Factors Affecting Quality of Life and Family Burden among the Families of Patients with Schizophrenia

Se-Ri Maeng; Won-Hyung Kim; Ji-Hyun Kim; Jae-Nam Bae; Jeong-Seop Lee; Chul-Eung Kim

doi:10.16946/kjsr.2016.19.2.78

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Maeng, Kim, Kim, Bae, Lee, and Kim: Factors Affecting Quality of Life and Family Burden among the Families of Patients with Schizophrenia

Original Article

Korean J Schizophr Res 2016;19(2):78-88.

Published online: 20 January 2016

DOI: https://doi.org/10.16946/kjsr.2016.19.2.78

Factors Affecting Quality of Life and Family Burden among the Families of Patients with Schizophrenia

Se-Ri Maeng, MD, Won-Hyung Kim, MD, Ji-Hyun Kim, MD, PhD, Jae-Nam Bae, MD, PhD, Jeong-Seop Lee, MD, PhD, Chul-Eung Kim, MD, PhD

Department of Psychiatry, Inha University School of Medicine, Inha University Hospital, Incheon, Korea

Address for correspondence: Chul-Eung Kim, Department of Psychiatry, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea Tel: 032-890-3475, Fax: 032-890-3580 E-mail: kce320@inha.ac.kr

Received 8 August 2016 Revised 8 October 2016 Accepted 12 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Study aimed to identify factors that may affect family burden and quality of life (QOL) of primary caregivers in schizophrenia family.

Methods

Among outpatients with schizophrenia undergoing treatment at the psychiatric department of a university hospital, 72 patients and their primary caregivers were investigated. Sociodemographic and clinical data were collected and analyzed.

Results

: As a result of multiple regression of primary caregivers' family burden (R²=0.284), primary caregiver's income (p=0.001) and patient's delusional symptoms (p=0.001) significantly explained the total family burden of primary caregivers. In multiple regression on QOL (R²=0.515), primary caregiver's income (p=0.033) and education level (p=0.006), patient's sex (p=0.006), treatment duration (p＜0.001), degree of disorganized speech (p=0.008), negative drug attitudes (p=0.026) and the attitude of overcoming stigma against mental patients (p=0.029) all significantly explained the average QOL score.

Conclusion

: Various factors determining primary caregiver's QOL, including Clinical symptoms such as patient's disorganized speech and clinically correctable factors such as negative drug attitude and insight into disease. Therefore, provision of education regarding drug and disease for patients and caregivers will be helpful to effectively reduce burden and improve the QOL of primary caregivers.

Keywords: Schizophrenia, Caregiver burden, Quality of Life.

References

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Fig. 1.

Flow chart of study participants.

Table 1.

Sociodemographic characteristics of the patients with schizophrenia

	Schizophrenia (N=72)
	N (%)
Sex
Male	36 (50)0.
Female	36 (50)0.
Age
≤ 29	15 (20.3)
30–39	16 (22.2)
400–49	16 (22.2)
500–59	17 (23.6)
≥ 60	8 (11.1)
Education
High school graduate or less	35 (48.6)
Some college or more	37 (51.4)
Marriage
Married	12 (16.7)
Never married	51 (70.8)
Others∗	9 (12.5)
Employment
Unemployed	56 (77.8)
Employed	16 (22.2)
Living arrangement
Living alone	11 (15.3)
Living with someone^†	61 (84.7)
Experience of community mental health program^‡
Yes	22 (30.6)
No	50 (69.4)

^∗ : cohabitation, divorce or widowed,†: living with family or residential psychiatric rehabilitation facility members,‡: community mental health center, family therapy or self-help group programs

Table 2.

