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Family caregivers and outcome of people with schizophrenia in rural China: 14-year follow-up study

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Abstract

Objective

This study examined the differences in 14-year outcomes of persons with schizophrenia with and without family caregiver(s) in a rural community in China.

Methods

All participants with schizophrenia (n = 510) aged 15 years and older were identified in a 1994 epidemiological investigation of 123,572 people and followed up in 2004 and 2008 in Xinjin County, Chengdu, China.

Results

Individuals without family caregiver in 1994 had significantly higher rate of homelessness (23.8 %) and lower rate of survival (47.5 %) in 2008 than those with family caregivers (5.1 and 70.9 %). Compared with individuals with family caregivers, those without family caregivers were more likely to be male, live alone, have fewer family members, lower family economic status, lower rates of marriage and complete remission, higher mean scores on PANSS and lower mean score on GAF in 2008. The predictors of participants without family caregiver in 2008 included having a small number of family members at baseline and being male.

Conclusions

The absence of a family caregiver is a predictive factor of poorer long-term outcome of persons with schizophrenia in the rural community. The critical role of family caregiving should be incorporated in the planning and delivering of mental health policies and community-based mental health services.

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References

  1. Parabiaghi A, Lasalvia A, Bonetto C, Cristofalo D, Marrella G, Tansella M, Ruggeri M (2007) Predictors of changes in caregiving burden in people with schizophrenia: a 3-year follow-up study in a community mental health service. Acta Psychiatr Scand 116:66–76

    Article  Google Scholar 

  2. García JIR, Chang CL, Young JS, López SR, Jenkins JH (2006) Family support predicts psychiatric medication usage among Mexican American individuals with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 41:624–631

    Article  Google Scholar 

  3. Pilling S, Bebbington P, Kuipers E, Garety P, Geddes J, Orbach G, Morgan C (2002) Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med 32:763–782

    CAS  PubMed  Google Scholar 

  4. Ran MS, Chan CL, Ng SM, Guo LT, Xiang MZ (2015) The effectiveness of psychoeducational family intervention for patients with schizophrenia in a 14-year follow-up study in a Chinese rural area. Psychol Med. doi:10.1017/S0033291715000197

    PubMed  Google Scholar 

  5. Bebbington P, Kuipers L (1994) The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychol Med 24:707–718

    Article  CAS  PubMed  Google Scholar 

  6. Butzlaff RL, Hooley JM (1998) Expressed emotion and psychiatric relapse: a meta-analysis. JAMA Psychiatry 55:547–552

    CAS  Google Scholar 

  7. Mihanović M, Restek-Petrović B, Bogović A, Ivezić E, Bodor D, Požgain I (2015) Quality of life of patients with schizophrenia treated in foster home care and in outpatient treatment. Neuropsychiatr Dis Treat 11:585–595

    PubMed  PubMed Central  Google Scholar 

  8. Jablensky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, Bertelsen A (1992) Schizophrenia: manifestations, incidence and course in different cultures: A World Health Organization ten-country study. Psychol Med Monogr Suppl 20:1–97

    Article  CAS  PubMed  Google Scholar 

  9. Saha S, Chant D, Welham J, McGrath J (2005) A systematic review of the prevalence of schizophrenia. PLoS Med 2:e14

    Article  Google Scholar 

  10. Bresnahan M, Menezes P, Varma V, Susser E (2003) Geographical variation in incidence, course and outcome of schizophrenia: A comparison of developing and developed countries. In: Murry R, Jones P, Susser E, van Os J, Cannon M (eds) The epidemiology of schizophrenia. Cambridge University Press, UK, pp 18–33

    Google Scholar 

  11. Ran MS, Xiang MZ, Li SX, Shan YH, Huang MS, Li SG, Liu ZR, Chen EYH, Chan CLW (2003) Prevalence and course of schizophrenia in a Chinese rural area. Aust NZ J Psychiatr 37:452–457

    Article  Google Scholar 

  12. Jenkins JH, Karno M (1992) The meaning of expressed emotion: theoretical issues raised by cross-cultural research. Am J Psychiatr 149:9–21

