What do caregivers of people with schizophrenia in Ethiopia really feel?

Researchers wanted to know how hard it is for Ethiopians to take care of family members with the mental disorder schizophrenia. What they think and feel influences the patient too. When a carer is often critical or angry, it can make the patient’s symptoms worse. . 

A person experiencing a schizophrenic episode interprets and experiences reality abnormally. They “hear” or “see” things that are simply not real. Such situations are typically emotionally, and even financially, very taxing for those close to the patient.

Very little is actually known about the stresses and types of emotions that Ethiopians who find themselves caring for such patients experience. This makes it difficult to adequately support them – and in the process to support the patients themselves.

The researchers therefore assessed the expressed emotions (EE) rankings of caregivers by considering how they talk about their situation, and whether they tend to be more critical, positive or aggressive. They found out how emotionally invested caregivers are with the family member they care for, and assessed which specific demographic and socio-economic factors influenced the type of emotions that caregivers in Ethiopia generally express.

The research team asked 422 family members who are the caregivers of patients suffering from schizophrenia to answer a structured questionnaire. They recruited participants through the psychiatry outpatient unit of the Jimma University Medical Center in southwestern Ethiopia. 

The study was conducted in 2019, after JImma University in Ethiopia gave the necessary ethical approval to protect the rights of participants. 

Participants answered questions about their age, gender, jobs and socio-economic status, and how long they have had the task of caregiver. They were also asked how often they felt critical, hostile, positive or emotionally overwhelmed or overinvolved towards the patient. 

Researchers specifically looked for things that could influence caregivers’ level of expressed emotions.

Around 1 in 4 caregivers (23.9%) were highly critical about their situation, while one in three (35.1%) were highly emotional about their involvement with their family member. 

Overall, 43,6% of participants expressed high emotions. Family members who had already been caring for a patient for more than 6 years were more than twice as likely to be more emotional about their position than those who have had a shorter shift. 

Caregivers with a high EE score typically expressed lots of critical comments and were emotionally overinvolved. Their households had to get by on less than 2000 Ethiopian Birr, and the patient had already suffered more than three schizophrenic episodes. 

The findings add to results from similar studies that have also been done on caregivers’ experiences in countries such as Nigeria, India and Britain. It increases what we know about the situation in an under-resourced country such as Ethiopia. 

The results show how important it is to also take care of the caregivers, as they play such a supportive role in the lives of schizophrenia patients. Contrary to previous research, the current study did not find any real link between a patient relapsing and caregivers having a high EE score.

But researchers caution that it is not possible to directly compare the results obtained from the Ethiopian study with that from others. Different assessment tools were for instance used in an American study, while a similar one in Nigeria only surveyed 50 participants. 

The possible link between the degree of caregivers’ expressed emotions and the possibility that patients might relapse must be further investigated. A standardised relapse instrument might be of value. 

The study provides much needed insights into the lived experiences of the families of schizophrenic patients within an African context. This topic is not well studied in Ethiopia, but has received some attention in other African countries such as Egypt and Nigeria. The research strengthens mental health research in Ethiopia, as it was conducted by researchers from two local universities.

Abstract

Background Expressed emotion (EE) measures the emotion of the caregivers of persons with schizophrinia and is predictive of symptom levels in a range of medical and psychiatric conditions. It is worthwhile to assess expressed emotion and associated factors among caregivers of patients with schizophrenia in Ethiopia since there is limited data on this issue in this part of the world.

Objective To assess the status of expressed emotions and selected patients’ clinical factors among caregivers of patients with schizophrenia attending psychiatry outpatient unit of Jimma university medical center, South west, Ethiopia, 2019.

Method A cross-sectional study design employed involving 422 caregivers of schizophrenic patients using consecutive sampling techniques. Data was collected using structured interviewer administrated questionnaires (Family Questioners) which assess the level of expressed emotion, entered into Epidata 4.4 and analyzed by Statistical package for social science (SPSS) version 25. Descriptive statistics used to summerize data, bivariate logistic regression was done to identify candidate variables for multivariable logistic regressions and the association between expressed emotion and predictor variables was identified by using a multiple logistic regression model.

Results High expressed emotion was observed in 43.6% of respondents. Caring for schizophrenic patients for about 6-8 years, having 3-4 episodes of the illness was significantly associated with high expressed emotion.

Conclusions This study revealed that there is high status of caregivers expressed emotion compared to other studies. It also showed that number of episode of illnesses had significant association with high caregivers expressed emotion. Health care systems, which provide interventions for patients with schizophrenia, need to design proper strategy to address caregivers need as well

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