An Educational Intervention to Reduce the Burden on Family Caregivers of Patients with Schizophrenia

International Journal of Nursing and Health Science
© 2019 by SSRG - IJNHS Journal
Volume 5 Issue 1
Year of Publication : 2019
Authors : Hani Hamed Ali Desouki, Saida El-Sayed Hassan IbrahimEl-Azzab, and Entisar Mohammed Mahmoud Abu-Salem
How to Cite?

Hani Hamed Ali Desouki, Saida El-Sayed Hassan IbrahimEl-Azzab, and Entisar Mohammed Mahmoud Abu-Salem, "An Educational Intervention to Reduce the Burden on Family Caregivers of Patients with Schizophrenia," SSRG International Journal of Nursing and Health Science, vol. 5,  no. 1, pp. 17-25, 2019. Crossref,


A. Background: Schizophrenia is a chronic psychosis and experiences a high burden level of the family caregiver and consequent impairment in their health condition.

B. Aim: This study aimed to explore the effectiveness of an educational intervention program for decreasing the family caregivers’ burden of patients with schizophrenia.

C. The study design: A quasi-experimental design was employed. The study was applied at the Psychiatric Outpatients Unit in Beni-Suef University Hospital. Forty-four family caregivers participated, 22 allocated to the experimental group and 22 in the control group.

D. Tool of the study: Demographic data and the Zarit Caregiver Burden Scale. The program was conducted once a week for four months in the experimental group. Results: the burden level diminished significantly in an experimental group; the mean scores of caregiver burden reduced from 84.05 pre-program into 53.24 post-program (P< 0.001). However, the mean scores in the control group were slightly changed. The program was effective for family caregivers with low educational levels.

E. Conclusion: The majority of the studied family caregivers’ burden was reduced after implementation of an educational program, with a highly positive significant statistical difference between parents and family caregivers with lower educational levels between before and after educational sessions.

F. Recommendations: Apply the components of this program in future studies, which emphasize to decline of burden levels of family caregivers of patients with schizophrenia and the mentally ill.


Burden, Caregivers, Education, Family, Intervention, Schizophrenia.


