Developing family resilience in chronic psychiatric illnesses.

Caregiving for an ill family member can be both stressful and rewarding. Caring for a relative with a psychiatric illness adds the burden of social stigma, both for the patient and the family caregivers, especially in minority cultures. Families from minority cultures may have a different understanding of mental illness and have difficulties with language, discrimination, and accessing services. The appraisal of caregiving must be assessed separately from a caregiver’s coping style. For example, caregiving may be perceived as low stress but the caregiver’s coping skills may be poor, resulting in high caregiver burden. Low perceived stress with strong coping skills results in the most reward and the least burden. High levels of caregiver burden occur in caregivers of relatives with schizophrenia, bipolar disorder, and chronic or recurrent mood disorders. Caregiver burden tends to be worse and more persistent with relatives who suffer from depressive disorders compared to bipolar disorder. Children of caregivers may have difficult behavior, loss of appetite, sleeplessness, with less playing and less attention at school. Caregiver burden can be reduced and caregiver reward can be maximized by improving family resilience. The concept of family resilience explains why some families experience lower burden and greater reward. Family resilience includes the ability to develop adaptive interpersonal skills, such as differentiating the person from the illness, and positive family qualities, such as mutual acceptance and empathic involvement. These family strengths contribute to a sense of family wellñbeing and offset difficulties in other areas of family functioning. The wellbeing of the family unit ensures the best outcome for both patient and caregiver.