The gift of peer understanding and suicide bereavement support groups: A qualitative study.

There is a growing recognition and need for more studies on groups practices and processes to develop greater insight into the helpful elements that may be distinctive to bereavement peer support groups for traumatic loss such as, suicide. Using a qualitative descriptive design, focus groups and individual interviews were conducted online and face-to-face with a purposive sample of 27 participants in Ireland and in Denmark, who were bereaved by suicided and were attending peer bereavement support groups. Data were analyzed through Thematic Analysis. The findings suggest that the group provided a safe place where people felt and nurtured a deep emotional connection, a place where people trusted themselves and others to speak the unspoken and to tell and re-tell their story without fear of consequence as well as a place where they learnt to process their loss. Findings are discussed and recommendations based on the findings are proposed.

Patient Experience of Physical Restraint in the Acute Setting: A Systematic Review of the Qualitative Research Evidence.

The use of physical restraint is a contentious practice in the acute mental health setting. There are a plethora of guidelines surrounding the safe use of restraint. However, there is a scarcity of literature dedicated specifically from the perspective of the patient. The existing literature suggests that there are serious physical and psychological implications associated with the use of physical restraint for both mental health patients and nurses alike. The debate surrounding this practice has been intensified by the compelling evidence suggesting that the application of restraint is not compatible with the values of recovery in mental health care. To influence clinical practice that governs the use of restraint, it is essential to explore patient experiences of its use. Therefore, this review aims to explore patient experiences of physical restraint in the acute setting. PubMed, CINAHL and PsycINFO were systematically searched using keywords; "physical restraint" and "patient experience" and "acute setting". The search yielded n = 482 papers in total. Following the application of rigorous inclusion and exclusion criteria and data extraction, a total of n = 9 papers were considered suitable for the systematic review. Quality was assessed using the MMAT instrument. Following analysis, three themes were identified: 'the bio-psychosocial impact of restraint on patients', 'the impact of restraint on the therapeutic relationship' and 'patient needs concerning the use of restraint'. Future research opportunities have been identified that will add to the body of evidence in developing appropriate health interventions and supports for this population.

"Attenuating Anxieties": A grounded theory study of mental health nurses' responses to clients with suicidal behaviour.

AIMS AND OBJECTIVES: To develop a grounded theory to explain mental health nurses' responses to clients with suicidal behaviour. BACKGROUND: Mental health nurses are an integral part of the multi-disciplinary teams supporting people who experience suicidal behaviour, yet limited research is available that explores how nurses respond to the needs of people at risk of suicide and what factors influence their responses and actions. METHODS: Grounded theory was the methodology for this study. Interviews were conducted with 33 mental health nurses working in an urban area in the Republic of Ireland. Data were analysed using the concurrent processes of comparative analysis, theoretical sampling, theoretical sensitivity and memo writing. COREQ 32-item checklist was used. RESULTS: The core category from the data was "Attenuating Anxieties." Participants' main concerns about caring for suicidal clients were related to their feelings of professional and personal vulnerability and the need to protect clients and themselves. This theory "Attenuating Anxieties" highlights the way in which nurses allay their anxieties by utilising historically known risk adverse strategies to care for the suicidal person. Acquisition of further psychotherapeutic training, clinical supervision as well as increased reflexivity protected some participants and enabled them to work creatively and collaboratively while supporting and facilitating therapeutic risk-taking. CONCLUSIONS: The theory of "Attenuating Anxieties" identifies how participants worked within the context of mental health as members of the "risk society," wherein they worried about the possibility and probability of a negative or adverse effect for both the client and self, leaving them to feel constantly vulnerable and unsafe. RELEVANCE TO CLINICAL PRACTICE: This theory highlights the need for a culture of openness that acknowledges nurses' and organisations' anxieties surrounding suicide and promotes a discourse among nurses that moves from a position of risk aversion to a relational and recovery-orientated approach.

An exploration of patient experiences of transitioning to a remote day programme following inpatient treatment in an adult eating disorder service.

