Fears of Harm Held By Caregivers about Relatives with Psychiatric Disorders

Background and Purpose: In this period of post-deinstitutionalization, much of the care for persons with severe psychiatric disorders (PD) is provided by their families. While caregiving offers gratification, it also results in extensive strains on the physical and mental health of caregivers. A primary stressor for caregivers is fears that relatives with PD may harm them or others.  Surprisingly, virtually no research has examined such fears. To fill this gap, using a conceptual model of factors associated with violence by relatives with PD, we examined the association of factors in three domains with fears held by caregivers that relatives with PD may harm them or others: 1) Relatives with PD, 2) Caregivers, and 3) Interactions between relatives with PD and caregivers.  The objective of the present investigation is to determine the extent to which proposed Relatives with PD, Caregivers, and Interaction factors are associated with fears of harm held by caregivers.

Methods: Employing a cross-sectional design, this investigation uses secondary data obtained from the National Alliance for Caregiving.  The subsample used in the present analysis is 1,505 family caregivers of relatives with PD who completed a national survey in September 2015.  Multivariate logistic regression was used to examine the association of factors with the occurrence of fears of harm held by caregivers that relatives with PD may harm them others. 

Results: Forty percent of caregivers (n = 601) had feared that their relatives with PD would harm them or others.  While controlling for significant covariates, the following factors were significantly associated with fears of harm: Relative with PD factors—serious mental health problem, alcohol and substance abuse condition, receipt of crisis mental health treatment, history of arrest; Interaction factors—greater difficulty getting relative with PD to take medications as prescribed and fear that relatives with PD would be hurt by others or die by suicide.

Conclusions and Implications: Social work practitioners and policy makers should be aware of how common fears of harm are by caregivers and how deleterious said fears are to caregivers’ well-being.  Practitioners are encouraged to offer inclusion of caregivers in the treatment of persons with PD.  Practitioners working with persons with PD and caregivers should assess fears held by caregivers, especially when persons with PD are known to endorse multiple risk factors.  In attempting to prevent fears held by caregivers, it may be helpful for social workers to provide interventions to persons with PD supporting medication adherence and attendance of substance abuse treatment, and providing intensive/assertive treatment services aimed at preventing mental health crises.