|
| |
 |
|
| ORIGINAL ARTICLE |
|
| Year : 2016 | Volume
: 12
| Issue : 1 | Page : 19-25 |
|
Relationship of functional status of persons having chronic ‘non-affective psychosis’ with anxiety, depression and self-esteem of family caregivers
Jyothis P Soly1, Sandhya Gupta2, Mamta Sood3
1 Nursing Services, AIIMS, New Delhi, India
2 Faculty-College of Nursing, AIIMS, New Delhi, India
3 Associate Professor, Department of Psychiatry, AIIMS, New Delhi, India
| Date of Web Publication | 17-Jun-2019 |
Correspondence Address:
Jyothis P Soly
Nursing Services, AIIMS, New Delhi
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2231-1505.255706
Family caregivers who provide care to the individuals with chronic disabling mental disorder are themselves at risk of developing physical and psychiatric symptoms due to constant demands on their energy and time. The physical strains of caring of someone who may not perform activities of daily living can have detrimental effects on psychological health of family caregiver. A cross sectional study was conducted on sample of 60 patients with chronic non-affective psychosis, currently in remission and their 60 family caregivers from the selected setting were included WHO Disability Assessment Schedule, for patients, Hamilton Anxiety Scale,Quick Inventory of Depressive Symptomatology Self Report 16 and Rosenberg Self-Esteem Scale for family caregivers were used to accomplish the aim of the study. The study revealed patients had highest level of functional disability in the domain of participation and lowest level was in the domain of mobility. Family caregivers were anxious and depressed. Self-esteem of family caregivers was found to be low in some of the caregivers. Functional disability of patients had statistically significant positive correlation with levels of anxiety of family caregivers and their levels of depression whereas significant negative correlation was found with levels of self-esteem of family caregivers. The study concludes that measures to deal with functional disability of persons with chronic non-affective psychosis is to be taken and the caregivers also need to be assessed for their mental health needs.
Keywords: Functional status, Non-Affective Psychosis, Anxiety, Depression, Self-esteem, Family Caregivers
How to cite this article:
Soly JP, Gupta S, Sood M. Relationship of functional status of persons having chronic ‘non-affective psychosis’ with anxiety, depression and self-esteem of family caregivers. Indian J Psy Nsg 2016;12:19-25 |
How to cite this URL:
Soly JP, Gupta S, Sood M. Relationship of functional status of persons having chronic ‘non-affective psychosis’ with anxiety, depression and self-esteem of family caregivers. Indian J Psy Nsg [serial online] 2016 [cited 2023 Jun 3];12:19-25. Available from: https://www.ijpn.in/text.asp?2016/12/1/19/255706 |
| Introduction | |  |
Family caregivers who provide care to the individuals with chronic disabling mental disorder are themselves at risk of developing physical and psychiatric symptoms due to constant demands on their energy and time[1]. Caregivers are the ones who are asked to shoulder burden of caring for longer period of time. The physical strains of caring of someone who may not perform activities of daily living such as bathing, grooming and other activities put many family caregivers at serious risk for poor physical health outcome.
The psychological health of family caregiver is negatively affected by providing care[2],[3]. Higher levels of anxiety, depression and other mental health effects are common among them[4],[5],[6]. Higher levels of stress can lead to harmful coping methods such as use of substances. They are the potential patients for mental health disturbances. Early recognition and treatment of psychological symptoms among caregivers is a major health concern. Family is a valuable resource to care for mentally ill patients and their health needs are to be looked after with concerted efforts[8],[9].Hence this study is planned to get the baseline data on anxiety, depression and self-esteem of family caregivers of persons having chronic non-affective psychosis. Study explored the relationship of functional status of persons having chronic ‘non-affective psychosis’ with anxiety, depression and self-esteem of family caregivers.
