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Running head: MENTAL ILLNESS EFFECTS ON FAMILY MEMBERS

FH0825
Mental Illness Effects on Family Members
S.W 3810
Wayne State University
July 17, 2014

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Running head: MENTAL ILLNESS EFFECTS ON FAMILY MEMBERS

Statement of the problem


If individuals with schizophrenia participate in social support therapy will they have less
stress and greater emotional support and will family members benefit from the intervention?
Schizophrenia effects millions of people every day but with proper treatment and
counseling the symptoms can be controlled. Schizophrenia disrupts the person affected by this
illness as well as their family members and caregivers. The characteristics of my population are
individuals with mental illnesses such as schizophrenia, and the burden on caregivers.
The individuals who require care are stressed due to their current mental state and in turn
those who serve them are stressed as well. This causes conflict and is not good for the patients
mental health and recovery. This stress could cause possible relapse or hospitalization of the
mentally ill person.
According to the Archives of Gerontology and Geriatrics Caregivers providing care to
chronically ill family members at home are potentially at risk for caregiver burden and declining
physical and psychological health (Archives of Gerontology and geriatrics phar.1).
The individuals giving the care are diagnosed with caregiver burden which is associated with
decline in mental health and causes sleep problems. The problems happen simultaneously as the
caregiver is caring for a family member and the burdens are long hour, physical stress from
assisting the ill family member and lack of being educated on how to deal with the problems and
stress of the job (Song et al., 1997).

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Running head: MENTAL ILLNESS EFFECTS ON FAMILY MEMBERS

The intervention for this problem would be social support systems and mutual support
group intervention. Furthering the individuals education level on the illness their family
member is facing and the support of the family member to the ill individual will bring down the
level of stress. The training and support will vary depending on the age of the person.
The outcome of this intervention will reduce stress on the mentally ill individual and
caregiver. The mutual support intervention will provide emotional support for them. The support
system will have an overlapping effect because the support and training will allow the caregiver
to effectively manage their time and respond to the ill person their caring for in a calmer manner.
The mental health of the caregiver should improve by feeling less stress and being able to talk
about their problems with others. The stress of the person with the mental illness will also drop
with the support of the family member during the duel invention sessions.

Research Design
A randomized controlled trial with a three-group repeated-measures design was
conducted at two regional psychiatric outpatient clinics between December 2008 and January.
The trial was registered with ClinicalTrials.gov.
The threats to validity would be if one of the patients with schizophrenia aged and their
condition changed by them become mature. A threat to validity would be if the ill person stopped
taking their medications or if their medication changed during the intervention. Another threat
would be if the for example with the mutual support intervention only one of the two involved in
the intervention participated enough to be measured. A threat to external validity in this
intervention would be the quality and training of the staff.

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Running head: MENTAL ILLNESS EFFECTS ON FAMILY MEMBERS

Given that this intervention is done on Chinese patients, there may be some cultural
biases. The cultural bias may compromise the results of the study because the non-Chinese
examiner may not understand the cultures behaviors and compare it to their own cultural
preference.
Sampling
The samplings were done by a random selection process 1,100 individuals with
schizophrenia and were all told to fill out a random questionnaire. One hundred and thirty-five
Chinese family caregivers and their patients with schizophrenia were randomly recruited, of
whom 45 family dyads received family led mutual support group, a psycho-education group, or
standard care.
The sampling frame for this study consists of the Chinese population with schizophrenia.
The advantages of this study that it was conducted by three clinic trials then compared. All the
study groups were randomly selected. The sample was calculated based on the studies
hypotheses and outcome variables. Three different clinical trials were conducted on individuals
within the Chinese with schizophrenia. Thirty-seven family units were required to participate up
to eighty percent of the intervention to detect any difference in the families functioning, or to see
in a change in the re-admission to the hospital because of issues with schizophrenia within a
years time frame. Participants were required to attend at least five sessions. From 520 family
dyads (patient and caregiver) that met the criteria of the study, 135 (26.0%) were randomly
selected and allocated to the three study groups (i.e., 45 family dyads in each group), with an
expected attrition rate of 20%.
Measurement

