (maximum score 112) on this scale. Normal – – –
In accordance with the scoring guidelines, a ‘‘Composite Mild – – 1 (1.33)
Scale’’ was also obtained by subtracting the negative score Moderate 36 (48) 1 (1.33) 74 (98.67)
from the positive score. This yields a bipolar index that ranges Severe 39 (52) 2 (2.67) –
Extremely severe – 72 (96) –
from –42 to + 42, which is essentially a difference score
reflecting the degree of predominance of one syndrome Figures in parentheses are percentages.
DOI: 10.1080/09638237.2016.1276537 Correlates of caregiving in schizophrenia 137

Mean scores indicated higher burden in spouses (mean in Table 4, it is seen that the total QOL score of the caregivers
¼ 83.10) than in parents (mean ¼ 82.20) and lower QOL in is negatively correlated with the general psychopathology
spouses (mean ¼ 91.86) than parents (mean ¼ 93.41). Kinship domain of the PANSS score of the patient. Similarly the
status also did not differentiate caregivers in terms of their anxiety scores of the caregivers are negatively correlated with
depression (t ¼ 1.31; p ¼ 0.19), anxiety (t ¼ 0.12, p ¼ 0.90) the negative symptoms of the patient.
and stress scores (t ¼ 0.03; p ¼ 0.98). With regard to correlations of the key variables with
The next comparison was based on the gender of the background factors, it was seen that the duration of the illness
caregivers, and t tests were run to compare male and female was not correlated with caregiver burden scores (r ¼ 0.01,
caregivers on the key dimensions. No statistically significant p40.05) but correlated negatively with the QOL of the
differences were obtained in this comparison on the ZBI caregiver (r ¼ 0.25; p50.05) and with the manifestation of
(t ¼ 1.62; p ¼ 0.10), depression (t ¼ 1.06; p ¼ 0.29), anxiety positive symptoms (r ¼ 0.48, p50.01) and positively with
(t ¼ 1.27; p ¼ 0.21) or stress (t ¼ 0.17; p ¼ 0.86) scores. negative symptoms (r ¼ 0.55, p50.01). The size of the family
However on the overall QOL score, significant difference correlated negatively with the QOL of the caregiver
was seen in terms of the gender of the caregivers (t ¼ 2.19; (r ¼ 0.34, p50.01) and also with their burden score (r ¼
p ¼ 0.03), and mean scores indicate higher QOL for male 0.34, p50.01). The age of the caregiver or that of the
caregivers (mean ¼ 93.9) than for females (mean ¼ 91.2). In patient however did not enter into any significant correlations
terms of the sub-dimensions of the QOL scale, significant with any of the subject dimensions.
differences were obtained for psychological and physical
well-being (t ¼ 3.20; p ¼ 0.002) and psychological burden and Predictors of caregiving burden
daily life domains (t ¼ 3.17; p ¼ 0.002), with higher mean A multiple regression was conducted to see if the scores of
scores for men on both. any of the DAS and PANSS subscales and the total QOL
Comparison was then made in relation to the gender of the score predicted the extent of burden (ZBI score) perceived by
care recipient also using t tests. No statistically significant the caregivers. The ZBI scores of the caregivers were treated
differences were obtained in this analysis for any of the as the dependent variable and the analysis performed by
subject dimensions on either the ZBI (t ¼ 0.95; p ¼ 0.35), treating the depression, anxiety, stress, negative symptoms,
depression (t ¼ 0.20; p ¼ 0.84), anxiety (t ¼ 1.09; p ¼ 0.28), positive symptoms, general psychopathology and total QOL
stress (t ¼ 1.53; p ¼ 0.13) and QOL scores (t ¼ 0.83; scores, as independent variables.
p ¼ 0.41). Using the enter method, it was found that together the
independent variables explained a significant amount of the
Correlations among variables
variance in the extent of burden perceived (F(7, 67) ¼ 2.37,
While it is not surprising to obtain correlations among p ¼ 0.02, R2 ¼ 0.14, R2 Adjusted ¼ 0.05). However, the depres-
dimensions of the same scale (PANSS or DASS) as portrayed sion ( ¼ 0.27, t(74) ¼ 2.17, p ¼ 0.03) and stress scores

Table 3. Burden and QOL profile of caregivers.