Sociodemographic characteristics of primary caregiv ers of patients with schizophrenia

	Primary caregiver (N=72)
	N (%)
Sex
Male	35 (48.6)
Female	37 (51.4)
Age
≤29	1 (1.4)
30–39	4 (5.6)
40–49	7 (9.7)
50–59	31 (43.1)
≥60	28 (39.4)
Education
High school graduate or less	46 (63.9)
Some college or more	26 (36.1)
Marriage
Married	47 (65.3)
Never married	10 (13.9)
Others∗	15 (20.8)
Employment
Unemployed	32 (44.4)
Employed	40 (55.6)
Total monthly income (Won)
＜500,000	29 (40.3)
500,000–2,000,000	37 (51.4)
＞2,000,000	6 (8.3)
Relationship with patient
Father	27 (37.5)
Mother	13 (18.1)
Spouse	9 (12.5)
Sibling	14 (19.4)
Offspring	9 (12.5)
Living with patien
Yes	52 (72.2)
No	20 (27.8)
Experience of community mental health program^†
Yes	20 (27.8)
No	52 (72.2)
∗: cohabitation, divorce or wido health center, family therapy or se	owed,†: community menta elf-help group programs

Table 3.

Clinical characteristics of the patients with schizophre nia

	Schizophrenia (N=72)
	N (%)
Duration of diagnosis (years)
＜1 yr	7 (9.7)
1–5 yr	18 (25.0)
6–10 yr	10 (13.9)
≥11 yr	37 (51.4)
Duration of treatment (years)
＜1 yr	9 (12.5)
1–5 yr	19 (26.4)
6–10 yr	12 (16.7)
≥11 yr	32 (44.4)
Number of admission
None	8 (11.1)
1–2	38 (52.8)
3–5	17 (23.6)
≥6	9 (12.5)
Number of outpatient visit for 3 months past
＜3	29 (40.3)
3–5	40 (55.6)
≥6	3 (4.2)
Number of comorbid physical illness
Yes	18 (25.0)
No	54 (75.0)
	Mean (SD)
KDAI-10
Subjective positive feeling	2.06 (3.75)
Subjective negative feeling	–1.50 (2.51)0.
FS (Final score)	3.56 (5.21)
K-ISMI
Alienation	13.81 (3.56)0
Stereotype endorsement	14.51 (2.85)0
Discrimination experience	10.36 (2.45)0
Social withdrawal	13.14 (3.17)0
Stigma resistance	12.31 (2.64)0
Total score	39.51 (9.94)0
DSM-5 CRDPSS
Hallucination	1.75 (0.90)
Delusion	1.97 (0.77)
Disorganized speech	1.53 (0.84)
Abnormal psychomotor behavior	1.18 (0.68)
Negative symptoms	1.85 (0.74)
Impaired cognition	1.85 (0.76)
CGI-S	3.40 (0.85)
GAF	52.44 (13.44)
K-SUMD
Awareness of mental disorder	1.86 (0.68)
Awareness of social consequences	1.97 (0.73)
Awareness of medication effects	1.78 (0.74)
Awareness of positive symptoms	5.99 (2.17)
Awareness of negative symptoms	6.21 (1.79)
Total score	17.81 (4.99)0

KDAI-10: Korean version of Drug Attitude Inventory-10, K-ISMI: Korean version of Internalized stigma of mental illness scale, DSM-5 CRDPSS: DSM-5 Clinician-Rated Dimensions of Psychosis Symptom Severity, CGI-S: Clinical Global Impression-Severity, GAF: Global Assessment of Functioning, K-SUMD: Korean version of Scale to Assess Unawareness of Mental disorder

Table 4.

Clinical characteristics of primary caregivers of patients with schizophrenia

	Primary caregiver (N=72)
	N (%)
FBS
Total score	42.00 (26.07)
Objective burden	12.44 (10.20)
Subjective burden	29.56 (17.30)
WHOQOL-BREF
Physical health domain	21.97 (5.25)
Psychological domain	16.67 (3.78)
Social relationships domain	8.47 (2.51)
Environmental domain	21.71 (4.90)
Overall QOL domain	5.61 (1.42)
Total score	74.42 (14.76)
QOL score (Average)	2.98 (0.59)

FBS: Family Burden Scale, WHOQOL-BREF: World Health Organization Quality of Life Assessment Instrument abbreviated version

Table 5.