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Running head: MENTAL ILLNESS EFFECTS ON FAMILY MEMBERS

The key variables investigated in this study Chinese patients with schizophrenia, the
number and duration of patients being readmitted to the hospital because of schizophrenia related
illnesses over a nine month period. Other variables are the patients and caregivers age, gender,
level of education, household income, and duration of the persons illness and the relationship of
the caregiver to the illness individual.
The finding might have been different if the relationship the caregiver had with the
mentally ill person wasnt blood related, the age and culture could have made a difference. The
culture of the patient could have been important in change because one culture may not view a
certain behavior as alarming; some schizophrenia related behavior could be ignored in another
culture and not be reported.
With regard to the outcome measures, a research assistant asked the family caregivers to
complete the Family Assessment Device (FAD), the Six-item Social Support Questionnaire
(SSQ6), and the Family Support Services Index (FSSI); while the patients were invited to
complete the Specific Level of Functioning Scale (SLOF). These scales were translated into
Chinese and tested on Chinese patients with schizophrenia, and were found to have satisfactory
reliability and validity (Chien and Chan, 2004; Chien et al., 2008). During psychiatric
consultations in the outpatient clinics, the attending psychiatrist assessed the severity of the
patients symptoms using the Brief Psychiatric Rating Scale (BPRS, Overall and Gorham, 1962).
The average number and duration of the patients re-hospitalizations over the previous nine
months were checked by the research assistant from the patient records of the clinics.
Demographic data of the patients and their caregivers such as their age, gender, level of
education, monthly household income, duration of mental illness, and relationship with the
patient, were collected by the research assistant at the time of recruitment. Antipsychotic

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Running head: MENTAL ILLNESS EFFECTS ON FAMILY MEMBERS

medications were recorded from patient treatment sheets and their dosages were converted into
haloperidol equivalents for comparison The FAD was used to assess multiple dimensions of
family functioning among patients with mental illness and other chronic diseases. It consists of
60 items to measure family functioning using a four-point Likert scale (from 1-strongly
disagree to 4-strongly agree). The Chinese version of the FAD demonstrated satisfactory
content validity and internal consistency, with Cronbachs alpha coefficients of between 0.78 and
0.92 for subscales and 0.97 for the overall scale. The SSQ6 developed by Sarason et al. (1987)
measures an individuals satisfaction with the social support available in his/her immediate social
environment. The items are rated on a six-point Likert scale, with a higher total score (ranging
from 0 to 6) indicating more satisfaction with the available social support. The translated Chinese
version indicated satisfactory content validity and internal consistency (Cronbachs a = 0.90)
when used in Chinese families of people with schizophrenia (Chien et al., 2006).
The 18-item BPRS developed by Overall and Gorham (1962) was used to assess the severity of
the patients symptoms or mental state. This scale has been used globally in research on mental
health services, indicating good content validity, inter-rater reliability (intra-class correlation =
0.89), and internal consistency (Cronbachs a = 0.85 (Chien et al., 2006; Overall and Gorham,
1962). The mental status of the patients was assessed and rated on a seven-point Likert scale for
each item (0 = not assessed, 1 = not present to 6 = extremely severe). The scores ranged from 0
to 108, with higher scores indicating more severe mental symptoms.
The 16-item FSSI is a checklist (Yes/No response) to measure community service needs and
utilization by families of patients with mental illness (Heller and Factor, 1991). Items were
modified by the authors in a previous study to indicate the community services available in Hong
Kong (Chien et al., 2008), and the instrument demonstrated satisfactory inter-rater reliability

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Running head: MENTAL ILLNESS EFFECTS ON FAMILY MEMBERS

(kappa value = 0.82) and internal consistency (Cronbachs a = 0.84). The SLOF is a 43-item
assessment scale, in which each item is rated on a five-point Likert scale (from 1-totally
dependent to 5-highly self-sufficient) along three functional areas for patients with
schizophrenia: self-maintenance, social functioning, and community living skills (Schneider and
Struening, 1983). The Chinese version demonstrated satisfactory content validity and internal
consistency (Cronbachs a = 0.880.96 for functional areas and 0.90 for overall scale) among
Chinese patients with schizophrenia (Chien et al., 2006).

