الفهرس 
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Abstract
Summary
Schizophrenia is a severe mental disorder, characterized by fundamental disturbance in thinking, perception, and emotions. Symptoms may cause social and occupational dysfunction which rises the patients’ dependence on caregivers leading to burdens among family caregivers.
Caregiving burden is described as an appraisal of negative psychological pressure; stressful or harmful, perceived by caregivers. It is obtained from the procedure of interaction between caregiver and care recipient, which is influenced by various elements related to the internal world and the external surroundings.
As the disease tends to be chronic and demanding, caregivers who care for their mentally-ill patients feel stressed, anxious, and depressed. Caregivers feel disconnected from society, because of limitations on their social and recreational interests, as well as racial inequality and mental disability stigma. In addition, depression contributes to both distress and disability in caregivers while undermining their ability to carry out their essential supportive role toward their relative with schizophrenia.
Empathy is a psychosocial concept composed of, at least, two major components, referring to the ability to know or understand another person’s emotions (cognitive component) and the ability to feel or share another person’s emotional state (affective/emotional component).
Therefore, family care providers with greater emotional empathy are especially prone to share others’ distress. When exposed to high levels of negative emotions in stressful environments, family care providers can develop empathy burnout and emotional exhaustion.
Psychiatric mental health nurses as a part of their roles offer inspired and suitable assistance for family caregivers in all matters of daily life such as, how to equilibrium caregiving plans, finding community support services and how to decrease stress through relaxation techniques.
Aim of the study:
The aim of the present study is to assess emotional empathy, burden and depression among family caregivers of patient with schizophrenia.
Research questions
1. What is the level of emotional empathy among family caregivers of patient with schizophrenia?
2. What is the level of burden experienced by family caregivers of patients with schizophrenia?
3. What is the level of depression experienced by family caregivers of patients with schizophrenia?
4. What are the relationships between emotional empathy, burden and depression among family caregivers of patients with schizophrenia?
Subjects and methods:
The methodology of this study was presented under the following four forms of design:
I. Technical design
Technical design of this study included research design, setting, subjects and tools of data collection.
a) Research design:
A descriptive relational design will be utilized in the study.
b) Setting:
This study was conducted at Aswan hospital for mental health and addiction treatment which was affiliated by Ministry of Health.
C-Subjects of the study:
The subject sample of this study included 186 family caregivers of patients with Schizophrenia attending follow-up outpatient clinic in the previously mentioned setting. They can be available at the time of study, fulfilling the following
inclusion criteria:
For patient:
1- Age: 18 years or above.
2- Sex: from both sexes.
3- Diagnosed case for schizophrenia for at least one year.
4- Without any co-morbid psychiatric disorders.
5- Patient adhered to treatment plan for at least 6 months.
For caregivers:
1- Age: adult caregiver who are closely related and directly involved with care of the patient with schizophrenia for at least one year.
2- Sex: from both sexes.
3- from all educational levels and different socioeconomic status.
4- Free from any severe physical and psychiatric disorders.
5- NOT responsible for caregiving of other patient in the family.
6- Agree to participate in the study.
D. Tools of data collection:
It included the following parts:
1-Interviewing questionnaire was designed by the researcher after reviewing related literature regarding schizophrenia and three parts are included as follows:
a. First part: demographic data of patient and caregiver: (Appendix I)
It was designed to assess demographic data of both family caregivers and patients with schizophrenia and it is divided into:-
- Caregiver’s demographic data: it included age, gender, level of education, marital status, occupation, family income and relation to patient.
- Patient’s demographic data: it includes age, gender and educational level.
b. The second part: history of illness regarding schizophrenia: (Appendix II)
It includes duration of illness and duration of treatment.
c. The third part: Knowledge about Schizophrenia: (Appendix III)
It is designed to assess caregiver knowledge about schizophrenia, it includes nature, epidemiology, causation, clinical features, treatment, and prognosis of schizophrenia.
2- Burden assessment schedule (BAS): (Appendix IV)
Burden assessment schedule is a valid and reliable tool. It is developed by Thara, et. al. (1998) and it is adopted by the researcher to assess objective and subjective burden experienced by the caregivers of chronic mental patients. It has a total of 40 items, the scale measuring 9 different areas of objective and subjective caregiver burden such as spouse relation factor, physical and mental health factor, external support factor, caregiver’s routines, financial support of patient, taking responsibility, socialization, patient’s behavior, and caregiver’s strategy.