WHAT IS KNOWN ON THE SUBJECT?: Traditionally, treatment for eating disorders (EDs) has been provided on an inpatient or outpatient basis, but more recently other levels of treatment provision to include, day care (DC) and community outreach programmes, have been developed. There is limited research exploring the experience of patients who have transitioned from inpatient ED treatment to a remote DC treatment. This lack of knowledge can impact mental health nurses' understanding of what that experience is like for patients and hence may influence the efficacy of collaboration and inclusion between patients and nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This research addresses this dearth of knowledge and adds to our understanding of patients' experiences of attending a remote DC programme following a period of inpatient treatment for an ED. This is an important study for nurses and other mental health professionals working with people in ED treatment, as it highlights the specific challenges and anxieties of transitioning from inpatient to a remote DC programme and the individualized supports advisable during this process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This research provides a basis on which nurses can understand and address the challenges experienced by patients after transitioning to a less intensive supportive ED programme. The understanding of these experiences will enhance the therapeutic alliance between the nurse and patient, which will in turn support the patient in increasing agency as they progress through their recovery. This research provides a foundation on which to develop specific supports that need to be in place to help patients manage the anxieties they experience as they transition to a less intense and remote treatment. Findings from these lived experiences can be used to support the development of similar DC programmes for EDs in other settings. ABSTRACT: INTRODUCTION: Day care (DC) treatment for people with an eating disorder (ED) provides for an easier transition from hospital to home, along with a treatment milieu where patients can maintain occupational and social functioning and allow for the transfer of newly acquired skills to everyday life. AIM: To explore patients' experiences of attending a remote day programme following intense inpatient treatment in an adult ED service. METHOD: A qualitative descriptive methodology informed the study. In-depth semi-structured interviews were conducted with 10 consenting patients. A thematic analysis framework was used to guide the process of data analysis. RESULTS: Three themes reflected participants' experiences: 'Moving On: Preparing for Change', 'Navigating a New Support System' and 'Increasing Agency'. DISCUSSION: An underlying issue for participants was an ongoing but changing experience of anxiety. While anticipatory anxiety is evident in preparing for discharge, this is replaced with a real-time anxiety as they endeavour to negotiate an effective support network. IMPLICATIONS FOR PRACTICE: The findings from this study provide a basis on which mental health nurses can develop timely and effective treatment and support systems with patients who are transitioning from a high support inpatient ED programme to a less intensive ED remote DC programme.

Operationalising a Recovery-Oriented Support and Information Programme Online: The EOLAS Programme.

Evidence demonstrates that psychoeducation interventions have clinical and recovery-related benefits for people experiencing psychosis and their family members. The EOLAS programmes are one example of recovery-oriented psychoeducation programmes for psychosis. They differ from other programmes in that they are co-designed and co-facilitated (peer and clinician) group programmes. Due to the COVID-19 pandemic, EOLAS went online using a videoconferencing platform. The study examined the feasibility, acceptability and usefulness of EOLAS-Online and explored whether some of the positive recovery outcomes reported by attendees regarding the in-person programmes were replicated online. Data were collected through an online survey and semi-structured interviews. Quantitative data were analysed using descriptive statistics. Thematic analysis was used for qualitative data. Fifteen attendees (40% of attendees) completed the surveys and eight participated in interviews. A total of 80% were satisfied/very satisfied with the programme. The programme was rated highly for increased knowledge of mental health, coping strategies, and engaging with peers. The use of technology was mostly unproblematic, although some audio and video-related challenges were identified. Engaging with the online programme was experienced positively, including facilitator support to engage. The overall findings indicate that EOLAS-Online is feasible, acceptable and useful in supporting attendees' recovery journeys.

Evaluation of mental health recovery and Wellness Recovery Action Planning education in Ireland: a mixed methods pre-postevaluation.

