Relationship of caregiver burden with coping strategies, social support, psychological morbidity, and quality of life in the caregivers of schizophrenia Natasha Kate, Sandeep Grover *, Parmanand Kulhara, Ritu Nehra Post Graduate Institute of Medical Education and Research, Chandigarh, India 1. Introduction Schizophrenia is a severe mental disorder, which places a considerable burden on the caregivers. Families experience a lot of physical, emotional and financial distress due to a patient’s abnormal behavior, and social and occupational dysfunction. In countries like India, where rehabilitation services are almost non- existent and there is no social security system, the role of the family becomes more important. Many studies from India have evaluated burden perceived by the caregivers of schizophrenia and these show that schizophrenia is a burdensome illness. Studies which have compared the burden of caregiving of schizophrenia with other psychiatric disorders, suggest that schizophrenia is more burdensome than recurrent depressive disorder (Chakrabarti et al., 1995), bipolar disorder (Chakrabarti et al., 1995; Chakrabarti and Gill, 2002), obsessive compulsive disorder (Thomas et al., 2004) and other neurotic disorders (Chakrabarti and Kulhara, 1999). However, previous studies from India have mostly used the Family Burden Interview (FBI) (Pai and Kapur, 1981) or Burden Assessment Schedule (BAS) (Thara et al., 1998), which are interviewer based instruments for assessment of burden in caregivers. The primary focus of the FBI is on objective burden, and it is relatively inadequate with regards to assessment of the subjective consequences of caregiving, which is assessed by only one item of the instrument. On the other hand, BAS assesses both objective and subjective burden, but still the major emphasis is on the objective burden. Over the years, several new burden-assessment instruments have been developed. One such instrument, the Involvement Asian Journal of Psychiatry 6 (2013) 380–388 A R T I C L E I N F O Article history: Received 23 December 2012 Received in revised form 9 March 2013 Accepted 30 March 2013 Keywords: Caregiver Burden Coping Quality of life A B S T R A C T Aim: To evaluate the relationship of caregiver burden as assessed by using Hindi Involvement Evaluation Questionnaire (IEQ) with coping strategies, social support, psychological morbidity, and quality of life of caregivers of patients with schizophrenia. Additionally, the relationship of caregiver-burden with sociodemographic variables, and clinical variables, including severity of psychopathology and level of functioning of patients, was studied. Methodology: The study included 100 patients with schizophrenia and their caregivers recruited by purposive random sampling. Results: Among the four domains of IEQ, highest number of correlations emerged with tension domain. Tension domain had positive correlation with the caregiver being single, time spent in caregiving per day, and use of avoidance, collusion, and coercion as coping strategies. Additionally, tension domain was associated with poor quality of life in all the domains of WHO-QOL Bref and was associated with higher psychological morbidity. Worrying urging-I domain of IEQ correlated with frequency of visits, higher use of problem focused coping and poor physical health as per the WHO-QOL Bref. Worrying urging-II domain of IEQ had positive correlation with higher level of positive symptoms, lower level of functioning of the patient, younger age of caregiver, caregiver being unmarried, and higher use problem focused and seeking social support as coping strategies. Supervision domain of IEQ correlated positively with lower income, being an unmarried caregiver, from an urban locality and non-nuclear family. Supervision domain was associated with poor physical health as assessed by WHO-QOL Bref. Conclusion: Caregiving burden, especially tension is associated with use of maladaptive coping strategies, poor quality of life and higher level of psychological morbidity in caregivers. ß 2013 Elsevier B.V. All rights reserved. * Corresponding author at: Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India. Tel.: +91 172 2756807; fax: +91 172 2744401/2745078. E-mail address: drsandeepg2002@yahoo.com (S. Grover). Contents lists available at SciVerse ScienceDirect Asian Journal of Psychiatry jo u rn al h om epag e: ww w.els evier.c o m/lo cat e/ajp 1876-2018/$ – see front matter ß 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajp.2013.03.014