title: Factors associated with caregiving burden and mental health conditions in caregivers of patients with anorexia nervosa in Japan.
abstract: BACKGROUND
  There are no studies about the caregiving burdens in families of patients with eating disorders in Japan, and only limited studies on the role of caregivers' stress coping, social support, and mental health. This study examines caregiving burdens, mental health conditions, and associated factors in caregivers of anorexia nervosa (AN) patients in Japan.
  
  
  METHODS
  Seventy-nine principal caregivers (70 mothers, 5 fathers, 3 spouses and 1 grandmother; mean age 56.0 ± 8.0 years) for outpatients with AN (all female; mean age 26.6 ± 7.9 years; BMI 14.6 ± 3.2 kg/m(2)) were evaluated using self-report questionnaires in a cross-sectional study. The questionnaires included caregiving burden (J-ZBI_8), mental health conditions (GHQ28), stress coping styles (CISS), social support (SNQ), severity of the patient's symptoms from the family's perspective (ABOS), and family functioning (GF-FAD). Clinical information about the patients was also obtained.
  
  
  RESULTS
  Mean caregiving burden assessed by J-ZBI_8 score was 12.4 ± 7.0 (SD). The total GHQ score was 31.6 ± 13.7 (Likert scoring) and 9.2 ± 7.0 (GHQ scoring). Of the respondents, 48 (60.7 %) indicated a high risk for mental health problems that exceeded the cutoff point of the GHQ. Significantly higher caregiving burden and poor mental health conditions were shown in the group who had contact with patients > 6 h a day compared to the group with daily patient contact < 3 h (F (2, 76) = 3.19, p = 0.047 and F (2, 76) = 9.39, p < 0.001, respectively). Stepwise multiple regression analysis indicated that the factors that significantly predicted the caregiving burden were severity of the patient's symptoms from the family's perspective (β = 0.47, p < 0.001) and Emotion-Oriented Coping (β = 0.38, p = 0.002) (R(2) = 0.401), while predictors of mental health conditions were Emotion-Oriented Coping (β = 0.522, p < 0.001), Affective Support (β = -0.419, p < 0.001), and contact time with patient (β = 0.201, p = 0.042) (R(2) = 0.602).
  
  
  CONCLUSIONS
  Caregivers of AN patients experienced heavy burdens and manifested poor mental health conditions. The severity of the patient's symptoms from the family's perspective and the greater use of emotion-oriented coping were associated with higher burdens. Greater use of emotion-oriented coping, less affective support and longer contact with patients were related to worse mental health conditions. Interventions to promote caregivers' adaptive coping styles may help reduce their caregiving burden and improve their mental health.
authors.affiliation: Institute of Women's Health, Tokyo Women's Medical University 9-9, Wakamatu-cyo, Shinzyuku-ku, Tokyo, 162-0056 Japan ; Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi-cyo, Kodaira-shi, Tokyo, 187-8553 Japan.
authors.forename: Chisato
authors.initials: C
authors.lastname: Ohara
authors.affiliation: School of Health Sciences Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Ohkawa, Fukuoka, 831-8501 Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Komaki
authors.affiliation: Department of Health Sciences, School of Medicine, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi 409-3898 Japan.
authors.forename: Zentaro
authors.initials: Z
authors.lastname: Yamagata
authors.affiliation: Institute of Women's Health, Tokyo Women's Medical University 9-9, Wakamatu-cyo, Shinzyuku-ku, Tokyo, 162-0056 Japan ; Health Services Center, National Graduate Institute for Policy Studies, 7-22-1, Roppongi, Minato-ku, Tokyo, 106-8677 Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Hotta
authors.affiliation: Institute of Women's Health, Tokyo Women's Medical University 9-9, Wakamatu-cyo, Shinzyuku-ku, Tokyo, 162-0056 Japan.
authors.forename: Toshiko
authors.initials: T
authors.lastname: Kamo
authors.affiliation: Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi-cyo, Kodaira-shi, Tokyo, 187-8553 Japan.
authors.forename: Tetuya
authors.initials: T
authors.lastname: Ando