Awareness of schizophrenia and caregiver burden

Changes in the health care system are causing people with severe mental illnesses such as schizophrenia to spend less time as hospital inpatients. As a result, an increasing number of families perform caregiving services that were once provided during extended hospital stays. Caregivers often experience poor physical and mental health, financial difficulties, and social isolation (McCarthy, Lesage, Brewin, Brugha, Mangen & Wing, 1989). These difficulties are known collectively as caregiver burden. A number of studies have investigated the relationship between caregiver burden and various patient factors. One patient factor that has not been investigated in the schizophrenia literature is lack of insight or unawareness. The present study sought to examine the relationship between patient unawareness and caregiver burden. Twenty six caregiver and patient pairs participated in the study. Patients met the DSM-IV criteria for schizophrenia or schizoaffective disorder and were being treated at McLean Hospital in Belmont, MA. All patients were required to have at least one identifiable family caregiver. The data were examined using two methods: Pearson Product Moment Correlations and regression analyses. Of all independent variables (unawareness, positive symptoms, negative symptoms, depression, and quality of life) patient unawareness was the only variable that significantly correlated with caregiver burden (r = .54, p = .01, n = 26). Patient unawareness was also the only variable accounting for a significant portion of the variance in caregiver burden (beta = .59 p = .01). Of specific symptoms of schizophrenia, unawareness of poor control of aggressive impulses was significantly correlated with caregiver burden (r = .91, p = .004, n = 7). The results of this study indicate that patient unawareness is correlated with, and is also the best predictor of caregiver burden. Future research is needed to develop treatment protocols to increase awareness in patients with schizophrenia. Research is also needed to determine the effect of these efforts on caregiver burden.