Effect of variables of patients with schizophrenia on the familial burden score and quality of life of primary caregivers

	FBS (Total score)		FBS (Objective)		FBS (Subjective)		QOL score
	Mean (SD)	F	Mean (SD)	F	Mean (SD)	F	Mean (SD)	F
Sex
Male	42.72 (27.57)	0.055	13.47 (11.12)	0.728	29.25 (18.14)	0.022	2.79(0.55)	∗7.481∗
Female	41.28 (24.86)	0.055	11.42 (9.23)	0.728	29.86 (16.67)	0.022	3.16 (0.58)	∗7.481∗
Age
≤29	41.20 (29.78)		12.80 (11.23)		28.40 (19.06)		3.33 (0.44)
30–39	44.69 (25.46)		11.00 (10.69)		33.69 (17.44)		2.73 (0.56)
40–49	48.69 (31.00)	0.626	15.06 (11.88)	0.391	33.63 (19.89)	1.021	2.87 (0.57)	^†4.198^†
50–59	34.88 (13.12)		11.53 (6.86)		23.35 (7.83)		3.18 (0.53)
≥60	39.88 (32.12)		11.38 (11.16)		28.50 (22.24)		2.59 (0.65)
Education
≤High school graduate	41.80 (23.29)	0.004	13.09 (8.91)	0.266	28.71 (15.60)	0.159	2.95 (0.60)	0.152
Some college or more	42.19 (28.78)	0.004	11.84 (11.37)	0.266	30.35 (18.95)	0.159	3.00 (0.60)	0.152
Marriage
Married	42.83 (22.42)		12.17 (7.91)		30.67 (15.48)		3.11 (0.68)
Never married	44.82 (27.69)	2.327	13.63 (11.05)	2.150	31.20 (18.16)	2.061	2.96 (0.60)	0.438
Others^‡	24.89 (13.00)		6.11 (4.46)		18.78 (10.77)		2.87 (0.38)
Living Arrangement
Living alone	40.67 (34.21)	0.037	11.75 (12.93)	0.066	28.92 (22.01)	0.019	3.11 (0.65)	0.695
Living with someone^§	42.27 (24.48)	0.037	12.58 (9.69)	0.066	29.68 (16.42)	0.019	2.95 (0.58)	0.695
Experience of community mental health program^¶
No	41.46 (26.44)	0.069	11.66 (10.36)	0.967	29.80 (17.57)	0.032	3.03 (0.59)	1.202
Yes	43.23 (25.80)		14.23 (9.83)		29.00 (17.06)	0.032	2.86 (0.58)	1.202
Duration of diagnosis (years)
＜1 yr	33.29 (7.06)		8.43 (4.11)		24.86 (5.64)		3.21 (0.52)
1–5 yr	35.17 (27.62)	1.028	10.33 (10.52)	1.028	24.83 (17.78)	0.974	3.30 (0.47)	∗3.814∗
6–10 yr	46.20 (36.35)	1.028	15.50 (12.71)	1.028	30.70 (24.26)	0.974	2.71 (0.75)	∗3.814∗
≥11 yr	45.84 (24.16)		13.41 (10.04)		32.43 (16.25)		2.85 (0.55)
Duration of treatment (years)
＜1 yr	40.67 (16.31)		10.44 (5.50)		30.22 (11.98)		3.20 (0.48)
1–5 yr	34.53 (26.99)	0.827	10.32 (10.22)	0.630	24.21 (17.50)	0.929	3.30 (0.45)	∗4.407∗
6–10 yr	43.25 (33.09)	0.827	13.75 (12.08)	0.630	29.50 (22.09)	0.929	2.75 (0.76)	∗4.407∗
≥11 yr	46.34 (24.94)		13.78 (10.56)		32.56 (16.45)		2.81 (0.54)
Number of admission
None	45.25 (23.47)		15.50 (8.40)		29.75 (16.18)		3.07 (0.56)
1–2	39.68 (27.92)	0.583	11.03 (10.63)	1.012	28.66 (18.44)	0.369	3.06 (0.60)	0.897
3–5	40.41 (26.47)	0.583	11.94 (10.55)	1.012	28.47 (17.51)	0.369	2.83 (0.63)	0.897
≥6	51.89 (19.82)		16.67 (8.78)		35.22 (14.09)		2.81 (0.53)
Number of outpatient visit (for 3 months past)
1–2	43.14 (26.05)		12.83 (9.88)		30.31 (17.99)		2.95 (0.53)
3–5	40.23 (24.90)	0.467	11.85 (10.00)	0.339	28.38 (16.19)	0.471	3.02 (0.64)	0.667
≥6	54.67 (47.17)		16.67 (18.45)		38.00 (29.00)		2.63 (0.61)
Comorbid physical illness
No	44.96 (28.71)	2.863	13.69 (10.99)	3.299	31.28 (18.98)	2.176	2.98 (0.63)	0.001
Yes	33.11 (12.61)	2.863	8.72 (6.18)	3.299	24.39 (9.46)	2.176	2.97 (0.47)	0.001

