Accessible summary
What is known on the subject?
Families act not only as the primary support for people with a diagnosis of schizophrenia but also as partners in the healthcare system.
Families who ...have members with mental disorders, particularly schizophrenia, experience challenges in family functioning.
Research on families in relation to schizophrenia primarily focuses on the determinants that affect family functioning from primary family caregivers' perspectives.
What does the paper add to existing knowledge?
This report provides evidence that there is a concordance between family functioning and inpatient psychiatric rehabilitation facilities for the patient–caregiver dyad; both care‐receivers and primary family caregivers considered family functioning as poor.
Care‐receivers with lower education levels, increased number of previous hospitalizations and poor quality of family‐centred care experienced unhealthy family functioning.
Primary family caregivers and care‐receivers with higher education levels, lower suicidality and greater quality of family‐centred care experienced healthier family functioning.
What are the implications for practice?
Understanding the degree of family functioning, particularly its concordance and correlates as perceived by patients and primary family caregivers, may serve as a platform for inculcating assessment of family functioning to achieve holistic patient care.
Open dialogue in family‐focused care planning is essential to facilitate collaborative partnerships and improve family functioning among people with a diagnosis of schizophrenia and their primary family caregivers.
Further research on culturally relevant, evidence‐based family interventions to enhance the functioning of affected families is warranted, especially for families with members in inpatient psychiatric rehabilitation facilities.
Introduction
Families provide frontline caregiving support for people with a diagnosis of schizophrenia. However, research primarily addresses correlates of family functioning from primary family caregivers' perspectives.
Aim
To examine perceived family functioning, particularly its concordance within patient–caregiver dyads and associated factors in families of people living with schizophrenia.
Methods
A cross‐sectional, descriptive correlational design was used. A total of 133 dyads of patients and primary family caregivers from inpatient psychiatric rehabilitation services participated. Descriptive statistics, independent‐sample t test, one‐way ANOVA, Pearson's correlation coefficients, intraclass correlation coefficient and stepwise multiple linear regression analyses were applied.
Results
Family functioning was perceived as impaired by patient–caregiver dyads, and there existed a concordance in this regard. Patients' and family caregivers' education levels, patients' suicidality, number of previous hospitalizations and quality of family‐centred care correlated with patients' and primary family caregivers' family functioning.
Discussion
Findings highlight the importance of patient‐ and family‐reported family functioning with implications to address individual and collective concerns.
Implications for Practice
Evidence‐based family interventions are crucial for assisting vulnerable families in promoting family functioning. Mental health nurses should facilitate collaboration and open dialogue concerning perspectives of patients and families to improve delivery of comprehensive mental health care.
Health‐related quality of life is an increasingly critical outcome of mental healthcare, yet its disease‐independent attributes, particularly family‐focused resilient indicators, for individuals with ...schizophrenia have not been explicitly examined. The aim of this study was to explore the degree of health‐related quality of life and to examine the mediating effect of family sense of coherence on internalized stigma and health‐related quality of life in individuals with schizophrenia. A cross‐sectional and correlational study design was used. A total of 111 individuals with schizophrenia were enrolled from the in‐patient psychiatric rehabilitation services of two psychiatric hospitals in Taiwan. Face‐to‐face structured interviews were applied to collect information. Data were analyzed with descriptive statistics and multiple regression analyses. The results indicated that affected individuals experienced impaired health‐related quality of life. Family sense of coherence partially mediated the relationship between internalized stigma and health‐related quality of life. This study indicates that knowledge about the role of family sense of coherence in mental health rehabilitation may assist mental healthcare professionals to provide therapeutic interventions to address internalized stigma, thereby promoting health‐related quality of life in individuals living with schizophrenia.
Caregiving for patients with schizophrenia is often challenging and may increase the risk of psychiatric morbidity among primary family caregivers. However, the associated factors of psychiatric ...morbidity among caregivers have not been fully investigated.
This study aimed to screen psychiatric morbidity and its correlates among primary family caregivers of persons with schizophrenia receiving inpatient psychiatric rehabilitation services.
A cross-sectional, correlational design was used. A total of 184 Taiwanese primary family caregivers in inpatient psychiatric rehabilitation units participated in the study. Descriptive statistics, Chi-square tests, independent t-tests, and a stepwise binary logistic regression analysis were performed to examine the association among primary family caregivers' psychiatric morbidity and primary family caregivers' sociodemographic characteristics and mutuality and patients' sociodemographic and clinical characteristics.