Variable Low High Median Mean SD Range

Total burden score 38 (25.3) 112 (74.7) 85.0 82.5 5.4 68–91
Total QOL score 44 (58.7) 31 (41.3) 92.0 92.9 5.1 79–105
Psychological & physical well-being 73 (97.3) 2 (2.7) 21.0 20.4 1.4 16–22
Psychological burden & daily life 61 (81.3) 14 (18.7) 32.0 31.5 1.8 25–34
Relationship with spouse 66 (88.0) 9 (12.0) 5.0 5.1 0.7 4–8
Relationship with psychiatric team 64 (85.3) 11 (14.7) 12.0 12.2 1.5 9–15
Relationship with family 60 (80.0) 15 (20.0) 4.0 4.4 0.9 2–6
Relationship with friends 58 (77.3) 17 (22.7) 6.0 6.4 1.1 2–8
Material burden 43 (57.3) 32 (42.7) 12.0 13.1 1.9 6–15

Figures in parentheses are percentages.

Table 4. Correlation matrix for key subject variables.

Positive Negative General

Variables symptoms symptoms psychopathology Depression Anxiety Stress Total ZBI Total QOL
Positive symptoms 1 – – – – – – –
Negative symptoms –0.75** 1 – – – – – –
General psychopathology –0.04 0.28* 1 – – – – –
Depression –0.20 0.10 0.06 1 – – – –
Anxiety –0.23 –0.26* –0.10 –0.29* 1 – – –
Stress –0.02 –0.01 –0.04 –0.25* –0.17 1 – –
Total ZBI –0.06 –0.01 –0.03 –0.18 –0.01 –0.19 1 –
Total QOL 0.12 –0.20 –0.31** –0.15 –0.08 –0.15 0.18 1

N ¼ 75; p50.05*; p50.01**.