| Material and Methods | | |
A cross sectional study was conducted in All India Institute of Medical Sciences. A sample of n1=60 patients who were taking follow up treatment for chronic non-affective psychosis, currently in remission (absence of symptoms for last 3 months) and their family caregivers n2=60 from the selected setting were included in the study. Informed consent was taken before participation. Demographic profile and selected variables of patients and their caregivers-data sheet, WHO Disability Assessment Schedule 2.0 for assessing functional status of patients, Hamilton Anxiety Scale for assessing anxiety of family caregivers, Quick Inventory of Depressive Symptomatology Self Report 16 for assessing depression and Rosenberg Self-Esteem Scale for assessing self-esteem of family caregivers were used to collect data. Reliability and validity of the tools were established prior to their use. Pilot study was done to before actual data collection. Descriptive and inferential statistics were used to accomplish the study objectives.
| Results | | |
Socio-demographic profile of patients
The mean age of patients having chronic non-affective psychosis was 36.10 years (SD±10.79). More than half (51.70%) of the patients were male and 48.30% were female. Fifty per cent of the patients were married. Educational status of 43.30% of the patients was of high school level and 25% were with primary level education. Most (63.30%) of the patients were unemployed. The mean age of patients at the time of onset of disease was 24.98 years (SD±9.32). Average duration of illness of the patients was 10.80 years (SD±7.48) and average duration of treatment was 10.08 years (SD±7.34). Most (61.70%) of the patients were diagnosed with paranoid schizophrenia. Forty five per cent of patients had first episode of illness and 26.60% had minimum three episodes.
Socio-demographic profile of family caregivers
The mean age of family caregivers was 46.30 years (SD±15.50). More than half (60%) of the family caregivers were male. Seventy five per cent of the family caregivers were married and 18.30% were unmarried. Educational status of 36.70% of the family caregivers was of secondary level and 26.70% were graduates. Most of the family caregivers (68.30%) were employed and 26.70% were unemployed. Forty five per cent of the family caregivers were parents and 27.39% were spouses of the patients. Most (91.70%) of the family caregivers were staying with the patients for more than 10 years of duration. There were 58.40% of family caregivers who spent more than two hours in caregiving per day. Absence of informal social support was reported by 31.70% of the family caregivers.
Functional Status of patients
Functional status of patient was impaired in all six domains of WHODAS 2.0. given in [Table 1] which shows domain wise mean scores of functional status of persons having chronic non-affective psychosis. Highest level of functional disability was found in the domain of participation (52.90±17.36) and lowest in the domain of mobility (17.17 ±18.84) of patients. Anxiety, Depression and Self-Esteem of family caregivers. | Table 1: Domain wise mean scores of functional status of patients (n1=60)
Click here to view |
As given in [Table 2] that the frequency distribution of levels of anxiety, depression and self-esteem reported by caregivers of persons having chronic non-affective psychosis. Majority of the caregivers (90%) were having mild anxiety followed by moderate (8.3%) and then very severe anxiety (1.7%). Anxiety was found to be mild in most of the family caregivers of patients. Dysfunctional levels of anxiety were found in ten per cent of family caregivers of patients. Mild depression was found in 26.7% of the caregivers, moderate depression in 6.7 % and very severe depression in 1.7% of the family caregivers. Thus thirty five per cent of the family caregivers were depressed which is a crucial issue to be taken care of by treating team [Table 2].Frequency distribution of levels of self-esteem in caregivers of persons having chronic non-affective psychosis is given in [Table 2]. Poor self-esteem was found in ten per cent of family caregivers which could have deleterious effects on them and the patients as well. | Table 2: Frequency distribution of levels of Anxiety, Depression and Self-esteem of family caregivers n2=60
Click here to view |
Correlation of functional status of persons having chronic non-affective psychosis with anxiety, depression and self-esteem of their family caregivers.
Correlation co-efficient and p values of correlation between levels of functional disability in various domains of patients with levels of anxiety, depression and self-esteem of their family caregivers are given in [Table 3]. | Table 3: Correlation between Functional Status of patients with Anxiety, Depression and Self-Esteem of their family caregivers n1=60, n2=60
Click here to view |
1). Correlation between levels of functional disability of patients with levels of anxiety of family caregivers
Statistically significant positive correlation was found between levels of functional disability of patients in the domain of cognition, self-care, life activities and participation with levels of anxiety of their family caregivers. That is if functional disability of the patient in these four domains was high then levels of anxiety of their family caregiver was also high [Table 3].
