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The association between family dysfunction and admission to an acute mental health inpatient unit: a prospective study

Published online by Cambridge University Press:  12 September 2019

J. H. P. Tan Open the ORCID record for J. H. P. Tan [Opens in a new window] ,
C. Conlon ,
A. Tsamparli ,
D. O’Neill  and
D. Adamis Open the ORCID record for D. Adamis [Opens in a new window]
J. H. P. Tan*
Affiliation:
Sligo Leitrim Mental Health Services, St. Columba’s, Ballytivnan, Clarion Road, Sligo, Ireland
C. Conlon
Affiliation:
Sligo Leitrim Mental Health Services, St. Columba’s, Ballytivnan, Clarion Road, Sligo, Ireland
A. Tsamparli
Affiliation:
Clinical Psychology Unit, Department of Primary Education, University of the Aegean, Rhodes, Greece
D. O’Neill
Affiliation:
Sligo Leitrim Mental Health Services, St. Columba’s, Ballytivnan, Clarion Road, Sligo, Ireland
D. Adamis
Affiliation:
Sligo Leitrim Mental Health Services, St. Columba’s, Ballytivnan, Clarion Road, Sligo, Ireland
*
*Address for correspondence: T. H. P. Jason, Sligo Leitrim Mental Health Services, St. Columba’s, Ballytivnan, Clarion Road, Sligo F91 CD34, Ireland. (Email: jasonhptan@yahoo.com)
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Abstract

Objectives:

With the shift from deinstitutionalization to community care in mental health services, relatives of persons with severe and enduring mental illnesses have had to take over the role as primary caregivers. Disturbed family dynamics have been observed within families with an ‘ill’ member. Although schizophrenia and related mental illnesses are biologically based disorders, environmental stress (including stress within family relationships) plays a major role in the onset and maintenance of symptoms. With this study, we assume that family dynamics play a central role in the course of severe psychiatric illness and hypothesized that dysfunction within family systems is a prognostic indicator of hospitalization in the course of schizophrenia/bipolar and schizoaffective disorders.

Methods:

Prospective, observational cohort study evaluating family functioning of 121 patients (schizophrenia/bipolar and schizoaffective disorder) from community at baseline and followed-up over 12-month period after recruitment. Measurements included demographics, diagnosis, Family Assessment Device – General Functioning, Perceived Criticism Scale, Brief Psychiatric Rating Scale, Global Assessment of Functioning and Social Support Questionnaire-6.

Results:

Significant differences found between patients admitted and not admitted during the 12-month time period for age (p = 0.003), Brief Psychiatric Rating Scale (BPRS; p = 0.026), Family Assessment Device – General Functioning (FAD-GF; p = 0.007) and Social Support Questionnaire total satisfaction level (p = 0.042) at baseline. Bivariate analysis showed that those admitted into hospital were younger with a higher BPRS score, less social satisfaction and disturbed family dynamics. FAD-GF (p = 0.006) and age (p = 0.022) were significant independent predictors for admission.

Conclusion:

This provides further evidence supporting importance of promoting better family functioning through modified family dynamics, integrating and involving family into the care of such patients.

Keywords

Admissionbipolar affective disorderchronic enduring mental illnessfamily functionschizoaffective disorderschizophrenia
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 39 , Issue 4 , December 2022 , pp. 340 - 350
Copyright
© College of Psychiatrists of Ireland 2019