AIM: To report a study evaluating the effectiveness of a Wellness Recovery Action Planning education programme. BACKGROUND: Internationally, mental health policy is advocating using recovery approaches to care. Underpinning these approaches is investment in education in recovery principles and methods and a need to provide evidence of the impact of this education. DESIGN: The study design employed a mixed methods approach. METHODS: Using questionnaires and focus groups, we evaluated 2- and 5-day Wellness Recovery Action Planning Education Programmes and assessed participants' attitudes towards recovery, knowledge of recovery and Wellness Recovery Action Planning beliefs. Data were collected between 2009 and 2010. Participants were people with personal experience of mental health problems, practitioners in mental health services and family members/carers of those with mental health problems. RESULTS: Comparing the pre and postmeasures showed that the programme increased participants' knowledge of and attitudes towards recovery and Wellness Recovery Action Planning. Although this increase was statistically significant for the 2-day programme, it was not so for the 5-day programme. Participants reported being very positive and enthusiastic about the programme and the benefits they had achieved personally and professionally as a result of participating. CONCLUSIONS: This exploratory study shows that providing mental health practitioners and people with personal experience of mental health problems with a systematic education and training in recovery principles using the Wellness Recovery Action Planning approach leads to positive changes in people's knowledge, skills and attitudes towards recovery. This education appeared to inspire, invigorate and empower people, and for many, it was a life changing experience.

Scoping Review of Peer-Led Support for People Bereaved by Suicide.

Suicide bereavement support groups are a widely available format of postvention service. Although other reviews have addressed peer-led bereavement interventions, no review has focused specifically on peer-led support for people bereaved by suicide. Informed by a framework for undertaking scoping reviews, we conducted a systematic review according to PRISMA-ScR guidelines. Searches conducted in May 2021 of peer-reviewed literature in MEDLINE (EBSCO), CINAHL Complete (EBSCO), PsycINFO (EBSCO), EMBASE (Elsevier), AMED (EBSCO), ERIC (EBSCO), Web of Science (Core Collection), ASSIA (Proquest), and Global Index Medicus. The search was not limited by language, and all studies were included to full text screening. The search identified 10 studies conducted between 1994 and 2020 in five countries. The selected papers were subjected to quality assessment. The interventions included face-to-face groups, telephone and online groups/forums and were evaluated using a variety of methodologies, which made comparison and synthesis challenging. Thematic analysis resulted in four themes: motivation, impact, aspects of intervention which hindered/enhanced outcomes, and recommendations for the practice of peer support made by the authors. While there were methodological limitations to most studies included in this review; the studies do indicate the potential benefit of peer-led support to those bereaved through suicide. Future studies should provide a definition of 'peer' and a clear description of the intervention being evaluated. As the field matures there is a need for more rigorous evaluation of peer interventions with representative samples, studies that compare the impact of various types of peer interventions, and studies of the peer group processes.

The Spaces of Peer-Led Support Groups for Suicide Bereaved in Denmark and the Republic of Ireland: A Focus Group Study.

Research has shown that people bereaved by suicide have an increased risk of mental health problems, suicidality and associated stigma, as well as higher rates of sick leave and increased rates of receiving disability pensions. Peer-led suicide bereavement support groups are perceived to enhance people's recovery by enabling shared experiences with others who are bereaved in similar circumstances. The aim of the research was to explore the viewpoints of participants living in Denmark and the Republic of Ireland on these peer-led support groups. This study focused on how the participants experienced being part of the peer-led support and how the participation affected them. We conducted four focus groups, two in Denmark and two in the Republic of Ireland, and two individual interviews, involving a total of 27 people bereaved by suicide. Data were analyzed thematically. The participants' experiences in the peer-led support groups were in contrast to what they had experienced in their daily lives. They felt alienated in daily living, as they believed that people could not comprehend their situation, which in turn led participants to search for people with similar experiences and join the peer-led support groups. While peer-led support groups may not be helpful for everyone, they created 'supportive spaces' that potentially affected the participants' recovery processes, from which we generated three key themes: (i) 'A transformative space', describing how the peer-led support group created a place to embrace change, learning and knowledge about suicide and suicide bereavement and the making of new connections; (ii) 'An alternative space for belonging and grieving', describing how the participants felt allowed to and could give themselves permission to grieve; and (iii) 'A conflicted space' describing how it was troublesome to belong to and participate in the peer-led support groups. In conclusion, despite the two cultural settings and different organizational approaches, the experiences were comparable. Peer-led support groups can, despite being a conflicted space for some, provide supportive spaces aiding the participants' recovery process.