2). Correlation between levels of functional disability of patients with levels of depression of family caregivers
Statistically significant positive correlation was found between levels of functional disability of patients in the domain of cognition, mobility, self-care, getting along with people, life activities and participation with levels ofdepression of their family caregivers. That is if functional disability of the patient in these six domains was high then levels of depression of their family caregiver was also high.
3). Correlation between levels of functional disability of patient with levels of self-esteem of family caregivers
Statistically significant negative correlation was found between levels offunctional disability of patients in the domain of getting along with people with levels of self-esteem of their family caregivers. That is if functional disability of the patient in the domain of getting along with people was high then levels of self-esteem of their family caregiver was low.[Table 3].
| Discussion | | |
Functional Status of patients
In the present study functional status of patients in thedomain of participation in society and community was highly disabled in comparison with other domains. Long term trends in chronic non-affective psychosis have an evident pattern of deterioration in social dimension[10]. Severe social disability in schizophrenia is a persistent phenomenon with deteriorating course as per long term follow-up studies[11]. Comparative analysis of social disability between affective and non-affective psychosis reported that schizophrenia and related disorders cause high social disability[12],[13] . Functional disability in day to day activities of household, work or school was found significant in patients of the present study. Several studies which assessed functional disability using disability assessment schedule reported similar findings[14]. A study which used Multidimensional Scale of Independent Functioning (MSIF) to assess real-world functional performance in three environments (work, education and independent living) reported that 68.7% of patients had poor functional outcome in work and educational domain[15]. Moderate impairment in life activities is reported in schizophrenic patients in another study[16]. Greater disability in work skills are reported in schizophrenia as compared to bipolar disorders[17]. To make and maintain personal and social relations and interpersonal relationships was found to be impaired in the study subjects. Similar finding are reported in Indian studies using disability assessment schedule[18],[19] .Western studies also reported similar findings though they have used different tools for assessing functional disability[20],[21],[22],[23]
Functional disability in cognitive domain which includes concentrating, remembering, analyzing and problem solving, learning new tasks, understanding and communicating was found in the present study. Cognitive disability in chronic non-affective psychosis is a widely explored domain with different assessment tools. Similar findings are reported in several other previous researches which are in line with the finding of the present study[24],[25],[26],[27]. In the domain of self-care of patient which includes bathing, dressing, eating and staying alone disability was comparatively low also same is reported in Indian and European studies as well[28],[29],[30],[31]. In mobility domain of patients which includes difficulty in moving around, standing, physical, emotional and mental aspects of getting out of home and walking long distances. This is the domain of maximum ability and least disability in the present study as compared to the domains of cognition, self-care, getting along with people, life activities and participation. This finding is consistent with the findings of previous study[32].
Anxiety, Depression and Self-Esteem of family caregivers
Moderate to severe levels of anxiety was reported by ten per cent of family caregivers in the present study and mild anxiety was reported by ninety per cent of family caregivers. Similar findings of high levels of anxiety was reported in previous studies on caregivers of patients having non-affective psychosis[33],[34],[35],[36],[37] though the percentage of family caregivers who were anxious was high in previous studies. The present study is carried out in the out-patient department of a tertiary care institutewhere a lot of support and guidance is available to the family caregivers from various health care professionals as it has good staff patient ratio. This may be the reason for the comparatively less number of family caregivers with higher levels of anxietyin the present study.
Over one third of the family caregivers were depressed and moderate to severe levels of depression was found in nearly onefifth of the family caregivers. Similar findings are reported in previous studies[38] but majority of the caregivers were with higher levels of depression[39],[40],41,42,43,44.This in congruency may be because the current study was done in a setting which has medical college and nursing college, as a result of which high patient to health professional ratio is available, so patients and caregivers are getting good amount of one to one attention. Low Self-esteem was found in ten per cent of family caregivers though self-esteem was good for the rest of the family caregivers. Low level of self-esteem in caregivers of persons with schizophrenia is reported in previous studies45 A study done on caregivers of schizophrenic patients reported that chronic caregiving makes people depressed and results in lowself esteem46,47.
