The influence of family system and individual psychological characteristics of the careg
Recieved: 07/02/2019
Accepted: 09/06/2019
Published: 10/20/2019
p.: 101-112
DOI: 10.11621/npj.2019.0311
Keywords: schizophrenia; family interventions; expressed emotion; quality of life; family burden
Available online: 20.10.2019
Trusova Anna V.. The influence of family system and individual psychological characteristics of the careg. // National Psychological Journal 2019. 3. p.101-112. doi: 10.11621/npj.2019.0311
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Background. Family of schizophrenic patient plays a key role in their psychosocial adaptation. On the other hand, according to numerous data, adverse family relations are associated with high relapse risk. Family member’s illness is a severe stress factor for the whole family. However, families differ from each other to the degrees of emerging dysfunctions. Yet mechanisms which underlay interactional disturbances in those families remain unexplored.
Objective. The study represents complex research of the role of symptoms severity, interactional characteristics of a family, which are represented in family flexibility and cohesion parameters (FACES-3), and emotional and communicative competence (EmIn Lousin D.V.) as well as life satisfaction of main caregiver in psychosocial adaptation of a patient with schizophrenia.
Design. The paper presents the research of 122 test subjects, paired in dyads – schizophrenic patient (paranoid form) and their major caregiver. Patients gender distribution: 33 female and 28 males, average age 32.5±9.44 (M±SD), hospitalizations rate – 5.44 ±5.27, average illness duration – 9.93±6.85. Caregiver’s genders: 12 males and 49 females. Average major caregiver’s age – 53±11.91.
Results. Derived from structural equations, a model was invented showing that symptoms severity plays negative role in psychosocial adaptation of a patient with schizophrenia (p<0.001), whilst more balanced family characteristics have a supportive effect (p<0.001). Communicative competence of major caregiver increases balance of family characteristics (p<0.001).
Conclusion. The results indicate that the possibilities of social adaptation in patients with schizophrenia are determined by both objective factors (the severity of psychopathological symptoms) and the character of family dysfunctions that are closely associated with the emotional and communicative competence of main caregivers. In this way development of communicational skills in major caregivers may be the part of complex psychosocial interventions into schizophrenic patient’s families. Further research in this area may be aimed both at assessing the effectiveness of interventions, and at improving the tools to be used through experimental methods of assessing the family disruptions and emotional and communicative competence, as well as expanding the number of measured parameters (e.g. cognitive deficit of patients) for a more comprehensive understanding of the problem.
Acknowledgments
The paper is prepared under scientific project No. 17-29-02173 with financial support of the Russian Foundation for Basic Research (RFBR).
Fig. 1. Final model of the relationship of the individual-personality characteristics of the caregiver, family dynamics, severity of symptoms and social functioning of the patient
NB: SF - social functioning of the patient (PSP); N - negative symptoms (PANSS); D - other disorders (somatic) (PANSS); Ire - interpersonal EQ caregiver; FACES - medium balanced family type.
Bold (Red) highlighted negative effects, normal font (green) - positive; dashed line - lack of communication.
