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Effectiveness of enhancing contact model on reducing family caregiving burden and improving psychological wellbeing among caregivers of persons with schizophrenia in rural China

Published online by Cambridge University Press:  26 September 2022

Yi-Zhou Wang
Affiliation:
Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
Xue Weng
Affiliation:
Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China
Tian-Ming Zhang
Affiliation:
Department of Social Work, Shanghai University, Shanghai, China
Ming Li
Affiliation:
Chengdu Xinjin Second People's Hospital, Chengdu, China
Wei Luo
Affiliation:
Chengdu Xinjin Second People's Hospital, Chengdu, China
Yin-Ling Irene Wong
Affiliation:
School of Social Policy & Practice, University of Pennsylvania, USA
Lawrence H. Yang
Affiliation:
Department of Social and Behavioral Sciences, New York University, USA Department of Epidemiology, Columbia University, NY, USA
Graham Thornicroft
Affiliation:
Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Lin Lu
Affiliation:
Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
Mao-Sheng Ran*
Affiliation:
Department of Social Work and Social Administration, University of Hong Kong, Hong Kong Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
*
Author for correspondence: Mao-Sheng Ran, E-mail: msrancd@outlook.com

Abstract

Background

It is unclear whether the enhancing contact model (ECM) intervention is effective in reducing family caregiving burden and improving hope and quality of life (QOL) among family caregivers of persons with schizophrenia (FCPWS).

Methods

We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin, Chengdu, China. In total, 253 FCPWS were randomly allocated to the ECM, psychoeducational family intervention (PFI), or treatment as usual (TAU) group. FCPWS in three groups were assessed caregiving burden, QOL and state of hope at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up, respectively.

Results

Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower caregiving burden scores both at T1 and T2 (p = 0.0059 and 0.0257, respectively). Compared with participants in the TAU group, participants in the PFI group had statistically significantly higher QOL scores in T1 (p = 0.0406), while participants in the ECM group had statistically significantly higher QOL scores in T3 (p = 0.0240). Participants in both ECM and PFI groups had statistically significantly higher hope scores than those in the TAU group at T1 (p = 0.0160 and 0.0486, respectively).

Conclusions

This is the first study to explore the effectiveness of ECM on reducing family caregiving burden and improving hope and QOL in rural China. The results indicate the ECM intervention, a comprehensive and multifaceted intervention, is more effective than the PFI in various aspects of mental wellbeing among FCPWS. Future research needs to confirm ECM's effectiveness in various population.

Type
Original Article
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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References