Correlation between Functional Status of persons having chronic non-affective psychosis with Anxiety, Depression and Self-Esteem of family caregivers
Correlation between levels of functional disability of patients with levels of anxiety of family caregivers
Statistically significant positive correlation was found between levels of functional disability of patients indomains of cognition, self-care, life activities and participation with levels of anxiety of their family caregivers. That is if functional disability of the patient in these four domains was high then levels of anxiety of their family caregiver was also high.
Correlation between levels of functional disability of patients with levels of depression of family caregivers
Statistically significant positive correlation was found between levels of functional disability of patients in domains of cognition, mobility, self-care, getting along with people, life activities and participation with levels of depression of their family caregivers. That is if functional disability of the patient in these six domains was high then levels of depression of their family caregiver was also high. No studies were found on patients of schizophrenia and related disorders which assessed the relationship between levels of functional disability of patients with levels of depression of family caregivers, hence comparison could be made only with a study on relationship between dementia patient’s levels of suffering and depression of their caregivers which reported that functional disability of the patients is associated with depressive symptoms of their family caregivers48.
Correlation between levels of functional disability of patients with levels of self-esteem of family caregivers
Statistically significant negative correlation was found between levels of functional disability of patients in the domain of getting along with people with levels of self-esteem of their family caregivers. That is if functional disability of the patient in the domain of getting along with people was high then levels of self-esteem of their family caregiver was low.
| Conclusion | | |
Persons having chronic non-affective psychosis had functional disability in the domains of cognition, mobility, self-care, getting along with people and participation. Highest level of functional disability was in the domain of participation and lowest level was in the domain of mobility. Family caregivers of persons having chronic non-affective psychosis have the potential for developing symptoms of anxiety and depression as some of the family caregivers were anxious and depressed. Self-esteem of family caregivers was found to be low in some of the caregivers which indicate they can go low on self-confidence and have difficulty in managing their life situations. Hence measure to deal with functional disability of persons with chronic non-affective psychosis is to be taken. Early identification of at risk family caregivers is to be done and appropriate referral sources are to be provided to them so that they will be able to balance their mental health and take proper care of their mentally ill relatives.
| References | | |
| 1. | Haley WE, Levine EG, Brown SL, Bartolucci AA.Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers.Psychol Aging. 1987 Dec;2(4):323-30. Available on: http://www.ncbi.nlm.nih.gov/pubmed/3268224. Accessed on 9 January 2014  |
| 2. | Oldridge ML, Hughes IC. Psychological well-being in families with a member suffering from schizophrenia.An investigation into longstanding problems.Br J Psychiatry. 1992 Aug;161:249-51. Available on: http://www.ncbi.nlm.nih.gov/pubmed/1355692. Accessed on 9 January 2014 |
| 3. | Onwumere J, Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, et al. Care giving and illness beliefs in the course of psychotic illness. Can J Psychiatry.2008 Jul; 53(7): 460-8. Available on: http://www.ncbi.nlm.nih.gov/pubmed/14611923. Accessed on 9 January 2014 |
| 4. | |
| 5. | |
| 6. | Lefley HP, University) MS of ASS (Case WR.Family caregiving in mental illness.Sage Publications; 1996. 280 p. Available on: http://books.google.co.in/books. Accessed on 19January 2014 |
| 7. | |