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References

Adamis, D, Petmeza, I, Mccarthy, G, Tsibidaki, A, Tsamparli, A (2019). Association of individual psychopathology with family functioning in a Greek nonclinical sample. Social Work in Mental Health 17, 59–72.CrossRefGoogle Scholar
Anderson, CM, Hogarty, G, Reiss, DJ (1981). The psychoeducational family treatment of schizophrenia. New Directions for Mental Health Services 1981, 79–94.10.1002/yd.23319811207CrossRefGoogle Scholar
Baeza, FLC, Da Rocha, NS, Fleck, MPDA (2018). Readmission in psychiatry inpatients within a year of discharge: the role of symptoms at discharge and post-discharge care in a Brazilian sample. General Hospital Psychiatry 51, 63–70.CrossRefGoogle Scholar
Bateson, G (2000). Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution, and Epistemology. University of Chicago Press: Chicago.Google Scholar
Bateson, G, Jackson, DD, Haley, J, Weakland, J (1956). Toward a theory of schizophrenia. Behavioral Science 1, 251–264.CrossRefGoogle Scholar
Boaz, TL, Becker, MA, Andel, R, Van Dorn, RA, Choi, J, Sikirica, M (2013). Risk factors for early readmission to acute care for persons with schizophrenia taking antipsychotic medications. Psychiatric Services 64, 1225–1229.CrossRefGoogle ScholarPubMed
Boterhoven De Haan, KL, Hafekost, J, Lawrence, D, Sawyer, MG, Zubrick, SR (2015). Reliability and validity of a short version of the general functioning subscale of the McMaster Family Assessment Device. Family Process 54, 116–123.CrossRefGoogle Scholar
Butzlaff, RL, Hooley, JM (1998). Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry 55, 547–52.CrossRefGoogle ScholarPubMed
Bylander, J (2019). Community-focused health care for the seriously ill. Health Affairs 38, 344–346.CrossRefGoogle ScholarPubMed
Byles, J, Byrne, C, Boyle, MH, Offord, DR (1988). Ontario child health study: reliability and validity of the general functioning subscale of the McMaster Family Assessment Device. Family Process 27, 97–104.CrossRefGoogle ScholarPubMed
Callaly, T, Hyland, M, Trauer, T, Dodd, S, Berk, M (2010). Readmission to an acute psychiatric unit within 28 days of discharge: identifying those at risk. Australian Health Review 34, 282–285.CrossRefGoogle Scholar
Callaly, T, Trauer, T, Hyland, M, Coombs, T, Berk, M (2011). An examination of risk factors for readmission to acute adult mental health services within 28 days of discharge in the Australian setting. Australasian Psychiatry 19, 221–225.CrossRefGoogle ScholarPubMed
Canive, JM, Sanz-Fuentenebro, J, Vazquez, C, Qualls, C, Fuentenebro, F, Tuason, VB (1995). Family environment predictors of outcome in schizophrenic patients in Spain: a nine-month follow-up study. Acta psychiatrica Scandinavica 92, 371–377.CrossRefGoogle Scholar
Chen, S, Collins, A, Anderson, K, Mckenzie, K, Kidd, S (2017). Patient characteristics, length of stay, and functional improvement for schizophrenia spectrum disorders: a population study of inpatient care in Ontario 2005 to 2015. The Canadian Journal of Psychiatry 62, 854–863.CrossRefGoogle ScholarPubMed
Chen, S, Collins, A, Kidd, SA (2018). Thirty-day and 5-year readmissions following first psychiatric hospitalization: a system-level study of Ontario’s psychiatric care. The Canadian Journal of Psychiatry 63, 410–415.10.1177/0706743717751667CrossRefGoogle ScholarPubMed
Dey, S, Menkes, DB, Obertova, Z, Chaudhuri, S, Mellsop, G (2016). Correlates of rehospitalisation in schizophrenia. Australasian Psychiatry 24, 356–359.CrossRefGoogle ScholarPubMed
Donisi, V, Tedeschi, F, Wahlbeck, K, Haaramo, P, Amaddeo, F (2016). Pre-discharge factors predicting readmissions of psychiatric patients: a systematic review of the literature. BMC Psychiatry 16, 449.CrossRefGoogle ScholarPubMed
