Understanding posttraumatic stress symptoms in carers of people with psychosis : a cross-sectional study

• Main Author: Kingston, Cara
• Other Authors: Onwumere, Juliana ; Kuipers, Elizabeth Alice ; Keen, Nadine
• Published: King's College London (University of London) 2012
• Subjects: 616.89
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.628160

Background: Many service users with psychosis will live with and/or maintain regular contact with informal carers. Findings from a small number of studies suggest that a significant number of carers of people with psychosis experience posttraumatic stress symptoms (Barton & Jackson, 2008; Loughland et al. 2009; Boye & Malt, 2002). However, it is unclear how these symptoms relate to a broader range of carer characteristics. The application of a stress and coping framework, including components from the cognitive model of PTSD (Ehlers & Clark, 2000) may help us to understand the relationships between posttraumatic stress symptoms and well-being in carers, and in turn help to shape interventions for both carers and service users. Aims: In a sample of carers of people with psychosis the study aimed to explore posttraumatic stress symptoms, including intrusive imagery, and to examine the relationship between posttraumatic stress symptoms, well-being and caregiving experiences. Methods: Thirty-two carers of people with psychosis completed self-report questionnaires and short interviews assessing posttraumatic stress symptoms, negative caregiving appraisals, appraisals of trauma, avoidant coping style, social support, expressed emotion, physical health and sleep quality. Results: Almost half (n = 15; 44%) of the participants reported symptoms of posttraumatic stress. Posttraumatic stress symptoms were associated with negative appraisals of caregiving, negative appraisals of trauma, greater levels of avoidant coping, and lower reported physical health. Associations between posttraumatic stress symptoms and social support, expression emotion and sleep quality, were not found. Negative intrusive images were identified in 35% (n = 11) of carers. Images were appraised as vivid and moderately to extremely distressing; and elicited strongly held negative beliefs about the self, others or the world. Conclusions: This study supports existing research to suggest that carers of people with psychosis can experience posttraumatic stress symptoms related to their caring role. It also lends support for the application of a stress and coping framework to understand relationships between posttraumatic stress symptoms and carer characteristics. Conclusions are limited by a relatively small sample and cross-sectional design. Future research is needed to assess causal relationships and the role of other factors implicated within theoretical models of stress and coping. The findings indicate that posttraumatic stress symptoms should be considered when designing and implementing interventions to meet carer needs and improve outcomes for both carers and service users.