    Article  CAS  PubMed  Google Scholar 

  13. Lefley HP (1990) Culture and chronic mental illness. Psychiatr Serv 41:277–286

    Article  CAS  Google Scholar 

  14. Hansson L, Middelboe T, Merinder L, Bjarnason O, Bengtsson-Tops A, Nilsson L, Sandlund M, Sourander A, SØrgaard KW, Vinding H (1999) Predictors of subjective quality of life in schizophrenic patients living in the community: a Nordic multicentre study. Int J Soc Psychiatry 45:247–258

    Article  CAS  PubMed  Google Scholar 

  15. Bond M (1996) Chinese values. In: Bond M (ed) The handbook of Chinese pscyhology. Oxford University Press, Oxford, pp 208–226

    Google Scholar 

  16. Chan GWL, Ungvari GS, Shek DTL, Leung JJP (2003) Hospital and community-based care for patients with chronic schizophrenia in Hong Kong: quality of life and its correlates. Soc Psychiatry Psychiatr Epidemiol 38:196–203

    Article  PubMed  Google Scholar 

  17. Leung J, Xu Y (2015) China’s social welfare. Polity Press, London

    Google Scholar 

  18. Ran MS, Chan CLW, Chen EYH, Mao WJ, Hu SH, Tang CP, Lin FR, Conwell Y (2009) Differences in mortality and suicidal behaviour between treated and never-treated people with schizophrenia in rural China. Br J Psychiatry 195:126–131

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ran MS, Chen S, Chen E, Ran BY, Tang CP, Lin FR, Li L, Li SG, Mao WJ, Hu SH (2011) Risk factors for poor work functioning of persons with schizophrenia in rural China. Soc Psychiatry Psychiatr Epidemiol 46:1087–1093

    Article  PubMed  Google Scholar 

  20. Yin Y, Zhang W, Hu Z, Jia F, Li Y, Xu H, Zhao S, Guo J, Tian D, Qu Z (2014) Experiences of stigma and discrimination among caregivers of persons with schizophrenia in China: a Field Survey. PLoS One 9:1–11

    Google Scholar 

  21. Xiang YT, Wang CY, Chiu HFK, Weng YZ, Bo QJ, Chan SS, Lee EH, Ungvari GS (2011) Socio-Demographic and clinical profiles of paranoid and nonparanoid schizophrenia: a prospective, multicenter study in China. Perspect Psychiatr Care 47:126–130

    Article  PubMed  Google Scholar 

  22. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS (2011) Burden of Chinese stroke family caregivers: the Hong Kong experience. Arch Phys Med Rehabil 92:1462–1467

    Article  PubMed  Google Scholar 

  23. Yan F, Xiang YT, Hou YZ, Ungvari G, Dixon L, Chan SS, Lee EH, Li WY, Li WX, Zhu YL, Chiu HE (2013) Suicide attempt and suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients. Soc Psychiatry Psychiatr Epidemiol 48:447–454

    Article  PubMed  Google Scholar 

  24. Ran MS, Mao WJ, Chan CLW, Chen EYH, Conwell Y (2015) Gender differences in outcomes in people with schizophrenia in rural China: 14-year follow-up study. Br J Psychiatry 206:283–288

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ran MS, Xiang MZ, Huang M, Shan Y (2001) Natural course of schizophrenia: 2-year follow-up study in a rural Chinese community. Br J Psychiatry 178:154–158

    Article  CAS  PubMed  Google Scholar 

  26. Pearson V (1993) Families in China: an undervalued resource for mental health? J Fam Ther 15:163–185

    Article  Google Scholar 

  27. Lin KM, Kleinman AM (1988) Psychopathology and clinical course of schizophrenia: a cross-cultural perspective. Schizophr Bull 14:555–567

    Article  CAS  PubMed  Google Scholar 

  28. Borge L, Martinsen EW, Ruud T, Watne Ø, Friis S (1999) Quality of life, loneliness, and social contact among long-term psychiatric patients. Psychiatr Serv 50:81–84

