Impact on families
How does schizophrenia impact on families?
A diagnosis of schizophrenia can have a large impact not only on the affected individuals, but also on the people closest to them. This topic considers the impact of schizophrenia on family members, and on the family as a unit.
Sometimes the family of a person with schizophrenia may experience different types of burden, particularly during acute phases of the illness. Burden is considered in terms of objective effects, such as illness severity or financial output, but also in terms of subjective effects, such as the emotional impact of the illness on family members.
What is the evidence for the impact of schizophrenia on families?
Moderate to low quality evidence suggests caregiving can have both negative and positive impacts. Coping, appraisal/attribution, and interpersonal response styles account for most of the variation in caregiver distress, with a strong association between emotional over-involvement and caregiver distress. High expressed emotion is common in families with around 50% of families reporting this trait. Emotional over-involvement, critical comments, hostility, and distress are reported in around 30% of families.
Siblings experience increased subjective burden, including feelings of guilt, shame, hurt and anxiety. Burden is highest in younger, female or more educated siblings, and the levels of burden is associated with patients’ symptom severity. Siblings have expressed a need for more information regarding the illness and its treatment, and would generally like to be involved in family support groups.
Family members often have difficulty recognising that an illness is developing in their relative and that the person is in need of help, resulting in delays in timing and type of help sought. Predominant barriers to seeking help by relatives are the perceived stigma of having a family member with a mental illness and reluctance of the ill relative to participate in the help-seeking process. The ill individuals’ wider social context and informal networks may inhibit help-seeking. Crises, or overt psychotic symptoms, are the main promoters of active help-seeking and facilitators to accessing services. Relatives’ informal networks often serve to assist in this process.
Moderate to high quality evidence finds carer psychoeducation improves carers’ perceived burden and depression, their knowledge of psychosis, negative caregiving experiences, and overall morbidities. Moderate quality evidence also shows family psychoeducation has a medium-sized benefit for reducing familial expressed emotion. Family intervention, which can include psychoeducation or mutual support, improves long-term family functioning, while also reducing long-term carer support service use. Home-based crisis intervention reduces family disruption and burden, and increases patients’ and relatives’ overall satisfaction levels.
Moderate quality evidence finds babies of mothers with schizophrenia in the peri-natal and post-natal periods show a two- to three-fold increase in the risk of mortality or congenital malformation. Lower quality evidence is unclear about the risk of mortality in older children. Moderate to high quality evidence suggests a two-fold increased risk of foetal mortality among pregnant mothers with a psychotic disorder, though the absolute risk of stillbirth in offspring of mothers with schizophrenia is < 2%. This evidence does not take into account any effects of other contributing factors such as medical conditions, medications or substance use.
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.