[1] Argermeyer, M., and Matschinger, H., The Stereotype of schizophrenia and its impact on discrimination against people with schizophrenia: Results from a representative survey in Germany. Schizophrenia Bulletin, 30 (2017) 1049 - 1061.
[2] Adewuya, A., and Makanuola, R., Subjective quality of life of Nigerian schizophrenia patients: socio-demographic and clinical correlates. Acta Psychiatr Scand, 120 (2009) 160 - 164. Available from:
[3] El-Azzab, S., Abu-Salem, E., Effective strategies for nurses empowering the life quality and antipsychotic adherence of patients with schizophrenia. Journal of nursing education and Practice, Sciedu Press, 8(10) (2018) 1 - 9. Available from:
[4] Sharif, F., Shaygan, M., and Mani, A., Effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz, Iran. BMC Psychiatry, 12(48) (2012) 1-9. Available from:
[5] Schulz, R., and Paula, R., Sherwood: physical and mental health effects of family caregiving. Am J Nurs., 108(9) (2008) 23-27. Available from: http://ww.doi:10.1097/01.NAJ.0000336406.45248.4c.
[6] Singh, P., and Prajapati, A., Burden of schizophrenia on caregivers in Nepal. Nepal Med Coll J., 15 (2012) 140 - 143.
[7] Shamsaei, F., Khan, M., Kermanshahi, S., Vanaki, Z., Grosse, A., and Holtforth, M., Family caregiving in bipolar disorder: Experiences of stigma. Iranian J Psychiatry, 8 (2013) 188 - 194.
[8] Delgado, P., Overload of care, solidarity, and strategy of the experience of relatives of Psychosocial Care Centers. PhysisRevista de SaúdeColetiva, 24(4) (2014)1103 - 1126.
[9] Ran, M., Xiang, M., Chan, W., Leff, J., Simpson, P., Huang, M., Shan, Y., and Li, S., Effectiveness of psycho-educational intervention for rural Chinese families experiencing schizophrenia, A randomized controlled trial. Social Psychiatry and Psychiatry Epidemiology, 38 (2016) 69 - 75.
[10] Zegwaard, M., Aartsen, M., Grypdonck, M., and Cuijpers, P., Differences in impact of long term caregiving for mentally ill older adults on the daily life of informal caregivers: a qualitative study. BMC Psychiatry, 13 (2013) 103. Available from: http://ww.doi: 10.1186/1471-244X-13103.
[11] Wan, K., and Wong, M., Stress and burden faced by family caregivers of people with schizophrenia and early psychosis in Hong Kong. Internal Medicine Journal, 49 (2019) 9-15.
[12] Bayoumi, M., Lifestyle modification toward improving quality of life and effects on caregivers' burden: Development of new nursing theory. Ann Nurs Primary Care, 1(1) (2018) 1- 5.
[13] Chang, H.Y., Chiou, C.J., and Chen, N.S., Impact of mental health and caregiver burden on family caregivers’ physical health. Arch Gerontol Geriatr, 50(3) (2010) 267 - 271.
[14] Ampalam, P., Gunturu, S., and the Padma, V., A comparative study of caregiver burden in psychiatric illness and chronic medical illness. Indian J Psychiatry, 54(3) (2012) 239 - 243.
[15] Zarit, S., Reever, K., and Back-Peterson, J., Relatives of the impaired elderly: correlates of feelings of burden. TheGerontologist, 20 (1980) 649 - 655.
[16] Ribé, J., Salamero, M., Pérez-Testor, C., Mercadal, J., Aguilera, C., Cleris, M., Quality of life in family caregivers of schizophrenia patients in Spain: Caregiver characteristics, caregiving burden, family functioning, and social and professional support. International Journal of Psychiatry in Clinical Practice, 22 (2018) 25-33, Available from: http://ww.doi:10.1080/13651501.2017.1360500.
[17] Fallahi, K., Sheikhona, M., Rahgouy, A., Rahgozar, M., and Sodagari,F., The effects of group psycho-educational program on the family burden in caregivers of Iranian patients with schizophrenia. Journal Psychiatric Mental Health Nursing, 21 (2014) 438 - 446.
[18] Yazici, E., Karabulut, U., Yildiz, M., Baskant, T., Eda, N., Çakir, U., and Celaleddin, T., Burden on caregivers of patients with schizophrenia and related factors. Turkish Association of Neuropsychiatry, 53 (2016) 96 -101.
[19] Wong, D., Lam, A., and Chan, S., Quality of life of caregiverswith relatives suffering from mental illness in Hong Kong: Health and quality of life outcomes, 10(15) (2011) 2 - 9.
[20] George, S., and Sreekumaran, N., Effect of psycho-education on knowledge, attitude and burden among caregivers of persons with bipolar disorders: Randomized controlled trial. International Journal of Advanced Research, 3(7) (2015) 199 - 208.
[21] Goncalves, L., Costa, M., Martins, M., Nassar, S., and Zunino, R., The family dynamics of elder elderly in the context of Porto, Portugal, 19(3) (2011) 458 - 466.
[22] Ranjbar, F., Rahmani, F., Ebrahimi, H., Hosseinzadeh, M., The effects of group psycho-educational program on attitude toward mental illness in families of patients with schizophrenia. Journal of Caring Sciences, 4(3) (2015) 243 - 251.
[23] Griffiths, K., Crisp, D., Barney, L., and Reid, R., Seeking help for depression from family and friends: A qualitative analysis of perceived advantages and disadvantages. BMC Psychiatry, 11 (2011) 196. Available from:
[24] Akbari, M., Alavi, M., Irajpour, A., and Maghsoudi, J., Challenges of family caregivers of patients with mental disorders in Iran: A narrative review. Iranian J Nursing Midwifery Res, 23 (2018) 329 - 337.
