American Journal of Psychiatric Rehabilitation, 13: 126142, 2010

Copyright # Taylor & Francis Group, LLC

ISSN: 1548-7768 print=1548-7776 online
DOI: 10.1080/15487761003757009

Caregiver Burden and Coping in

Schizophrenia and Bipolar Disorder:
A Qualitative Study
K. K. Ganguly
Deputy Director General, Indian Council of Medical
Research, Ansari Nagar, New Delhi, India; Former
Assistant Professor of Medical Anthropology, Institute of
Human Behaviour & Allied Sciences, Delhi, India
R. K. Chadda
Professor of Psychiatry, All India Institute of Medical
Sciences, New Delhi, India; Former Professor of
Psychiatry, Institute of Human Behaviour & Allied
Sciences, Delhi, India
T. B. Singh
Professor and Head, Department of Clinical Psychology,
Institute of Human Behaviour & Allied Sciences, Delhi,
India
Caregivers of people with severe mental disorders suffer from having a considerable burden as a result of their caregiving role. They develop different
kinds of coping strategies to deal with this burden. There has been a lack of
qualitative studies on caregiver burden and coping, especially from nonWestern populations. The present paper reports findings of a longitudinal

The authors are grateful to the Indian Council of Medical Research for supporting
the study and to Prof. J. S. Bapna, Prof. N. G. Desai, Dr. D. K. Gupta, Dr. H. L. Joshi,
Ms. Ashima Srivastava, and Ms. Himali Bangia for their contributions at different
stages of the study.
Address correspondence to Dr. K. K. Ganguly, ICMR Ansari Nagar, New Delhi, India
110029. E-mail: kalyanganguly@hotmail.com

126

Caregiver Burden and Coping in Schizophrenia 127

study of burden and coping in a group of caregivers of people suffering from
schizophrenia and bipolar affective disorder (BAD). Qualitative assessments
were done by focus group discussions (FGDs) with the caregivers over a period of about a year. Caregivers reported burden in different areas including
effects on family functioning, social isolation, financial problems, and health.
They used multiple coping strategies including developing compassion in
caregiving, hoping for a better future, developing faith in God, participating
in religious practices, and helping others with a similar problem.
Keywords: Bipolar disorder; Burden; Caregiving; Coping; Schizophrenia

Mental disorders are a leading source of disease-related burden

to society (Murray & Lopez, 1996). Severe mental illnesses such as
schizophrenia and bipolar affective disorder impose a great burden
on caregivers and families, as well as on the patients themselves
(Pai & Kapur, 1983; Fadden, Bebbington, & Kuipers, 1987; Schene,
Van Wijugaarden, & Koeter, 1998; Chakrabarti & Gill, 2002; Nehra,
Chakrabarti, Kulhara, & Sharma, 2005; Magliano et al., 1998).
Burden, a common English word, has become popular in the field
of psychiatry following deinstitutionalization. There are some
minor differences in the way the term has been defined by different
investigators. According to Platt (1985), burden refers to the presence of problems, difficulties, or adverse events that affect the lives
of psychiatric patients. Other authors have distinguished between
objective and subjective burden (Grad & Sainsbury, 1963;
Hoenig & Hamilton, 1966). Objective burden refers to the physical
burden of care as a consequence to behavioral changes in people
with mental illness and their social effects on the caregivers daily
life and to disruptions to the family or household because of the
patients illness that are potentially verifiable and observable (Platt,
1985). Subjective burden has generally been conceived in two ways.
In the first, it is tied to the previously assessed objective burden,
with each difficult behavior or disruption being assessed for its perceived burdensomeness. In the second approach, general ratings
are made of how distressed by the patients illness the caregiver
feels, including emotional reactions, perceptions of strain, reduced
morale, anxiety, and depression (Rabins, Mace, & Lucas, 1982).
Chronic illness of a family member is an objective stressor that
results in strain for the caregiver or relative because of the difficult tasks of caring for that person (Schene, 1990), and is likely
to affect both the physical and mental health of the caregiver