^∗ : statistically significant p value (＜0.05),†: statistically significant p value (＜0.005),‡: cohabitation, divorce or widowed, §: living with family or residential psychiatric rehabilitation facility members, ¶: community mental health center, family therapy or self-help group programs

Table 6.

Effect of variables of primary caregivers on the familial burden score and quality of life of primary caregivers

	FBS (Total score)		FBS (Objective)		FBS (Subjective)		QOL score
	Mean (SD)	F	Mean (SD)	F	Mean (SD)	F	Mean (SD)	F
Sex
Male	33.09 (19.78)	^†8.840^†	9.66 (7.91)	∗5.400∗	23.43 (13.60)	9.575^†	3.04 (0.54)	0.698
Female	50.43 (28.65)	^†8.840^†	15.08 (11.46)	∗5.400∗	35.35 (18.56)	9.575^†	2.92 (0.64)	0.698
Age
≤29	31.00 (0.00)		9.00 (0.00)		22.00 (0.00)		3.32 (0.00)
30–39	32.00 (20.69)		13.25 (10.08)		18.75 (10.69)		3.47 (0.61)
40–49	41.29 (32.58)	0.393	13.00 (11.27)	0.080	28.29 (21.85)	0.820	2.88 (0.77)	4.713^†
50–59	39.06 (26.13)		11.55 (10.30)		27.52 (16.50)		3.21 (0.46)
≥60	45.29 (24.36)		32.89 (17.25)		32.89 (17.25)		2.67 (0.55)
Education
≤High school graduate	46.30 (28.17)	3.599	13.67 (11.09)	1.873	32.63 (18.70)	4.206∗	2.81 (0.57)	12.472^†.
Some college or more	34.38 (20.21)	3.599	10.27 (8.16)	1.873	24.12 (13.13)	4.206∗	3.28 (0.50)	12.472^†.
Marriage
Married	37.79 (22.10)		10.70 (8.43)		27.09 (15.42)		3.13 (0.54)
Never married	41.90 (30.27)	2.676	14.40 (10.73)	2.185	27.50 (20.16)	2.761	2.96 (0.62)	7.403^†
Others^‡	55.27 (31.72)		16.60 (13.74)		38.67 (19.04)		2.51 (0.51)
Employment
Unemployed	46.88 (27.96)	2.043	13.69 (10.89)	0.854	33.19 (18.48)	2.596	2.85 (0.67)	2.714
Employed	38.10 (24.11)	2.043	11.45 (9.64)	0.854	26.65 (15.93)	2.596	3.08 (0.50)	2.714
Total monthly income (Won)
＜500,000	56.00 (31.33)		17.03 (12.45)		38.97 (20.14)		2.68 (0.62)
500,000–2,000,000	33.22 (17.46)	^†8.601^†	9.76 (7.26)	^†5.825^†	23.46 (12.39)	8.795^†	3.14 (0.49)	^†7.961^†
＞2,000,000	28.50 (5.89)		6.83 (4.07)		21.67 (3.14)		3.41 (0.35)
Relationship with patient
Father	50.93 (27.74)		14.59 (11.16)		36.33 (17.70)		2.92 (0.58)
Mother	34.77 (27.20)		9.77 (9.79)		25.00 (19.82)		2.89 (0.64)
Spouse	34.33 (6.78)	1.438	10.33 (3.81)	0.649	24.00 (4.64)	1.856	3.14 (0.55)	0.483
Sibling	36.29 (19.04)		11.57 (9.10)		24.71 (11.96)		3.11 (0.59)
Offspring	42.22 (36.21)		13.33 (13.84)		28.89 (23.06)		2.93 (0.65)
Living with patient
Yes	43.65 (27.13)	0.751	12.81 (10.33)	0.235	30.85 (18.14)	1.043	2.97 (0.63)	0.018
No	37.70 (23.18)	0.751	11.50 (10.06)	0.235	26.20 (14.80)	1.043	2.99 (0.47)	0.018
Experience of community mental health program^§
No	41.91 (24.68)	0.003	11.60 (9.26)	1.915	30.32 (16.88)	0.525	3.00 (0.61)	0.398
Yes	42.33 (31.79)	0.003	15.67 (13.07)	1.915	26.67 (19.14)	0.525	2.89 (0.53)	0.398

