In general, interventions are composed of several different elements, including training in stress management, coping skills, and problem solving, as well as counseling and support and sharing of emotions and advice ( 9). However, the exact content of this part of the interventions varies considerably. Management of the disease is also part of 80 percent of the interventions ( 10). In several interventions education is the central element, including oral presentations, discussions, question-and-answer periods, and the distribution of written material. In a review Kazarian and Vanderheyden ( 10) found that most family interventions had an educational element in which information about diagnosis, etiology, course, and treatment of mental illness is given to participants. The content of family interventions varies greatly. Other indicators of effectiveness could not be identified. A meta-analysis of 16 effect studies of family interventions found that interventions with less than 12 sessions did not have a significant effect on relatives' burden ( 9). However, it is not entirely clear which elements of the content and design of the intervention determine its effectiveness. Research indicates that these interventions can effectively reduce relatives' burden ( 9). These interventions focus on improving relatives' quality of life by reducing stress and burden ( 1). The popularity of supportive interventions in recent years is due both to the gradual realization by professionals that the primary burden and responsibility for care of a mentally ill person lies essentially with the family ( 8) and to the pleas of the self-help family organizations for more and better support for relatives. Other interventions are primarily directed at supporting relatives ( 1). Effectiveness studies of these interventions have demonstrated a strong effect in preventing relapse fairly consistently ( 7). Because of the clear relationship between the level of expressed emotion in relatives and relapse ( 6), these interventions concentrate on diminishing the level of expressed emotion through education, training, and therapy. Some interventions are aimed at preventing the patient's relapse. Research in this area, which started in the mid-1950s ( 2), has consistently indicated that the burden on relatives of caring for the patient is considerable and that the relatives' well-being and mental health may become seriously impaired ( 3).ĭuring the past few decades several psychosocial interventions for relatives of patients with schizophrenia have been developed, varying from one educational session ( 4) to intensive family interventions of 15 sessions or more ( 5). The findings suggest that psychoeducation should concentrate on helping relatives cope with the strain on the relationship with the patient and on improving their ability to cope with the patient's behavior.īecause of the deinstitutionalization of psychiatric patients in recent decades, relatives have become the most important caregivers for adults with major psychiatric disorders ( 1). CONCLUSIONS: Strong evidence was found for the relationship between objective and subjective burden and for the hypothesis that particular elements of objective burden contribute more to subjective burden than others. Two aspects of objective burden-strain on the relationship with the patient and ability to cope with the patient's behavior-were related to almost all the investigated aspects of subjective burden. In two regression models, objective burden together with the other predictors explained 57 percent and 54 percent of the variance in subjective burden. RESULTS: Burden in general and emotional exhaustion were the aspects of subjective burden best predicted by objective burden. Regression analyses were conducted, with elements of subjective burden as dependent variables and elements of objective burden, demographic characteristics, and characteristics of the patient's disorder as predictors. A total of 164 participants from 19 psychoeducational groups organized by nine community mental health centers completed the Dutch translation of the Maslach Burnout Inventory and the Involvement Evaluation Questionnaire. METHODS: The study used pretest data from an intervention study in which psychoeducational family support groups in the Netherlands were evaluated. The relationship between subjective burden and objective burden was investigated among caregivers of patients with serious mental illness in the Netherlands who were attending psychoeducational support groups. OBJECTIVE: The effectiveness of family interventions may be improved by concentrating on elements of objective burden that best predict subjective burden.
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