128 K. K. Ganguly et al.

(Brown & Biirstwistle, 1998). In India, as in many developing
countries, most people with mental illness are cared for by family
members (Chadda et al., 2000). In the past, the traditional joint
family system in India acted as a buffer against various kinds of
stress (Sethi & Manchanda, 1978). However, owing to rapid urbanization and industrialization, the joint family is breaking down.
Nuclear families are more vulnerable to stress and are less
equipped to handle relatives with mental illness (Kapoor, 1992).
A number of studies have shown that caregivers of people with
schizophrenia and bipolar affective disorder (BAD) experience
considerable burden while caring for their loved one (Chadda et al.,
2007; Fadden et al., 1987; Magliano et al., 1998; Perlick et al., 2004).
Burden has been found to be dependent on the characteristics of
people with mental illness and their caregivers, the relationship
between them, and their environment (Fadden et al., 1987; Nehra
et al., 2005; Hou et al., 2007; Magana et al., 2007; Schene et al., 1998;
Winefield & Harvey, 1993). Hyperactivity, irritability, sadness, and
withdrawal in people with mental illness have been reported to be
perceived as the most distressing behaviors by the caregivers, affecting their emotional health and life in general (Reinares et al., 2006).
Thus, it is important to assess various characteristics of caregiver
burden and its adverse effects on caregiving, so that appropriate
actions can be taken to mange the problem.
It also is important to understand caregivers coping mechanisms
for tackling burden, because it affects not only caregivers day-to-day
functioning and is a constant source of stress, but how this stress is
managed also has bearing on the course of the persons illness and
prospects for improvement (Scazufca & Kuipers, 1996, 1999; Nehra
et al., 2005). If maladaptive coping styles are identified, caregivers
can be helped to adopt healthier coping styles, so as to continue in
a healthy caregiving role. Coping strategies include problem solving,
support seeking, and avoidance (Scazufca & Kuipers, 1996, 1999;
Nehra, Chakrabarti, Kulhara, & Sharma, 2005). A positive correlation
has been observed between caregiver burden and use of avoidance
as a coping strategy (Chadda, Singh, & Ganguly, 2007; Perlick et al.,
2008). A higher perception of burden has been reported to be associated with poor outcome in persons with BAD, the relationship
probably being mediated through families affective response and
patients medication adherence (Perlick et al., 2004, 2007).
Coping and other elements of the caregiving experience in BAD
and schizophrenia have been found to be broadly similar (Nehra

Caregiver Burden and Coping in Schizophrenia 129

et al., 2005; Chadda et al., 2007). Coping efficacy is affected by many
variables in addition to severity of symptoms and caregiver burden,
and it has been shown to have a negative relation to caregiver
psychological distress and a positive relation to caregivers expressions of praise, approval, or affection toward their ill relatives
(Ramrez Garca, Hernandez, & Dorian, 2009).
The relationship between caregiver burden, coping, and its
determinants is complex. Though a large amount of literature is
available on caregiver burden and coping and a number of reliable
instruments are available for their assessment, measuring both
caregiver burden and coping involves many intricacies and complexities, as there are many individual variations. This necessitates
the need for qualitative assessment (Jungbauer, Wittmund, &
Dietrich, 2003). Most studies on burden and caregiving in mental
disorders have assessed burden and caregiving using only quantitative instruments.
The intricacies and complexities involved at the interface of
severe mental illness and burden of caregiving prompted the
authors to acquire a thorough understanding of the phenomena
through assessing burden and coping strategies and their correlates
in a group of caregivers of persons with schizophrenia and BAD in
a prospective design, using both qualitative and quantitative
methods. The findings of the quantitative component of the study
have been discussed in another paper (Chadda et al., 2007).
The study was conducted by a team of psychiatrists, a clinical
psychologist, and a social and behavioral scientist to look into
various qualitative dimensions of the quality of life of caregivers
and their ways of dealing with their ill relatives. In the present
communication, qualitative dimensions of the relationship between
caregivers and persons with mental illness, caregiver burden and
coping, and their effects on the care of persons with illness have
been dealt with at length.
METHODS

Sample Selection
The study was conducted from November 2001 to October 2003 in an
outpatient setting at the Institute of Human Behavior and Allied
Sciences in Delhi, India. Most of the persons attending the service
were suffering from severe psychotic illnesses such as schizophrenia,

