To the Editor: In a study reported in the August 2006 issue, Perlick and her colleagues (1) examined baseline data from the CATIE study (Clinical Antipsychotic Trials of Intervention Effectiveness) to determine the correlates of family burden in schizophrenia. The researchers are to be commended for their four-factor solution of more than 40 variables related to family burden and their innovative examination of how the quality of life of adults with schizophrenia and their use of services are related to the burdens experienced by their family. I offer a few comments about the theory and methodological approach.
The seminal literature on family caregiving in schizophrenia has shown that burden consists of both objective and subjective domains (2), which have been empirically validated as consisting of distinct sets of correlates (3). It seems that the authors' report on the components and correlates of family burden could have been strengthened had they recognized this line of research and the types of burden that exist.
Caregivers were defined as family members or friends who were identified by the adult with schizophrenia as being most directly involved with his or her care. Although demographic characteristics of the caregivers were analyzed as covariates, the authors did not present descriptive data on caregivers' age, gender, race, socioeconomic status, or their relationship to the adult with schizophrenia. This information is important, because the experiences and relationships between adults with severe mental illness and their parents, siblings, other relatives, and friends are unique (4), and the components and correlates of burden examined in this report could be distinctly related to the type of kin relationship. For example, research has found that the burdens experienced by parents and siblings who faced similar types of maladaptive behaviors depended on the amount of instrumental support they provided to their relatives with severe mental illness (5). Thus findings from the study by Perlick and colleagues would have been strengthened if data were analyzed across different types of family caregivers to determine whether certain burdens varied because of the kinship status of the caregivers.
Dr. Smith is a postdoctoral scholar in the Department of Psychiatry, Washington University School of Medicine, St. Louis.
Perlick DA, Rosenheck RA, Kaczynski R, et al: Components and correlates of family burden in schizophrenia. Psychiatric Services 57:1117-1125, 2006
Hoenig J, Hamilton M: The schizophrenic patient in the community and his effect on the household. International Journal of Social Psychiatry 12:165-176, 1966
Montgomery RJV, Gonyea JG, Hooyman NR: Caregiving and the experience of subjective and objective burden. Family Relations 34:19-26, 1985
Jones SL: Caregiver burden: the experience of parents, children, siblings, and spouses of people with mental illness. Psychiatric Rehabilitation Journal 20:84-87, 1997
Reinhard SC, Horwitz AV: Caregiver burden: differentiating the content and consequences of family caregiving. Journal of Marriage and the Family 57:741-750, 1995