Duane S. Bishop

The McMaster Approach to Families: theory, assessment, treatment and research

The McMaster Approach to Families is a comprehensive model of family assessment and treatment. This paper provides an overview of the McMaster Approach and consists of five major sections. First, the under-lying theoretical model (McMaster Model of Family Functioning) is described. Second, the three assessment instruments of the approach (Family Assessment Device, McMaster Clinical Rating Scale, McMaster Structured Interview of Family Functioning) and their psychometric properties are summarized. Third, the family treatment model (Problem Centered Systems Therapy of the Family) is presented. Fourth, the research conducted using the McMaster Approach is reviewed. Finally, the clinical uses and advantages of the McMaster Approach are discussed.

An intervention trial to improve adherence to community treatment by adolescents after a suicide attempt

OBJECTIVE To determine whether a problem-solving intervention would increase adherence to outpatient treatment for adolescents after a suicide attempt. METHOD Sixty-three adolescents who had attempted suicide and were evaluated in an emergency department between 1997 and 2000 were randomly assigned to undergo standard disposition planning or a compliance enhancement intervention using a problem-solving format. At 3 months after the intervention, all evaluable adolescents, guardians, and outpatient therapists were contacted to determine adherence to outpatient treatment. RESULTS At 3-month follow-up, the compliance enhancement group attended an average of 7.7 sessions compared with 6.4 sessions for the standard disposition group, but this difference was not statistically significant. However, after covarying barriers to receiving services in the community (such as being placed on a waiting list and insurance coverage difficulties), the compliance enhancement group attended significantly more treatment sessions than the standard disposition-planning group (mean = 8.4 versus 5.8 sessions). CONCLUSION Interventions designed to improve treatment attendance must address not only individual and family factors but also service barriers encountered in the community that can impede access to services.

Family functioning in the families of psychiatric patients

Abstract The functioning of families of five psychiatric groups and a group of nonclinical families was assessed by the Family Assessment Device (FAD), a recently developed multidimensional measure of family functioning. The results indicated that families of patients with major depression, alcohol dependence, and adjustment disorder reported greater family dysfunction than nonclinical families. Families of schizophrenic and bipolar patients did not differ significantly from controls.

The relationship between the perception of social support and post-stroke depression in hospitalized patients.

In our study we examined the relationship between the perceived adequacy of social support and post-stroke depression in 76 hospitalized Australian patients. Social support or the perception of its lack, particularly from a spouse care-giver, was associated significantly with both the presence and severity of depressive disorder. Furthermore, depressed patients who perceived their support to be inadequate had a longer duration of depressive illness than depressed patients who perceived their support in a more favorable light. We conclude that following stroke, perception of social support from key relationships may mediate the emotional response to this life crisis. The implications of these findings are discussed.

Depressed patients with dysfunctional families: Description and course of illness.

Sixty-eight depressed patients were subdivided according to their familys level of family functioning into functional and dysfunctional groups. Patients from dysfunctional families did not differ from those from functional families on measures of severity of depression, chronicity of depression, depression subtypes, other nonaffective psychiatric diagnoses, history of depression, or neuroendocrine functioning. Patients from dysfunctional families did have significantly higher levels of neuroticism. A 12-month follow-up of these patients indicated that depressed patients with dysfunctional families had a significantly poorer course of illness, as manifested by higher levels of depression, lower levels of overall adjustment, and a lower proportion of recovered patients. Thus, impaired family functioning appears to be an important prognostic factor in major depression.

Family functioning and the course of major depression

Abstract Thirty-eight psychiatric inpatients with major depression and their families were assessed during the acute phase of the depressive disorder and at remission or 12-month follow-up. They were matched to 28 nonclinical control families. Depressed families reported worse family functioning than control families, both during the acute episode and at remission. The depressive episode was significantly shorter (4.1 months) in those families that improved in family functioning during follow-up than in those that did not (8.1 months) improve. The familys perception of its functioning during the acute episode was not a good predictor of the length of depression for its family member.