130 K. K. Ganguly et al.

BAD, and severe depression. They were mostly accompanied by their
family members, who were also the caregivers.
Persons diagnosed as having schizophrenia and BAD and their
caregivers were screened for the study. Inclusion criteria for
persons with illness included age (1550 years), diagnosis of schizophrenia or BAD per the International Classification of Diseases,
Diagnostic Criteria of Research (ICD DCR) (World Health Organization, 1993), and availability of family members or caregivers for
assessment. A minimum duration of illness of 1 year was required
to be included in the study, and the person should have been clinically stable for a minimum of 3 months before the study. Persons
with any associated chronic physical illness, comorbid substance
use disorder, or having any living family member in the same
household suffering from psychiatric illness staying were excluded,
since this could be a confounding variable while making assessment of burden and coping in the caregivers. To be included in
the study, the caregivers needed to be consenting adults with no
history of mental illness, who had been caring for the person with
illness for at least 1 year. Written informed consent was provided
by the caregivers and the persons with illness, as appropriate.
The study was approved by the institutes ethics committee.
About 1,000 persons attending the service were screened over a
period of 1 year for the study, out of which 305 (150 with schizophrenia and 150 with BAD) met the study criteria. All persons with
illness and caregivers consented for the study. Participants
attended outpatient services regularly during the period of study.
Since we had planned to have 200 completed cases, follow-up
assessments were stopped once the target was achieved.

Assessments
A focus group discussion (FGD) is a qualitative method. Its purpose
is to obtain in-depth information on concepts, perceptions, and
ideas of a group. An FGD aims to be more than a question-andanswer interaction. The idea is that group members discuss the
topic among themselves, with guidance from the facilitator (Greenbaum, 1993). The FGDs were used for qualitative assessment. Ten
sessions of FGDs were conducted with the caregivers under the
supervision of a medical anthropologist. Each session included a
group of 10 persons, caring for both schizophrenia and BAD, and
each session lasted about an hour. Audio recording was done and

Caregiver Burden and Coping in Schizophrenia 131

notes were also taken for the sessions. Caregivers were considered a
homogeneous group as far as caregiving was concerned,
considering that they were caring for persons with severe and
chronic mental illnesses from similar socio-demographic backgrounds. The institute where the work was carried out is a publicly
funded hospital, and it caters mainly to patients from the lower and
lower-middle socioeconomic strata of the population.
As the FGD opened, the facilitator introduced himself and explained the purpose of organizing the session. Initiating the discussions, the moderator emphasized that psychiatric illness may have
different symptoms but the problems it creates are more or less the
same, although different in intensity. The sessions aimed at getting
details about the various domains of caregiving, to understand the
characteristics of burden the caregivers face, and their ways of coping.
The FGDs explored caregivers critical perceptions and values and
the collective consciousness of the caregivers about the skillful handling of ill relatives. To overcome hesitation of the passive members,
every group member was encouraged to participate in discussion.
The members discussed problems faced in caregiving and how they
were resolved. We had initially planned to cover all the study participants in the FGDs, but only half the caregivers could attend the sessions owing to such logistics as travel distance and timing of sessions.
The FGDs were analyzed by the teams medical anthropologist,
using the technique of narrative analysis, which involves consideration of a chronologically told story, focusing on how elements
are sequenced, why some elements are evaluated differently
from others, how the past shapes perceptions of the present, how
the present shapes perceptions of the past, and how both shape
perceptions of the future. The metaphors and the narrations were
key for analysis of the data. As the study was not aimed to prove
or disprove a hypothesis, it was appropriate to use narrative
analysis for interpretation of FGD data.
RESULTS

Sample Characteristics
The initial intake consisted of 305 persons with illness and their
caregivers (150 of schizophrenia and 155 of BAD), out of which
100 patients and 100 caregivers, each having relatives with schizophrenia and BAD, completed the 6-month follow-up. Focus groups

132 K. K. Ganguly et al.

were carried out with the 100 patients selected for the study.
On statistical analysis, no significant differences were seen in
socio-demographic and clinical characteristics between the cases
and the dropouts.
Thirty-six percent of persons with schizophrenia were in the age
group 1530, compared with 44% of the BAD group. About 20% of
patients in both groups were over 40. Seventy-five percent of
persons with schizophrenia and 65% of those with BAD were males
and 65% in both the groups were married. Nearly one third had
received up to 5 years of formal education, about half had
completed their schooling, and 16% had graduated. About half
the patients lived in joint families. Despite their illness, over 80%
in both groups were working. Common occupations included
agriculture, clerical work, small-scale business, and homemaking.
More than 85% of patients belonged to the low socio-economic
group, with a monthly income of less than 2,000 Indian rupees.
The two groups were comparable on most of the variables, except
that 40% of the BAD subjects came from a rural background,
compared with just 13% of the schizophrenia group (p < .001).
The two caregiver groups were comparable across various
socio-demographic variables. About one fourth of the caregivers
in both groups were younger than 25 or older than 50. Fifty-eight
percent in the BAD group and 49% in the schizophrenia group were
males. About half had received less than 5 years of formal
education. Parents and spouses formed three fourths of the
caregivers. More than 90% of the caregivers were living in the same
household as their relatives and were having daily contact with
them. Most of the caregivers had been living with their ill relatives
for more than 10 years.
FINDINGS OF THE FGDs
FGD findings are presented in the form of various themes about the
caregiver burden and coping methods, which emerged during the
sessions. Some of the themes overlap.

