Schizophrenia caregivers take health hit.

Although people suffering from long-term, incapacitating psychiatric disorders were once consigned to mental institutions and hospital back wards, as many as 2 out of 3 now live with family members. People caring for a mentally ill relative not only face a draining and seemingly endless task but may in certain cases catch far more than their fair share of colds and other infectious illnesses, a new study suggests.

The frequent appearance of hallucinations, delusions, and other so-called positive symptoms in people diagnosed with schizophrenia accompanies high numbers of infectious ailments in their caregivers, asserts a team led by psychologist Dennis G. Dyck of Washington State University in Spokane.

Symptoms of schizophrenia that are classified as negative, such as persistent apathy and social withdrawal, exhibit no link to caregivers' infectious ills, the scientists report in the July/August PSYCHOSOMATIC MEDICINE.

These long-lasting, negative symptoms did, however, create a greater burden for caregivers than intermittent positive symptoms, the researchers contend. In the study, the team measured burden by evaluating care-related money woes, worry about one's afflicted relative, self-blame for the situation, and stigma attached to having a mentally ill family member.

The new evidence "contributes to a growing body of literature suggesting that ... caregiving may be not only burdensome but actually hazardous to the caregiver's health," comments psychiatrist Igor Grant of the University of California, San Diego in the same journal issue.

Other researchers have found that people who care for spouses with Alzheimer's disease report high levels of burden and depression and also exhibit signs of weakened immune function (SN: 4/6/91, p. 217). Unlike Alzheimer's disease, however, schizophrenia typically strikes young adults who then require decades of care from relatively young parents or siblings.

The mental and physiological consequences of this type of "very-long-term stress" for caregivers have attracted little scientific attention, Grant says.

In the new work, a nurse interviewed 70 people who cared for relatives with schizophrenia--mainly mothers tending adult children--about their own physical symptoms and physician visits in the past 6 months. Caregivers averaged 52 years old, and their charges, 33 years.

A second interviewer then assessed each caregiver's perceived burden, depression, anger, support from friends and family, and style of coping with stress. Coping styles included wishful thinking (such as hoping for a miracle), focusing on problems (making and following a plan of action), avoidance (trying to forget about the problem), relying on religious faith (such as frequent prayer), and self-blame for the relative's illness.

Several independent raters also estimated the extent of the burden that each patient placed on his or her caregiver.

Caregivers who engaged in wishful thinking, avoidance, and self-blame tended to find their situations extremely burdensome. Surprisingly, caregivers who formulated specific plans also reported a comparably high level of burden.

Although not citing especially high or low burden, those who relied on religious faith or were satisfied with the support received from friends and family cited the lowest rates of infectious illness, the researchers hold.

Caregivers with excessive burdens didn't necessarily report an elevated rate of illness. Burdens imposed on caregivers apparently do not lay the groundwork for infectious illness, Dyck's group theorizes. Instead, specific aspects of the condition under care--such as positive symptoms in schizophrenia--and a caregiver's coping style influence the immune system's ability to fend off infections, in their view.

This health-undermining process may hinge on caregivers' behavioral responses, such as eating poorly and exercising little, or on emotional distress that sparks a cascade of hormonal and immune changes, Grant says.