Importance of Contributing to the Family: Reciprocity Observed in Veterans with Serious Mental Illness (WITHDRAWN)

Historically, the impact of serious mental illness (SMI) on family has focused on caregiving burden.  It is estimated that 35% to 75% of adults with SMI live with family members and many more families are actively involved in  their relative’s life despite residing separately. Living with and helping a family member with SMI can be challenging and as a result, a body of research has labeled this as“caregiving burden.” Recent research highlight the bidirectional relationship between the person with SMI and their family members. Evidence from parent and sibling research suggests that helping a relative with SMI can lead to positive transformations including deepening sense of self-awareness and greater empathy toward others in society.  Although there has been an increase in awareness of the potential for reciprocity,  there is a major gap in knowledge regarding the contributions of the person with SMI to the family..

This secondary analysis of data obtained from a randomized control trial of a family-based intervention (Recovery-Oriented Decisions for Relative’s support (REORDER)) focuses on the relationships of Veterans with SMI and their family members. An innovative chart extraction strategy of clinicians’ notes and observations about relationships was conducted to examine reciprocity among veterans and their family.  

A total of 232 Veterans with SMI completed an initial 90- minute in-person interview and were randomly assigned to the REORDER intervention. Clinicians documented treatment of both groups in routine chart notes. Verbatim chart notes that referenced family or relatives was extracted. Of the 226 participants, chart notes including family were identified for 189 participants.  A total of  1694 extracted chart note were coded using a framework analysis approach. Relationship reciprocity was an a priori theme and was coded as present when the clinician described an activity of Veteran helping his/her family members, or family members helping the Veteran. Of the 189 participants, 143 participants had at least 1 clinician chart note that was coded for reciprocity; 46  participants had no indication of reciprocity in their entries. The 143 participants who had reciprocity present in their entries were then grouped to compare those who contribute to their families versus those who only receive.

Data were analyzed using SPSS. Descriptive statistic tests as well as ahierarchical logistic regression analysis was conducted to assess the unique contribution of demographic, symptom and perception of family relationship variables in predicting Veterans contributing to family.

Contrary to our hypothesis, the between group comparison results showed that Veterans that contributed to their family had significantly worse positive and depressive SMI symptoms and perceived more serious conflict with family in the past 30 days. However, the logistic regression results show that positive symptoms, depressive symptoms and conflict do not have significant predictive value of Veterans contributing.

This study is unique in its effort to increase awareness of how individuals with SMI contribute to their family and could help inform interventions on how to foster reciprocity in family relationships, family involvement in treatment, and reduce feelings of burden reported by family members who provide assistance.