The prevalence of psychiatric morbidity among primary family caregivers was 48.4%. Unemployment, lower mutuality, additional dependents in need of care, and caring for patients with more psychiatric hospitalizations were the most significant factors for psychiatric morbidity among primary family caregivers.
Mental healthcare professionals should recognize patients and their primary family caregivers as a unit of care. Primary family caregivers must receive increased assistance, including supportive resources and therapeutic interventions, to reduce psychiatric morbidity.
To evaluate associations between maternal lifetime traumatic stress and offspring birthweight and examine modifying effects of third trimester cortisol and fetal sex.
Analyses included 314 ...mother–infant dyads from an ethnically mixed pregnancy cohort. Maternal lifetime trauma was reported via the Life Stressor Checklist-Revised. Fenton birthweight for gestational age z-scores (BWGA-z) were calculated. A 3-cm scalp-nearest maternal hair segment collected at birth was assayed to reflect cumulative third trimester cortisol secretion. Multivariable regression was used to investigate associations between maternal lifetime trauma and BWGA-z and examine 2- and 3-way interactions with cortisol and fetal sex. Because subjects with low or high cortisol levels could represent susceptible populations, varying coefficient models that relax the linearity assumption on cortisol level were used to assess the modification of maternal lifetime trauma associations with BWGA-z as a function of cortisol.
Women were primarily minorities (41% Hispanic, 26% black) with ≤12 years education (63%); 63% reported ≥1 traumatic event. Prenatal cortisol modified the association between maternal lifetime trauma and birthweight. Women with higher lifetime trauma and increased cortisol had significantly lower birthweight infants in males; among males exposed to the 90th percentile of cortisol, a 1-unit increase in trauma score was associated with a 0.19-unit decrease in BWGA-z (95% CI, −0.34 to −0.04). Associations among females were nonsignificant, regardless of cortisol level.
These findings underscore the need to consider complex interactions among maternal trauma, disrupted in utero cortisol production, and fetal sex to fully elucidate intergenerational effects of maternal lifetime trauma.
This study aimed to investigate the factors influencing mental health nurses' attitudes towards people with mental illness. A descriptive correlation design was used. A sample of 180 Taiwanese mental ...health nurses was recruited from mental health‐care settings. Data were analyzed with descriptive statistics, Pearson's product‐moment correlation, Student's t‐test, one‐way anova, and a hierarchical multiple regression analysis. Negative attitudes were found among mental health nurses, especially with respect to individuals with substance abuse compared with those with schizophrenia and major depression. Mental health nurses who were older, had more clinical experiences in mental health care, and demonstrated greater empathy expressed more positive attitudes towards people with mental illness. Mental health nurses working at acute psychiatric units demonstrated more negative attitudes towards mental illness compared with those working in psychiatric rehabilitation units and outpatient clinics or community psychiatric rehabilitation centres. Particularly, length of mental health nursing practice and empathy significantly accounted for mental health nurses' attitudes towards mental illness. Understanding nurses' attitudes and their correlates towards people with mental illness is critical to deliver effective mental health nursing care.
Prenatal particulate air pollution exposure may alter lung growth and development in utero in a time-sensitive and sex-specific manner, resulting in reduced lung function in childhood. Such ...relationships have not been examined for nitrate (NO3-).
We implemented Bayesian distributed lag interaction models (BDLIMs) to identify sensitive prenatal windows for the influence of NO3- on lung function at age 7 years, assessing effect modification by fetal sex. Analyses included 191 mother-child dyads. Daily ambient NO3- exposure over pregnancy was estimated using a hybrid chemical transport (Geos-Chem)/land-use regression model. Spirometry was performed at mean (SD) age of 6.99 (0.89) years, with forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) z-scores accounting for child age, sex, height and race/ethnicity.
Most mothers were Hispanic (65%) or Black (22%), had ≤ high school education (67%), and never smoked (71%); 17% children had asthma. BDILMs adjusted for maternal age and education and child's asthma identified an early sensitive window of 6–12 weeks gestation, during which increased NO3- was significantly associated with reduced FEV1 z-scores specifically among boys. BDLIM analyses demonstrated similar sex-specific patterns for FVC.
Early gestational NO3- exposure is associated with reduced child lung function, especially in boys.
•Prenatal nitrate exposure is associated with reduced lung function at age 7 years•Link between prenatal nitrate exposure and lung function deficits is male-specific•Significant effects occur during early sensitive window of 6-12 weeks gestation
Family functioning, particularly among primary family caregivers for patients with schizophrenia, is a global concern that poses unprecedented challenges. The family unit is a pivotal agent for the ...preservation of the integrity of individual members. Little attention has been paid to the changes in family functioning and their predictors in primary family caregivers. This study aimed to examine the changes in and the correlates of family functioning in primary family caregivers of individuals with schizophrenia over a 6-month post-discharge period.
