Family Contact and Health Status Among Older Adults with Serious Mental Illness

Objective: Persons with SMI are at significant risk of institutionalization in nursing homes due to psychiatric symptoms and comorbid medical conditions. Given the mounting evidence that social support is a key factor in effective illness management in a variety of medical populations, and the fact that family psychoeducation is an evidence-based practice for improving the course of SMI, families present a potentially untapped source of support for health self-management practices that prolong community tenure among older persons with SMI. The purpose of the present study was to evaluate the amount of family contact in a community-based sample of older persons with SMI (age 50 and over) and to compare the health and mental health status of older adults with SMI across varying levels of family contact (i.e., low, moderate, high). We hypothesized that older adults with SMI who had the highest levels of family contact would report poorer physical health and mental health status.

Methods: This study involved the secondary analysis of a data set based on a randomized controlled trial evaluating the effectiveness of the HOPES program compared to usual service in older persons with SMI receiving mental health services at one of three public-sector mental health centers. The present analyses are based on 180 adults (mean age 60) with SMI. Descriptive statistics were used to estimate the amount of family contact and analysis of variance (ANOVAs) were used to compare the health and mental health status of respondents with 0-1 family contacts in the past month, 2-30 family contacts in the past month, and those living with family members. Post-hoc analyses using Tukey's Honestly Significantly Difference test were used to test for differences that were significant in the ANOVAs.

Results: Over three-quarters of respondents (77.8%) reported speaking with a relative on the telephone over the past month, and 67.2% reported getting together with a family member in the past month. Respondents who were living with family had higher levels of depression and poorer mental health functioning than those with 0-1 family contacts over the past month. The same order of differences was found on self-rated health status. Respondents who were living with family and those who had 2-30 family contacts over the past month had a greater number of comorbid diseases and more severe medical conditions than those with 0-1 family contacts.

Conclusions and Implications: Our findings add to the evidence that older adults with SMI have regular contact with family members and may benefit from family-based interventions. Older adults with SMI who had the highest levels of family contact had the poorest physical and mental health status. This underscores the potential protective role of the family in preventing institutionalization among persons with SMI as a result of psychiatric symptoms and/or medical comorbidiy. Developing interventions that provide families with education about mental illness and comorbid medical problems and knowledge about illness management techniques may enable them to be beneficial in supporting the community tenure of persons with SMI in later life.