| 8. | |
| 9. | Hsiao C-Y, Van Riper M. Research on caregiving in Chinese families living with mental illness: a critical review. J FamNurs. 2010 Feb; 1 6 ( 1 ):6 8 - 1 0 0. Available on: http://www.ncbi.nlm.nih.gov/pubmed/20145286. Accessed on 9 January 2014 |
| 10. | Ganev K. Long-term trends of symptoms and disability in schizophrenia and related disorders. Soc Psychiatry PsychiatrEpidemiol. 2000 Sep;35(9):389-95. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 11089666. Accessed on 10 January 2014 |
| 11. | Wiersma D, Wanderling J, Dragomirecka E, Ganev K, Harrison G, An Der Heiden W, et al. Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres. Psychol Med. 2000 Sep;30(5):1155-67. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 12027051. Accessed on 10 January 2014 |
| 12. | Adegbaju DA, Olagunju AT, Uwakwe R. A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: towards evidence-guided rehabilitation intervention. Soc Psychiatry PsychiatrEpidemiol. 2013 Sep;48(9):1405-15. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 23385802. Accessed on 10 January 20141 |
| 13. | Bottlender R, Strauss A, Möller H-J. Social disability in schizophrenic, schizoaffective and affective disorders 15 years after first admission.Schizophr Res. 2010 Jan;116(1):9-15. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 19896334. Accessed on 10 January 2014 |
| 14. | Adegbaju DA, Olagunju AT, Uwakwe R. A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: towards evidence-guided rehabilitation intervention. Soc Psychiatry PsychiatrEpidemiol. 2013 Sep;48(9):1405-15. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 23385802. Accessed on 10 January 201414 |
| 15. | Shamsi S, Lau A, Lencz T, Burdick KE, DeRosse P, Brenner R, et al. Cognitive and symptomatic predictors of functional disability in schizophrenia. Schizophr Res. 2011 Mar;126(1-3):257-64. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 20828991. Accessed on 11 January 2014 |
| 16. | Mohr P, Rodriguez M, Bravermanová A, Melicher T, Ceplová Z, Cermák J, et al. Social and functional capacity o f schizophrenia patients: A cross-sectional study. Int J Soc Psychiatry. 2013 Jun 17. Available on: http://www.ncbi.nlm.nih.gov/pubmed/23775144. Accessed on 10 January 2014 |
| 17. | Bowie CR, Depp C, McGrath JA, Wolyniec P, Mausbach B T , Thornquist MH, et al. Prediction of real-world functional disability in chronic mental disorders: a comparison of schizophrenia and bipolar disorder. Am J Psychiatry. 2010 Sep;167(9):1116-24. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 20478878. Accessed on 11 January 2014 |
| 18. | Balhara YPS, Verma R, Deshpande SN. A study of profile of disability certificate seeking patients with schizophrenia over a 5 year period. Indian J Psychol Med. 2013 Apr;35(2):127-34. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 24049222. Accessed on 11 January 2014 |
| 19. | 19 Narayan KK, Kumar DS. Disability in a Group of Long-stay Patients with Schizophrenia: Experience from a Mental Hospital. Indian J Psychol Med. 2012 Jan;34(1):70-5. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 22661812. Accessed on 12 January 2014 |
| 20. | Mohr P, Rodriguez M, Bravermanová A, Melicher T, Ceplová Z, Cermák J, et al. Social and functional capacity of schizophrenia patients: A cross-sectional study. Int J Soc Psychiatry. 2013 Jun 17. Available on: http://www.ncbi.nlm.nih.gov/pubmed/23775144. Accessed on 10 January 2014 |
| 21. | Adegbaju DA, Olagunju AT, Uwakwe R. A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: towards evidence-guided rehabilitation intervention. Soc Psychiatry PsychiatrEpidemiol. 2013 Sep;48(9):1405-15. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 23385802. Accessed on 10 January 2014 |
| 22. | Shamsi S, Lau A, Lencz T, Burdick KE, DeRosse P, Brenner R, et al. Cognitive and symptomatic predictors of functional disability in schizophrenia. Schizophr Res. 2011 Mar;126(1-3):257-64. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 20828991. Accessed on 11 January 2014 |
