British Carers Of People With Schizophrenia More Burdened Than German Carers

Main Category: Caregivers / Homecare
Also Included In: Schizophrenia
Article Date: 20 Jun 2007 - 1:00 PDT

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British caregivers of people with schizophrenia have a greater burden than German caregivers, according to a new study published in the April issue of the British Journal of Psychiatry.

The burden on relatives of people with schizophrenia may be influenced not only by patient and caregiver characteristics, but also by national differences in mental healthcare service provision.

This study analysed for the first time data from several centres in Britain and Germany. Information was gathered at 5 time points, reflecting the situation of relatives over a 2-year period.

Current per capita expenditure on mental health in Germany is appreciably higher than in Britain (US $289 v. $203). Germany has on average 7.5 psychiatric beds per 10,000 population, whereas Britain has only 5.8.

Overall, research has shown that the number of unmet needs for care (covering basic living conditions, healthcare, social contact, functioning and services) seems higher among people in Britain than in Germany.

In addition, satisfaction with relatives' involvement in psychiatric care - particularly relevant to family burden - is distinctly lower in Britain than in Germany (London 2.9 v. Leipzig 3.8).

In this study 333 patients with schizophrenia and their key relatives in Germany were examined and compared with 170 patients and relatives in Britain. The average age in both countries of caregivers was 39; almost two-thirds were female; and a third were the parents of the affected patients. Patients had been mentally ill on average for 13 years.

It was found that the British sample included a higher proportion of caregivers who were spending less than 9 hours a week with the patient. Caregivers from Britain were more pessimistic about their ability to cope with the patient's behaviour than those from Germany.

Patients from Britain included fewer married people, but more men and more currently employed people.

After taking relevant individual variables into account, 'country' remained a significant predictor of caregiver burden: caregivers from Britain were more burdened than those from Germany. This was despite British caregivers having less time in mutual contact, patients having fewer serious symptoms of schizophrenia in Britain than in Germany, and a better employment situation among the British sample.

In line with previous research, the study found that relatives of people with schizophrenia experienced the highest burden from worries, and the lowest burden in relation to the supervision of the patient.

The researchers comment that the national difference in family burden may in part be explained by differences in the mental healthcare system, Germany having considerably more psychiatric beds than Britain.

Furthermore, opportunities for daytime structured activities, which include work and work-related activities, as well as other structured activities and social contact, are better in Germany than in Britain. This could also affect caregiver burden.

It may be that insufficient support for patients in Britain requires relatives to take over, entirely or partly, tasks that are covered by the mental healthcare system in Germany, say the researchers. Such tasks include urging patients to take proper care of themselves, or to undertake some kind of activity.

The results suggest that, in comparison with Germany, the support of patients with schizophrenia in Britain falls more to informal than to professional healthcare, and that this may account for the higher levels of burden among British caregivers.

Future studies might look at whether the cost savings achieved at the expense of relatives ultimately result in health problems from the increased care-related burden.

Royal College of Psychiatrists

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