"When my worse fear happened": Mental health nurses' responses to the death of a client through suicide.

WHAT IS KNOWN ON THE SUBJECT?: The death of a client to suicide evokes a range of grief responses for mental health nurses (MHNs), which vary in intensity according to the nature of the therapeutic relationship with the deceased client. There are limited qualitative studies on the experiences of nurses working in the community and the personal or professional strategies used by nurses to cope with the death of a client by suicide. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Following a client suicide, MHNs were often left to carry the burden of grief alone and to care for themselves with the support of their family and colleagues. While all participants perceived the need for support following the death of a client by suicide, they were offered minimal support beyond the debriefing meetings, with their grief experience being largely unacknowledged and disenfranchised. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MHNs and services need to establish and promote a culture of openness in which suicide is anticipated as a possible outcome, even with excellent standards of care and wherein all staff are supported and encouraged to discuss and reflect on their concerns and fears during the aftermath of a client suicide. As MHNs are often left to carry the burden of grief alone, services need to recognize the emotional cost of embodied engagement with clients and families and provide the necessary supports. ABSTRACT: Introduction Experiencing a client's death through suicide is complex and challenging, yet limited research exists on how MHNs might deal with its aftermath. Aim This study aimed to explore the impact and responses of MHNs to a client suicide. Method The study design is a secondary analysis of an existing data set involving semi-structured interview with 33 MHNs that were analysed using the principles of grounded theory. To answer the secondary question on the impact and responses of MHNs to the death of a client by suicide a subset of the data from 10 participants who experienced the death of a client by suicide were re-analysed using thematic analysis. Ethical approval was granted by the university ethics committee. Findings The findings identified five themes: "Hearing the news," "Experiencing the impact of grief," "Grieving privately" "Searching for meaning" and "Questioning practice." Discussion Findings highlighted that although participants perceived the need for support, they were offered minimal support beyond the debriefing meetings, with their grief experience being largely unacknowledged and disenfranchised. Implications for practice MHN services need to promote a culture of openness wherein all MHNs are supported and encouraged to discuss their concerns and fears during the aftermath of a client suicide.

Mental health nurses' perceived preparedness to work with adults who have child sexual abuse histories.

WHAT IS KNOWN ON THE SUBJECT?: The high prevalence of adults presenting to the mental health services places mental health nurses (MHNs) in a unique position to help to identify and support the person with the associated challenges of child sexual abuse (CSA). Feelings of discomfort have been identified by mental health nurses (MHNs) when working with survivors of CSA due to a lack of knowledge, poor confidence and feeling unprepared to inquire and respond to such a sensitive topic. WHAT DOES THE STUDY ADD TO EXISTING KNOWLEDGE?: MHNs are willing to engage in CSA dialogue; however, the level of engagement is often conditional with clear parameters set by participants. Whilst all participants reported they were willing to engage in conversation initiated by the service user, some were unwilling to listen to details of the CSA and used strategies to censor service users from providing details of the CSA. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Whilst self-protecting boundaries helped MHNs to engage in CSA dialogue, strategies to censor aspects of the service user's dialogue may reinforce the belief that their experience of CSA is too shameful to talk about, hence denying the reality of their experience and contributing to feelings of re-shaming. MHNs need a combination of theoretical knowledge and psychosocial skills to achieve clinical competence when working with CSA; therefore, training should not only include information pertaining to facts and statistics but also case presentations, clinical training and supervision. Clinical supervision was highlighted by all participants as a necessary means of formal support, more specifically group clinical supervision whereby peer support can also be availed of in a formalized setting. ABSTRACT: Introduction The high prevalence of adults presenting to the mental health services places mental health nurses (MHNs) in a unique position to support the person with the associated challenges of CSA, yet little is known about the preparedness of MHNs to work with this client population. Aim To explore MHNs' perceived preparedness to work with adults who have CSA histories, and to elicit their views, skills and confidence in relation to working with this sensitive issue. Method In-depth semi-structured interviews were conducted with five consenting MHNs. A qualitative descriptive methodology informed the study. A thematic analysis framework guided the data analysis. Results The findings assert that MHNs are willing to work with survivors of CSA despite feeling unprepared to so, MHNs described feeling ill-prepared in how to respond to CSA, calling for not just education and training specific to CSA but also citing the need for clinical supervision and additional guidelines to enhance their preparedness. Discussion Results of this study further highlighted the omission of CSA within nursing curricula and the absence of role models within clinical practice as a major barrier to preparedness to work with survivors of CSA. Recommendations are made for training, education and the inclusion of clinical supervision.

