THE EFFECT OF AN EDUCATION PROGRAM IN FAMILY CAREGIVERS OF AN INDIVIDUAL WITH SCHIZOPHRENIA

The Effect of an Education Program in Family Caregivers of an Individual with Schizophrenia Schizophrenia is a serious mental illness that aggravates a persons ability to think clearly, to build interpersonal relations and manage emotions (Summerville and Atherley, 2012). More than two million Americans suffer from this illness today, which shows relatively high frequency of its occurrence. Schizophrenia can be developed at any age, still the first symptoms of the illness appear between the ages of 16 and 25 in three quarters of the affected. The development of the illness in adults after age 40 and children is very uncommon (NAMI, 2008). The statistics shows that 25 percent of persons diagnosed with this illness experience only one psychotic episode in their life (Torrey, 2001). 70 percent of the affected by schizophrenia are able to live beyond its limitations and experience a quality of life partially, whereas 10 percent end their own lives through suicide (Torrey, 2001). Homelessness is the destiny of another 10 percent living with the illness. In addition, less than 5 percent of the people diagnosed with schizophrenia show the greater level of violence than the average person (Torrey, 2001). Schizophrenia is a very challenging illness. Hallucinations and delusions, lack of content and brief speech, emotional flatness and lack of expressiveness, lack of understanding the illness, which commonly accompany it, aggravate a persons ability to perform complex memory tasks, to organize own thinking or to operate with several ideas simultaneously (NAMI, 2008). Since the changes in brain chemistry and structure are mainly responsible for schizophrenia, the behavior of even treated people can be unusual and unsettling (Torrey, 2001). Such inappropriate, unpredictable and disorganized behavior of the people living with schizophrenia creates a plethora of problems for them, their families and community. The

THE EFFECT OF AN EDUCATION PROGRAM IN FAMILY CAREGIVERS OF AN INDIVIDUAL WITH SCHIZOPHRENIA

absence of affective treatment and care results in social exclusion of these people that are shunned as the targets of social prejudice (NAMI, 2008, p. 1). Another spectrum of challenges, associated with schizophrenia, is connected with the future of the ill family members. According to the statistics, 70 percent of persons suffering from schizophrenia live with their parents. The parents as the caregivers are exposed to the worries about the further care they would not be able to provide. It causes also physical health problems, distress, burden, stress, diminished quality of life, the lower life satisfaction, anxiety and depressions (Saunders, 2003). Moreover, family caregivers of an individual with schizophrenia report the risk for their own mental health, their financial strain, work, etc. (Summerville and Atherley, 2012). Conflicts with the person they care for, discrepancies in the care received from the healthcare system and frustration, connected with the systems for mental healthcare, justice, law and government (Summerville and Atherley, 2012) are the additional challenges for the family caregivers, which also should be addressed with the help of educational programs, nurse led groups or support groups. Correct diagnosis and early treatment is crucial for the recovery of the people affected by schizophrenia (Grandon, et al, 2008). However, the illness is often an enormous stressor for the families that are not able to provide the people living with the illness with compassion, respect and understanding that are equally important for an efficient treatment. Often, not only a person, suffering from schizophrenia, but the whole family lives in isolation and fear (Saunders, 2003). Being uninformed about the illness and feeling ashamed, family members try to cope with it on their own, hiding it from others (NAMI, 2008). The acceptance of the illness and its realities is the most difficult step families need to take. According to Grandon, et al, 2008, objective burden that means negative consequences for family routines and subjective burden, entailing emotional disturbances experienced by the caregiver are the main

THE EFFECT OF AN EDUCATION PROGRAM IN FAMILY CAREGIVERS OF AN INDIVIDUAL WITH SCHIZOPHRENIA

hurdles families meet in such situations. Socio-demographic, clinical and personality variables have also a great effect on the level of burden experienced by caregivers. Moreover, functional limitations and disturbed behavior of the family members with schizophrenia are the main stressors for the caregivers (Grandon, et al, 2008). In order to provide a satisfying and meaningful life for these people, support, understanding and services that can make difference are necessary. Psychosocial rehabilitation is one of the educational programs that helps people living with schizophrenia as well as their families to overcome the barrier, caused by the illness and to enter a comprehensive social life. The Program of Assertive Community Treatment pursues also the same goal. Family to Family is a significant educational program as well. It supports the families in sharing their experience of caring for family members with schizophrenia, and provides help for those in need (NAMI, 2008; Rose, 1998; Wueker, 2000). Other types of psycho-educational programs proved to be useful in reducing burden, relapses, and increasing social functioning of patients and relatives (Grandon, et al, 2008, p.340). Participation in social support network is very beneficial for the reduction of burden. The findings of the researches show that the improvement of the special components of these programs is very important to address the problem under consideration. For instance, the increased attention to clinical characteristics of the patients with schizophrenia and to personality and socio-demographic characteristics of the caregivers may add to the effectiveness of the program (Chan, 2011). There is also a strong evidence that social support groups for the family caregivers of an individual with schizophrenia improve their emotional wellbeing and reduce family burden (Rose, 1998). The needs expressed by caregivers, namely, improved mental health rehabilitation services, comprehensive and accurate information about the peculiarities of their family members illness and respect from mental

