Stress among caregivers of schizophrenia - a pilot analysis

Ajithakumari G, Hemavathy V. Stress among caregivers of schizophrenia - a pilot analysis. Cardiometry; Issue 22; May 2022; p. 435-443; DOI: 10.18137/cardiometry.2022.22.435443; Available from:

Schizophrenia affects approximately 24 million people or 1 in 300 people (0.32%) worldwide. This rate is 1 in 222 people (0.45%) among adults [1]. It costs patients, caregivers, and society a lot of money because it’s chronic and often incapacitating. Caregivers of people with schizophrenia experience a lot of stress and emotional strain, and they’re often compelled to take care of them for the rest of their lives [2]. Having a relative with mental illness can be stressful for many families. Ignorance and misconceptions among patient caregivers, deinstitutionalization policies, and a lack of resources all contribute to a high illness burden among caregivers. Many families believe they lack the resources they require to manage their members’ mental illnesses [3]. Severe mental illness, such as schizophrenia, has a terrible effect on both individuals and their families. In India, the family is an important source of support for the mentally sick. Despite their incredible fortitude in caring for their relatives, Indian families face a great deal of physical and emotional suffering [4].

• 2    Literature Review

Schizophrenia is a functional psychosis characterized by cognitive, emotional, volitional, and perceptual disturbances. Finally, it leads to a decline of personality. In a state of clear consciousness, the sickness occurs. Unlike many other mental illnesses, schizophrenia frequently renders a person helpless [5]. Schizophrenia patients experience abrupt changes in mood, thinking, perception, and overall behavior. These alterations are frequently accompanied by reality illusions. Family support is extremely vital to the health and well-being of many persons living with schizophrenia. It is equally critical for families to be well-informed and supported [6].

Schizophrenia is a common mental illness that affects people from all walks of life and from all corners of the globe. Schizophrenia affects three to four people out of every 1000 people in any given society [7]. This disease affects about 1% of the general population at some point in their lives. Two-thirds of the cases are between the ages of 15 and 30. The disease is more prevalent among the lower socioeconomic levels [8].

The prevalence rate for schizophrenia is believed to be roughly 1.1 percent of the population over the age of 18 (source: NIMH), which indicates that up to 51 million individuals worldwide are affected by the disease at any given time, including:

China has a population of 6 to 12 million people (a rough estimate based on the population)

India’s population ranges from 4.3 to 8.7 million people (a rough estimate based on the population)

The United States has 2.2 million people; Australia has 285,000 people; and Canada has over 280,000 individuals.

In the United Kingdom, around 250,000 instances have been diagnosed.

Schizophrenia is a severe mental condition that affects a person’s ability to think, feel, and act. People with schizophrenia may appear to have lost touch with reality, causing tremendous distress for the person, their family, and friends [9].

• 3    Materials and Method

• 3.1.    The Purpose of This Research

• 3.2.    Objectives of the Study

A pilot study was done among 28 caregivers with schizophrenia to examine the study’s viability and feasibility in the analogous procedure as that of the original study in Sree Balaji Medical College and Hospital. Eventually data was anatomized to find out the felicity of the statistics [10].

The goal of this pilot study in Sree Balaji Medical College and Hospital, Chennai, was to see how successful psychosocial interventions were at reducing stress among caregivers of schizophrenia patients [11].

• •    To determine the preassessment level of stress among caregivers of schizophrenia in experimental and control group

• •    To assess and compare post assessment level of stress among caregivers of schizophrenia in experimental and control group.

• •    To compare the effectiveness of psychosocial interventions between experimental and control group

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• •    To determine the relationship between demographic characteristics and the post-assessment level of stress in the experimental group.

• 4.1.    Research Approach

  The term “research approach” refers to the general technique for conducting research. (Treece & Treece, 1986).The selection of research approach is a basic procedure to conduct a research study. The investigator evaluates the effectiveness of psychosocial interventions among caregivers of schizophrenic patients based on the problem chosen for the study and the goal to be achieved, so the quantitative evaluative exploration approach was considered as an appropriate exploration approach for this study [12].