Factors affecting mental health nurses working with clients with first-episode psychosis: A qualitative study.

WHAT IS KNOWN ABOUT THE SUBJECT?: First-episode psychosis (FEP) usually occurs in adolescence, a time of great change and upheaval and the effect on the sufferer and their family can be immense The nurse's role is to alleviate this suffering, aid recovery and minimize the risk of relapse. They manage this onerous task ideally through the therapeutic relationship, and use the skills of assessment and risk identification in order to maximize patient outcomes. WHAT DOES THE STUDY ADD TO EXISTING KNOWLEDGE?: The study adds knowledge about the challenges that mental health nurses experience specifically in the presentation of first-episode psychosis The findings of this study reinforce the idea that pathways to care need to be clearly identified with a community-wide educational led experience This study illuminates the fact that additional training and formalized clinical supervision are necessary for mental health nurses to improve quality of care and reduce stress levels, both of which lead to better clinical outcomes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental Health nurses should engage with additional training, formalized clinical supervision and avail of peer support in order to improve confidence, skills and quality of care. Dialogue among mental healthcare colleagues is important not only about caring for people presenting with a first-episode psychosis but in relation to the wider community and family. This demonstrates the need for family-centred care within the mental health profession. There should be more recognition of the social impact on the individual during untreated psychosis with regard to isolation and withdrawal as well as factors which also affect help-seeking behaviours. ABSTRACT: Introduction Although there is much research on mental health nurses working with individuals presenting with psychosis, there is a lack of knowledge about the factors that impact the experience of nurses in the presentation specifically of first-time psychosis. Aim This study aimed to explore the factors that impact on the experience of mental health nurses working with individuals and their families who present with a first-time psychosis. Method This qualitative study was conducted through individual semi-structured interviews with eight mental health nurses recruited from community mental health settings with a minimum of 2 years post-qualification experience. Data were then subjected to a thematic content analysis. Results This study identified the importance of therapeutic engagement, as well as the need to have clear pathways to care and building capacity through clinical supervision and training when working with this population. Implications for practice Mental Health nurses should engage with additional training, formalized clinical supervision and avail of peer support in order to improve confidence, skills and quality of care, leading to better therapeutic engagement. Pathways to care should be embedded within the wider community to ensure ease of access for individuals and their families. There should be more recognition of the social impact on the individual during untreated psychosis with regard to isolation and withdrawal as well as factors which also affect help-seeking behaviours.

Caring for patients with suicidal behaviour: an exploratory study.

Patients presenting to the emergency department (ED) with suicidal behaviour is relatively common. While many of these patients may be referred on to specialist mental health services, many are either discharged with no psychiatric follow-up or leave before being seen. There is therefore an increasing onus on the staff of EDs to become involved in the assessment and initial management of this patient group. The aim of this study was to describe the experiences and challenges that nurses encounter when caring for patients who present to the ED with suicidal behaviour. Forty-two ED nurses completed a 15-item semi-structured questionnaire. Participants in this study identified risk assessment as part of their role but did not focus on psychosocial assessment or psychological management of this patient group. Feelings of sympathy and compassion were reported towards these patients; however, there was often a prior judgement of the perceived 'genuineness' of the presentation. Finally, challenges experienced included a lack of appropriate communication skills and insufficient resources within the ED to adequately care for this vulnerable patient group.

