Research That Matters (January 17 - 20, 2008)

Purpose: Research on families of individuals with schizophrenia has consistently found the relative's level of psychiatric symptoms is the strongest predictor of the family burden. Similarly, studies of expressed emotion (EE) indicate that clients may become more symptomatic in response to high levels of family stress. However, researchers have yet to examine the bidirectional effects between family burden and symptoms. The goal of this study was to examine whether levels of family burden have an effect on client symptoms over time, and conversely, whether the client's symptoms lead to increased levels of family burden over time.

Methods: The data were drawn from a larger longitudinal study of aging families of adults with schizophrenia. Mothers, who were providing care to a son or daughter with schizophrenia, completed an in-home interview and self-administered questionnaire at each wave of data collection, which were spaced 18 months apart. At each time period, caregiver burden was measured by the Zarit Burden Interview. The adult with schizophrenia was asked to participate by independently completing a self-administered questionnaire, which included the Symptom Severity Scale from the Schizophrenia Outcomes Module: Informant Version. This analysis is based on 110 mother/adult child dyads who participated in the first two waves of the study. The mothers averaged 70 years old and the adult children with schizophrenia averaged 41 years old. Approximately 43% of the adults with schizophrenia lived with their parents. A cross-lagged analysis was conducted looking at the effects of caregiver burden at Time 1 on the adult's psychiatric symptoms at Time 2, and the effect of the adult's psychiatric symptoms at Time 1 on levels of caregiver burden at Time 2.

Results: Caregiver burden at Time 1 was significantly (â=.14, p<.05) related to an increase in psychiatric symptoms at Time 2. After controlling for psychiatric symptoms at Time 1, caregiver burden explained an additional 2% of the variance in level of psychiatric symptoms at Time 2. Conversely, psychiatric symptoms at Time 1 were significantly (â=.11, p<.05) related to an increase in caregiver burden at Time 2. Controlling for caregiver burden at Time 1, psychiatric symptoms explained approximately 2% of the variance in caregiver burden at Time 2.

Implications: This is the first study to demonstrate empirically the bidirectional nature of the relationship between caregiver burden and symptom levels in adults with schizophrenia. Our study findings indicate that interventions targeted at reducing caregiver burden will have beneficial effects for consumers of mental health services. The findings speak to the importance of training social workers in models of family psychoeducation, which has been shown to reduce caregiver burden. The study findings also speak to the importance of working with clients to better control and manage their symptoms. A reduction in symptoms improves not only the quality of life of clients but also reduces caregiver burden, which over time may allow the family to play a more supportive role in their relative's life.