Article

Getmanenko Ya.A., Trusova A.V., Dobrovol’skaya A.E., Sofronov A.G. (2019). The influence of family system and individual psychological characteristics of the caregiver on the effectiveness of socio-psychological adaptation in patients with schizophrenia. National Psychological Journal, [Natsional’nyy psikhologicheskiy zhurnal], (12)3, 101–112

Abstract

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.

Received: 07/02/2019
Accepted: 09/06/2019
Pages: 101-112
DOI: 10.11621/npj.2019.0311

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Keywords: schizophrenia; family interventions; expressed emotion; quality of life; family burden;

Available Online 20.10.2019

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
Indicator	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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For citing this article:

Getmanenko Ya.A., Trusova A.V., Dobrovol’skaya A.E., Sofronov A.G. (2019). The influence of family system and individual psychological characteristics of the caregiver on the effectiveness of socio-psychological adaptation in patients with schizophrenia. National Psychological Journal, [Natsional’nyy psikhologicheskiy zhurnal], (12)3, 101–112