• 4.2.    Research Design

• 4.3.    Variables

• 4.4.    Sample

• 4.5.    Criteria for Sample Collection

• 4.6.    Inclusion Criteria

  • •    The care givers of clients diagnosed with schizophrenia having a history of illness for 6 months or more.

  • •    The care givers who were willing to share in this study.

  • •    The care givers who speak and understand Tamil or English.

  • •    The care givers who belong to the age group of 1860 times will be included.

  • •    The caregivers who were willing to come for follow up

• 4.7.    Exclusion Criteria

Research Methodology

This study advocated for a true experimental research design.

The study’s demographic factors include age, religion, gender, level of education, and patient relationship. Income sufficiency, work position, and caregiver’s duty duration are all factors to consider. As a result of their caring obligations, many have lost their jobs. Marriage status, residence, and family type are all factors to consider [13].

Caregivers of schizophrenia who satisfied the addition criteria were named as samples

The samples for the study were grounded on the succeeding criteria

Care givers of other psychiatric conditions will be excluded from the study.

The care givers who are having any hearing difficulty were excluded from the study

• 4.8.    Research Tool and Technique

  • 4.8.1.    Part I

• 4.8.2.    Part II

  Zarit Burden interview was used to determine the stress levels among the caregivers of schizophrenia. This tool was developed by Steven H Zarit and Judy M. Zarit (1983, 1990)

• 4.9.    Considerations of Ethics

It included a structured interview companion with questions about the demographic data of the caregivers of schizophrenic case.

The intended study was carried out with the approval of the Sree Balaji Medical College and Hospital’s institutional ethics commission. Authorization was attained from the Head of the Institution [14]. Due concurrence was attained from the Dean of Sree Balaji Medical College and Hospital and the head of the Psychiatric department for the airman study [15]. Informed concurrence of each sample was attained before the data collection and assertion was given to them that the obscurity of each existent would be maintained [16].

In Table 1 the researcher explains about the demographic variable, 42.86% belong to 18-30 years,71.43% Hindu,64.29% female in experimental group where as in control group 35.71% belong to 18-30 years, 64.29% Hindu, 57.14% female.

In Table 2 Prior to psychosocial therapies, 71.43 percent of careers in the Experimental group had a moderate level of score, while 28.57 percent had a severe level of score. In the control group, 78.57 percent

Table 1

Demographic Profile.

Demographic variables		Group
		Experimental (n=14)		Control(n=14)
		n	%	n	%
Age	18-30 years	6	42.86%	5	35.71%
	31-40 years	3	21.43%	5	35.71%
	41-50 years	3	21.43%	2	14.29%
	51-60 years	2	14.29%	2	14.29%
Religion	Hindu	10	71.43%	9	64.29%
	Muslim	2	14.29%	2	14.29%
	Christian	2	14.29%	3	21.43%
Gender	Male	5	35.71%	6	42.86%
	Female	9	64.29%	8	57.14%
Level Of Education	Illiterate	4	28.57%	4	28.57%
	Elementary	3	21.43%	5	35.71%
	Secondary	7	50.00%	5	35.71%
	High school	0	0.00%	0	0.00%
	College	0	0.00%	0	0.00%
Relationship With The Patient	Spouse	7	50.00%	6	42.86%
	Parents	4	28.57%	4	28.57%
	Sibling	2	14.29%	2	14.29%
	Children	1	7.14%	2	14.29%
Perceived income adequacy	Yes	5	35.71%	4	28.57%
	No	9	64.29%	10	71.43%
Employment Status	Employed	6	42.86%	8	57.14%
	Unemployed	8	57.14%	6	42.86%