Caregiver Burden
Nonacceptancedownright avoidanceby society of a person
with mental illness, prejudice, stigma, impact on family functioning, and financial problems were some of the aspects of burden that

Caregiver Burden and Coping in Schizophrenia 133

came out during the FGD sessions with relatives. These are
discussed in the following paragraphs.

Nonacceptance by Society and Social Isolation

Many caregivers expressed a sense of isolation from the rest of the
society. The father of a young man said, People stop coming to the
house. Even close relatives are reluctant to come. The father of a
young unmarried woman with schizophrenia said, The family
has to hide the disease because she is unmarried. If we tell anyone,
we will face difficulty in finding a suitable match for her . . . .
Sometimes I am not able to share my feelings and tension with
anybody because of her illness.

Prejudice and Stigma

One caregiver commented: Esteem and social status of the family
has been reduced to the ground, because people dont want to talk
to us. They avoid us. Other statements were: The person with
mental illness is generally avoided and even scolded. The people
with mental illness are looked upon as inferior and people treat
them as different. Many people try to avoid them and feel
inferior while talking to them.
Social stigma and prejudice, which people with mental illness
and their families face in society, is obvious from the above statements, and they add to caregiver burden. The caregivers generally
felt that society does not sympathize with people with mental
illness, and it lacks understanding of their limitations and problems. A person with mental illness often remains unappreciated,
is frequently blamed for his or her problems, and is misunderstood
by the general public.

Effects on Family Functioning

The wife of a person with BAD said that their children were unable
to concentrate on studies because of the problems their father
created. Another caregiver expressed that they would curtail
spending on all their necessities and luxuries, as expenses on
medicines were increasing day by day. The wife of another person
with BAD said, with a heavy heart, Once he ran away with all the
jewelry, and after that our financial position got worse.
When asked whether the illness affects the health and day-to-day
activities of caregivers, most replied positively. One caregiver
said, More or less the life of every family member gets affected.

134 K. K. Ganguly et al.

The mother of a young male with schizophrenia said, We have to
leave one person at home for him when we are away. We all keep
on worrying about him for the whole day. All caregivers were
concerned; they unequivocally said that there had to be someone
at home in their absence. The wife of a man with schizophrenia
said, He is unable to do anything of his own. Everything has to
be told clearly to him, and one person always has to remain at home
engaged in his care only. Another caregiver revealed: The time is
the hardest and affects the daily routine of all the family members
for at least 3 months, whenever he has a relapse.
Thus, day-to-day activities of all the family members are
affected, including childrens studies, adults daily chores, social
activities, and even day-to-day functioning of the family.

Caregivers Vocation
One of the caregivers said, If I have to go for some important
work, I am always worrying about him, and remain tense till I come
back home. A businessman who was married to a woman with
schizophrenia commented, It affects my work efficiency to a great
extent, especially when she is more disturbed. The caregiving
appeared to be associated with adverse effects on the caregivers
occupation.

Treatment Burden
Noncompliance with treatment was also a major concern. Because
of the need for long-term treatment, persons with mental illness
many times stopped treatment out of frustration. This would
increase behavioral disturbances and increase the risk of exacerbation of the symptoms, hence pose stress on the caregiver.
Representative statements from the caregivers were: Whenever
she stops treatment, she looses temper and does whatever she
wants to do. But still they bear it because they know it is not in
her hands. We have to curtail necessities, luxuries, as expenses
on medicines are increasing day by day.

Financial Burden
Most of the caregivers spoke about the financial strains associated
with caring for the relative with mental illness. For example, the
wife of a man with BAD stated, I cant control how he spends
his money. All I can do is to make as much as I can. An aged caregiver said, It takes time to treat this problem. People who do not

Caregiver Burden and Coping in Schizophrenia 135

have good source of income face financial problems. The wife
of another person with schizophrenia, who was the only
wage-earning member of the family, said, There is a major
financial problem whenever he is not earning regularly due to the
illness. As noted above, the wife of a person with BAD had said,
Once he ran away with all the jewelry. Thereafter our financial
position got further worse. Finally, the financial situation of the
caregivers was further aggravated, as they were not able to devote
their time to their job, affecting their earnings.