3-Multi-Dimensional Emotional Empathy Scale (MDEES). (Appendix V)
The original MDEES scale is valid and reliable tool. It is developed by Caruso and Mayer. (1998) and adopted by the researcher. It comprises 30 questions, including the multidimensional emotional evaluation of empathic skills of individuals. scale measuring multiple dimensions of emotional empathy.
The scale consists of six domains: suffering, positive sharing, responsive crying, emotional attention, feeling for others, and emotional contagion.
4-IV- Center for Epidemiologic Studies Depression (CES-D) (Appendix VI)
CES-D is a valid and reliable tool. It is developed by Radloff, (1977) and adopted by the researcher. CES-D is one of the most widely used instruments for assessing depression in family caregivers of patients with psychiatric disorders. It covers affective, psychological, and somatic symptoms. The items of the scale are symptoms associated with depression. It includes 20 items rated on a 4-point Likert scale which are: Rarely (Less than 1 day), Some (1-2 days), Occasionally (3-4 days) and Most (5-7 days).
The findings of the study can be summarized as follows:
1- Two fifths of the studied caregivers’ age was more than 50 years old, and their mean age was 46.24±12.31 years. As regard to their gender and marital status, more than half of them are female and married respectively. Regarding the relation to the patient, less than one third of them are mothers. In relation to the educational level and the employment of the caregivers under the study, more than two fifths and more than half of them finished their primary education and are employed respectively. Regarding the adequacy of monthly income, three quarters of them had adequate monthly income. In relation to duration of patient`s illness and caregiving duration, less than two thirds of them the patient had the illness for more than 5 years, and the caregiving duration was more than 5 years respectively.
2- Less than one quarter of the studied patients` age ranged from 31: 35 years old, their mean age was 35.9±8.91 years. As regard to gender and educational level, less than three fifths and half of them were male and finished secondary education respectively.
3- Three quarters of the studied caregivers of patients with schizophrenia had unsatisfactory level of knowledge about schizophrenia, while one quarter of them had satisfactory level of knowledge about schizophrenia.
4- Three fifths of the studied caregivers of patients with schizophrenia had high level of emotional empathy, while only (14%) of them had low level of emotional empathy.
5- Less than three quarters of the studied caregivers had severe level of total burden. Also, only (11%) of them had very mild level of total burden. While only (5.4%) of them had moderate level of total burden.
6- The majority of the studied caregivers of patients with schizophrenia had depressive symptoms.
7- There were strong positive correlations between total levels of burden of the studied caregivers and their level emotional empathy and depression. Also, there is a strong negative correlation between total levels of emotional empathy of the studied caregivers and their level of depression.
Conclusion
Based on the results of the current study, it can be
concluded that:
less than three-quarters of the studied caregivers had a severe level of the total burden. Regarding depressive symptoms, the majority of the studied caregivers of patients of schizophrenia had depressive symptoms. Furthermore, three-fifths of the studied caregivers had a high level of emotional empathy. Also, the current study reveals that Caregivers of patients with schizophrenia who experience severe burdens had high emotional empathy and severe depressive symptoms. Meanwhile, caregivers with high emotional empathy had mild depressive symptoms.
Recommendations
Considering the findings of the study, the following recommendations are outlined:
• Designing and implementing a psycho-educational supportive program for family caregivers of patients with schizophrenia to reduce their burden and depression as well as enhance their coping abilities and the quality of life to overcome their burden of caregiving.
• The establishment of a counseling program for patients with mental illness and their caregivers including Schizophrenia to improve their psychological well-being.
• The establishment of a day care unit under the umbrella of the ministry of health to provide bio-psychosocial care for patients with Schizophrenia to decrease the burden among caregivers.
• The development of a rehabilitation program to provide primary, secondary, and tertiary rehabilitation to enhance the quality of life for patients of Schizophrenia and their caregivers.
• Educational sessions and community-raising awareness toward mental disorders to reduce social stigma.
• Future research should examine whether caregivers who are high in emotional empathy should learn to regulate their emotions to others’ suffering and maintain the distinction between self and other has preventive and/or therapeutic value for protecting their mental health.