(WITHDRAWN) Disease-Related Stressors of Caregiving Burden Amongst Different Types of Family Caregivers of Persons with Schizophrenia in Rural China

Background and Purpose: Identifying determinants associated with caregiver burden is essential in developing appropriate strategies for family interventions and home-based services. Previous studies have documented the respective impacts of symptom severity, social functioning and aggressive behaviors of persons with schizophrenia on caregiver burden. However, little is known about the impacts of schizophrenia on different types of family caregiving burden. This study aims to examine how the severity of schizophrenia, social functioning and aggression are associated with perceived burden among different types of family caregivers, including parents, spouses, children, siblings and other relatives of persons with schizophrenia.

Methods: The analytic sample included 300 dyads of persons with schizophrenia and their family caregivers. Persons with schizophrenia (≥15 years) were identified in an epidemiological investigation in 2015 in Xinjin County, Chengdu, China. The trained psychiatrists with more than five years’ clinical experience utilized the International Classification of Disease (ICD-10) as a standardized instrument for a diagnosis of schizophrenia, to establish diagnostic reliability. Severity of symptoms was assessed by Positive and Negative Syndrome Scale (PANSS). Social functioning of the patients were measured by the Social Disability Screening Schedule (SDSS) and the Global Assessment of Functioning (GAF). Aggressive behaviors were measured by the Modified Overt Aggression Scale (MOAS). Perceived caregiving burden was estimated by the Burden Scale for Family Caregivers (BSFC-s). Hierarchical regression analysis with the stepwise inclusion method was performed to measure potential factors influencing caregiving burden.

Results: A higher level of burden was significantly associated with female caregivers, larger family size, lower income, worse symptoms, poorer social functioning and/or more aggressive behaviors. Parent caregivers showed greater burden if the patients had a lower level of social interest and concern, and/or had aggressive behavior in damaging property. Mother caregivers showed greater burden than fathers. Spouses of patients who lacked marital functioning tended to perceive greater burden. Patients attacking others was related to a higher burden of child caregivers. A heavier burden of other relatives was significantly correlated with patients’ more aggressive behaviors in terms of verbal attacking and self-harm.

Conclusions and Implications: This study identifies which component contributes most to a higher level of burden perceived among different types of family caregivers, which has seldom been discussed. The study found distinct associations between these factors and caregiving burden in different types of family caregivers. Our findings have implications for health-care professionals and practitioners in terms of tailoring family-based or individualized intervention to ameliorate caregiver burden according to kinship types, and deal with behavioral or functional problems in schizophrenia. In future research, to improve home-based services in rural Chinese communities, it would be enlightening to continue exploring the distinct impacts of patients’ behavioral problems and social functioning on different family members who engage in schizophrenia care. Furthermore, given that schizophrenia care is a chronic course, the duration of care should be considered to further investigate the dynamics of interactions between schizophrenia management and caregiving burden among various types of caregiving.