Masako Kageyama

Rate of Family Violence Among Patients With Schizophrenia in Japan

Family violence is a serious concern in the era of deinstitutionalization in Japan. Consequently, we aimed to clarify the rate of family violence among patients with schizophrenia, and differences by sex and relationship to the patient. We asked households belonging to a family group association to complete a self-administered mail survey. Of 350 households that responded, data for 302 were analyzed. The rate of violence toward any family member was 60.9% over the lifetime and 27.2% in the past year. Order of lifetime rates for family members from highest to lowest was 51.0% for mothers, 47.0% for fathers, 30.7% for younger sisters, 23.8% for spouses, 19.5% for younger brothers, 18.2% for older sisters, 17.1% for older brothers, and none for children. Younger sisters were more likely to be victims compared to other siblings. Fathers and older brothers were likely to be victims when patients were male.

Psychological Distress and Violence Towards Parents of Patients with Schizophrenia

The present study investigated the relationship between violence and psychological distress experienced by parents of patients with schizophrenia. Questionnaire data from 379 parents were analyzed. A total of 151 parents (39.8%) had not experienced violence in the past year, whereas 96 (25.3%) and 132 (34.8%) had experienced psychological violence only or physical violence, respectively. A total of 216 (57.0%) of parents reported being psychologically distressed. Multiple logistic regression revealed that the risk of psychological distress significantly increased with the experience of psychological and physical violence, lower household income, greater family stigma, and the increasing age of patients.

Social Workers’ Support Skills for Parents with Mental Disorders: A Qualitative Descriptive Study in Child-Welfare Social Workers

Results: Almost half of the parents with mental disorders identified in this study were diagnosed with addictive or personality disorders. Social workers supported parents in the following goals: “being able to consult when the need arises,” “living conditions with minimum level of safety and comfort for children,” “living arrangements suitable for the family,” “independence of the family,” and “growth of children.” Social workers supported more comfortable and realistic living arrangements for each family and supported them to live independently. The social workers supported the parents with the following support skills: “assessment of the needs of the family,” “assessment of and support to relationships with parents,” “assessment and support of growth of children,” “assessment and support in child-raising by parents,” “assessment and support for the stability of medical condition of parents,” “support through cooperation with other related agencies,” and “continuing support for being an independent family.”

Child-rearing Support Provided by Public Health Nurses to People with Mental Illness: Qualitative Descriptive Study

Background: The growing rates of deinstitutionalization in Japan have resulted in an increase in the number of children being raised by parents with mental illness. Given this situation, public health nurses working for local governments play an important role. Objective: The purpose of this qualitative descriptive study was to describe the child-rearing support provided by public health nurses to parents with mental illness. Methods: Seven nurses identified 28 cases of parents with mental illness. Descriptions of the goals and details of the appropriate nursing support were extracted from transcripts, coded, and categorized. Results: Parents with mental illness diagnosed with addiction and personality disorders were more difficult to support than those diagnosed with mood disorders or schizophrenia. Public health nurses supported parents with mental illness with the aim of achieving goals such as “building continuous consultative relationships,” “ensuring living conditions had a minimum level of safety and comfort,” “parents playing their roles,” “parents and children living together in the community,” and “fostering children’s growth.” While they provided support by “assessing their relationships with parents,” “building consultative relationships with parents,” “assessing parents’ illnesses/disorders and supporting,” “assessing child-rearing abilities and supporting,” and “cooperating with related agencies,” they tended to focus on the growth of the children rather than the recovery of parents. Conclusion: Consultative relationships were the beginning of support, as well as the most important and difficult skill. Public health nurses need to provide support for the recovery of parents with mental illness and learn about personality disorders and addiction.

The structure of the perceived professional identity of Japanese public health nurses

OBJECTIVE As health problems become more diverse and complicated, the way public health nurses (PHNs) work is changing. Research at the conceptual level of professional identity of PHNs is lacking. This study aimed to explore the structure of the perceived professional identity of Japanese PHNs. DESIGN AND SAMPLE Grounded theory method was used. Twenty-five PHNs in Japanese municipalities were participated in the study. MEASUREMENTS Data were collected through semistructured interviews and analyzed using open, axial, and selective coding. RESULTS Three categories emerged: (1) providing support to the consulter directly, (2) working as a member of the administrative organization, and (3) working for all residents to improve community development. The modality of perceived professional identity showed interindividual and intraindividual differences and was either stable or unstable. The perceived professional identities coexisted, but there was a conflict between (1) and (2). CONCLUSION PHNs should be made aware of the three identities revealed in our study and the possibility of a conflict between identities. Moreover, to ensure working for all residents to improve community development, a population-based approach to education is needed with cooperation of universities and clinical practice.

