Association between symptom profile of schizophrenia and the perceived wellbeing in their caregivers

Pugazhendhi K., Kathir M., Ravishankar J.


Background: The chronic nature of Schizophrenia has a devastating impact not only on the patients but also in their caregivers. The burden experienced by the caregivers can seriously affect the psychological wellbeing and caregivers take up multiple coping strategies to tackle the burden. This study was undertaken to find the association between symptom profile of Schizophrenia patients and the perceived wellbeing of their caregivers.

Methods: 30 patients with schizophrenia and their caregivers (parents or spouses), who were actively involved in care of the patient for at least 6 months prior to assessment, were included in the study. Patients were evaluated by socio demographic data sheet and Positive and negative syndrome scale (PANSS) while their caregivers were evaluated using Caregiver socio demographic data sheet, Burden Assessment Schedule (BAS), Coping Checklist (CCL) and Psychological Well Being Questionnaire (PWBQ). Statistical analysis was done using Chi square test and Fischer exact test for categorical variables, Pearson correlation to find correlation between data and Analysis of variance (ANOVA) to find significance of study parameters between groups. p < 0.05 was considered significant.

Results: Burden experienced by caregivers was more with a severe symptom profile. Moderate correlation is found between patient’s positive symptom profile, negative symptom profile and burden. There was a weak correlation between patient`s symptom profile and care givers coping strategies. The total PANSS scores did not influence the pattern of coping. There was no statistically significant difference in coping strategies in positive and negative symptom of schizophrenia. There was a moderate negative correlation between patient`s symptom profile (positive and total PANSS score) and psychological wellbeing in caregivers. However, there was a weak correlation between patient negative symptom profile and psychological wellbeing in caregivers.

Conclusions: Burden and wellbeing of the care givers of schizophrenic patients are closely inter related. These parameters are in turn related to patient’s symptoms profile namely, the overall psychopathology and more with the positive symptoms of schizophrenia. Though all care givers used different coping strategies, there did not appear to be any interrelation between strategies and the perceived burden, well-being and patient’s psychopathology.


Burden, Caregivers, Coping, Schizophrenia, Wellbeing

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Lefley HP. Family Burden and Family Stigma in major mental illness. American Psychologist. 1989;44(3):556-60.

van Wijngaarden B, Schene AH. Caregiving Consequences in The Netherlands and Other European Countries: The Development and Use of the Family. Family Interventions in mental illness: International perspectives. 2002:145.

Robin E. Clark. Family costs associated with severe mental illness and substance abuse. Hospital Community Psychiatry. 1994;45(8):808-13.

Cohler BJ, Pickett SA, Cook JA. The psychiatric patient grows older: Issues in family care. Springer. 1991:82-110.

Hoenig J, Hamilton MW. The schizophrenic patient in the community and his effect on the household. Inter J social Psychiatry. 1966;12(3):165-76.

Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Social Behavior. 1980;21:219-39.

Lazarus RS. From psychological stress to the emotions; A history of changing outlooks. Annual Review of Psychology. 1993;44:1-21.

Dyck DG, Short R, Vitaliano PP. Predictors of burden and infectious illness in schizophrenia caregivers. Psychosomatic Medicine. 1999;61(4):411-9.

Lysaker PH, Lancaster RS, Nees MA, Davis LW. Attributional style and symptoms as predictors of social function in schizophrenia. J Rehabilitation Research Development. 2004;41(2):225-32.

Velligan DI, Mahurin RK, Diamond PL, Hazleton BC, Eckert SL, Miller AL. The functional significance of symptomatology and cognitive function in schizophrenia. Schizophrenia research. 1997;25(1):21-31.

Magaña SM, Ramírez García JI, Hernández MG, Cortez R. Psychological distress among latino family caregivers of adults with schizophrenia: the roles of burden and stigma. Psychiatric services (Washington, DC). 2007;58(3):378-84.

Reddy VM, Chandrashekar CR. Prevalence of mental and behavioural disorders in india: a meta-analysis. Ind J Psychiatry. 1998;40(2):149-57.

Thara R, Srinivasan TN. The outcome of marriage in schizophrenia. Social Psychiatry Psychiatric Epidemiology. 1997;32:416-20.

Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin. 1987;13(2):261-76.

Thara R, Padmavati R, Kumar S, Srinivasan L. Burden assessment schedule instrument to assess burden on caregivers of chronic mentally ill. Ind J Psychiatry. 1998;40(1);21-9.