[25] World Federation of Mental Health (WFMH)., Caring for the caregiver: Why your mental health matters when you are caring for others. Woodbridge VA: WFMH, (2010).
[26] Muralidharan, A., Lucksted, A., Medoff, D., Fang, L., and Dixon, L., Stigma: A Unique Source of Distress for Family Members of Individuals with Mental Illness. J Behav Health Serv Res, 43 (2016) 484‑493.
[27] Chine, W., Chan, S., and Morrissey, J., The perceived burden among Chinese family caregivers of people with schizophrenia. J Clin Nurs., 16 (2007)1151‑1161.
[28] Marimbe, B., Kajawu, L., Muchirahondo, F., Marimbe, B., Cowan, F., Lund, C., Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe: Original research. Africa J Disabil, 5 (2016) 1 - 9.
[29] Padierna, A., Martín, J., Aguirre, U., González, N., Muñoz, P., and Quintana, J., Burden of caregiving amongst family caregivers of patients with eating disorders. Soc Psychiatry Psychiatry Epidemiol, 48 (2013) 151 - 161.
[30] Alexander, G., Bebee, C., Chen, K., Vignes R., Dixon, B., and Escoffery, R., Burden of caregivers of adult patients with schizophrenia in a predominantly African ancestry population. Qual Life Res, 25 (2016) 393‑400.
[31] Boyer, L., Caqueo‑Urízar, A., Richieri, R., Lancon, C., Gutiérrez‑Maldonado, J., and Auquier, P., Quality of life among caregivers of patients with schizophrenia: A cross‑cultural comparison of Chilean and French families. BMC FamPract., 13(2012) 42‑ 50.
[32] Tanriverdi, D., Mandakini, M., The effect psycho-education intervention has on the caregiving burden of caregivers for schizophrenic patients in Turkey. International of Journal Nursing Practice, 18 (2012) 281-288.
[33] Huis, V., Verkaik, R., Mistiaen, P., Meijel, B., and Francke, A., The effectiveness of interventions in supporting self-management of informal caregivers of people with dementia; a systematic meta-review. Biomed Central Geriatric journal, 15(1) (2015) 147.
[34] Yildirim, A., Buzlu, S., Hacıhasanoğlu, R., Camcıoğlu, T., Erdiman, S., and Ekinci, M., The effect of family-to-family support programs provided for families of schizophrenic patients on information about illness, family burden and self-efficacy. Turkish Journal of Psychiatry, 25 (1) (2014) 31 - 37.
[35] Stam, H., and Cuijpers, P., Brief report: Effects of family interventions on burden of relatives of psychiatric patients in the Netherland: A pilot study. Community Mental Health Journal, 37(2) (2001) 179 - 187.
[36] Hsiao, C.Y., and Tsai, Y.F., Factors of caregiver burden and family functioning among Taiwanese family caregivers living with schizophrenia. J Clin Nurs, 24(11–12) (2015) 1546 - 1556.
[37] Chen, L., Zhao, Y., Tang, J., Jin, G., Liu, Y., Zhao, X., Chen, C., and Lu, X., The burden, support, and needs of primary family caregivers of people experiencing schizophrenia in Beijing communities: a qualitative study. BMC Psychiatry, 19(75) (2019) 1 - 10. Available from: http://www.doi: 10.1186/s12888-019-2052-4.
[38] Martín, J., Padierna, A., Aguirre, U., González, N., Muñoz, P., Wijngaarden, B., Anton, A., Quintana, J., Caregivers’ consequences of care among patients with eating disorders, depression or schizophrenia. BMC Psychiatry, 15(124) (2015) 1-10. Available from: http://ww.doi:10.1186/s12888-015-0507-9.
[39] El-Mahdi, M., Kamel, F., Esmael, A., Lotfi, M., Kamel, A., and Elhosini, A., Burden of care on female caregivers and its relation to psychiatric morbidity, Department of Psychiatry, Faculty of Medicine, Al Azhar University, Cairo, Egypt, Middle East, (2010).
[40] Abdel-kader, N., Shaheen, M., and Abdel-Aziz, E., Impact of the psychoeducational program on burdens among family caregivers of schizophrenic patients. Mental Health Nursing, Faculty of Nursing, Cairo University, Cairo, Egypt, 7(12) (2011) 822 - 830. (ISSN: 1545 - 1003). Available from:
[41] Souza, S., Ricardo, S., Mariane, A., and Jansen, K., Six-session caregiver psycho-education on bipolar disorder: Does it bring benefits to caregivers?.International Journal of Social Psychiatry, 62(4) (2016) 377 - 385.
[42] Gutierrez-Maldonado, J., Caqueo-Urı ́za, A., Effectiveness of a psycho-educational intervention for reducing burden in Latin American families of patients with schizophrenia, 6 (2007) 739-747. Available from: http://ww.doi.10.1007/s11136-007-9173-9.
[43] Bandeira, M., Family burden interview scale for relatives of psychiatric patients: Reliability study of the Brazilian version. Rev Bras Psiquiat 29(1) (2007) 47 - 50.
[44] Chang, K., Huang, X., Cheng, J., and Chien, C., The chronic sorrow experiences of caregivers of the client with schizophrenia in Taiwan: a phenomenological study. Perspect Psychiatr Care, 54(2) (2018) 281 - 286.
[45] El-Azzab, S., The program for coping methods to improve auditory hallucinations among patients with psychiatric disorders: A randomized controlled trial, American Journal of Nursing Science, 7(6) (2018) 268 - 280. Available from: http://www.doi: 10.11648/j.ajns.20180706.20.
[46] Ramírez, A., Palacio, J., Vargas, C., Díaz-Zuluaga, A., Duca, K., andBerruecos, Y., Expressed emotions, burden and family functioning of patients with schizophrenia and bipolar affective disorder type I of a multimodal intervention program: PRISMA, Rev ColombPsiquiat, 46 (2017) 2 - 11.