In response .

The definition of suicidal behaviour used in the study referred to above was taken from the Australian Commonwealth Department of Health and Aged Care, now the Australian Government Department of Health and Ageing.

Parents' experiences of participation in the care of hospitalised children: a qualitative study.

BACKGROUND: The introduction of unrestricted visiting hours has led to the encouragement of parents to stay with and participate in the care of their hospitalised child. In order to stay with the hospitalised child, parents have to be away from home or work, which in turn impacts on their personal and family life. However, no published study on parents' experiences of childcare participation during paediatric hospitalisation has been found for a Chinese population. OBJECTIVES: This study explored Chinese parents' experiences of their participation in taking care of their hospitalised child. DESIGN: A qualitative exploratory design was adopted to capture parents' experiences of participation. SETTINGS: The study was conducted in four paediatric wards of a regional acute general hospital in the New Territories, a major geographical region of Hong Kong. PARTICIPANTS: Nineteen parents (16 mothers and three fathers) who had a child hospitalised for more than 48 h and identified themselves as staying comparatively longer with the child than their counterpart were recruited. METHODS: Data were collection by tape-recorded semi-structured interview. RESULTS: Four major categories that illustrated parents' experiences of participation in childcare were identified: reasons for staying with the child, rescheduling of family's routine, expectations of nurses, and comments on facility provisions. The findings highlight parents' desire for participation in caring for their hospitalised child, their unexpressed needs for communication and concern about the non-monetary costs of participation. CONCLUSIONS: Most parents viewed accompanying their hospitalised child as an unconditional aspect of being a parent and had a strong desire for participation. Parents' need for communication and emotional support during their participation of childcare in paediatric unit are universal. As Chinese parents are passive in seeking help, nurses should take the initiative in assessing their needs and offering them support accordingly.

Documentary analysis of risk-assessment and safety-planning policies and tools in a mental health context.

Despite the articulated need for policies and processes to guide risk assessment and safety planning, limited guidance exists on the processes or procedures to be used to develop such policies, and there is no body of research that examines the quality or content of the risk-management policies developed. The aim of the present study was to analyse the policies of risk and safety management used to guide mental health nursing practice in Ireland. A documentary analysis was performed on 123 documents received from 22 of the 23 directors of nursing contacted. Findings from the analysis revealed a wide variation in how risk, risk assessment, and risk management were defined. Emphasis within the risk documentation submitted was on risk related to self and others, with minimal attention paid to other types of risks. In addition, there was limited evidence of recovery-focused approaches to positive risk taking that involved service users and their families within the risk-related documentation. Many of the risk-assessment tools had not been validated, and lacked consistency or guidance in relation to how they were to be used or applied. The tick-box approach and absence of space for commentary within documentation have the potential to impact severely on the quality of information collected and documented, and subsequent clinical decision-making. Managers, and those tasked with ensuring safety and quality, need to ensure that policies and processes are, where possible, informed by best evidence and are in line with national mental health policy on recovery.

There is more to risk and safety planning than dramatic risks: Mental health nurses' risk assessment and safety-management practice.

Risk assessment and safety planning are considered a cornerstone of mental health practice, yet limited research exists into how mental health nurses conceptualize 'risk' and how they engage with risk assessment and safety planning. The aim of the present study was to explore mental health nurses' practices and confidence in risk assessment and safety planning. A self-completed survey was administered to 381 mental health nurses in Ireland. The findings indicate that nurses focus on risk to self and risk to others, with the risk of suicide, self-harm, substance abuse, and violence being most frequently assessed. Risk from others and 'iatrogenic' risk were less frequently considered. Overall, there was limited evidence of recovery-oriented practice in relation to risk. The results demonstrate a lack of meaningful engagement with respect to collaborative safety planning, the identification and inclusion of protective factors, and the inclusion of positive risk-taking opportunities. In addition, respondents report a lack of confidence working with positive risk taking and involving family/carers in the risk-assessment and safety-planning process. Gaps in knowledge about risk-assessment and safety-planning practice, which could be addressed through education, are identified, as are the implications of the findings for practice and research.

