Burden, reward, and coping of adult offspring of patients with depression and bipolar disorder.

BACKGROUND: In previous years, research has focused on the situation of psychiatric patients' minor children. The aims of this qualitative study were to describe the experience of adult children of depressed and bipolar patients, including positive and negative factors as well as coping mechanisms, and to investigate possible predictors of burden in order to identify children in need of professional support. METHODS: A total of 30 adult children were interviewed using a semi-structured interview. In addition, all children completed the Freiburg Questionnaire of Coping with Disease (Freiburger Fragebogen zur Krankheitsverarbeitung, FKV). Regression analysis indicated the most relevant predictors of burden. RESULTS: All (100%) of the children reported emotional burden due to the illness of their parent, 90% suffered from impaired family life, and 77% experienced burden due to the parent's symptoms. Reward (positive experience) was reported regarding the intensification of the parent-child relationship. Linear regression analysis shows predictors for highly burdened children as well as for children who are more prone to maladaptive ways of coping. Higher burden was significantly associated with the child's age, severity of illness of the parent, and specific diagnosis. CONCLUSIONS: Although some positive aspects of parental affective disorder exist, this study underlines that children primarily suffer from their parent's disorder and that this burden does not stop in adulthood. Providing professional support to adult as well as to minor children of affected individuals should become standard of care in clinical settings.

[40 years in-patient suicide research of the working group "Suicidality and the psychiatric hospital"]. / 40 Jahre Kliniksuizidverbundstudie der AG "Suizidalität und Psychiatrisches Krankenhaus".

OBJECTIVE: To give an retrospective overview according to the so-called in-patient suicide especially in German psychiatric hospitals. METHOD: Summary of results of the working group "Suicidality and the psychiatric hospital" during the last four decades in Germany. RESULTS: First, it could be shown that there was a real increase of in-patient suicides during the 70(th) and 80(th) years. Two other results are important 1) an impressive decrease of suicide rates in the two last decades and 2) the observation of a change from the new high-risk group "young schizophrenic patients" back to the traditional suicide risk group of depressed patients.

[High utilisers with affective and schizophrenic disorders in the psychiatric health care system: a comparison between Eastern and Western Germany]. / High Utiliser in der psychiatrischen Versorgung: ein Ost-West-Vergleich bei affektiven und schizophrenen Störungen.

OBJECTIVE: High utilisers of psychiatric services are defined as a group of patients showing a great amount of service use, especially inpatient care, consequently causing immense costs. There is a lack of studies investigating differences between East and West Germany. METHODS: Service use and psychopathology were examined in 350 high utilisers receiving inpatient treatment in one East German and three West German psychiatric hospitals. RESULTS: Whereas current length of stay was higher in participants from West Germany, readmissions were more frequent in the East German participants who also exhibited higher psychopathology. CONCLUSION: Presumably, the deficient situation of outpatient health care in East Germany is compensated by increased stationary admission, consequently leading to a structural promotion of high utilisation.

[A needs-oriented discharge planning intervention for high utilisers of psychiatric services: quality of the implementation and opportunities for improvement]. / Eine bedarfsorientierte Entlassplanungsintervention bei Patienten mit hoher Inanspruchnahme des psychiatrischen Versorgungssystems: Qualität der Umsetzung und Verbesserungsmöglichkeiten.

OBJECTIVE: Process evaluation of a needs-oriented discharge planning and monitoring (NODPAM) intervention for patients with severe mental illness with high utilisation of inpatient psychiatric care (within a RCT showing lack of evidence of superiority over treatment as usual). METHODS: Analysis of intervention drop-outs vs. intervention group patients participating in the intervention; analysis of the impact of intervention characteristics on unmet needs over time. RESULTS: Patients with more severe forms of illness were more likely to be among intervention drop-outs, a relatively high proportion of unmet needs persisted in patients participating in the intervention. Good intervention implementation and high patient satisfaction with the intervention were associated with a reduction of unmet needs. CONCLUSIONS: The NODPAM intervention failed to reach patients with high service use and more severe forms of illness; quality of intervention implementation might have contributed to the lack of superiority over treatment as usual. The intervention might not have been well integrated in routine treatment and was therefore experienced as extraneous to routine care.

Rewards of caregiving and coping strategies of caregivers of patients with mental illness.

