title: Linking family cohesion and flexibility with expressed emotion, family burden and psychological distress in caregivers of patients with psychosis: A path analytic model.
abstract: The present study aimed to evaluate a path analytic model accounting for caregivers' psychological distress that takes into account perceived family cohesion and flexibility, expressed emotion and caregiver's burden associated with the presence of mental illness in the family. 50 first-episode and 50 chronic patients diagnosed with schizophrenia or bipolar disorder (most recent episode manic severe with psychotic features) recruited from the Inpatient Psychiatric Unit of the University Hospital of Heraklion, Crete, Greece, and their family caregivers participated in the study. Family functioning was assessed in terms of cohesion and flexibility (FACES-IV), expressed emotion (FQ), family burden (FBS) and caregivers' psychological distress (GHQ-28). Structural equation modelling was used to evaluate the direct and indirect effects of family dynamics on caregivers' psychological distress. The results showed that neither family cohesion nor family flexibility exerted significant direct effects on caregivers' psychological distress. Instead, the effect of flexibility was mediated by caregivers' criticism and family burden indicating an indirect effect on caregivers' psychological distress. These results apply equally to caregivers of first episode and chronic patients. Family interventions aiming to improve dysfunctional family interactions by promoting awareness of family dynamics could reduce the burden and improve the emotional well-being of family caregivers.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece; Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece. Electronic address: koutra.k@gmail.com.
authors.forename: Katerina
authors.initials: K
authors.lastname: Koutra
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Simos
authors.affiliation: Department of Psychology, University of Crete, Rethymnon, Greece.
authors.forename: Sofia
authors.initials: S
authors.lastname: Triliva
authors.affiliation: Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Lionis
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Alexandros N
authors.initials: AN
authors.lastname: Vgontzas
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D019260:Expressed Emotion; D005190:Family / Q000523:psychology*; D005195:Family Relations; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000523:psychology*; D012559:Schizophrenia; D012565:Schizophrenic Psychology; D013315:Stress, Psychological / Q000523:psychology*
keywords: Burden; Expressed emotion; Family cohesion; Flexibility; Path analysis; Psychological distress