Evans, L, Cowlishaw, S, Hopwood, M (2009). Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder. The Journal of Family Psychology 23, 531–539.CrossRefGoogle ScholarPubMed
Friedmann, MS, Mcdermut, WH, Solomon, DA, Ryan, CE, Keitner, GI, Miller, IW (1997). Family functioning and mental illness: a comparison of psychiatric and nonclinical families. Family Process 36, 357–367.Google ScholarPubMed
Hodgson, RE, Lewis, M, Boardman, AP (2001). Prediction of readmission to acute psychiatric units. Social Psychiatry and Psychiatric Epidemiology 36, 304–309.CrossRefGoogle ScholarPubMed
Hooley, JM, Parker, HA (2006). Measuring expressed emotion: an evaluation of the shortcuts. Journal of Family Psychology 20, 386.CrossRefGoogle ScholarPubMed
Hooley, JM, Teasdale, JD (1989). Predictors of relapse in unipolar depressives: Expressed emotion, marital distress, and perceived criticism. Journal of Abnormal Psychology 98, 229.CrossRefGoogle ScholarPubMed
House, JS (2001). Social isolation kills, but how and why? Psychosomatic Medicine 63, 273–274.10.1097/00006842-200103000-00011CrossRefGoogle ScholarPubMed
Hung, Y-Y, Chan, H-Y, Pan, Y-J (2017). Risk factors for readmission in schizophrenia patients following involuntary admission. PLoS One 12, 1–11.CrossRefGoogle ScholarPubMed
Kabacoff, RI, Miller, IW, Bishop, DS, Epstein, NB, Keitner, GI (1990). A psychometric study of the McMaster Family Assessment Device in psychiatric, medical, and nonclinical samples. Journal of Family Psychology 3, 431.CrossRefGoogle Scholar
Keitner, GI, Miller, IW, Fruzzetti, AE, Epstein, NB, Bishop, DS, Norman, WH (1987). Family functioning and suicidal behavior in psychiatric inpatients with major depression. Psychiatry 50, 242–255.10.1080/00332747.1987.11024356CrossRefGoogle ScholarPubMed
Kelly, BD (2015). Mental health policy in Ireland: a decade after a vision for change, where are we now? Irish Medical Journal 108, 293.Google Scholar
Keshavan, MS, Morris, DW, Sweeney, JA, Pearlson, G, Thaker, G, Seidman, LJ, Eack, SM, Tamminga, C (2011). A dimensional approach to the psychosis spectrum between bipolar disorder and schizophrenia: the Schizo-Bipolar Scale. Schizophrenia Research 133, 250–254.CrossRefGoogle Scholar
Kohler, O, Horsdal, HT, Baandrup, L, Mors, O, Gasse, C (2016). Association between Global Assessment of Functioning scores and indicators of functioning, severity, and prognosis in first-time schizophrenia. Clin Epidemiol 8, 323–332.10.2147/CLEP.S109036CrossRefGoogle ScholarPubMed
Koyama, A, Akiyama, T, Miyake, Y, Kurita, H (2004). Family functioning perceived by patients and their family members in three Diagnostic and Statistical Manual-IV diagnostic groups. Psychiatry and Clinical Neurosciences 58, 495–500.10.1111/j.1440-1819.2004.01291.xCrossRefGoogle ScholarPubMed
Labrum, T, Solomon, P (2018). Safety fears held by caregivers about relatives with psychiatric disorders. Health & Social Work 43, 165–174.CrossRefGoogle ScholarPubMed
Laing, RD, Esterson, A (1970). Sanity, madness, and the family: Families of schizophrenics. Pelican: Oxford, England.Google Scholar
Lakey, B, Mccabe, KM, Fisicaro, SA, Drew, JB (1996). Environmental and personal determinants of support perceptions: three generalizability studies. The Journal of Personality and Social Psychology 70, 1270–1280.CrossRefGoogle ScholarPubMed
Lay, B, Lauber, C, Rossler, W (2006) Prediction of in-patient use in first-admitted patients with psychosis. European Psychiatry, 21, 401–409.10.1016/j.eurpsy.2005.12.004CrossRefGoogle ScholarPubMed