A prospective, longitudinal study was conducted.
A total of 58 primary family caregivers of patients with schizophrenia were recruited from two psychiatric hospitals in Taiwan. Data were collected four times, including 1 week before hospital discharge and at 1-, 3-, and 6-month intervals post-discharge. Demographic and clinical questionnaires, the Affiliate Stigma Scale, the Family Empowerment Scale, and the General Functioning subscale were used to collect data. Generalized Estimating Equations were applied for data analysis.
Approximately 59.6%-77.6% of primary family caregivers presented unhealthy family functioning during the 6-month post-discharge period. Significant reductions in family functioning of primary family caregivers were noted in the group with unhealthy family functioning; however, family functioning of primary family caregivers remained unchanged in the group with healthy family functioning over 6 months. Affiliate stigma and family empowerment significantly accounted for the changes in family functioning of primary family caregivers in the groups with unhealthy and healthy family functioning, respectively.
This study highlights affiliate stigma and family empowerment as long-term predictors of changes in family functioning for primary family caregivers and as pivotal targets of mental health care.
Family-centered interventions with a focus on ameliorating affiliate stigma and enhancing family empowerment are recommended to improve family functioning for primary family caregivers of patients with schizophrenia at different periods after hospital discharge.
Purpose
This study aimed to examine the quality of family‐centered care perceived by primary family caregivers and its influencing factors in mental healthcare practice.
Design
A cross‐sectional, ...correlational study.
Methods
A convenience sample of 121 mental health nurses and 164 primary family caregivers of patients with schizophrenia was recruited from acute psychiatric wards and chronic psychiatric rehabilitation wards in three psychiatric hospitals in Taiwan. Structured questionnaires for mental health nurses were designed to examine nurses’ attitudes toward schizophrenia and the importance of families in nursing care. Primary family caregivers were assessed to determine their perceptions of quality of family‐centered care. At least one primary family caregiver of patients was matched to a nurse who took major responsibility for the patient during the hospitalization. Data were analyzed with descriptive statistics, Pearson’s product‐moment correlations, independent t‐test, one‐way analysis of variance, and stepwise regression analyses.
Results
Quality of family‐centered care perceived by primary family caregivers regarding the provision of general and specific information, as compared to enabling and partnership, coordinated and comprehensive care, and respectful and supportive care, was relatively inadequate. Younger and more educated primary family caregivers, having relatives with schizophrenia in acute wards, less supportive nurses’ attitudes toward schizophrenia, and the importance of family in nursing care were correlated with poor primary family caregivers’ perceptions of quality of family‐centered care. Nurses’ supportive attitudes toward schizophrenia and chronic psychiatric rehabilitation wards where patients received care were key factors in determining better quality of family‐centered care.
Conclusions
Findings provide a platform for the development of effective continuing education and training programs to equip mental health nurses with supportive attitudes toward mental illness and an integration of the family in nursing care, which will ultimately improve mental health care for families experiencing mental health problems.
Clinical Relevance
Efforts in professional training to address stigma and encourage a family‐centered approach into recovery‐oriented practice for practicing mental healthcare providers, including mental health nurses, are recommended.
We studied associations between prenatal exposure to particulate matter with diameter ≤ 2.5 μm (PM2.5) and postpartum psychological functioning in a lower income, ethnically mixed sample of urban US ...women enrolled in a pregnancy cohort study. Analyses included 557 mothers who delivered at ≥37 weeks gestation. Daily estimates of residential PM2.5 over gestation were derived using a satellite-based spatio-temporally resolved model. Outcomes included the Edinburgh Postnatal Depression Scale (EPDS) score from 6 or 12 months postpartum and subscale scores for anhedonia, depressive and anxiety symptoms. Associations were also examined within racial/ethnic groups. Distributed lag models (DLMs) were implemented to identify windows of vulnerability during pregnancy.
Most mothers had less than a high school education (64%) and were primarily Hispanic (55%) and Black (29%). In the overall sample, a DLM adjusted for age, race, education, prenatal smoking, and season of delivery, we found significant associations between higher PM2.5 exposure in the second trimester and increased anhedonia subscale scores postpartum. In race stratified analyses, mid-pregnancy PM2.5 exposure was significantly associated with increased total EPDS scores as well as higher anhedonia and depressive symptom subscale scores among Black women.
Increased PM2.5 exposure in mid-pregnancy was associated with increased depressive and anhedonia symptoms, particularly in Black women.
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