Table 1. Descriptive statistics of the clinical and psychological characteristics of the sample
|
Indicator |
N |
N (%) |
Mean |
SD |
Median |
q1 |
q3 |
|
PANSS Positive Symptoms |
- |
- |
13.46 |
3.53 |
13.0 |
11.0 |
16.0 |
|
PANSS Negative Symptoms |
- |
- |
23.74 |
7.18 |
25.0 |
18.0 |
30.0 |
|
PANSS Composite Index |
- |
- |
-10.33 |
6.43 |
-11.0 |
-14.0 |
-6.0 |
|
PANSS General somatic disorders |
- |
- |
30.49 |
8.14 |
29.0 |
24.0 |
36.0 |
|
PANSS Total |
- |
- |
67.66 |
16.03 |
66.0 |
55.0 |
80.0 |
|
PSP Patient |
- |
- |
58.48 |
16.13 |
59.0 |
47.0 |
71.0 |
|
QOL patient |
- |
- |
188.16 |
29.41 |
186.0 |
171.0 |
206.0 |
|
EQ patient interpersonal |
- |
- |
36.90 |
8.81 |
36.0 |
31.0 |
43.0 |
|
EQ patient intrapersonal |
- |
- |
44.28 |
10.50 |
44.0 |
37.0 |
53.0 |
|
EQ patient general |
- |
- |
81.18 |
17.71 |
80.0 |
68.0 |
91.0 |
|
LSI caregiver |
- |
- |
22.69 |
6.35 |
22.0 |
18.0 |
27.0 |
|
EQ interpersonal component caregiver |
- |
- |
39.52 |
6.61 |
39.0 |
34.0 |
43.0 |
|
EQ intrapersonal caregiver |
- |
- |
50.75 |
6.64 |
51.0 |
46.0 |
4.0 |
|
EQ total caregiver rate |
- |
- |
90.15 |
11.55 |
89.0 |
83.0 |
9.0 |
NB: N - absolute values; N (%) - fractions of the whole; Mean - arithmetic mean; SD - standard deviation; Median - median value; q1 - 25 percentile; q3 - 75 percentile/
Table 2. Comparison of EQ methodology data with standard indicators
|
Indicator |
Median |
q1 |
q3 |
U |
P |
|
EQ patient interpersonal |
3.0 |
1.0 |
5.0 |
261.0 |
<0.001 |
|
EQ patient intrapersonal |
5.0 |
4.0 |
7.0 |
778.5 |
0.277 |
|
EQ interpersonal caregiver |
4.0 |
2.0 |
5.0 |
215.5 |
<0.001 |
|
EQ intrapersonal caregiver |
7.0 |
6.0 |
8.0 |
1139.0 |
<0.001 |
Table 3. FACES-3 Method data
|
Unity Rate |
N |
N(%) |
|
Disunited |
42 |
68.85 |
|
Disjunct |
15 |
24.59 |
|
Connected |
4 |
6.56 |
|
Linked |
0 |
0 |
|
Adaptation Type |
N |
N(%) |
|
Rigid |
3 |
4.92 |
|
Structural |
5 |
8.2 |
|
Flexible |
9 |
14.75 |
|
Chaotic |
44 |
72.13 |
|
System Type |
N |
N(%) |
|
Medium balanced |
31 |
50.82 |
|
Unbalanced (extreme) |
30 |
49.18 |
Table 4. Descriptive table with a grouping factor "balance of the family system"
|
Indicator |
Unbalanced Type |
Balanced Type |
|
|||||||||
|
N |
% |
Mean |
SD |
N |
% |
Mean |
SD |
χ2
|
P |
log (odd) |
s.e. |
|
|
Female gender |
16 |
53 |
- |
- |
17 |
55 |
- |
- |
- |
- |
- |
- |
|
Male gender |
14 |
47 |
- |
- |
14 |
45 |
- |
- |
- |
- |
- |
- |
|
Age |
- |
- |
34 |
9.7 |
- |
- |
31 |
8.9 |
3.27 |
0.070 |
- |
- |
|
Number of hospitalizations |
- |
- |
6.1 |
5.9 |
- |
- |
4.8 |
4.7 |
0.62 |
0.430 |
- |
- |
|
Disease duration |
- |
- |
11 |
6.6 |
- |
- |
8.8 |
7.0 |
2.55 |
0.110 |
- |
- |
|
PANSS Positive Symptoms |