Lin, C-H, Chen, W-L, Lin, C-M, Lee, M-D, Ko, M-C, Li, C-Y (2010). Predictors of psychiatric readmissions in the short- and long-term: a population-based study in Taiwan. Clinics (Sao Paulo, Brazil) 65, 481–489.CrossRefGoogle Scholar
Mahendran, R, Mythily, Chong S-A, Chan, YH (2005). Brief communication: factors affecting rehospitalisation in psychiatric patients in Singapore. International Journal of Social Psychiatry 51, 101–105.CrossRefGoogle ScholarPubMed
Mansfield, AK, Keitner, GI, Dealy, J (2015). The family assessment device: an update. Family Process 54, 82–93.CrossRefGoogle ScholarPubMed
Martens, L, Addington, J (2001). The psychological well-being of family members of individuals with schizophrenia. Social Psychiatry and Psychiatric Epidemiology 36, 128–133.CrossRefGoogle ScholarPubMed
Martyn, D, Andrews, L, Byrne, M (2014). Prevalence rates and risk factors for mental health difficulties in adolescents aged 16 and 17 years living in rural Ireland. Irish Journal of Psychological Medicine 31, 111–123.CrossRefGoogle ScholarPubMed
Masland, SR, Drabu, S, Hooley, JM (2018). Is perceived criticism an independent construct? Evidence for divergent validity across two samples. Journal of Family Psychology 33, 133–142.CrossRefGoogle ScholarPubMed
Mayoral, F, Berrozpe, A, De La Higuera, J, Martinez-Jambrina, JJ, De Dios Luna, J, Torres-Gonzalez, F (2015). Efficacy of a family intervention programme for prevention of hospitalisation in patients with schizophrenia. A naturalistic multicenter controlled and randomised study in Spain. Revista de Psiquiatría y Salud Mental (English Edition) 8, 83–91.CrossRefGoogle ScholarPubMed
Mcinerney, SJ, Finnerty, S, Walsh, E, Spelman, L, Edgar, NE, Hallahan, B, Mcdonald, C (2018). Quality of life and social functioning of former long-stay psychiatric patients transferred into the community: a 10 year follow up study. Social Psychiatry and Psychiatric Epidemiology 53, 795–801.CrossRefGoogle ScholarPubMed
Mckay, JR, Maisto, SA, Beattie, MC, Longabaugh, R, Noel, NE (1993). Differences between alcoholics and spouses in their perceptions of family functioning. Journal of Substance Abuse Treatment 10, 17–21.CrossRefGoogle ScholarPubMed
Mental Health Commission (2006). Community Mental Health Services in Ireland: Activity and Catchment Area Characteristics 2004. Dublin. https://www.mhcirl.ie/File/commMHSireact.pdf Google Scholar
Miklowitz, DJ (2004). The role of family systems in severe and recurrent psychiatric disorders: a developmental psychopathology view. Development and Psychopathology 16, 667–688.CrossRefGoogle ScholarPubMed
Miller, IW, Kabacoff, RI, Keitner, GI, Epstein, NB, Bishop, DS (1986) Family functioning in the families of psychiatric patients. Comprehensive Psychiatry 27, 302–312.CrossRefGoogle ScholarPubMed
Miller, IW, Ryan, CE, Keitner, GI, Bishop, DS, Epstein, NB (2000). The McMaster approach to families: theory, assessment, treatment and research. Journal of Family Therapy 22, 168–189.10.1111/1467-6427.00145CrossRefGoogle Scholar
Moncrieff, J, Steingard, S (2019). A critical analysis of recent data on the long-term outcome of antipsychotic treatment. Psychological Medicine 49, 750–753.10.1017/S0033291718003811CrossRefGoogle ScholarPubMed
Moss, J, Li, A, Tobin, J, Weinstein, IS, Harimoto, T, Lanctôt, KL (2014) Predictors of readmission to a psychiatry inpatient unit. Comprehensive Psychiatry 55, 426–430.CrossRefGoogle ScholarPubMed
Norman, RMG, Malla, AK, Manchanda, R, Harricharan, R, Takhar, J, Northcott, S (2005). Social support and three-year symptom and admission outcomes for first episode psychosis. Schizophrenia Research 80, 227–234.CrossRefGoogle ScholarPubMed