Demographic variables		Group
		Experimental (n=14)		Control(n=14)
		n	%	n	%
Duration of caregivers role	1-10 years	9	64.29%	8	57.14%
	>10 years	5	35.71%	6	42.86%
Losing Job because Of Care Giving Responsibility	Yes	14	100.00%	14	100.00%
	No	0	0.00%	0	0.00%
Marital Status	Single	4	28.57%	2	14.29%
	Married	8	57.14%	9	64.29%
	Widowed	2	14.29%	3	21.43%
Residence	Rural	5	35.71%	6	42.86%
	Urban	9	64.29%	8	57.14%
Type of family	Nuclear	5	35.71%	7	50.00%
	Joint	9	64.29%	7	50.00%

Table 2

Score for the Pretest Level of Stress

Stress Levels Experiment Control Chi square test n % n % No stress 0 0.00% 0 0.00% χ2=0.19 P=0.66(NS) Mild stress 0 0.00% 0 0.00% Moderate stress 10 71.43% 11 78.57% Severe 4 28.57% 3 21.43% Total 14 100.00% 14 100.00% of careers received a moderate score, while 21.43 percent received a severe grade [17].

In Table 3 After psychosocial therapies, 64.29 percent of careers in the Experimental group had a medium level of score, whereas 35.71 percent have a severe level of score. 85.71 percent of careers in the control group had a moderate level of score, whereas 14.29 percent have a severe level of score.

In Table 4 Pre-test, caregivers in the experimental group scored 57.07, whereas caregivers in the control group scored 56.14, a difference of 0.93. This difference is modest and statistically insignificant. In terms of the post-test, the Experimental group caregivers have a score of 39.86, while the post-test caregivers have a score of 54.43, a difference of 14.57. This difference is big and statistically significant.

In Table 5 Pre-test, caregivers in the experimental group scored 57.07, whereas caregivers in the control group scored 56.14, a difference of 0.93. This difference is modest and statistically insignificant. In terms of the post-test, the Experimental group caregivers have a score of 39.86, while the post-test caregivers have a score of 54.43, a difference of 14.57. This difference is big and statistically significant.

In Table 6 Experimental group the mean stress score before psychosocial intervention was 57.07 whereas after psychosocial intervention it was reduced to 39.86. In control group the mean stress score before psychosocial intervention was 56.14 whereas after psychosocial intervention it was reduced to 54.43.The effectiveness of psychosocial interventions on stress was proved by the reduction of stress score in Experimental group by 19.56% whereas in control group by 1.94%.

In Table 7 the relationship between the post-test level of stress score and caregiver demographic factors revealed that caregivers in the 40-60 year age range, male caregivers, and joint family caregivers have milder stress levels than others. The Chi square test/Yates corrected chi square test was used to determine statistical significance.

In Figure 1 the pre-test level of stress score in the experimental group is 71.43% moderate stress and 28.57% severe stress and in the control group 78.57% moderate stress and 21.43% severe stress.

In Figure 2 the post-test level of stress score in the experimental group is 64.29% mild stress and 35.71% moderate stress and in the control group is 85.71% moderate stress and 14.29% severe stress.

Table 3

Score for the post Test Level of Stress.

Stress Levels	Experimental		Control		Chi square test
	n	%	n	%
No stress	0	0.00%	0	0.00%	χ2=13.88 P=0.001***(S)
Mild stress	9	64.29%	0	0.00%
Moderate stress	5	35.71%	12	85.71%
Severe	0	0.00%	2	14.29%
Total	14	100.00%	14	100.00%

Table 4

Mean Stress Score Pre and Post Test Comparison.

Group		N		SD	Mean reduction score	Paired t-test
Experimental	Pre-test	14	57.07	4.07	17.21	t=11.55 p=0.001*** (S)
	Post-test	14	39.86	4.89
Control	Pre-test	14	56.14	3.90	1.71	t=1.47 p=0.17 (NS)
	Post-test	14	54.43	5.89

Table 5

The Mean Stress Score in the Experimental and Control Groups.

