The association between family dysfunction and admission to an acute mental health inpatient unit: a prospective study.

OBJECTIVES: With the shift from deinstitutionalization to community care in mental health services, relatives of persons with severe and enduring mental illnesses have had to take over the role as primary caregivers. Disturbed family dynamics have been observed within families with an 'ill' member. Although schizophrenia and related mental illnesses are biologically based disorders, environmental stress (including stress within family relationships) plays a major role in the onset and maintenance of symptoms. With this study, we assume that family dynamics play a central role in the course of severe psychiatric illness and hypothesized that dysfunction within family systems is a prognostic indicator of hospitalization in the course of schizophrenia/bipolar and schizoaffective disorders. METHODS: Prospective, observational cohort study evaluating family functioning of 121 patients (schizophrenia/bipolar and schizoaffective disorder) from community at baseline and followed-up over 12-month period after recruitment. Measurements included demographics, diagnosis, Family Assessment Device - General Functioning, Perceived Criticism Scale, Brief Psychiatric Rating Scale, Global Assessment of Functioning and Social Support Questionnaire-6. RESULTS: Significant differences found between patients admitted and not admitted during the 12-month time period for age (p = 0.003), Brief Psychiatric Rating Scale (BPRS; p = 0.026), Family Assessment Device - General Functioning (FAD-GF; p = 0.007) and Social Support Questionnaire total satisfaction level (p = 0.042) at baseline. Bivariate analysis showed that those admitted into hospital were younger with a higher BPRS score, less social satisfaction and disturbed family dynamics. FAD-GF (p = 0.006) and age (p = 0.022) were significant independent predictors for admission. CONCLUSION: This provides further evidence supporting importance of promoting better family functioning through modified family dynamics, integrating and involving family into the care of such patients.

The Greek family system when a child has diabetes mellitus type 1.

AIM: To depict the characteristic ways that families who have a child suffering from diabetes and face difficulties with metabolic control function. In addition, to reveal the ways that this functioning is related to metabolic control problems. METHODS: Qualitative methods were used, including an in-depth interview and observation of 30 Greek families having one child suffering from diabetes mellitus type 1 and facing difficulties with metabolic control. An average of 10 meetings were conducted with each family, including separate meetings with each individual family member, the parental couple and the family as a whole. Methods were based on thematic categories provided by the model of the "psychosomatic family". RESULTS: The presence of the disease and the requirements of the treatment regimen seemed to be associated with certain family characteristics: enmeshed relationships, ambiguous roles and rules, break down of hierarchy, coalition between mother and patient, absence of father's involvement and "infantilization" of the suffering child. Also in such families, healthy siblings are assigned parental roles and, finally, the families present signs of social exclusion. CONCLUSION: The study provides important findings concerning the psychological characteristics of the families under study. The present ways of functioning are associated with the difficulties families face when coping with the treatment regimen.