Caregivers Physical and Mental Health

According to one caregiver, It affects physical health to a large
extent and sometimes I suspect whether I will also become a
patient. Another caregiver said, All of us have developed one
or other kind of physical problems. The wife of a young person
with schizophrenia stated, When we are anxious, we are not able
to do the work. Only half of the work gets completed. The father of
a young woman with schizophrenia, whose marriage had broken
up owing to her illness, said, All responsibilities have to be met
by me. Nobody is helping me financially, so tension increases.
The brother of a person suffering from BAD said, I become so
frustrated sometimes that I think of either killing him or myself.
Some of the caregivers had developed secondary depression, and
were seeking treatment for themselves.

Concerns for the Future

There were genuine concerns among caregivers for the future,
especially in those caregivers who were in the older age groups,
concerning who would take care of the person in the caregivers
absence, especially if no other family members were available.
Unfortunately, India does not have any long-stay, aftercare homes
for persons with mental illness. An aged caregiver with tears in
his eyes said, I take care of him all the time, but after me, who?
Now the situation is changing drastically. I am not able to do the
work because of age.

Coping Methods
Focus group sessions also provided evidence of various coping
methods used by the caregivers to deal with their burden. They

136 K. K. Ganguly et al.

reported a wide range of emotions like fear, concern, confusion,
frustration, hope, caring, compassion, sympathy, love, sadness,
grief, anger, resentment, and guilt at one point or another while
caring for their relatives. Thus, both positive as well as negative
emotions were reflected at different times. Some important themes
that were discussed follow.

Compassionate Feelings
The husband of a woman with BAD said, I have become more
compassionate and try more and more to learn about the disease
and its management. Some considered their caregiving role as
leading to improvements in their relationships, as with the person
who said, If you care for somebody, you automatically get close to
that person, and the relationship improves.

Faith in God
Having faith in God was an important coping strategy voiced by
some caregivers. Most felt that one should do ones duty of taking
care of their relative with illness and provide him or her with
the best treatment and leave everything else for God. Said one
caregiver, Best coping strategies are that there should be complete
and timely treatment, and the rest depends on God.

Self-Help Approach
The husband of a woman suffering from schizophrenia commented
that whenever he comes across any person behaving like his
wife, he tells the family members of the person how to deal with
him or her.

Acceptance and Finding a Solution

Acceptance of the illness as it exists was another strategy employed.
One caregiver said, We are aware of the fact that this problem is of
long term and is now part of our life. Another person rationalized
the behavior of a suffering relative by saying that we have to fight
with everybody and try to convince them that he is not doing it
intentionally.

Supportive Handling
Tackling the behavioral disturbances at home has been described as
whenever she stops treatment, she loses her temper and does
whatever she wants to do. But still I bear with it because I know

Caregiver Burden and Coping in Schizophrenia 137

it is not in her hands . . . . She loses her temper, breaks things,
shouts when her demands are not met. But the person with illness
can be tackled not by anger . . . but by coaxing, cajoling, and good
suggestions.

Hopefulness
Caregivers were hopeful of a good future. The father of a young
male with schizophrenia expressed it: If good things change, so
do the bad things, and therefore our bad time will also pass away.
The mother of another person with illness said, If things are not
good, tomorrow will be better.

Religious Participation
Religion was often a source of support. Most of the caregivers
believed in God and thought that He would help them out in this
situation. Some of the caregivers said, I do weekly fasting so that
he gets well soon . . . . I pray every day and it helps me in difficult
times.
DISCUSSION
This study has assessed the burden and coping strategies adopted
by caregivers of persons with schizophrenia and BAD in a prospective design. Many psychosocial issues regarding caregiving and
strategies to cope up with the burden of caregiving came up during
the FGDs. The sessions brought out the finer qualitative nuances
involved in routine interaction of a caregiver with an ill relative,
shedding light on the caregivers perception of the illness, its burden, and the various coping strategies adopted by them. Caregivers
were facing burden in multiple areas like social isolation, restriction
of various social and leisure activities, financial burden, adverse
effects on health, social stigma, and adverse effects on family functioning. They were using healthy coping strategies like positive and
compassionate approach, religious support, supportive handing,
and taking regular guidance from experts.
In India, most people suffering from psychiatric disorders do not
receive any financial benefits from the state on account of their illness or unemployment. Those living in nuclear families are facing a
new problem, because in the past families used to be bigger, and
joint families were capable of providing human as well as material

