Family Problems, Distress, and Perceived Need for Treatment Among Veterans with Serious Mental Illness

Background and Purpose: Persons with serious mental illness (SMI) often receive support from family members and report their family relationships enrich their lives. However, like members of the general population, persons with SMI also experience distressing problems with relatives. As a component of providing recovery-oriented care, treatment providers should be prepared to assist clients with SMI in resolving family problems. Unfortunately, limited research has examined family problems from the perspectives of persons with SMI, hindering effective intervention in this area. The primary objectives of the present analyses are to examine, from the perspectives of veterans with SMI, the extent to which factors in two domains (characteristics of persons with SMI and family dynamics) are associated with 1) family problems, 2) distress related to family problems, and 3) perceived importance of treatment addressing family problems.

Methods: This study is a secondary analysis of baseline data collected in the Recovery-Oriented Decisions for Relatives’ Support study. Two hundred and twenty-six veterans with SMI were recruited through outpatient mental health programs in two Veterans Integrated Service Networks. Dependent variables (family problems, distress related to family problems, and importance of treatment addressing family problems), were measured with the family module from the Addiction Severity Index. The following independent variables were measured with established scales: depressive symptoms, perceived family support and satisfaction, general family functioning, family problem solving, affirming family communication, and incendiary family communication. A series of bivariate and multivariate logistic regression models were estimated.

Results: Nearly one-half of participants reported experiencing serious problems with family members in the past 30 days. Participants most commonly reported experiencing such problems with siblings (19%), sexual partners (16%), close friends (15%) and mothers (11%). Approximately 30% of participants reported being very troubled by family problems and 43% reported considering treatment for family problems to be very important. In multivariate analyses, the occurrence of family problems was positively associated with female gender of persons with SMI (OR = 4.35), and frequency of family contact (OR = 1.56), with incendiary family communication approaching significance (OR = 1.13, p = .07). Distress related to family problems was negatively associated with family problem solving (OR = 0.19). The only variable in multivariate analyses significantly associated with considering treatment addressing family problems to be important was distress related to family problems (OR = 5.09).

Conclusions and Implications: The results of these analyses suggest that a large minority of persons with SMI receiving outpatient mental health treatment may experience serious family problems, be distressed regarding these problems, and consider treatment addressing family problems to be important. It is imperative that social workers and other practitioners inquire about family problems and clients’ desires for treatment addressing such problems. Although the present study is exploratory, results from multivariate analyses suggest that incendiary communication and family problem solving, in particular, may be associated with experiencing family problems and distress related to such problems. It may be beneficial for clinical interventions aiming to ameliorate family problems to include education and support regarding effective communication and problem solving skills.