138 S. Stanley et al. J Ment Health, 2017; 26(2): 134–141

( ¼ 0.26, t(74) ¼ 2.16, p ¼ 0.03) were the only two key significant predictors that influence caregiver burden. A high
variables that significantly predicted the burden perceived by prevalence of depressive symptoms and anxiety has been
the caregivers. reported in caregivers of patients with chronic mental
illnesses (Magaña et al., 2007; Perlick et al., 2007).
Discussion Caregivers with higher psychological distress have been
The composite PANSS score shows that the majority of care found to have a heavier caregiving burden (Cw Lam et al.,
recipients predominantly exhibited positive symptoms. The 2013). Caregivers of persons with schizophrenia experience
Type I or positive syndrome is composed of florid symptoms, more stress due to the nature of the symptoms as well as the
such as delusions, hallucinations and disorganized thinking, prolonged duration of illness (Raj et al., 2016). Spending
which are superimposed on the mental status of the person more time with the patient, being assaulted by the patient,
(Kay et al., 1987). It is to be expected that those with a interruption to work, disputes with children and other
predominance of positive symptoms would experience more relatives and feelings of increased psychological burden are
disorientation, disorganization and distortion of reality, thus factors associated with caregiver depression (Rodrigo et al.,
posing a greater difficulty in management. Positive symptoms 2013).
create a sense of powerlessness, helplessness and heighten Low QOL on various dimensions has been seen in the
fears in others (Magliano et al., 1998), and severity of positive caregivers in this study, and this agrees with findings from
symptoms has been associated with higher levels of caregiver earlier studies (Awadalla et al., 2005; Li et al., 2004; Margetić
burden (Chen et al., 2004). et al., 2013). Previous studies reveal a negative correlation
This study has however not found any significant statistical between caregivers’ age and their QOL (Awadalla et al.,
correlation between any of the three subscales of the PANSS 2005; Margetić et al., 2013), but this has not been evidenced
and caregiver burden, and none of these have been elicited as in our study. Correlations between low QOL and high burden
predictors of caregiver burden through regression analysis. in caregivers reported by Foldemo et al. (2005) have also not
This is in agreement with the findings of Aydin et al. (2009). been established in our study. In terms of kinship status, we
Previous studies have however found a positive relationship did not find any significant difference between parents and
between PANSS scores and caregiver burden (Adeosun, 2013; spouse on QOL. However other studies have indicated that
Perlick et al., 2006; Ponangi et al., 2014). The general parents show lower QOL than other family members
psychopathology scores of PANSS showed a negative correl- (Awadalla et al., 2005; Margetić et al., 2013). We found
ation with the QOL scores of the caregivers. The general gender differences and lower QOL in female caregivers, and
psychopathology subscale consists of 16 symptoms that this is in consonance with an earlier study from India
include disorientation, disturbance of volition, poor impulse (Rammohan et al., 2002). We obtained significant relation-
control, unusual thought content and social avoidance. It ships between patient characteristics such as the duration of
seems that these symptoms create difficulty in patient their illness, their positive and negative symptoms and the
management and impact the QOL of the caregivers. QOL of their caregivers. This indicates that chronicity of
The finding of high perceived burden in caregivers of illness and symptom severity does adversely impact care-
persons with schizophrenia in this study is in agreement with givers’ QOL (Jagannathan et al., 2014). Based on the gender
of the patients, no difference was seen in terms of the QOL of
several studies from India (Ampalam et al., 2012; Ganguly
caregivers, and this is congruent with another study from
et al., 2010; Kate et al., 2013; Mandal et al., 2014) and also
India (Sreeja et al., 2009).
those from the West (Lowyck et al., 2004; Roick et al., 2006;
Wolthaus et al., 2002). Disruption in family life and in family
interaction, financial burden and adverse consequences in Implications for intervention
terms of well-being and health are some consequences of The evidence relating to dealing with caregiving issues
caregiving burden reported by earlier studies from India conclusively demonstrates the usefulness of family-based
(Chakrabarti et al., 1995; Talwar & Matheiken, 2010; Thara interventions in lessening negative outcomes for caregivers
et al., 1998). Patient characteristics (such as age, gender, (Chakrabarti, 2016). While the focus of clinical intervention
symptomatology and duration of illness) did not influence the has been on the patient (and rightly so), this tends to disregard
burden of caregivers in this study. In terms of gender, the and side-line the needs of caregivers with no supportive
literature reports an association between family burden and intervention strategies put in place to enable them deal
patients being male (Roick et al., 2007) and greater burden in effectively with the demands and challenges encountered in
female caregivers (Thunyadee et al., 2015). Based on the caregiving.
gender of the patients, no difference was seen in terms of A systematic review of the efficacy of psychoeducational
caregivers’ burden and this is in agreement with an earlier programmes among families of patients with schizophrenia
study from India (Sreeja et al., 2009). found that they were highly effective in increasing knowledge
The adverse consequence of caregiving on the mental levels and coping strategies (Sin & Norman, 2013) and to
health status of caregivers has been evidenced by several improve patient functioning (Li & Arthur, 2005). The
other studies (Gater et al., 2014; Gupta et al., 2015; Mitsonis psychoeducational approach would be relevant in the Indian
et al., 2012; Stanley et al., 2016; Suro & De Mamani, 2013). context given the economics involved besides the fact that
High scores obtained for depression, anxiety and stress in this illiteracy and ignorance play a huge role in understanding the
study are indicative of heightened psychological distress in nature of mental illness. Orientation of caregivers to aspects
caregivers. Depression and stress levels also emerged as such as the nature of schizophrenia, its prognosis, relapse and
DOI: 10.1080/09638237.2016.1276537 Correlates of caregiving in schizophrenia 139

the importance of adherence to medication would enable interventions involving psychoeducational approaches and
more favourable family attitudes towards the patient. the provision of support groups for caregivers be envisaged as
There is also evidence that social support is a key issue integral components of management and care of people with
that influences the burden perceived by caregivers schizophrenia.
(Adeosun, 2013; Aggarwal et al., 2011). The provision of
supportive networks would thus go a long way in Declaration of interest
mitigating caregiver burden. Peer support that involves
sharing and learning from the experiences of other This study did not receive any funding. The authors declare
caregivers could also provide comfort in the knowledge no conflict of interest.
that one is not alone in facing distressful situations.
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