O’hagan, M, Cornelius, V, Young, AH, Taylor, D (2017). Predictors of rehospitalization in a naturalistic cohort of patients with bipolar affective disorder. International Clinical Psychopharmacology 32, 115–120.CrossRefGoogle Scholar
Øiesvold, T, Saarento, O, Sytema, S, Vinding, H, Göstas, G, Lönnerberg, O, Muus, S, Sandlung, M, Hansson, L (2000). Predictors for readmission risk of new patients: the Nordic comparative study on sectorized psychiatry. Acta Psychiatrica Scandinavica 101, 367–373.CrossRefGoogle Scholar
Olfson, M, Mechanic, D, Boyer, CA, Hansell, S, Walkup, J, Weiden, PJ (1999). Assessing clinical predictions of early rehospitalization in schizophrenia. Journal of Nervous and Mental Disease 187, 721–729.CrossRefGoogle ScholarPubMed
Pearson, JC, Casper, MF, Child, JT, Spiering, K (2008). Family problem solving: a comparative study of adult children in Puerto Rico and the upper Midwest. Journal of Intercultural Communication Research 37, 139–156.CrossRefGoogle Scholar
Peris, TS, Miklowitz, DJ (2015). Parental expressed emotion and youth psychopathology: new directions for an old construct. Child Psychiatry & Human Development 46, 863–873.CrossRefGoogle ScholarPubMed
Pini, S, De Queiroz, V, Dell’osso, L, Abelli, M, Mastrocinque, C, Saettoni, M, Catena, M, Cassano, GB (2004). Cross-sectional similarities and differences between schizophrenia, schizoaffective disorder and mania or mixed mania with mood-incongruent psychotic features. European Respiratory Journal 19, 8–14.Google ScholarPubMed
Pitschel-Walz, G, Leucht, S, Bauml, J, Kissling, W, Engel, RR (2001). The effect of family interventions on relapse and rehospitalization in schizophrenia–a meta-analysis. Schizophr Bull 27, 73–92.CrossRefGoogle ScholarPubMed
Procidano, ME, Heller, K (1983). Measures of perceived social support from friends and from family: three validation studies. The American Journal of Community Psychology 11, 1–24.10.1007/BF00898416CrossRefGoogle ScholarPubMed
Reiss, D (1981). The Family’s Construction of Reality. Harvard University Press: Cambridge, MA.Google Scholar
Renshaw, KD (2008). The predictive, convergent, and discriminant validity of perceived criticism: a review. Clinical Psychology Review 28, 521–534.CrossRefGoogle ScholarPubMed
Revier, CJ, Reininghaus, U, Dutta, R, Fearon, P, Murray, RM, Doody, GA, Croudace, T, Dazzan, P, Heslin, M, Onyejiaka, A (2015). Ten-year outcomes of first-episode psychoses in the MRC ÆSOP-10 study. The Journal of Nervous and Mental Disease 203, 379.CrossRefGoogle ScholarPubMed
Roick, C, Heider, D, Kilian, R, Matschinger, H, Toumi, M, Angermeyer, MC (2004). Factors contributing to frequent use of psychiatric inpatient services by schizophrenia patients. Social Psychiatry and Psychiatric Epidemiology 39, 744–751.CrossRefGoogle ScholarPubMed
Roncone, R, Ventura, J, Impallomeni, M, Falloon, I, Morosini, P, Chiaravalle, E, Casacchia, M (1999). Reliability of an Italian standardized and expanded Brief Psychiatric Rating Scale (BPRS 4.0) in raters with high vs. low clinical experience. Acta Psychiatrica Scandinavica 100, 229–236.CrossRefGoogle ScholarPubMed
Russell, DW, Booth, B, Reed, D, Laughlin, PR (1997). Personality, social networks, and perceived social support among alcoholics: a structural equation analysis. Journal of Personality 65, 649–692.CrossRefGoogle ScholarPubMed
Salvi, G, Leese, M, Slade, M (2005). Routine use of mental health outcome assessments: choosing the measure. The British Journal of Psychiatry 186, 146–152.CrossRefGoogle ScholarPubMed
Sarason, IG, Levine, HM, Basham, RB, Sarason, BR (1983). Assessing social support: the social support questionnaire. Journal of Personality and Social Psychology, 44, 127.CrossRefGoogle Scholar