Rao K, Subbakrishna DK, Prabhu GG. Development of a coping checklist-a preminary report. Ind J Psychiatry. 1989;31(2):128-33.

Bhogle S, Jaiprakash I. Development of the Psychological well-being (PWB) Questionnaire. J Personality Clinical Studies. 1995;11(1-2):5-9.

Muralidhar D, Shariff IA. Obstacles in the way of readjustment of mental patients in the family. J Rehabilitation Asia. 1981;21(4):37-41.

Gautam S, Nijhawan M. Burden on families of schizophrenic and chronic lung disease patients. Ind J Psychiatry. 1984;26:156-9.

Gopinath, PS, Chaturvedi, SK. Distressing behavior of schizophrenics at home. Acta Psychiatrica Scandinavica. 1992;86:185-8.

Ali M, Bhatti RS. Social support system and family burden due to chronic schizophrenia in rural and urban background. Ind J Psychiatry. 1988;30(4):349-53.

Bharat S. Research on family structure and problems: Review, implications and suggestions. Research on families with problems in India. 1991;1:33-67.

Chakrabarti S, Raj L, Kulhara P, Avasthi A, Verma SK. Comparison of the extent and pattern of family burden in affective disorders and schizophrenia. Ind J Psychiatry. 1995;37(3):105-12.

Pai S, Kapur RL. Evaluation of home care treatment for schizophrenia patients. Acta Psychiatrica Scandinavica. 1983;67(2):80-8.

Shankar R, Kamath S, Joseph AA. Gender differences in disability: A comparison of married patients with schizophrenia. Schizophr Res. 1995;16:17-23.

Mahendru RK, Singh V, Sachan SN. A study of psychiatric morbidity in the spouses of schizophrenic patients. Ind J Psychiatry. 1997;39:48.

Pai S, Kapur RL. The burden on the family of a psychiatric patient: Development of an interview schedule. Brit J Psychiatry. 1981;138:332-5.

Moily S, Murthy RS, Nagarajaiah B, Sekar K, Puttamma M, Kumar KV, et al. Burden in families with schizophrenic patients in a rural community. Indian J. Psychiatry. 1997;39:48.

Vohra AK, Garg S, Gaur DR. A study of burden on families of schizophrenia and depressive disorder. Abstracts of the scientific papers presented at the 54-annual national conference of Indian Psychiatric Society. Ind J Psychiatry. 2000;42:33.

Chandrasekaran R, Sivaprakash B, Jayestri SR. Coping Strategies of the Relatives of Schizophrenic Patients. Ind J Psychiatry. 2002;44(1):9-13.

Trivedi JK, Dalal PK, Kalra H. Family burden and coping strategy in relatives of schizophrenic patients. Ind J Psychiatry, Supplement. 2003;106.

Rammohan A, Rao K, Subbakrishna DK. Burden and Coping in Caregivers of Persons with Schizophrenia. Ind J Psychiatry. 2002;44(3):220-7.

Provencher HL, Mueser KT. Positive and negative symptom behaviors and caregiver burden in the relatives of persons with schizophrenia. Schizophrenia Research. 1997;26(1):71-80.

Magliano L, Marasco C, Fiorillo A, Malangone C, Guarneri M, Maj M. The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy. Acta Psychiatrica Scandinavica. 2002;106(4):291-8.

Wolthaus JE, Dingemans PM, Schene AH, Linszen DH, Wiersma D, Van Den Bosch RJ, et al. Caregiver burden in recent-onset schizophrenia and spectrum disorders: the influence of symptoms and personality traits. J Nervous Mental Dis. 2002;190(4):241-7.

Mahendru, R.K. Mental morbidity and personality pattern in the spouses of schizophrenic patients. Ind J Psychiatry. 1996;38;14-5.

Kumar S, Mohanty S. Spousal burden of care in schizophrenia. J Ind Academy Applied Psychol. 2007;33(2):189-94.

Roychaudhuri J, Mondal D, Boral A, Bhattacharya D. Family burden among long term psychiatric patients. Ind J Psychiatry. 1995;37(2):81-5.

Magaña SM, Ramírez García JI, Hernández MG, Cortez R. Psychological distress among latino family caregivers of adults with schizophrenia: the roles of burden and stigma. Psychiatric services (Washington, DC). 2007;58(3):378-84.

Rammohan A, Rao K, Subbakrishna DK. Religious coping and psychological well-being in carers of relatives with schizophrenia. Acta Psychiatrica Scandinavica. 2002;105(5):356-62.