Which factors influence the psychological distress among relatives of patients with chronic functional psychoses? An exploratory study in a community mental health care setting

Aim: This research aimed to assess the contribution of the five core areas of the transactional stress model to the relatives' psychological distress (PD) when informally taking care of patients with functional psychoses treated in community mental health care. Subjects and methods: Cross-sectional data from 163 relatives were collected in interviews, while data on 158 patients were collected by analyzing clinical charts. The following areas were assessed: socio-demographic and illness-related features of the patients, socio-demographic features of the relatives (environmental variables); sense of coherence, mastery, causal attributions and opinions of relatives about mental disorders (person variables); interpersonal problems with the patients as well as the assessment of their symptoms by the relatives themselves (primary appraisal); support received, critical life events and burden of relatives caused by their own illnesses (secondary appraisal); control behavior and efforts of relatives to engage the patients in activities (coping). PD was assessed with the 12-item version of the General Health Questionnaire. Bi-variate correlation analysis and a multiple linear regression model were the main test statistical approaches. Results: Correlation analysis showed that differences between diagnostic groups referred to primary and secondary appraisal processes, in particular. Results of the statistical model provided evidence for the importance of primary appraisal and person variables for influencing PD, and for the lack of importance of coping and environmental variables. Conclusion: The study enhanced the validity of the transactional stress model to demonstrate the influence of salutogenetic concepts such as sense of coherence

Patients' views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries

This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at http://bjp.rcpsych.or

Symptoms associated with victimization in patients with schizophrenia and related disorders

Background: Patients with psychoses have an increased risk of becoming victims of violence. Previous studies have suggested that higher symptom levels are associated with a raised risk of becoming a victim of physical violence. There has been, however, no evidence on the type of symptoms that are linked with an increased risk of recent victimization. Methods: Data was taken from two studies on involuntarily admitted patients, one national study in England and an international one in six other European countries. In the week following admission, trained interviewers asked patients whether they had been victims of physical violence in the year prior to admission, and assessed symptoms on the Brief Psychiatric Rating Scale (BPRS). Only patients with a diagnosis of schizophrenia or related disorders (ICD-10 F20–29) were included in the analysis which was conducted separately for the two samples. Symptom levels assessed on the BPRS subscales were tested as predictors of victimization. Univariable and multivariable logistic regression models were fitted to estimate adjusted odds ratios. Results: Data from 383 patients in the English sample and 543 patients in the European sample was analysed. Rates of victimization were 37.8% and 28.0% respectively. In multivariable models, the BPRS manic subscale was significantly associated with victimization in both samples. Conclusions: Higher levels of manic symptoms indicate a raised risk of being a victim of violence in involuntary patients with schizophrenia and related disorders. This might be explained by higher activity levels, impaired judgement or poorer self-control in patients with manic symptoms. Such symptoms should be specifically considered in risk assessments