Allerby, K., Sameby, B., Brain, C., Joas, E., Quinlan, P., Sjöström, N., … Waern, M. (2015). Stigma and burden among relatives of persons with schizophrenia: Results from the Swedish COAST study. Psychiatric Services, 66(10), 10201026.10.1176/appi.ps.201400405CrossRefGoogle ScholarPubMed
Bauer, M. S. (2002). A review of quantitative studies of adherence to mental health clinical practice guidelines. Harvard Review of Psychiatry, 10(3), 138153. doi: 10.1080/10673220216217CrossRefGoogle ScholarPubMed
Baxter, A. J., Charlson, F. J., Cheng, H. G., Shidhaye, R., Ferrari, A. J., & Whiteford, H. A. (2016). Prevalence of mental, neurological, and substance use disorders in China and India: A systematic analysis. The Lancet Psychiatry, 3(9), 832841.10.1016/S2215-0366(16)30139-0CrossRefGoogle Scholar
Benke, C., Autenrieth, L. K., Asselmann, E., & Pané-Farré, C. A. (2020). Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Research, 293, 113462. doi: 10.1016/j.psychres.2020.113462CrossRefGoogle ScholarPubMed
Bhugra, D., Tasman, A., Pathare, S., Priebe, S., Smith, S., Torous, J., … Ventriglio, A. (2017). The WPA-Lancet psychiatry commission on the future of psychiatry. The Lancet Psychiatry, 4(10), 775818. doi: 10.1016/S2215-0366(17)30333-4CrossRefGoogle ScholarPubMed
Bobak, C. A., Barr, P. J., & O'Malley, A. J. (2018). Estimation of an inter-rater intra-class correlation coefficient that overcomes common assumption violations in the assessment of health measurement scales. BMC Medical Research Methodology, 18(1), 93. doi: 10.1186/s12874-018-0550-6CrossRefGoogle ScholarPubMed
Chang, X., Gong, Q., Li, C., Yue, W., Yu, X., Yao, S., & Feng, J. (2021). Psychiatric disorders in China: Strengths and challenges of contemporary research and clinical services. Psychological Medicine, 51, 19781991.10.1017/S0033291721002816CrossRefGoogle Scholar
Corrigan, P. W. (2012). Where is the evidence supporting public service announcements to eliminate mental illness stigma? Psychiatric Services, 63(1), 7982. doi: 10.1176/appi.ps.201100460CrossRefGoogle ScholarPubMed
Dixon, L., Adams, C., & Lucksted, A. (2000). Update on family psychoeducation for schizophrenia. Schizophrenia Bulletin, 26(1), 520. doi: 10.1093/oxfordjournals.schbul.a033446CrossRefGoogle ScholarPubMed
Fan, C. C., & Chen, Y. Y. (2011). Factors associated with care burden and quality of life among caregivers of the mentally ill in Chinese society. International Journal of Social Psychiatry, 57(2), 195206. doi: 10.1177/0020764009348440Google ScholarPubMed
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175191. doi: 10.3758/BF03193146CrossRefGoogle ScholarPubMed
García-Castro, F. J., Alba, A., & Blanca, M. J. (2020). Association between character strengths and caregiver burden: Hope as a mediator. Journal of Happiness Studies, 21(4), 14451462. doi: 10.1007/s10902-019-00138-2CrossRefGoogle Scholar
Guan, Z., Huang, C., Wiley, J. A., Sun, M., Bai, X., & Tang, S. (2020). Internalized stigma and its correlates among family caregivers of patients diagnosed with schizophrenia in Changsha, Hunan, China. Journal of Psychiatric and Mental Health Nursing, 27(3), 224236. doi: 10.1111/jpm.12571CrossRefGoogle ScholarPubMed
Hernandez, M., Barrio, C., & Yamada, A.-M. (2013). Hope and burden among Latino families of adults with schizophrenia. Family Process, 52(4), 697708.10.1111/famp.12042CrossRefGoogle ScholarPubMed
Horn, S. R., Weston, S. J., & Fisher, P. A. (2020). Identifying causal role of COVID-19 in immunopsychiatry models. Brain Behavior and Immunity, 88, 68. doi: 10.1016/j.bbi.2020.05.066CrossRefGoogle ScholarPubMed
Huang, Y., Wang, Y., Wang, H., Liu, Z., Yu, X., Yan, J., … Wu, Y. (2019). Prevalence of mental disorders in China: A cross-sectional epidemiological study. The Lancet. Psychiatry, 6(3), 211224. doi: 10.1016/s2215-0366(18)30511-xCrossRefGoogle Scholar