138 K. K. Ganguly et al.

resources for the care of people with mental illness. As these
families gradually break down into nuclear households, it becomes
an onerous duty for the already extremely busy family members to
look after persons with mental illness. Having such a person in the
family means that the caregiver may eventually lose his or her job
or otherwise considerably limit his or her activities in order to
extend constant care to the sick. In our observation most parents
can still provide all possible help to their ill children in their caregiving role. This principle largely holds true for the interdependency of spouses on one another during crisis (i.e., negotiating
with mental illness). FGDs brought out that both parents and
spouses, in spite of all odds, remain steadfast in their commitment
to care for their loved one.
When the family breaks down due to death or divorce, the role of
caregiving may be taken by some other relative, such as parents or
siblings. Such examples emerged in the FGDs. Similar findings
have been reported from India by Addlakha (1999) in a qualitative
study. Even if the patient is rejected by her husband, the mother
extends all sorts of support to her ill daughter as well as to her
grandchildren. Caregivers brave all odds to support the person
with mental illness.
However, the situation is dismal with respect to community
support beyond the immediate family. Rather than giving help,
society has an ambivalent attitude toward persons with mental
illness. It was often brought out in the FGDs that neighbors and
even relatives look down upon the person with illness and the
caregivers. Even the courtesy call or meeting in a social gathering
in the presence of such caregivers was not a welcome proposition.
The families suffer silently. In the absence of community support
structures, they are the sole institutions that care for people with
mental illness, and, at the same time, suffer from the social stigma
associated with it. David Karp, in his Mental illness, care giving,
and emotion management, has explained in detailbased on
some 50 in-depth interviewshow caregivers to a spouse, parent,
child, or sibling suffering from depression, manic-depression, or
schizophrenia manage their emotions over time (Karp, 2000).
According to Karp, the realization that mental illness may be a permanent feature stokes more negative emotions, anger, and resentment. Caregivers eventual recognition that they cannot control
their family members illness allows them to decrease involvement
without guilt. Moral boundaries of caregiving necessarily shift as

Caregiver Burden and Coping in Schizophrenia 139

the mental illness emerges over time, and it becomes imperative to
balance the needs of the mentally ill person with the needs of those
who provide care and support. Karp has tried to explain the issue
in the form of four Cs: I did not cause it, I cannot cure it, I
cannot control it, and All I can do is cope with it. The FGDs
were replete with such coping strategies.
In the assessment carried out using a quantitative approach in
the same sample, the authors found maladaptive coping strategies
during the sessions, though this may be an unusual finding. However, while the same group of caregivers was found to use problem
solving and social supportseeking coping strategies primarily,
they also were found to be occasionally using coping methods such
as denial, acting out, and dreaming (Chadda et al., 2007). These did
not emerge as prominent themes in the FGDs.
It is clear from the study that severe psychiatric disorders like
BAD and schizophrenia can be handled well by the family or
near-and-dear ones, as opposed to health facilitybased care. It is
important to emphasize here that the caregiver group selected in
the study was a highly motivated one that had been caring for their
relatives for a number of years. They had been visiting the hospital
with their relatives for a long time, which may have been responsible for inculcating in them healthful coping methods. Thus, it
may not be appropriate to generalize the findings to all settings.
The study shows that family caregivers who are in contact with
treatment teams for a long time learn to develop healthful coping
methods to deal with the burden of caring for relatives with
severe mental illness by both experience and prolonged therapeutic
contact with the treating doctors.
The study has some limitations. Only one session of FGD was
carried out with each caregiver who participated in the sessions.
Because of logistical constraints, not all the caregivers could be
covered in FGDs. Homogeneity of the FGD groups also tended to
add bias to the study so the latent bias of the study design could
not be eliminated.

CONCLUSIONS
Caregivers of persons suffering from schizophrenia and BAD suffer
similar patterns and severity of burden and use similar kinds of
coping mechanisms. The relationship between the caregiver and

140 K. K. Ganguly et al.

the ill relative is of varying types and of a complex nature. Caregivers in the present study showed no differences in dispensation
of care irrespective of their relationship with their ill relative.
Spouses and parents were equally concerned and caring for their
loved one, unlike observations made in various Western studies.
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