Telephone-Delivered Psychosocial Intervention Reduces Burden in Dementia Caregivers

The objective of this study was to examine the preliminary efficacy of Family Intervention: Telephone Tracking — Dementia (FITT-D), a multi-component intervention that is delivered in 23 telephone contacts over 12 months. Thirty-three dementia caregivers were randomly assigned to receive either FITT-D ( n = 16) or standard care (n = 17) using urn randomization to balance the groups on dementia severity, caregiver gender and relationship type (spouse versus other). Inclusion criteria included formal dementia diagnosis, caregiving for at least six months, residing with the care recipient, and providing at least four hours of direct supervision per day. Masters-level therapists contacted caregivers by telephone over 12 months. Each contact followed a standardized treatment manual, involving assessment and individualized application of interventions to address mood, family functioning, social support and health. Outcomes included Zarit Burden Interview, Revised Memory and Behavior Problem Checklist, and the Geriatric Depression Scale at baseline and 12 months (end of treatment). Caregivers receiving FITT-D exhibited significantly lower burden scores and less severe reactions to memory and behavior problems than caregivers in the standard care condition. Findings provide preliminary evidence for the efficacy of FITT-D, a potentially highly accessible, low-cost intervention for dementia caregivers.

Caregiver Burden and Depression Among Informal Caregivers of HIV-infected Individuals

BACKGROUND: Few studies have examined the factors associated with depression in informal caregivers of HIV-infected persons.OBJECTIVE: To investigate the relationship between depression and caregiver burden among informal caregivers of HIV-infected individuals.DESIGN: Cross-sectional study using baseline data from an ongoing randomized trial of a supportive telephone intervention.PARTICIPANTS: One hundred seventy-six dyads of HIV patients and their informal caregiver.MEASUREMENTS: Depression was defined as a Beck Depression Inventory >10. A Caregiver Strain Index >6 identified informal caregivers with a high caregiver burden. We used logistic regression to identify characteristics that were associated with depression in the informal caregiver.RESULTS: Informal caregivers were 42 years old (SD, 13), 53% female, 59% nonwhite, and 30% had education beyond high school. Forty-seven percent of informal caregivers were the patient’s partner, 18% a friend, and 35% a family member. Twenty-seven percent of informal caregivers had a high caregiver burden, and 50% were depressed. We found significantly greater odds of informal caregiver depression with high caregiver burden (OR, 6.08; 95% CI, 2.40 to 15.4), informal caregiver medical comorbidity besides HIV (OR, 2.32; 95% CI, 1.09 to 4.92), spending all day together (OR, 3.92; 95% CI, 1.59 to 9.69), having to help others besides the HIV patient (OR, 2.55; 95% CI, 1.14 to 5.74), and duration of the HIV patient’s diagnosis (OR, 1.01 per month; 95% CI, 1.00 to 1.01).CONCLUSIONS: High caregiver burden was strongly associated with depression among HIV-infected individuals’ informal caregivers, who themselves had difficult life circumstances. Informal caregivers of HIV patients may be in need of both mental health services and assistance in caregiving.

Stroke: Morale, family functioning, health status, and functional capacity

Twenty-two stroke patients and their spouses were studied. All patients were living at home and had had a stroke at least one year previously. Of the 22 patients 14 were men and eight were women. Couples were assessed on the variables of morale, family functioning, health status, and patient functional capacity. For all variables, patient-spouse and husband-wife differences were tested. Couples from a previously studied random community sample were matched to the stroke couples on age and socioeconomic status (SES). Identical morale, family functioning, and health status data collected on these couples were compared to the stroke data. The results included the following: Stroke patients and their spouses were healthy on all variables. Members of the couple did not differ on most variables whether compared as husband-wife or patient-spouse. Wives from the two samples did not differ on any variable. Husbands from the stroke sample differed from the matched husbands on only one health variable--the number of doctor visits made in the past six months.

Pathological crying and laughing: Treatment with sertraline

OBJECTIVE To evaluate the efficacy of sertraline for treating pathological laughing and crying after stroke. DESIGN Case series. SETTING Inpatient rehabilitation units of a community and a tertiary-care hospital. PATIENTS One patient was a 62-year-old right-handed man who had two strokes approximately 2 years apart and had computed tomography consistent with a cerebral infarct involving the left middle cerebral artery branches in the left parietal lobe. A second patient was a 72-year-old right-handed man who had a right middle cerebral artery infarct. He had a questionable history of depression prior to the stroke. INTERVENTION Both patients had poststroke labile affect that was interfering with their rehabilitation. Sertraline was prescribed. MAIN OUTCOME MEASURES Pretreatment and posttreatment scores on the Pathological Crying and Laughing Scale and Functional Independent Measure. RESULTS Both patients showed significant improvement after taking sertraline-improvement that was reflected in their pretreatment and posttreatment scores on the Pathological Crying and Laughing Scale and Functional Independent Measure. The staff noted improvements in sleeping, eating, social interaction, and therapy participation. Both patients tolerated the sertraline well and had no significant side effects.