OBJECTIVE: The study sought to broaden the focus of research on caregivers' burden by examining caregiving rewards and their relation to coping skills. METHODS: Data from semistructured interviews with 60 family caregivers of patients with mental illness in Germany were examined by content analysis. Information was gathered with the Freiburg Questionnaire on Coping With Illness. Both t tests and regression analyses were used to analyze data. RESULTS: Caregivers made 413 statements about rewards, which were assigned to six categories. "Gratitude and affection from the patient" was the most frequently cited, and "active, problem-oriented coping" was the coping strategy most used. Three variables predicted identification of a greater number of rewards, explaining 39% of variance: "increased religiousness and searching for meaning," "caregiver's younger age," and "more statements about burden." CONCLUSIONS: To support caregivers, a shift in orientation from focusing on burden to emphasizing resources is necessary.

Cyber-support: an analysis of online self-help forums (online self-help forums in bipolar disorder).

BACKGROUND: The Internet is becoming increasingly important in psychiatry and psychotherapy. AIMS: The objective of this study was to evaluate if and how online self-help forums are used by patients with bipolar disorders, their relatives and treating professionals. METHODS: A total of 2400 postings in two online forums were analysed qualitatively and quantitatively. RESULTS: "Disclosure", "friendship" and "online-group cohesion" were the main self-help mechanisms. The topics most discussed were "social network", "symptoms of the illness" and "medication". Factor analyses revealed three factors concerning self-help mechanisms: "group cohesion", "emotional support" and "exchange of information", as well as three factors concerning fields of interest: "illness-related aspects", "social aspects" and "financial and legal issues". CONCLUSION: We infer that the main interest in participating in online forums for patients with bipolar disorders and their relatives is to share emotions and to discuss their daily struggles with the illness. Our study also reveals that social networking is very important for patients coping with bipolar disorders. Psycho-educative programmes should focus on those aspects.

Burden, rewards, and coping--the ups and downs of caregivers of people with mental illness.

Besides burden, we need to examine potential rewards of caregiving and coping strategies to determine effective means of supporting caregivers of people with mental illness. Therefore, we conducted semistructured interviews with 60 caregivers of patients with mental illness and analyzed the transcripts with a summarizing content analysis. The interviews focused on negative and positive aspects of providing care and on coping strategies; the latter was also evaluated with the Freiburg Questionnaire on Coping with Illness. The caregivers named 787 individual statements of burden and 413 individual statements of rewards. A factor analysis of the rewards identified growth in character as the main factor. The items with the highest factor loading are increase in self-confidence, inner strength, maturity, and life experience. Linear regression and regression tree analysis identified predictors for caregiver burden. To effectively reduce the burden on caregivers, we need knowledge about their concrete burdens. However, to optimize resource orientation, we must also pay much more attention to the potential rewards of caring.

Are there associations between caregiver information and suicidal behavior in psychiatric inpatients?

OBJECTIVE: The study aimed at exploring associations between inpatient suicides/attempted suicides in a psychiatric hospital and involvement of family caregivers in treatment. METHODS: Based on the German psychiatric basic documentation systems (DGPPN-BADO), we analyzed a total sample of 49,257 cases of inpatient care (1998-2007) from a large psychiatric tertiary care university hospital and as a subsample all cases of schizophrenia, depression, acute stress/adjustment disorders and personality disorders (n = 22,880). Involvement of family caregivers was evaluated according to the following variables: admission to hospital due to recommendation of caregiver, conversation between therapist and caregiver, psychoeducation of caregiver as well as psychopharmacological and/or psychotherapeutic non-compliance of patient. Descriptive and bivariate analyses were performed. RESULTS: Of the 22,880 cases in the subsample, 31 inpatient suicides and 198 attempted inpatient suicides were recorded. We could not find any significant associations of caregiver involvement variables with inpatient suicide. In contrast, for the total sample (n = 49,257), attempted suicide was associated with more conversation between therapists and caregivers (χ(2) = 3.863, df = 1, p = 0.049) and with psychopharmacological (χ(2) = 4.822, df = 1, p = 0.028) and psychotherapeutic (χ(2) = 13.041, df = 1, p = 0.000) non-compliance of the patients. CONCLUSION: Further research is needed regarding the influence of caregivers on suicidal behavior of mentally ill inpatients.

"Mad or bad?": burden on caregivers of patients with personality disorders.

