Dyadic effects of stigma on quality of life in people with schizophrenia and their family caregivers: Mediating role of patients' perception of caregivers' expressed emotion.

Schizophrenia, as a stressful diagnosis, profoundly impacts the whole family, especially people with schizophrenia and their caregivers. This study tested the potential mediating role of expressed emotion in the association between mental health stigma and quality of life in caregiver-patient dyads. Using a 2-wave longitudinal design with a 6-month interval between assessments, 161 dyads of patients with schizophrenia and their family caregivers (one patient and one caregiver) completed measures of mental health stigma, expressed emotion, and quality of life. The results showed that patients' self-stigma had no significant actor or partner effect on expressed emotion or quality of life. In contrast, caregivers' stigmatizing attitudes toward patients had a significant partner effect on patients' perception of caregivers' expressed emotion and quality of life. The mediating effect of patients' perception of caregivers' expressed emotion in the association between caregivers' stigmatizing ideas toward patients and patients' quality of life was significant. By focusing on the interdependence of patients and their caregivers, this study highlights the role of caregivers' stigmatizing attitudes toward patients and patients' perception of caregivers' expressed emotion on patients' quality of life. Psychoeducation and interventions should not only aim to reduce the self-stigma of people with schizophrenia but also their caregivers' stigmatizing ideas toward patients. Family interventions targeted at reducing the EE level of caregivers and patients' perception of caregivers' EE would also benefit the adaptation and quality of life of people with schizophrenia and their caregivers.

The longitudinal association between narcissism and problematic social networking sites use: The roles of two social comparison orientations.

The present study aimed to explore whether the tendency to compare one's abilities and opinions to those of others (social comparison orientation) could longitudinally mediate the association between narcissism and problematic SNS use. A total of 1,196 college students were assessed at three time points over 22 months. The results showed that narcissism at time 1 was positively related to problematic SNS use at time 3 and that ability comparison at time 2 longitudinally mediated the association between narcissism at time 1 and problematic SNS use at time 3, whereas the longitudinal mediating effect of opinion comparison at time 2 was not significant. These findings suggest that narcissism more distally and ability comparison more proximally may be risk factors for engaging in problematic SNS use, and it is important to distinguish between types of social comparisons in problematic SNS use behaviors.

Psychometric properties of the Chinese version of the Family Questionnaire among the caregivers of people with schizophrenia.

Introduction: Expressed emotion refers to relatives' attitudes and emotional behaviors toward mentally ill family members. It is a robust predictor of patients' illness outcomes and caregivers' wellbeing in a wide range of mental disorders. However, expressed emotion has not been fully explored in the Chinese context. One reason is the lack of reliable and cost-effective measurements. A reliable, valid, and user-friendly instrument is needed to support the research and clinical practice based on expressed emotion in China. This study aimed to translate, adapt, and examine the psychometric properties (factorial structure, measurement invariance, internal consistency reliability, and concurrent validity) of a Chinese version of the Family Questionnaire. Methods: A total of 248 caregivers participated in the study. A translation and back-translation procedure was applied to translate the Family Questionnaire into Chinese. We compared two models to examine the factor structure of the questionnaire by performing confirmatory factor analysis. We also conducted measurement invariance analysis to test whether the factor structure of the tool is invariant across male and female groups. Reliability was evaluated with Cronbach's α. The concurrent validity was examined by testing the predictivity of the expressed emotion on relevant outcomes with path analysis. We used the STROBE checklist to report. Results: The item-total correlation coefficients of the scale ranged from 0.375 to 0.752. The confirmatory factor analysis indicated that the Chinese version of the Family Questionnaire displays the original two-factor structure (emotional overinvolvement and criticism; X2 = 335.50, df = 169, X2/df = 1.985, RMSEA = 0.063, SRMR = 0.058, CFI = 0.913, and TLI = 0.902). In addition, the two-factor structure was invariant across the male and female groups. The two subscales showed excellent internal consistency, with Cronbach's alpha of 0.92 for both emotional overinvolvement and criticism. The concurrent validity of the Chinese version was supported by the good predictivity of the two subscales to care burden, family function, and quality of life. All path coefficients were significant, and the absolute values of path coefficients ranged from 0.23 to 0.72. Conclusion: The Chinese version of the Family Questionnaire is a valid and reliable measurement of expressed emotion in the Chinese context.

Caregivers' burden and schizophrenia patients' quality of life: Sequential mediating effects of expressed emotion and perceived expressed emotion.