- |
- |
13 |
3.6 |
- |
- |
14 |
3.5 |
0.03 |
0.854 |
- |
- |
|
PANSS Negative Symptoms |
- |
- |
26 |
6.3 |
- |
- |
21 |
7.1 |
9.73 |
0.002 |
-1.52 |
0,49 |
|
PANSS Composite Index |
- |
- |
-13 |
5.7 |
- |
- |
-7.8 |
6.1 |
12.28 |
<0.001 |
1,75 |
0,50 |
|
PANSS Other Disturbances |
- |
- |
34 |
7.5 |
- |
- |
28 |
7.7 |
8.28 |
0.004 |
-1,36 |
0,47 |
|
PANSS Total |
- |
- |
73 |
15 |
- |
- |
62 |
15 |
7.64 |
0.006 |
-1,30 |
0,47 |
|
PSP Patient |
- |
- |
49 |
11 |
- |
- |
68 |
15 |
21.11 |
<0.001 |
2,51 |
0,55 |
|
QOL Patient |
- |
- |
180 |
24 |
- |
- |
196 |
32 |
5.29 |
0.021 |
1,07 |
0,46 |
|
EQ Patient Interpersonal |
- |
- |
35 |
7.9 |
- |
- |
39 |
9.4 |
1.65 |
0.198 |
- |
- |
|
EQ Patient Intrapersonal |
- |
- |
42 |
11 |
- |
- |
46 |
10 |
3.57 |
0.059 |
- |
- |
|
EQ Patient Total score |
- |
- |
77 |
17 |
- |
- |
85 |
17 |
3.94 |
0.047 |
0,92 |
0,46 |
|
LSI caregiver |
- |
- |
20 |
4.5 |
- |
- |
25 |
6.9 |
9.77 |
0.002 |
1,52 |
0,49 |
|
EQ Interpersonal caregiver |
- |
- |
36 |
5.6 |
- |
- |
43 |
5.3 |
25.16 |
<0.001 |
3,17 |
0,63 |
|
EQ Intrapersonal caregiver |
- |
- |
48 |
5.7 |
- |
- |
53 |
6.4 |
12.23 |
<0.001 |
1,72 |
0,49 |
|
EQ Total score caregiver |
- |
- |
83 |
9.4 |
- |
- |
97 |
9.7 |
20.42 |
<0.001 |
2,47 |
0,55 |
Table 5. Statistical Model Coefficients
|
Variables |
Model 1 |
Model 2 |
Final Model |
|
SF ~ P |
-0.017(0.050). z=-0.33. (p=0.742) |
-0.007(0.054). z=-0.13. (p=0.894) |
|
|
SF ~ N |
-0.069(0.029). z=-2.35. (p=0.019) |
-0.109(0.024). z=-4.50. (p<0.001) |
-0.094(0.016). z=-5.85. (p<0.001) |
|
SF ~ D |
-0.077(0.027). z=-2.88. (p=0.004) |
-0.050(0.023). z=-2.22. (p=0.026) |
-0.067(0.012). z=-5.67. (p<0.001) |
|
SF ~ Ire |
0.014(0.023). z=0.62. (p=0.536) |
-0.068(0.025). z=-2.67. (p=0.008) |
-0.003(0.008). z=-0.42. (p=0.675) |
|
SF ~ Ira |
-0.013(0.031). z=-0.42. (p=0.675) |
-0.030(0.028). z=-1.06. (p=0.289) |
|
|
SF ~ QOL |
0.033(0.032). z=1.03. (p=0.305) |
0.014(0.023). z=0.60. (p=0.546) |
|
|
SF ~ FACES |
0.926(0.409). z=2.26. (p=0.024) |
0.737(0.070). z=10.53. (p<0.001) |
0.556(0.065). z=8.50. (p<0.001) |
|
FACES ~ Ire |
|
0.164(0.027). z=6.07. (p<0.001) |
0.085(0.003). z=25.54. (p<0.001) |
|
FACES ~ Ira |
|
0.038(0.019). z=1.96. (p=0.050) |
|
|
FACES ~ QOL |
|
0.002(0.028). z=0.09. (p=0.928) |
|
|
Mediation:= a*b |
|
|
0.047(0.006). z=7.42. (p<0.001) |
|
total := c+a*b |
|
|
0.044(0.008). z=5.48. (p<0.001) |
|
chi |
χ²=0.000. df=38.000. p=1.000 |
χ²=65.630. df=42.000. p=0.011 |
χ²=26.366. df=41.000. p=0.963 |
|
rmsea |
0.000. p=1.000 |
0.097. p=0.059 |
0.000. p=0.990 |
|
srmr |
0.000 |
0.207 |
0.131 |
|
cfi |
1.000 |
0.000 |
1.000 |
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