Jaki, T., & Wason, J. M. S. (2018). Multi-arm multi-stage trials can improve the efficiency of finding effective treatments for stroke: A case study. BMC Cardiovascular Disorders, 18(1), 215. doi: 10.1186/s12872-018-0956-4CrossRefGoogle ScholarPubMed
James, S. L., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., … Abdelalim, A. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392(10159), 17891858. doi: 10.1016/s0140-6736(18)32279-7CrossRefGoogle Scholar
Kim, H., Chang, M., Rose, K., & Kim, S. (2012). Predictors of caregiver burden in caregivers of individuals with dementia. Journal of Advanced Nursing, 68(4), 846855.10.1111/j.1365-2648.2011.05787.xCrossRefGoogle ScholarPubMed
Kuipers, E. (2010). Time for a separate psychosis caregiver service? Journal of Mental Health, 19(5), 401404. doi: 10.3109/09638237.2010.510155CrossRefGoogle ScholarPubMed
Li, X. H., Deng, S. Y., Zhang, T. M., Wang, Y. Z., Wei, D. N., Wong, I. Y. L., … Ran, M.-S. (2021). Affiliate stigma of mental illness in family caregivers of persons with mental illness in Hong Kong. International Journal of Social Psychiatry, 110. 10.1177/00207640211057723.Google ScholarPubMed
Li, X. H., Zhang, T. M., Yau, Y. Y., Wang, Y. Z., Wong, Y. L. I., Yang, L., … Ran, M. S. (2020). Peer-to-peer contact, social support and self-stigma among people with severe mental illness in Hong Kong. International Journal of Social Psychiatry, 67(6), 622631.10.1177/0020764020966009CrossRefGoogle ScholarPubMed
Parmar, M. K. B., Carpenter, J., & Sydes, M. R. (2014). More multiarm randomised trials of superiority are needed. The Lancet, 384(9940), 283284. doi: 10.1016/s0140-6736(14)61122-3CrossRefGoogle ScholarPubMed
Peng, M. M., Chen, H. L., Zhang, T., Yao, Y. Y., Li, Z. H., Long, L., … Ran, M. S. (2019). Disease-related stressors of caregiving burden among different types of family caregivers of persons with schizophrenia in rural China. International Journal of Social Psychiatry, 65(7–8), 603614. doi: 10.1177/0020764019866224CrossRefGoogle ScholarPubMed
Perlick, D. A., Nelson, A. H., Mattias, K., Selzer, J., Kalvin, C., Wilber, C. H., … Corrigan, P. W. (2011). In our own voice-family companion: Reducing self-stigma of family members of persons with serious mental illness. Psychiatric Services, 62(12), 14561462.10.1176/appi.ps.001222011CrossRefGoogle ScholarPubMed
Ran, M. S., Chan, C. L., Ng, S. M., Guo, L. T., & Xiang, M. Z. (2015). The effectiveness of psychoeducational family intervention for patients with schizophrenia in a 14-year follow-up study in a Chinese rural area. Psychological Medicine, 45(10), 21972204. doi: 10.1017/S0033291715000197CrossRefGoogle Scholar
Ran, M. S., Chui, C. H., Wong, I. Y., Mao, W. J., Lin, F. R., Liu, B., & Chan, C. L. (2016). Family caregivers and outcome of people with schizophrenia in rural China: 14-year follow-up study. Social Psychiatry & Psychiatric Epidemiology, 51(4), 513520. doi: 10.1007/s00127-015-1169-0CrossRefGoogle ScholarPubMed
Ran, M. S., Peng, M. M., Yau, Y. Y., Zhang, T. M., Li, X. H., Wong, I. Y. L., … Lu, L. (2021). Knowledge, contact and stigma of mental illness: Comparing three stakeholder groups in Hong Kong. International Journal of Social Psychiatry, 68(2), 365375. doi: 10.1177/0020764021997479CrossRefGoogle ScholarPubMed
Ran, M. S., Wang, Y. Z., Lu, P. Y., Weng, X., Zhang, T. M., Deng, S. Y., … Lu, L. (2022). Effectiveness of enhancing contact model on reducing stigma of mental illness among family caregivers of persons with schizophrenia in rural China: A cluster randomized controlled trial. The Lancet Regional Health – Western Pacific, 22, 100419. doi: 10.1016/j.lanwpc.2022.100419CrossRefGoogle ScholarPubMed