Violence Towards Family Caregivers by Their Relative with Schizophrenia in Japan

There have been several violence-related deaths in Japan due to family violence by persons with severe mental illness against their caregivers. However, it is not often acknowledged that these violent acts are mainly directed at family members. This study aimed to clarify what acts of violence family caregivers experienced from their relative with schizophrenia, and how frequently these violent incidents occurred in their lifetime. We also examined caregivers’ thoughts of death about themselves and their relatives, as well as their consultation efforts and escape from the violence perpetrated by their relative. Of the 277 caregivers, 87.7% had experienced psychological violence and 75.8% had experienced physical violence perpetrated by their relative. Of 210 caregivers who had experienced physical violence, 26.7% had thought of murder-suicide and 31.0% had wished for their relative’s death. Family violence by persons with schizophrenia is not rare but a common occurrence in Japan and may have fatal consequences.

Post-traumatic stress disorder in parents of patients with schizophrenia following familial violence

The present study conducted in Japan aimed to clarify the relationship between violence directed towards parents by patients with schizophrenia and parents’ risk of post-traumatic stress disorder (PTSD). Questionnaire data from 353 parents were analyzed. In total, 84 of the 353 parents (23.8%) reported the Impact of Event Scale-Revised (IES-R) score ≥ 25 (high-IES-R), indicative of a high risk of developing PTSD. The rate of high-IES-R scores was significantly higher among parents who had experienced an act of violence that was likely to result in severe injury by their adult child with schizophrenia (OR = 2.03; 95% CI 1.09–3.80; using “never experienced” as a reference) and in parents of patients who were hospitalized at the time of the survey (OR = 2.47; 95% CI 1.01–6.06; using “regularly visited a psychiatrist” as a reference). Therefore, parents experiencing violence by their adult child with schizophrenia are at a risk of developing PTSD. Parents of patients with schizophrenia, who are at a high risk of PTSD, are not usually provided the required support in Japan. To prevent violence and provide support for family members who may develop PTSD, it is necessary to establish crisis intervention programs, especially given the current emphasis on deinstitutionalization policy in Japan.

Validity and reliability of the Family Empowerment Scale for caregivers of adults with mental health issues.

WHAT IS KNOWN ON THE SUBJECT?: Empowerment of family caregivers of adults with mental health issues has received increasing attention among mental health nurses in Japan and has been recognized as a new goal of family interventions. The Family Empowerment Scale (FES) was originally developed to measure the empowerment status of parents of children with emotional disorders. However, it was later applied to broader health issues. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We developed a Japanese version of the FES for family caregivers of adults with mental health issues (FES-AMJ) and examined the validity and reliability among parents. Results showed that the FES-AMJ had acceptable concurrent validity and reliability; however, insufficient construct validity was found, especially for the subscale regarding the service system. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further studies need to modify the scale. Clarification of ideal family empowerment status in the service system through discussion with mental health nurses and family caregivers may be important. ABSTRACT Introduction The Family Empowerment Scale (FES) was originally developed for parents of children with emotional disorders. In Japan, family empowerment is gaining increasing attention and may be one goal of nursing interventions. Aim To develop a Japanese version of the FES for family caregivers of adults with mental health issues and to study the validity and reliability of this scale among parents. Method We translated the FES into Japanese and administered this self-report questionnaire to 275 parents. Results The multitrait scaling analysis revealed acceptable convergent validity and insufficient discriminant validity among all subscales. In particular, all items of the Service system subscale had insufficient discriminant and/or convergent validity. Each subscale significantly correlated with the indicator of empowerment. The intraclass correlation coefficients of each subscale were .855-.917. Cronbachs alpha of each factor ranged from .867 to .895. Discussion The Service system subscale may not linearly reflect family empowerment, and instead may depend on unclear roles of family caregivers of adults, disorder severity or insufficient services. Implications for practice Further studies need to modify the scale. Clarification of ideal family empowerment status in the service system through discussion with mental health nurses and family caregivers may be important.