Ines Nitsche

Which factors influence the psychological distress among relatives of patients with chronic functional psychoses? An exploratory study in a community mental health care setting

AimThis research aimed to assess the contribution of the five core areas of the transactional stress model to the relatives’ psychological distress (PD) when informally taking care of patients with functional psychoses treated in community mental health care.Subjects and methodsCross-sectional data from 163 relatives were collected in interviews, while data on 158 patients were collected by analyzing clinical charts. The following areas were assessed: socio-demographic and illness-related features of the patients, socio-demographic features of the relatives (environmental variables); sense of coherence, mastery, causal attributions and opinions of relatives about mental disorders (person variables); interpersonal problems with the patients as well as the assessment of their symptoms by the relatives themselves (primary appraisal); support received, critical life events and burden of relatives caused by their own illnesses (secondary appraisal); control behavior and efforts of relatives to engage the patients in activities (coping). PD was assessed with the 12-item version of the General Health Questionnaire. Bi-variate correlation analysis and a multiple linear regression model were the main test statistical approaches.ResultsCorrelation analysis showed that differences between diagnostic groups referred to primary and secondary appraisal processes, in particular. Results of the statistical model provided evidence for the importance of primary appraisal and person variables for influencing PD, and for the lack of importance of coping and environmental variables.ConclusionThe study enhanced the validity of the transactional stress model to demonstrate the influence of salutogenetic concepts such as sense of coherence.

Standardized Assessment of Psychopathology by Relatives of Mentally Disordered Patients

Background: For optimizing the validity of diagnoses of mental disorders, several sources of information should be used to assess psychopathological symptoms. Among these are relatives of patients with mental illness. The very low number of empirical studies examining the assessment of psychopathology by relatives of adult, nondemented mentally ill patients stands in significant contrast to the clinical importance of this source of information, however. Sampling and Methods: Using the Positive and Negative Syndrome Scale (PANSS), researchers asked 163 relatives of patients with the main clinical ICD-10 diagnosis of schizophrenic, recurrent depressive or bipolar disorders to rate the current symptoms of the patients at the time of outpatient community-oriented treatment. Results: On average, severity of symptoms was rated as absent or minimal, although anxiety, depression and passive/apathetic social as well as emotional withdrawal, motor retardation, poor attention, and disturbance of volition were clearly rated above the PANSS mean total score for all patients. A six-factor structure identified by factor analysis better illustrates the significant differences in the assessments of the three main diagnostic groups than the three established PANSS scales. With the exception of ‘problematic social behavior’, differences among the diagnostic groups appeared in all factors and were particularly pronounced for ‘delusional beliefs’ and ‘motor impairments’. Conclusions: The results of this study showed that the use of standardized instruments such as PANSS for the assessment of psychopathology by relatives is not only practical, but produces adequately reliable results. The use of PANSS for this purpose, however, requires interviewing of relatives by trained experts able to explain technical terms. Because this study did not sufficiently explore the validity of this approach, further research on this specific issue is urgently needed and should, for example, assess the concordance of ratings between professionals and relatives as well as correlation with suitable external criteria.

Zur faktoriellen Stabilität der deutschen Version des Questionnaire on the Opinions of the Family (QOF)

Zusammenfassung. Die Anzahl von standardisierten Untersuchungsinstrumenten, die Meinungen von Angehorigen zu Ursachen und sozialen Konsequenzen psychischer Storungen erfassen, ist sehr gering. Mit hoherem methodischen Aufwand wurde bislang lediglich der in Italien fur schizophrene Storungen konzipierte Questionnaire on the Opinions of the Family (QOF) entwickelt. In einem deutschen Forschungsprojekt konnte die Subskalenstruktur des italienischen QOF in einer Gruppe von Angehorigen (N = 161) von Patienten mit rezidivierend depressiven, bipolar affektiven oder schizophrenen Storungen nicht repliziert werden, was die Entwicklung einer ersten deutschen Version dieses Instrumentes (18 Items) veranlasste. Hiermit lies sich eine 3-Faktoren-Losung identifizieren, die die Angehorigenmeinungen in die Inhaltsbereiche “soziale Distanz“, “soziale Integration“ und “Orientierung auf Ressourcenoptimierung“ untergliedert. Die faktorielle Stabilitat der deutschen QOF-Version wurde in einer weiteren unabhangigen Angehorigen...