Families are the best source of caring for chronic psychiatric patients. Families take care of approximately 60–85% of people with a handicap or disability . The burden is observed among caregivers because of chronic psychiatric patients, such as patients with schizophrenia or bipolar in family. Schizophrenia and bipolar disorder are chronic and debilitating ones that can lead to progressive reduction in social interaction (social isolation), their jobs and many dimensions are affected in a person’s life. The prevalence of schizophrenia is 1% and bipolar disorder is 1% in all communities .
Schizophrenia and bipolar disorder are chronic and debilitating disorders that lead to significant social isolation. Their performance and most aspects of a person’s life are affected by these disorders. Stressor assessment and management of family burden is an important issue. It helps the caregivers to provide better care for patients. The results show improving coping strategies to reduce the burden is also important .
Increased responsibilities in families lead to awareness of these patients’ problems. This will be helpful for caregivers of patients to deal with these problems . Some studies showed that the diversity and intensity of care could lead to susceptibility to stress in caregivers of patients. If appropriate intervention is not done, this problem may reduce the level of physical and mental health of caregivers . The overloading pressure that was caused due to patient caring is called family burden in 1950 . Burden is a certain amount of psychological pressure and problems expressed by caregivers or the patient’s family in 1966. It includes a range of psychological, emotional, social, and economic conditions. The burden imposed by the care of a mental illness can reduce the quality of a caregiver’s life . In other words, burden lead to poor quality of life in caregivers and this issue causes poor caring, poor compliance, and violent behavior inward to patient . Burden is two types; “objective” and “subjective”. Objective burden is negative caregivers’ experiences due to the role of caregiver. Objective burden involves the disruption of family life that is potentially observable. Subjective burden is a feeling that occurs in caregivers following the care of the patients .
Coping style is as action-oriented and intra psychic efforts to manage the demands caused by stressful events. It is important for its significant impact on stress-related psychiatric and physical health outcomes and suitable intervention choice . Lazarus theory conceptualized coping as a complex, organized sequence of behaviors that include cognitive appraisal, action impulses, patterned revised transactional model somatic reactions, and reflect physiological aspects of a particular emotion. Folkman and Lazarus defined eight factors of coping: confrontative coping, distancing, self-controlling, seeking social support, accepting responsibility, escape-avoidance, goal directed problem-solving and positive reappraisal .
The impact of burden like any other stressors depends on cognitive assessment of the problem and resources that are available to cope with it. The person’s vulnerability to psychological pressure depends on person’s coping skills and social supports . Caring of chronic patients, including schizophrenia leads to use of maladaptive coping strategies in their caregivers. It causes challenges in mental health . There is no direct correlation among burden, feelings of perceived burden, and its negative consequences. So that, Folkman and Lazarus discussed that coping strategies play a mediating role in feeling of burden and their perception of negative consequences . Problem-focused coping styles can reduce the burden and emotion-focused coping styles and ineffective coping styles can increase the burden, or at least there has no effect on adjustment. In summary, family burden of schizophrenia and bipolar disorders depends on coping strategies they use . In a study by Noori on caregivers of schizophrenic patients found that, the psychological burden between them was moderate to severe. This rate was higher in female and more subjective. It was shown the coping strategies are different between caregivers . Khajavi et al. showed that the level of psychological burden in caregivers of schizophrenia patients was higher than caregivers of bipolar patients, but they did not find a significant correlation between problem-solving coping style and burden . Distress is more often in caregivers who report more consequences, who tend to use more ineffective coping style, and have passive reaction styles .
Purpose of most interventions is improving patient mental health, and caregivers’ situation was the second goal in those researches. Accurate assessment of emotional status, evaluating various stressful situations and providing efficient social support can reduce burden care. Appropriate intervention for caregivers includes giving useful information, careful assessment of problems and supporting them. This type social support reduces isolation, helping problem solving when deal with problems and they give sufficient attention to improve patients’ quality of life. In other words, burden has important effect on caregivers’ quality of life. It causes poor care or violent behavior against patients or poor therapeutic compliance. The impact of burden like any other stressor depends on cognitive assessment of the problem and resources that are available to cope with it. The vulnerability of any person is influenced by his coping skills and availability of social support .
There is no direct correlation between stress, feelings of stress and its negative consequences. Folkman and Lazarus believe that coping strategies have mediating role in cost burden and its negative consequences . Using problem-focused coping styles reduce the burden and emotion-focused coping style and ineffective style increase the burden or these have no effective roles in adjustment .
The burden is depending on caregivers’ coping strategies . In Iran, family plays a pivotal role in caring of severe and chronic psychiatric patients. The research hypothesis is that there is an inverse correlation between problem-oriented coping strategy and psychological burden of caregivers of schizophrenia and bipolar patients. Another hypothesis is that there is a direct and significant correlation between emotion-oriented coping strategy and psychological burden of these two groups of patients. This study aimed to evaluate stressful factors in Iranian caregivers and their coping strategies use for this domain.