| 23. | Bowie CR, Depp C, McGrath JA, Wolyniec P, Mausbach BT, Thornquist MH, et al. Prediction of real-world functional disability in chronic mental disorders: a comparison of schizophrenia and bipolar disorder. Am J Psychiatry. 2010 Sep;167(9):1116-24. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 20478878. Accessed on 11 January 2014 |
| 24. | Bowie CR, Depp C, McGrath JA, Wolyniec P, Mausbach BT, Thornquist MH, et al. Prediction of real-world functional disability in chronic mental disorders: a comparison of schizophrenia and bipolar disorder. Am J Psychiatry. 2010 Sep;167(9):1116-24. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 20478878. Accessed on 11 January 2014 |
| 25. | Sanchez P, Ojeda N, Pena J, Elizagarate E, Yoller AB, Gutierrez M, et al. Predictors of longitudinal changes in schizophrenia: the role of processing speed. J Clin Psychiatry. 2009 Jun;70(6):888-96. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 19422757. Accessed on 10 January 2014 |
| 26. | Mohan I, Tandon R, Kalra H, Trivedi JK. Disability assessment in mental illnesses using Indian Disability Evaluation Assessment Scale (IDEAS). Indian J Med Res. 2005 Jun;121(6):759-63. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 16037620. Accessed on 19 January 2014 |
| 27. | Narayan KK, Kumar DS. Disability in a Group of Long-stay Patients with Schizophrenia: Experience from a Mental Hospital. Indian J Psychol Med. 2012 Jan;34(1):70-5. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 22661812. Accessed on 12 January 2014 |
| 28. | Mohr P, Rodriguez M, Bravermanová A, Melicher T, Ceplová Z, Cermák J, et al. Social and functional capacity of schizophrenia patients: A cross-sectional study. Int J Soc Psychiatry. 2013 Jun 17. Available on: http://www.ncbi.nlm.nih.gov/pubmed/23775144. Accessed on 10 January 2014 |
| 29. | Adegbaju DA, Olagunju AT, Uwakwe R. A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: towards evidence-guided rehabilitation intervention. Soc Psychiatry PsychiatrEpidemiol. 2013 Sep;48(9):1405-15. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 23385802. Accessed on 10 January 2014 |
| 30. | Balhara YPS, Verma R, Deshpande SN. A study of profile of disability certificate seeking patients with schizophrenia over a 5 year period. Indian J Psychol Med. 2013 Apr;35(2):127-34. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 24049222. Accessed on 11 January 2014 |
| 31. | Narayan KK, Kumar DS. Disability in a Group of Long-stay Patients with Schizophrenia: Experience from a Mental Hospital. Indian J Psychol Med. 2012 Jan;34(1):70-5. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 22661812. Accessed on 12 January 2014 |
| 32. | Narayan KK, Kumar DS. Disability in a Group of Long-stay Patients with Schizophrenia: Experience from a Mental Hospital. Indian J Psychol Med. 2012 Jan;34(1):70-5. Available on: http://www.ncbi.nlm.nih.gov/pubmed/ 22661812. Accessed on 12 January 2014 |
| 33. | |
| 34. | Yusuf AJ, Nuhu FT. Factors associated with emotional distress among caregivers of patients with schizophrenia in Katsina, Nigeria. Soc Psychiatry PsychiatrEpidemiol. 2011 Jan;46(1):11-6. Available on: http://www.ncbi.nlm.nih.gov/pubmed/19907909. Accessed on 14 January 2014 |
| 35. | |
| 36. | De Silva D, de Silva S. A preliminary study of the impact of long-term psychotic disorder on patients’ families. Ceylon Med J. 2001 Dec;46(4):121-3. Available on: http://www.ncbi.nlm.nih.gov/pubmed/12164027. Accessed on 14 January 2014 |
| 37. | Angermeyer MC, Matschinger H, Holzinger A. [Burden of relatives of chronic psychiatric patients]. PsychiatrPrax. 1997 Sep;24(5):215-20. Available on: http://www.ncbi.nlm.nih.gov/pubmed/9417542. Accessed on 14 January 2014 |
| 38. | Angermeyer MC, Matschinger H, Holzinger A. [Burden of relatives of chronic psychiatric patients]. PsychiatrPrax. 1997 Sep;24(5):215-20. Available on: http://www.ncbi.nlm.nih.gov/pubmed/9417542. Accessed on 14 January 2014 |
| 39. | |
| 40. | Yusuf AJ, Nuhu FT. Factors associated with emotional distress among caregivers of patients with schizophrenia in Katsina, Nigeria. Soc Psychiatry PsychiatrEpidemiol. 2011 Jan;46(1):11-6. Available on: http://www.ncbi.nlm.nih.gov/pubmed/19907909. Accessed on 14 January |
[Table 1], [Table 2], [Table 3]
|
Search Pubmed for