Caregiver Burden, Coping and Social Support among Family Caregivers of Persons with Schizophrenia (SPSS)

Caregiver Burden, Coping and Social Support among Family Caregivers of Persons with Schizophrenia is an MSW Semester 4 dissertation for the Medical and Psychiatric Social Work specialisation. It studies the people who carry most of India's mental-health care load: family members — usually parents, spouses or siblings — who live with and look after a person with schizophrenia.

The study is set in the outpatient department of a (fictional) Bengaluru psychiatric hospital, Sahana Institute of Mental Health, and surveys 150 primary caregivers. It measures caregiver burden with the Indian-developed Burden Assessment Schedule (BAS) from SCARF, Chennai; coping strategies with the Brief COPE; perceived social support with the MSPSS; and psychological distress with the DASS-21. A socio-demographic and clinical data sheet records relationship to patient, duration of illness, number of hospitalisations and treatment adherence.

Analysis is done in SPSS: descriptive statistics, reliability, Pearson correlations, t-tests and ANOVA across caregiver groups, and a hierarchical regression predicting burden from illness characteristics, coping styles and social support. Two short case studies of caregivers with high burden illustrate the numbers and connect them to social work intervention.

The bundle covers the synopsis, instruments with citations, sampling and ethics (IEC approval, consent, the Mental Healthcare Act, 2017), the BCU CPD-4.5 dissertation format (70 report + 30 viva), a 12-slide presentation and a viva bank.

Abstract

In India, most persons with schizophrenia live with their families, who provide daily care, supervise medication, manage crises and absorb financial loss. This burden is linked to caregiver distress and, in turn, to relapse in the patient. This dissertation examines the level of burden among 150 family caregivers attending a psychiatric OPD in Bengaluru and its relationship with coping strategies, perceived social support and psychological distress. The Burden Assessment Schedule, Brief COPE, MSPSS and DASS-21 are used, and data are analysed in SPSS with correlation, group comparison and hierarchical regression. Two case studies illustrate the findings. Implications for psychiatric social work practice — psychoeducation, family support groups and linkage to disability benefits — are discussed.

Introduction

Schizophrenia is a chronic psychotic disorder affecting thinking, perception and social functioning. In the Indian context, strong family involvement is often considered protective, but it also means that families bear the cost of care with limited formal support. Burden has an objective side (time, money, disruption of routine) and a subjective side (worry, stigma, grief). How caregivers cope — by problem-solving, seeking support, turning to religion, or through denial and self-blame — and how much support they perceive from family, friends and significant others may shape how heavy that burden feels.

Review gap

Indian studies from NIMHANS, SCARF and other centres have documented high caregiver burden, and several have examined coping. Fewer studies combine burden, coping, perceived social support and distress in a single model in a Bengaluru OPD sample, and fewer still translate the findings into specific psychiatric social work interventions using case illustrations.

Hypotheses

• H1: Burden will correlate positively with caregiver distress (DASS-21).
• H2: Perceived social support will correlate negatively with burden.
• H3: Avoidant coping will correlate positively, and problem-focused coping negatively, with burden.
• H4: Burden will differ by relationship to patient and duration of illness.
• H5: Coping and social support will predict burden over and above illness characteristics.

Feasibility

The hospital's psychiatric social work department provides access through the block placement. Instruments are available in English and Kannada or can be administered as an interview. Data collection of 150 caregivers is achievable over eight weeks of OPD days. SPSS is taught in the research course.

Family caregivers of persons with schizophrenia in India provide long-term, unpaid care with little formal support. Psychiatric social workers at outpatient departments see caregivers who are exhausted, anxious, financially strained and isolated, yet OPD services focus mainly on the patient's medication and symptoms. Without evidence on how heavy caregiver burden is, and which factors make it lighter or heavier, family interventions tend to be generic and irregular.

It is not clear, in the Bengaluru OPD context, how burden relates to caregivers' coping strategies, their perceived social support and their own psychological distress, or which caregiver groups — parents, spouses, older caregivers, those caring for longer — are most at risk. This dissertation assesses caregiver burden among family caregivers of persons with schizophrenia, examines its relationship with coping, social support and distress, and uses the findings to recommend targeted psychiatric social work interventions such as psychoeducation, coping-skills groups and linkage to entitlements.

In scope

• Primary family caregivers (18–65 years, living with the patient for at least one year) of outpatients diagnosed with schizophrenia by a psychiatrist (ICD-10/ICD-11) at one Bengaluru psychiatric OPD.
• Standardised measures of burden, coping, social support and distress, plus two illustrative case studies.
• Quantitative analysis in SPSS and practice recommendations.

Out of scope

• Diagnosis or assessment of the patient by the student; clinical data are taken from the case file with permission.
• Caregivers of inpatients or of patients with other disorders.
• Intervention delivery or evaluation.
• Any recording of Aadhaar, UDID or disability certificate numbers.

Research design

A cross-sectional descriptive-correlational design with an embedded case-study component (two cases).

Sample and sampling

• Universe: primary caregivers of outpatients with schizophrenia attending the OPD on follow-up days.
• Sample size: 150 caregivers — sufficient for a hierarchical regression with about ten predictors at the conventional 10–15 cases per predictor, and for detecting medium correlations with power above .90.
• Technique: consecutive sampling of eligible caregivers on OPD days until 150 is reached.
• Inclusion: primary caregiver (most involved in daily care), living with the patient ≥ 1 year, 18–65 years, consents. Exclusion: caregivers with a known psychiatric illness themselves, paid caregivers.

Instruments

Procedure

Synopsis approved by guide → Institutional Ethics Committee (IEC) approval of the hospital → permission from the head of the psychiatric social work department → pilot with 10 caregivers → consecutive recruitment on OPD days → interview-administered tools in a private room (40–45 minutes) → debrief and referral to the psychiatric social worker where distress is high.

Analysis (SPSS)

Descriptives and reliability; Pearson correlations (H1–H3); t-test and one-way ANOVA with post hoc tests (H4); hierarchical regression (H5) with Block 1 illness variables, Block 2 coping, Block 3 social support; assumptions checked (normality of residuals, VIF, Durbin–Watson).

Timeline (24 weeks)