Ran, M. S., Xiang, M. Z., Chan, C. L., Leff, J., Simpson, P., Huang, M. S., … Li, S. G. (2003). Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia – a randomised controlled trial. Social Psychiatry & Psychiatric Epidemiology, 38(2), 6975. doi: 10.1007/s00127-003-0601-zCrossRefGoogle ScholarPubMed
Ran, M. S., Xiang, M. Z., Simpson, P., & Chan, C. L. W. (2005). Family-based mental health care in rural China. Hong Kong: Hong Kong University Press.Google Scholar
Sin, J., Elkes, J., Batchelor, R., Henderson, C., Gillard, S., Woodham, L. A., … Cornelius, V. (2021). Mental health and caregiving experiences of family carers supporting people with psychosis. Epidemiology and Psychiatric Sciences, 30, e3. doi: 10.1017/S2045796020001067CrossRefGoogle ScholarPubMed
Sin, J., Gillard, S., Spain, D., Cornelius, V., Chen, T., & Henderson, C. (2017). Effectiveness of psychoeducational interventions for family carers of people with psychosis: A systematic review and meta-analysis. Clinical Psychology Review, 56, 1324. doi: 10.1016/j.cpr.2017.05.002CrossRefGoogle ScholarPubMed
Sin, J., & Norman, I. (2013). Psychoeducational interventions for family members of people with schizophrenia: A mixed-method systematic review. Journal of Clinical Psychiatry, 74(12), e1145e1162. doi: 10.4088/JCP.12r08308CrossRefGoogle ScholarPubMed
Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., … Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet, 387(10023), 11231132. doi: 10.1016/S0140-6736(15)00298-6CrossRefGoogle ScholarPubMed
Vadher, S., Desai, R., Panchal, B., Vala, A., Ratnani, I. J., Rupani, M. P., & Vasava, K. (2020). Burden of care in caregivers of patients with alcohol use disorder and schizophrenia and its association with anxiety, depression and quality of life. General Psychiatry, 33(4), e100215. doi: 10.1136/gpsych-2020-100215CrossRefGoogle ScholarPubMed
Wong, Y. L. I., Kong, D., Tu, L., & Frasso, R. (2018). ‘My bitterness is deeper than the ocean’: Understanding internalized stigma from the perspectives of persons with schizophrenia and their family caregivers. International Journal of Mental Health Systems, 12(1), 14. doi: 10.1186/s13033-018-0192-4CrossRefGoogle Scholar
Yu, Y., Liu, Z. W., Tang, B. W., Zhao, M., Liu, X. G., & Xiao, S. Y. (2017). Reported family burden of schizophrenia patients in rural China. PLoS ONE, 12(6), e0179425.10.1371/journal.pone.0179425CrossRefGoogle ScholarPubMed
Yu, Y. H., Peng, M. M., Bai, X., Luo, W., Yang, X., Li, J., … Ran, M. S. (2020). Schizophrenia, social support, caregiving burden and household poverty in rural China. Social Psychiatry & Psychiatric Epidemiology, 55(12), 15711580.10.1007/s00127-020-01864-2CrossRefGoogle ScholarPubMed
Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist, 20(6), 649655.10.1093/geront/20.6.649CrossRefGoogle ScholarPubMed
Zhang, T. M., Wong, Y. L. I., Yu, Y. H., Ni, S. G., He, X. S., Bacon-Shone, J., … Ran, M. S. (2019). An integrative model of internalized stigma and recovery-related outcomes among people diagnosed with schizophrenia in rural China. Social Psychiatry & Psychiatric Epidemiology, 54, 911918.10.1007/s00127-018-1646-3CrossRefGoogle ScholarPubMed
Zhang, Y., Subramaniam, M., Lee, S. P., Abdin, E., Sagayadevan, V., Jeyagurunathan, A., … Chong, S. A. (2018). Affiliate stigma and its association with quality of life among caregivers of relatives with mental illness in Singapore. Psychiatry Research, 265, 5561. doi: 10.1016/j.psychres.2018.04.044CrossRefGoogle ScholarPubMed
Zhou, Y., Rosenheck, R., Mohamed, S., Ou, Y., Ning, Y., & He, H. (2016). Comparison of burden among family members of patients diagnosed with schizophrenia and bipolar disorder in a large acute psychiatric hospital in China. BMC Psychiatry, 16(1), 283. doi: 10.1186/s12888-016-0962-yCrossRefGoogle Scholar