title: Providing care to relatives with mental illness: reactions and distress among primary informal caregivers.
abstract: BACKGROUND
  The responsibility of caring for relatives with mental illness often falls on the family members. It has been reported that the reactions to or consequences of providing care are what rendered the role of a caregiver challenging and hence a source of distress. This present study thus aimed to identify socio-demographic correlates of caregiving experiences using the Caregiver Reaction Assessment (CRA) and to examine the associations between reactions to caregiving and psychological distress.
  
  
  METHODS
  A total of 350 caregivers with relatives seeking outpatient care at a tertiary psychiatric hospital were recruited for this study. Distress among caregivers was assessed using the Patient Health Questionnaire (PHQ-9). The CRA was administered to measure reactions from caregiving in four domains including impact on schedule and health (ISH), impact on finance (IF), lack of family support (LFS) and caregiver esteem (CE). Participants also completed a questionnaire that asked for their socio-demographic information. Multivariable linear regression analysis was first used with domains of CRA as outcome variables and socio-demographic variables as predictors in the models. The next set of multivariable linear regression analysis tested for the association between CRA domains and distress with CRA domain scores as outcome variables and PHQ-9 score as predictor, controlling for socio-demographic variables.
  
  
  RESULTS
  Socio-demographic correlates of CRA domains identified were age, education, employment, income and ethnicity. Domain scores of CRA were significantly associated with PHQ-9 score even after controlling for socio-demographic variables. A higher distress score was associated with greater impact felt in the domain of ISH (β = 0.080, P < 0.001), IF (β = 0.064, P < 0.001), and LFS (β = 0.057, P < 0.001), and was associated with lower CE domain scores (β = -0.021, P < 0.05).
  
  
  CONCLUSIONS
  This study identified several socio-demographic correlates of caregiving reaction in the different domains. Each of these domains was found to be significantly associated with caregiver distress. Higher distress was associated with stronger impact on the negative domains and a lower impact in the positive domain of caregiving reaction. Interventions such as educational programs at the caregiver level, and also promoting wider social care support in these domains may help to address caregiver distress.
authors.affiliation: Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore. sherilyn_sh_chang@imh.com.sg.
authors.forename: Sherilyn
authors.initials: S
authors.lastname: Chang
authors.affiliation: Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
authors.forename: Yunjue
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
authors.forename: Anitha
authors.initials: A
authors.lastname: Jeyagurunathan
authors.affiliation: Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
authors.forename: Ying Wen
authors.initials: YW
authors.lastname: Lau
authors.affiliation: Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
authors.forename: Vathsala
authors.initials: V
authors.lastname: Sagayadevan
authors.affiliation: Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
authors.forename: Siow Ann
authors.initials: SA
authors.lastname: Chong
authors.affiliation: Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
authors.forename: Mythily
authors.initials: M
authors.lastname: Subramaniam
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D002681:China; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Burden; Caregiver; Caregiver Reaction Assessment; Caregiving reaction; Distress; Mental health