The burden on caregivers of patients with personality disorders is often greatly underestimated or completely disregarded. Possibilities for caregiver support have rarely been assessed. Thirty interviews were conducted with caregivers of such patients to assess illness-related burden. Responses were analyzed with a mixed method of qualitative and quantitative analysis in a sequential design. Patient and caregiver data, including sociodemographic and disease-related variables, were evaluated with regression analysis and regression trees. Caregiver statements (n = 404) were summarized into 44 global statements. The most frequent global statements were worries about the burden on other family members (70.0%), poor cooperation with clinical centers and other institutions (60.0%), financial burden (56.7%), worry about the patient's future (53.3%), and dissatisfaction with the patient's treatment and rehabilitation (53.3%). Linear regression and regression tree analysis identified predictors for more burdened caregivers. Caregivers of patients with personality disorders experience a variety of burdens, some disorder specific. Yet these caregivers often receive little attention or support.

Revisiting the association of aggression and suicidal behavior in schizophrenic inpatients.

Our study investigated the association of aggression and suicidal behavior in schizophrenic inpatients. Eight thousand nine hundred one admissions for schizophrenia (1998-2007) to a psychiatric university hospital were included. Schizophrenic suicides (n = 7)/suicide attempters (n = 40) were compared to suicides (n = 30)/suicide attempters (n = 186) with other diagnoses and to schizophrenic non-attempters regarding aggression. Logistic regression analysis was performed to explore risk factors for attempted suicide. Schizophrenic suicides/suicide attempters did not differ from other suicides/suicide attempters or from schizophrenic non-attempters with regard to aggression. Risk of inpatient suicide attempt was increased for patients with attempted suicide at admission, high school graduation, and disorganized subtype. Aggression could not be found to be a predictor of attempted suicide. Aggression seems to have a minor role for suicidal behavior in schizophrenia.

Burden of caregivers of patients with bipolar affective disorders.

Thirty-two problem-oriented interviews with caregivers of patients with bipolar affective disorders were analyzed using content analysis. The 722 statements of caregivers about their experiences of subjective burden because of the illness of their family members were summarized in 49 global statements and correlated by factor analysis to 10 types of burden. In particular, patients' noncompliance as well as the helplessness of the caregivers in interaction with the (changing) depressive and manic symptoms of the ill family members emerged as serious burdens on the caregivers. Whereas female caregivers suffered more from problems regarding quality of relationship with the patient, male caregivers experienced more constraints on their own autonomy, uncertainty concerning their judgment of patients' capacity, and uncertainty because of the changing symptoms of illness. The findings of this study highlight that an appreciation of caregivers' own consternation and information about how best to handle the (uncooperative) behavior of the patient should be taken into account in psychoeducational groups as well as in the daily work routine of professionals.

Reducing suicides through an alliance against depression?

BACKGROUND: Since 2003, the Regensburg Alliance Against Depression, the regional partner of the German Alliance Against Depression, has been conducting a four-level intervention program to improve early detection and treatment of patients with depression, which was successfully piloted in the framework of the German Research Network on Depression and Suicidality. METHODS: After 5 years of campaign, the suicide rates before and after the intervention were evaluated in comparison with two control regions and with the German overall rate. FINDINGS: The results show that only the suicide rate in Regensburg fell significantly during the intervention period. The drop in the suicide rate was due to a significant decrease in male suicides. INTERPRETATION: An intensive community-based campaign could be effective in lowering suicide rates. Especially, the combination of continuing medical educations (CMEs) for general practitioners focusing on 'male depression' and low-threshold campaigns for the general public seems to reach male depressive patients.

[The "ideal" doctor from the view of psychiatric patients]. / Der "ideale" Arzt aus Sicht psychiatrischer Patienten.

OBJECTIVE: The study aimed to investigate the expectations of patients in a general psychiatric hospital regarding an "ideal" doctor. METHODS: 60 problem centred interviews with psychiatric in-patients were analysed by using a summarizing content analysis. RESULTS: Analysis of interview data showed three fundamental areas, which are important for patients: doctors' personality, physician-patient-interaction and treatment as well as doctors' treatment environment. The "ideal" doctor 1. is reachable and takes his time (75%), 2. is friendly and congenial (63%), 3. shows commitment and interest (60%), 4. is an understanding and sensitive contact person (60%), 5. is responsive to needs of patients (55%). CONCLUSIONS: For that reason, optimal time management and social competence is necessary and should be a part of medical students' and doctors' education. Focusing on patients' expectations can positively influence their treatment satisfaction.