Group		N	Mean	SD	Mean difference score	Student independent t-test
Pre-test	Experimental	14	57.07	4.07	0.93	t=0.61 p=0.54 (NS) [1]
	Control	14	56.14	3.90
Post-test	Experimental	14	39.86	4.88	14.57	t=7.13 p=0.001*** (S) [1]
	Control	14	54.43	5.89

Table 6

Effectiveness of Psycho social Interventions.

Group	Test	Maximum score	Mean score	Mean Difference of stress reduction score with 95% Confidence interval	Percentage Difference of stress reduction score with 95% Confidence interval
Experimental	Pre-test	88	57.07	17.21(14.14 –20.29)	19.56 %( 16.07% –23.06%)
	Post test	88	39.86
Control	Pre-test	88	56.14	1.71(-0.80 – 4.23)	1.94%(-0.91% –4.80%)
	post-test	88	54.43

Table 7

Relationship between Caregivers’ Demographic Variables and Post-Test Stress Score (Experimental Group)

Demographic variables		Post-test level of stress score				n	Chi square test /Yates corrected chi square test
		Mild stress		Moderate stress
		n	%	n	%
Age	18-40 years	5	55.56%	4	44.44%	9	χ2=0.83 p=0.36(NS)
	41-60 years	4	80.00%	1	20.00%	5
Religion	Hindu	5	50.00%	5	50.00%	10	χ2=3.11 p=0.08(NS)
	Muslim/Christian	4	100.00%	0	0.00%	4
Gender	Male	5	100.00%	0	0.00%	5	X 2=4.32 p=0.03*(S)
	Female	4	44.44%	5	55.56%	9
Level Of Education	Illiterate	2	50.00%	2	50.00%	4	χ2=0.50 p=0.48(NS)
	literate	7	70.00%	3	30.00%	10

Demographic variables		Post-test level of stress score				n	Chi square test /Yates corrected chi square test
		Mild stress		Moderate stress
		n	%	n	%
Relationship With The Patient	Spouse	4	57.14%	3	42.86%	7	χ2=0.31p=0.58(NS)
	Others	5	71.43%	2	28.57%	7
Perceived income adequacy	Yes	2	40.00%	3	60.00%	5	χ2=2.00p=0.15(NS)
	No	7	77.78%	2	22.22%	9
Employment Status	Employed	3	50.00%	3	50.00%	6	χ2=0.93p=0.33(NS)
	Unemployed	6	75.00%	2	25.00%	8
Duration of caregivers role	1-10 years	7	77.78%	2	22.22%	9	χ2=2.00p=0.15(NS)
	>10 years	2	40.00%	3	60.00%	5
Losing Job because Of Care Giving Responsibility	Yes	9	64.29%	5	35.71%	14	χ2=0.00p=1.00(NS)
	No	0	0.00%	0	0.00%	0
Marital Status	Married	7	87.50%	1	12.50%	8	χ2=2.34p=0.13(NS)
	Single/widowed	2	33.33%	4	66.67%	6
Residence	Rural	2	40.00%	3	60.00%	5	χ2=1.99p=0.16(NS)
	Urban	7	77.78%	2	22.22%	9
Type of family	Nuclear	1	20.00%	4	80.00%	5	x 2=6.96p=0.01**(S)
	Joint	8	88.89%	1	11.11%	9

Figure 1. The Pre-Test Level of Stress Score in the Experimental and Control Groups

Experimental

Control

Figure 2. The Post-Test Level of Stress Score in the Experimental and Control Groups

In Figure 3 the association between the post-test levels of stress score and demographic variables of caregivers depicted that male caregivers are having more mild stress level score than others.

In Figure 4 the association between the post-test levels of stress score and demographic variables of caregivers depicted that joint family caregivers are having more mild stress level score than others.

• 4.10.    Validity and Reliability

Experts in nursing, medicine, and psychology fought hard for content validity. The Cronbach alpha method was used to assess the tool’s reliability. Coping (0.85) score reliability correlation coefficient These correlation coefficients were extremely high, making it a useful tool for assessing the ef- ficacy of psychosocial therapies on stress among schizophrenia caregivers in a specific hospital in Chennai [18].