Background: Increasing attention has been paid to the role of caregivers' burden in affecting quality of life (QoL) of schizophrenic patients. However, less is known about potential mediation mechanisms underlying this relationship. The current study aimed to explore the sequential mediating effect of expressed emotion and perceived expressed emotion on the relationship between care burden and QoL among people with schizophrenia. Methods: 135 Chinese families (one patient and one caregiver) participated in this study. Caregivers reported their care burden and expressed emotion, patients reported their perceived expressed emotion and QoL. Results: The results of the correlation analysis showed that care burden was negatively related to patients' QoL, including physical, psychological, and social relationships domains, with patients' sex, age, educational level, employment status, and medication-taking as covariates. The sequential mediating effects of criticism and perceived criticism between care burden and QoL were not significant. However, the sequential mediating effects of emotional over-involvement and perceived emotional over-involvement (EOI) between care burden and QoL (including physical and psychological domain) were significant. Conclusion: The results indicated that reducing the burden and expressed emotion of caregivers could be helpful to improve schizophrenia patients' QoL.

Cross-sectional evaluation of the adequacy of guardianship by family members of community-residing persons with mental disorders in Changning District, Shanghai.

BACKGROUND: The disease burden associated with chronic psychiatric illnesses is high and is projected to grow rapidly. A community-based management system for persons with mental illness was established in Shanghai in 2012 based on the Shanghai Mental Health Regulations that were developed to conform with China's new mental health law. AIM: Evaluate the guardianship services provided by family members to persons with mental illnesses living in the Changning District of Shanghai. METHODS: The legal guardians of 4034 of the 4283 community-dwelling persons with psychiatric disorders living in Changning District who are registered in the Shanghai Information Management System of Mental Health were interviewed by local community health doctors and local neighborhood committee officials. The adequacy of guardianship was assessed based on standardized criteria (including the guardian's regular attendance at mental health training sessions, and their level of assistance in the treatment, daily life, and rehabilitation of the patient) and the main reasons for inadequate guardianship were recorded. RESULTS: The majority of guardians (3331, 83.6%) adequately fulfilled their guardianship duties. Advanced age and ill-health of the guardian was the main contributing factor in 87% of the 703 cases in which the guardianship was classified as inadequate. Other factors associated with inadequate guardianship included the patient's unstable clinical condition or failure to adhere to medication, and when the guardian did not live in the same household as the patient. The patient's diagnosis, the guardian's level of education, and the relationship between the guardian and patient were also associated with the adequacy of guardianship. CONCLUSIONS: The guardianship-based community services for mentally ill individuals in urban China works reasonably well. But the rapid aging of China's population may gradually decrease the ability of China's families to continue to assume this heavy burden. Alternative models of providing high-quality, community-based services for persons with mental disorders need to be developed as part of the roll-out of China's new mental health law.

Effectiveness of a rehabilitative program that integrates hospital and community services for patients with schizophrenia in one community in Shanghai.

BACKGROUND: One possible reason for the less than satisfactory long-term outcomes for schizophrenia is the lack of coordination between inpatient and community-based services. AIM: Assess the effectiveness of a rehabilitation model for schizophrenia that integrates hospital and community services. METHODS: Ninety patients with schizophrenia participating in an integrated rehabilitation program at 10 community centers in Changning, Shanghai (intervention group) and 52 community-based patients with schizophrenia randomly selected from all patients in Changning participating in routine outpatient care (control group) were assessed at enrollment using the Positive and Negative Syndrome Scale (PANSS) and the Morningside Rehabilitation Status Scale (MRSS) and then re-assessed 1 year later by clinicians who were blind to the group assignment of the patients. The patients' registered guardians (the vast majority were co-resident family members) were assessed at the same times using the Family Burden Scale (FBS), the Self-rating Depression Scale (SDS), the Self-rating Anxiety Scale (SAS) and the Social Support Rating Scale (SSRS). RESULTS: At enrollment the clinical status of patients in the two groups (assessed with PANSS) was similar but the social functioning measures assessed by MRSS were significantly worse in the intervention group than in the control group. After one year the improvement of both clinical symptoms and social functioning measures were significantly greater in the intervention group than in the control group. In the year of follow-up, 3 individuals (3.3%) in the intervention group and 6 individuals (11.5%) in the control group were re-hospitalized (Fisher Exact Test, p=0.074). The feelings of burden, depression, anxiety and reported social support among guardians of patients in the intervention group were not significantly different from those for guardians of patients in the control group either at the time of enrollment or after the 1-year intervention. However, guardians in the intervention group showed a significant decrease in depressive and anxiety symptoms over the one-year follow-up. CONCLUSIONS: Rehabilitative approaches that integrate hospital and community services can improve clinical and social outcomes for patients with schizophrenia. Further development of these programs is needed to increase the proportion of patients who achieve regular employment (i.e., 'community re-integration') and to provide family members with better psychosocial support.