Sarason, IG, Sarason, BR, Shearin, EN, Pierce, GR (1987). A brief measure of social support: practical and theoretical implications. Journal of Social and Personal Relationships, 4, 497–510.CrossRefGoogle Scholar
Sarmiento, IA, Cardemil, EV (2009). Family functioning and depression in low-income Latino couples. The Journal of Marriage and Family Therapy 35, 432–445.CrossRefGoogle ScholarPubMed
Scazufca, M, Kuipers, E (1998). Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients’ social functioning. Psychological Medicine, 28, 453–461.CrossRefGoogle ScholarPubMed
Schmutte, T, Dunn, CL, Sledge, WH (2010). Predicting time to readmission in patients with recent histories of recurrent psychiatric hospitalization: a matched-control survival analysis. The Journal of Nervous and Mental Disease 198, 860–863.10.1097/NMD.0b013e3181fe726bCrossRefGoogle ScholarPubMed
Scott, J, Colom, F, Pope, M, Reinares, M, Vieta, E (2012). The prognostic role of perceived criticism, medication adherence and family knowledge in bipolar disorders. Journal of Affective Disorders, 142, 72–76.CrossRefGoogle ScholarPubMed
Shor, E, Roelfs, DJ, Yogev, T (2013). The strength of family ties: a meta-analysis and meta-regression of self-reported social support and mortality. Social Networks 35, 626–638.CrossRefGoogle Scholar
Staccini, L, Tomba, E, Grandi, S, Keitner, GI (2015). The evaluation of family functioning by the family assessment device: a systematic review of studies in adult clinical populations. Family Process 54, 94–115.CrossRefGoogle ScholarPubMed
Tsamparli, A, Petmeza, I, Mccarthy, G, Adamis, D (2018). The Greek version of the McMaster Family Assessment Device. PsyCh Journal 7, 122–132.CrossRefGoogle ScholarPubMed
Valenstein, M, Copeland, LA, Blow, FC, Mccarthy, JF, Zeber, JE, Gillon, L, Bingham, CR, Stavenger, T (2002). Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Medical Care 40, 630–639.CrossRefGoogle ScholarPubMed
Van Der Post, LFM, Peen, J, Dekker, JJM (2014) A prediction model for the incidence of civil detention for crisis patients with psychiatric illnesses: the Amsterdam study of acute psychiatry VII. Social Psychiatry and Psychiatric Epidemiology 49, 283–290.CrossRefGoogle ScholarPubMed
Ventura, J, Green, MF, Shaner, A, Liberman, RP (1993). Training and quality assurance with the brief psychiatric rating scale: “the drift busters.”. International Journal of Methods in Psychiatric Research 3, 221–244.Google Scholar
Vitale, A, Mannix Mcnamara, P, Cullinan, V (2015). Promoting mental health through multidisciplinary care: experience of health professionals working in community mental health teams in Ireland. International Journal of Mental Health Promotion 17, 188–200.10.1080/14623730.2015.1023660CrossRefGoogle Scholar
Waller, G, Slade, P, Calam, R (1990). Who knows best? Family interaction and eating disorders. British Journal of Psychiatry 156, 546–550.CrossRefGoogle ScholarPubMed
Weinstock, L, Keitner, G, Ryan, C, Solomon, D, Miller, I (2006). Family functioning and mood disorders: a comparison between patients with major depressive disorder and bipolar I disorder. Journal of Consulting & Clinical Psychology 74, 1192–1202.CrossRefGoogle ScholarPubMed
Woo, BKP, Golshan, S, Allen, EC, Daly, JW, Jeste, DV, Sewell, DD (2006). Factors associated with frequent admissions to an acute geriatric psychiatric inpatient unit. Journal of Geriatric Psychiatry and Neurology 19, 226–230.CrossRefGoogle Scholar
Zanardo, GLDP, Moro, LM, Ferreira, GS, Rocha, KB (2018). Factors associated with psychiatric readmissions: a systematic review. Paidéia (Ribeirão Preto) 28, e2814.CrossRefGoogle Scholar