• 5    Results and Discussion

  • 5.1.    Demographic Variable

• 5.2.    Pre-Test Level of Stress Score in Experimental and Control Group

Most of the caregivers were from the age group of 18-30 years, Hindu and female. Majority of them completed their secondary level of education and their relationship with patient was spouse.

Before psychosocial interventions, in Experimental group, 71.43% of the caregivers were having moder-

Mild stress

Moderate stress

Male

Female

Figure 3. Relationship between Caregiver Gender and Posttest Stress Score

Figure 4. The Relationship between Post-Test Stress Levels and the Type of Family Caregivers

ate level of score, 28.57% of them having severe level of score. In control group, 78.57% of the caregivers were having moderate level of score, 21.43% of them having severe level of score

• 5.3.    Posttest Level of Stress Score in Experimental and Control Group

• 5.4.    Comparison of Pre-test and Post-Test Mean Stress Score

• 5.5.    Comparison of Mean Stress Score between Experimental and Control Group

• 5.6.    Effectiveness of Psychosocial Interventions and Generalization of Stress Reduction Score

• 5.7.    Association between Post-test Level of Stress Score and Caregivers Demographic Variables (Experimental Group)

After psychosocial interventions, in Experimental group, 64.29% of the caregivers are having mild level of score, 35.71% of them having severe level of score. In control group, 85.71% of the caregivers are having moderate level of score, 14.29% of them having severe level of score

Considering Experiment group, in pre-test they are having 57.07 score and in post-test they are having 39.86 score, so the difference is 17.21 this difference is large and it is statistically significant. Considering Control group, in pre-test they are having 56.14 score and in post-test they are having 54.43 score, so the difference is 1.71, this difference is small and it is not statistically significant.

Considering pre-test, Experimental group caregivers are having 57.07 score and in control they are having 56.14 score, so the difference is 0.93, this difference is small and it is statistically not significant. Considering post-test, Experimental group caregivers are having 39.86 score and in post-test they are having 54.43score, so the difference is 14.57, this difference is large and it is statistically significant

In Experimental group the mean stress score before psychosocial intervention was 57.07 whereas after psychosocial intervention it was reduced to 39.86. In control group the mean stress score before psychosocial intervention was 56.14 whereas after psychosocial intervention it was reduced to 54.43. The effectiveness of psychosocial interventions on stress was proved by the reduction of stress score in Experimental group by19.56% whereas in control group by 1.94%.

The association between the post-test level of stress score and demographic variables of caregivers depicted that 40-60 years group caregivers, male caregivers and joint family caregivers are having more mild stress level score than others. Statistical significance was assessed using Chi square test/Yates corrected chi square test.

• 6    Conclusion

Majority of the caregivers was female from a joint family .Most of the caregivers were residing in urban area. Before psychosocial interventions, in Experimental group, 71.43% of the caregivers were having moderate level of score, 28.57% of them having severe level of score. In control group, 78.57% of the caregivers were having moderate level of score, 21.43% of them having severe level of score.After psychosocial interventions, in Experimental group, 64.29% of the caregivers are having mild level of score, 35.71% of them having severe level of score. In control group, 85.71% of the caregivers are having moderate level of score, 14.29% of them having severe level of score.When comparing the mean stress score in Experimental group, in pre-test they are having 57.07 score and in post-test they are having 39.86 score, so the difference is 17.21 this difference is large and it is statistically significant. Considering Control group, in pre-test they are having 56.14 score and in post-test they are having 54.43 score, so the difference is 1.71, this difference is small and it is not statistically significant. The effectiveness of psychosocial interventions on stress was proved by the reduction of stress score in Experimental group by19.56% whereas in control group by 1.94%.This pilot study concludes by proving the effectiveness of psychosocial interventions on stress among caregivers of schizophrenia.

Conflict of interest nil

Funding nil

Author contributions

The authors read the ICMJE criteria for authorship and approved the final manuscript.