^∗ : statistically significant p value (＜0.05),†: statistically significant p value (＜0.005),‡: cohabitation, divorce or widowed, §: community mental health center, family therapy or self-help group programs

Table 7.

Caregiver burden of variable selection by stepwise

	Parameter Estimate	Standard Error	t value	p
FBS, total score (R²=0.284)				＜0.001
Caregiver, income	–15.022-	4.115	–3.650-	0.001
Patient, CRDPSS (delusion)	11.365	3.347	3.395	0.001
FBS, objective burden (R²=0.218)				＜0.001
Caregiver, income	0–4.768-	1.734	–2.750-	0.008
Patient, CRDPSS (delusion)	03.111	1.428	2.178	0.033
FBS, subjective burden (R²=0.322)				＜0.001
Caregiver, income	–10.348-	2.709	–3.820-	＜0.001
Patient, CRDPSS (delusion)	08.916	2.297	3.882	＜0.001
Caregiver, sex (female)	02.127	0.979	2.174	0.033

FBS: Family Burden Scale, CRDPSS: DSM-5 Clinician-Rated Dimensions of Psychosis Symptom Severity

Table 8.

Caregiver quality of life of variable selection by stepwise

	Parameter Estimate	Standard Error	t value	p
Average QOL score (R²=0.515)				＜0.001
Caregiver, income	0.203	0.093	2.181	0.033
Caregiver, education	0.322	0.112	2.870	0.006
Patient, sex (female)	0.304	0.108	2.821	0.006
Patient, treatment duration	–0.175-	0.046	–3.776-	＜0.001
Patient, CRDPSS (disorganized speech)	–0.111-	0.063	–1.756-	0.008
Patient, KDAI-10 (negative)	–0.049-	0.022	–2.273-	0.026
Patient, K-ISMI (stigma resistance)	0.046	0.021	2.227	0.029
QOL-Physical health (R²=0.508)				＜0.001
Caregiver, education	2.478	0.953	2.599	0.012
Caregiver, sex (female)	–3.479-	0.938	–3.708-	＜0.001
Patient, sex (female)	4.150	0.936	4.433	＜0.001
Patient, treatment duration	–1.532-	0.412	–3.718-	＜0.001
Patient, KDAI-10 (negative)	–0.555-	0.182	–3.046-	0.003
Patient, K-ISMI (stigma resistance)	0.496	0.177	2.804	0.007
QOL-Psychological (R²=0.178)				＜0.001
Caregiver, income	2.591	0.661	3.921	＜0.001
QOL-Social relationships (R²=0.276)				＜0.001
Patient, diagnosis duration	–0.768-	0.241	–3.189-	0.002
Patient, CRDPSS (disorganized speech)	–0.649-	0.313	–2.075-	0.042
Patient, KDAI-10 (negative)	–0.308-	0.104	–2.959-	0.004
QOL-Environmental (R²=0.352)				＜0.001
Caregiver, education	3.896	0.977	3.987	＜0.001
Patient, treatment duration	–1.865-	0.440	–4.237-	＜0.001
Patient, K-SUMD (positive symptom awareness)	–0.668-	0.224	–2.983-	0.004

CRDPSS: DSM-5 Clinician-Rated Dimensions of Psychosis Symptom Severity, KDAI-10: Korean version of Drug Attitude Inventory-10, K-ISMI: Korean version of Internalized stigma of mental illness scale, K-SUMD: Scale to Assess Unawareness of Mental disorder-short form

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