Data Collection
After written consent was obtained from patients and their caregivers in the outpatient
clinics, the trained research assistant administered the pre-test questionnaires (and demographic
data) before the family dyads were randomly assigned into one of the three study groups (Time
1). During the patients follow-up in the clinic, the research assistant, who was blind to the
participants intervention conditions, also again asked the patients and their family caregivers to
complete the seven outcome measures for three post-tests at one week (Time 2), 12 months
(Time 3) and 24 months (Time 4), following the interventions. The patients hospitalization rates
(frequency and days/month of hospitalizations) in the previous nine months were examined.
The advantages of the form of data collection help the invention not to become
contaminated by bias because the examiner is unaware of participates intervention conditions.
This prevents the examiners not to be influenced by any outside sources.
The only thing that could have been done differently to collect data is to collect the information
of longer periods of time to see if the erosion of time will affect the results.

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Running head: MENTAL ILLNESS EFFECTS ON FAMILY MEMBERS

Ethics and Cultural Considerations


Permission to conduct the study was obtained from the outpatient clinics and the Human
Subjects Ethics Committee of The Hong Kong Polytechnic University. Before randomization,
written consent was sought from the patients and their family caregivers to participate in the
study on a voluntary basis. They were informed of the purpose of the study and what would be
expected of them as participants. They were also guaranteed confidentiality on their personal
information and the data that was collected, and assured of their right to terminate their
participation in the study at any time without any impact on the patients treatment.
This intervention would prove effective with the population chosen by me because the
intervention placed the caregiver and participate together which creates a better bond and
understanding of one another position. Pairing the patient and the caregiver together for
invention brings the unit into on world instead of viewing each other from a foreign place.
The cultural sensitiveness of my target population and of the intervention reviewed is that
the Asian population is less likely to disclose information verses the Western population that are
more reluctant to reveal information to stranger than to people they know out of fear of being
judged or exposed.
Results and Implications
The mutual support intervention group identifies a possible solution to effects that the
mental illness schizophrenia causes on caregivers as well as the patient. This intervention not
only addresses the ill individual problems but also the caregiver. Family psycho-education and
behavioral management interventions for people with schizophrenia are addressed in this
intervention and will work on my target population.

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Running head: MENTAL ILLNESS EFFECTS ON FAMILY MEMBERS

This is important because when caring for a person who has mental disabilities the
caregiver themselves need to be in a good mental state. If the caregivers stressed hes at risk for
abusing their patient and becoming depressed. This invention targets prevention and the risk of
relapse which has been identified in phase 1.
Practitioner Expertise
To conduct an intervention on individuals with schizophrenia and family support groups
the professions expertise needed with be knowledge of clinical trial process, psychologist, nurse,
social work expertise to understand who people behave, sociologist, medical, and group therapy.
Knowledge of cognitive functioning will be required and interrelated studies.
The challenges or barriers that would make it difficult or infeasible to implement this
intervention in my agency would be lack of educated examiners and funding to conduct such an
intervention.
Conclusion
The family-led program for mutual support was deemed to be effective on individuals
with schizophrenia and their families. The intervention will be a positive tool in finding ways in
which to rehabilitee those who suffer from schizophrenia and the families who care for them.

Bibliography

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Running head: MENTAL ILLNESS EFFECTS ON FAMILY MEMBERS

Chien, W. T., & Chan, S. W. (2013). The effectiveness of mutual support group
intervention for Chinese families of people with schizophrenia: A randomized controlled trial
with 24-month follow-up. International Journal of Nursing Studies, 50(10), 1326-1340.

Okamoto, K., & Harasawa, Y. (2009). Emotional support from family members and
subjective health in caregivers of the frail elderly at home in Japan. Archives of Gerontology and
Geriatrics, 49(1), 138-141.

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