The use of learning contracts in mental health nursing clinical placement: an action research.

This paper examines the implementation of learning contracts with a cohort of undergraduate nursing students in Hong Kong during a mental health nursing clinical placement. An action learning approach was used by the researchers. Data collection methods included questionnaires and semi-structured interviews. Results showed that students' autonomy and motivation in clinical learning increased through the use of learning contracts. There was more sharing between students and teachers and the quality of teaching and learning was improved. The report concludes that contract learning should be integrated into the curriculum of nurse education as a learning strategy for nursing students.

The perceived burden among Chinese family caregivers of people with schizophrenia.

AIMS: The aim of this study was to examine the level of perceived burden of the Chinese families caring for a relative with schizophrenia and to test its associations with their demographic characteristics, social and family factors and health condition. BACKGROUND: Despite the increased demands on family members to provide care for patients with schizophrenia in community care, little is known about the level of family burden among these family caregivers and its relationship with their demographic, social and cultural backgrounds. METHODS: This was a cross-sectional descriptive study. A total of 203 family caregivers were recruited from three regional psychiatric outpatient clinics in Hong Kong. They were asked to complete a set of well-validated questionnaires, consisting of the Chinese version of four instruments - Family Burden Interview Schedule, Family Assessment Device, Six-item Social Support Questionnaire and MOS 36-Item Short Form Health Survey and a socio-demographic data sheet. Statistical analyses were conducted to test the differences in mean burden scores between subgroups, the inter-relationships among the mean scores of the scales and socio-demographic variables and the predictors of family burden. RESULTS: The families who perceived a higher level of caregiver burden were those who lived in a family with poorer functioning, worse health status and less satisfaction of social support. The caregivers' burden score was positively correlated with their age; conversely, it was negatively correlated with their monthly household income and number of family members living with patient. Social support was the best predictor of caregiver burden. CONCLUSION: These findings increase our understanding about the socio-demographic and cultural variables influencing the well being of family caregivers of a relative with schizophrenia. Helping families to maintain and enhance a supportive social network may represent a useful means to reduce family burden in schizophrenia. RELEVANCE TO CLINICAL PRACTICE: This understanding helps health professionals and researchers to identify different sources and domains of burden from a Chinese cultural perspective and take into account of these factors when planning interventions for family caregivers.

Effectiveness of a mutual support group for families of patients with schizophrenia.

AIM: This paper reports a study to examine the effectiveness of a 12-session mutual support group for Chinese families caring for a relative with schizophrenia compared with a psycho-educational group and routine family support services in Hong Kong. BACKGROUND: Schizophrenia is a disruptive and distressing illness for patients and their families. With the current trend of community care for mental illness, there is evidence that family intervention reduces patient relapse and re-hospitalization, satisfies the health needs of families and enhances their coping capabilities. METHODS: A randomized controlled trial was conducted from May 2002 to June 2003 with 96 Chinese families of a relative with schizophrenia selected from two psychiatric outpatient clinics in Hong Kong. Families were randomly assigned to receive mutual support (n = 32), psycho-education (n = 33) or standard care only (n = 31). The interventions were delivered at outpatient clinics over a 6-month period. Pre- and post- (1 week and 6 months) testing took place and families' functioning, mental health service utilization, patients' level of functioning and duration of re-hospitalization were measured. RESULTS: At both post-test periods, family caregivers and patients in the mutual support group reported statistically significant improvements on family and patients' level of functioning, when compared with their counterparts in the psycho-education and standard care groups. CONCLUSIONS: The findings support the use of mutual support groups as an effective modality of family intervention in a Chinese population caring for a family member with schizophrenia to improve both family and patient functioning.