    Article  CAS  PubMed  Google Scholar 

  29. Yang K (1995) Chinese social orientation: an integrative analysis. In: Lin T, Tseng W, Yeh E (eds) Chinese societies and mental health. Oxford University Press, Oxford, pp 19–39

    Google Scholar 

  30. Xiong W, Phillips M, Hu X, Wang R, Dai Q, Kleinman J, Kleinman A (1994) Family based intervention for schizophrenic patients in China: a randomised controlled trial. Br J Psychiatry 165:239–247

    Article  CAS  PubMed  Google Scholar 

  31. Davidson RJ, Kabat-Zinn J, Shchumacher J, Rosenkranz M, Muller D, Santorelli SF, Urbanowski F, Harrington A, Bonus K, Sheridan JF (2003) Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med 65:564–570

    Article  PubMed  Google Scholar 

  32. Mattsson M, Topor A, Cullberg J, Forsell Y (2008) Association between financial strain, social network and five-year recovery from first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 43:947–952

    Article  PubMed  Google Scholar 

  33. Chien WT, Chan SW, Morrissey J (2007) The perceived burden among Chinese family caregivers of people with schizophrenia. J Clin Nurs 16:1151–1161

    Article  PubMed  Google Scholar 

  34. Gumley AI, Taylor HEF, Schwannauer M, MacBeth A (2014) A systematic review of attachment and psychosis: measurement, construct validity and outcomes. Acta Psychiatr Scand 129:257–274

    Article  CAS  PubMed  Google Scholar 

  35. Berry K, Wearden A, Barrowclough C (2007) Adult attachment styles and psychosis: an investigation of associations between general attachment styles and attachment relationships with specific others. Soc Psychiatr Psychiatr Epidemiol 42:972–976

    Article  Google Scholar 

  36. Ran MS, Leff J, Hou ZJ, Xiang MZ, Chan CLW (2003) The characteristics of expressed emotion among relatives of patients with schizophrenia in Chengdu, China. Cult Med Psychiatry 27:95–106

    Article  PubMed  Google Scholar 

  37. Miralles C, Alonso Y, Verge B, Setó S, Gaviria AM, Moreno L, Cortés MJ, Gutiérrez-Zotes A, Vilella E, Martorell L (2014) Personality dimensions of schizophrenia patients compared to control subjects by gender and the relationship with illness severity. BMC Psychiatry 14:242–262

    Article  Google Scholar 

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Acknowledgments

The authors thank the Xinjin Mental Hospital and the Chengdu Mental Health Center for collaboration and data collection.

Author information

Authors and Affiliations

  1. Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China

    Mao-Sheng Ran, Cheryl H. K. Chui & Cecilia Lai-Wan Chan

  2. School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA

    Irene Yin-Ling Wong

  3. Chengdu Mental Health Center, Chengdu, 610036, China

    Wen-Jun Mao

  4. Xinjin Mental Hospital, Xinjin, 611432, Chengdu, China

    Fu-Rong Lin

  5. Jingzhou Mental Health Center, Jingzhou, 434000, Hubei, China

    Bo Liu

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  1. Mao-Sheng Ran
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  5. Fu-Rong Lin
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  7. Cecilia Lai-Wan Chan
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Corresponding author

Correspondence to Mao-Sheng Ran.

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Conflict of interest

None.

Funding

The 1994 Chengdu study was supported by a grant from the China Medical Board in New York (CMB, 92-557; MZ Xiang, PI). This study was supported in part by Global Research Initiative Program from National Institutes of Health (NIH, 1R01 TW007260-01; Ran MS, PI) and American Foundation for Suicide Prevention (AFSP; Ran MS, PI).

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Ran, MS., Chui, C.H.K., Wong, I.YL. et al. Family caregivers and outcome of people with schizophrenia in rural China: 14-year follow-up study. Soc Psychiatry Psychiatr Epidemiol 51, 513–520 (2016). https://doi.org/10.1007/s00127-015-1169-0

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  • DOI: https://doi.org/10.1007/s00127-015-1169-0

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