THE EFFECT OF AN EDUCATION PROGRAM IN FAMILY CAREGIVERS OF AN INDIVIDUAL WITH SCHIZOPHRENIA

healthcare professionals can be achieved in nurse led groups (Summerville and Atherley, 2012). In order to support family caregivers of an individual with schizophrenia, a coping model, suggested by Lazarus and Folkman (1984) can be applied. The concept of coping is defined through the person and environment relationship that generates the demands and emotions, a caregiver should manage (Lazarus and Folkman, 1984). An individual with schizophrenia automatically causes changes in family, adaptation to which drastically affects the way of life family caregivers lead. Moreover, their wellbeing is also endangered, which may result in repercussions for an individual, living with the illness. The cognitive relational theory of emotion and coping helps to develop adequate reaction to the stressors the caregiver faces through two interacting cognitive appraisal processes (Lazarus and Folkman, 1984). Cognitive appraisal appears to be the way a caregiver interprets the changes caused by schizophrenia. The primary appraisal determines the character of the changes, their possible harmfulness, benefits, challenge, threat and importance. If cognitive and motivational characteristics of caregivers make them vulnerable to the occurrence of the family members illness, the process of coping is expected to be difficult (Lazarus and Folkman, 1984). During the second appraisal, social, material, psychological and physical resources that can help the caregivers to cope with the situation are evaluated. In such a case, the equality of all resources is the predictor of successful coping. If the discrepancies between the resources are very dramatic, it is more likely that the caregiver will interpret the event as a threat (Lazarus and Folkman, 1984). Temporal factors of coping are also very significant, since they show the dependence of coping on the availability of the support network. This factor is also crucial to be analyzed because of its ability to determine the adjustment strategies and the style of coping for the

THE EFFECT OF AN EDUCATION PROGRAM IN FAMILY CAREGIVERS OF AN INDIVIDUAL WITH SCHIZOPHRENIA

caregivers. Cultural, religious and believes of personal control are also responsible for the coping, according to Lazarus and Folkman, 1984. Therefore, it is especially important to support an internal locus of control that helps caregivers to cope with the stress. However, the difference between active and passive coping, where the first entails personal reaction to eliminate the stressor and the second the control of the response to the stressor may shape the whole process of coping. Emotion-focused, problem-focused and perception-focused coping (Lazarus and Folkman, 1984) strategies should be also intermingled in order to produce the desired effect. Since the biggest burden is always experienced at the beginning of the event, the further coping of the caregivers increases due to the gathered experience and a positive shift in the acceptance, understanding and addressing schizophrenia in family members. The further investigation of this concept is also significant because of the gender coping preferences (Lazarus and Folkman, 1984). For instance, sex differences in the styles of coping showed that men preferred self-control strategies and women positive reappraisal. All in all, coping by Lazarus and Folkman, 1984 alter either emotional reaction to the event or the situation. Moreover, it helps to control the source of the stressor, which automatically eliminates possible difficulties in the coping strategies. Although, the concept of coping, described above, can be applied to various types of stressors, its efficacy for the family caregivers of an individual with schizophrenia was also analyzed. The coping by Lazarus and Folksman, 1984 can be used for all individual cases of the problem under consideration, looking for the best possible coping styles and strategies, suitable for every single caregiver. Addressing, not only the perception of the event but also correspondence of such characteristics as age, ethnicity, gender, social, psychological,

THE EFFECT OF AN EDUCATION PROGRAM IN FAMILY CAREGIVERS OF AN INDIVIDUAL WITH SCHIZOPHRENIA

physical and cultural characteristics of the caregivers, it can help to develop effective way of adjustment and coping of the event. References Chan, S.W. (2011). Global Perspective of Burden of Family Caregivers for Persons with Schizophrenia. Archives of Psychiatric Nursing, 25 (5): 339-349. Grandon, P., Jenaro, C. and Lemos, S. (2008). Primary Caregivers of Schizophrenia Outpatients: Burden and Predictor Variables. Psychiatry Research, 158: 335343. Lazarus, R.S. and Folkman, S. (1984). Stress, Appraisal and Coping. Springer Publishing Corporation. NAMI. (2008). Understanding Schizophrenia and Recovery. The National Alliance of Mental Illness. Retrieved from: <www.nami.org>. Rose, L. (1998). Benefits and Limitations of Professional Family Interactions: the Family Perspective. Archives of Psychiatric Nursing, 12 (3): 140-147. Saunders, J.C. (2003). Families Living with Severe Mental Illness: Literature Review. Issues in Mental Health Nursing, 24: 175-198. Summerville, C. and Atherley, G. (2012). Hope for Family Caregivers Caring for Family Members with Schizophrenia: a Discussion. Torrey, E. (2001). Surviving Schizophrenia: a Manual for Families, Consumers, and Providers. (4th Edition). Harper Collins. Wuerker, A.K. (2000). Families and Schizophrenia. Issues in Mental Health Nursing, 21: 127-141.

THE EFFECT OF AN EDUCATION PROGRAM IN FAMILY CAREGIVERS OF AN INDIVIDUAL WITH SCHIZOPHRENIA