Background: Severe mental illnesses (SMI) cause significant impairment for those living with the illnesses and often rely on caregivers for the ongoing care. Available evidence suggests that individuals responsible for caregiving may get distressed due to the caregiving experience, a phenomenon researchers call caregiver burden. Following the shift to community-centered mental health services, several studies on caregiving burden have been conducted in high income countries (HIC). However, there remains scarcity of data on the subject in SubSaharan Africa including Malawi. Therefore, the present study investigated the prevalence and associated factors of caregiving burden among caregivers of individuals with SMI at St John of God Hospitaller Services (SJOGHS) in Mzuzu-Malawi. Methods: The study adopted a hospital based cross sectional study. Recruitment took place at two outpatient departments of SJOGHS. Informal caregivers who were 18 years and above were asked to participate. The study recruited 139 caregivers and two research assistants approached participants at the waiting area. Caregivers who gave consent were asked questions about their caregiving activities using the Zarit Burden Interview (ZBI) (maximum score, 88). Data analysis was done using frequency distributions and descriptive statistics. The study used non-parametric tests such as a chi-square on all categorical measurements to test associations between variables and parametric tests such as t test on all continuous variables. The unadjusted and adjusted associations between socio-demographic factors and caregiving burden was conducted using logistic regression models. Results: On average, most caregivers experienced mild to moderate caregiving burden on the ZBI score (31.5 ± 16.7). In the adjusted model after controlling for caregivers’ gender, caregivers’ age, level of education, social support, care recipients’ age and care recipients’ gender, only caregivers’ age, social support and care recipients’ age remained significantly associated with caregiving burden. Older caregivers were more likely to experience caregiving burden than younger caregivers (OR=1.03, 95% CI 1.00-1.06), caregivers with social support were 71 % less likely to develop caregiving burden than those without social support (OR=0.29, 95% CI 0.14-0.62) and caregivers of older care recipients were less likely to experience caregiving burden than those of younger care recipients (OR=0.26, 95% CI 0.11-0.64). v Conclusion: Even though the caregiving burden found in this study was low compared to other previous studies in some arguably developed countries such as Iran and Turkey, it remains high in other developing countries such as Ghana and Nigeria. The low burden in this study, could be attributed to several factors and context in which the study was conducted. One such factor is the routine psychoeducation that the hospital often conducts for caregivers during the subsequent monthly reviews of their care recipients. An important follow up would be to investigate caregiving burden among caregivers who are unable to access the services at SJOGHS. The results of this study are important to guide policy in the formation of effective community programs that may assist mitigate the burden of informal caregivers. Finally, to understand the importance and implications of informal caregiving, further studies are needed in Malawi.

Thesis submitted in fulfilment for the requirements of Masters Degree in Psychology, University of Zululand, 2002 / The present investigation is a descriptive experimental study with two conditions (experimental and control conditions). The main aim was to develop, implement and evaluate a program directed at educating health professionals and families to accept and manage people presenting with mental health problems. The second aim was to teach mental health promotion strategies. To this end, a questionnaire was administered to a group of health professionals and relatives. Results suggest that the participants' training programme significantly improved attitudes and increased knowledge and understanding about mental illness.

The current study consisted of two experiments to examine the impact of home-based therapy on mental illness in multiproblem families. Review of the literature focused on the interplay between poverty and mental illness in defining multiproblem families and the utilization of home-based therapy with this population and others. Experiment 1 focused on delineating the type and severity of psychological distress in families characterized as multiproblem. Subjects were 58 participants in the Community-Family Partnership, a Comprehensive Child Development Program located at Utah State University in Logan, Utah. In this sample, serious psychological distress was evident with depression in both women and men as a primary symptom. Female participants in Experiment 1 showed psychological distress across more subscales and higher standardized mean difference effect sizes on the global subscales of the Symptom Checklist-90-Revised than male participants. Significant distress was also evident on the Somatization and Obsessive-Compulsive subscales for female participants and on the Hostility subscale for male participants. In a corollary to Experiment 1, participants in this study also fit the description of multiproblem based on their demographic characteristics. Experiment 2 implemented a home-based therapy program based on Sherman's Action Counseling model and evaluated its effectiveness in terms of reduction of psychological distress. Six individuals drawn from the Experiment 1 sample participated in Experiment 2. At pretest, they were not demographically different from the Experiment 1 sample, and they exhibited severe psychological symptoms such that their score profiles on the Symptom Checklist 90-Revised met both definitions of caseness for that instrument. These subjects participated in nine weekly sessions of home-based therapy based on the Action Counseling model. Therapy was very successful for one subject, moderately successful for four subjects, and not successful for one subject using reduction of psychological distress as the measure of effectiveness. Additionally, Experiment 2 examined elements of the therapy that contributed to effectiveness. Mastery of and implementation of the 10 Action Counseling steps appeared to contribute to therapy success. Limitations were discussed with respect to internal and external validity in the current study. Recommendations for future work were provided.

The essays featured in this collection highlight the gaps, as well as parallels, between mental illness and the human condition. In "Appearances," the narrator struggles with her own visual identity especially after reflecting on her Mom's own lengthy history with the mirror. In "Migrations," the lyrical voice of the narrator carries the reader through the typical day of a clinically depressed female character. Lastly, "Attempting the Fall," addresses the issues society has with mental illness by following the narrator from her suicide attempt to the mental ward.

Mental illness carries a pervasive stigma. Research uncovered several theories to explain stigma, including the Attribution Theory, the Biological Model, Belief in a Just World (BJW), and Social Dominance Orientation (SDO). Previous research identified a mediational pathway in which BJW influenced SDO, and where SDO predicted stigmatizing beliefs and intent to discriminate. There is a lack of research examining BJW and SDO from within the framework of mental illness controllability. This study attempted to fill in the gap within stigma literature by examining if perceived mental illness controllability influences the BJW-SDO- Stigma model. Analyses failed to replicate the previously found model. The replication failure could be due to using different measures for BJW and stigma, sample differences, possible inadequate power, and possible spurious original findings. Additionally, findings that a personal mental illness diagnosis and knowing someone with mental illness are associated with greater stigma could account for the replication failure. .

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Serious Mental Illness (SMI) is a severe and complex psychiatric condition with significant medical comorbidity. Although many patients with SMI utilize substantial healthcare resources, their healthcare outcomes are far worse than those of persons without SMI, often leading to early death. There are numerous barriers preventing these patients from obtaining optimal healthcare. The current study focused on available research emphasizing appropriate healthcare for persons with SMI who live in rural communities. The goals of the current study were to 1) to establish base rates of SMI presenting in rural primary care practices, 2) to identify and describe interventions to help individuals with SMI seek and adhere to appropriate treatment from their PCPs in rural areas, and 3) to investigate any existing interventions designed to educate or train primary care providers who serve patients with SMI, and to evaluate the effectiveness of such practices. This study involved a systematic review of the literature following the PRISMA guidelines. Results suggest that base rates of SMI in rural primary care settings have not been reported, and that there are few interventions available that are effective in increasing access to resources, adherence to treatment, and education for healthcare professionals working with patients with SMI. These findings have crucial implications for preventative healthcare screenings and medical and psychiatric interventions, yet more research is needed to determine whether these interventions could be feasible and successful for patients with SMI in rural community settings.

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