Cross-sectional survey of the relationship of symptomatology, disability and family burden among patients with schizophrenia in Sichuan, China

BACKGROUND Schizophrenia is a chronic condition that leads to high rates of disability and high levels of family burden but the interactive relationship between these variables remains unclear, particularly in low- and middle-income countries where the vast majority of patients live with their families. AIM Assess the symptom severity, level of disability, and family burden among clinically stable outpatients with schizophrenia in Sichuan, China. METHODS A total of 101 clinically stable outpatients with schizophrenia who had a median duration of illness of five years were assessed using the World Health Organization Disability Assessment Scale 2.0 (WHODAS II), the Positive and Negative Syndrome Scale (PANSS) and the Family Adaptation, Partnership, Growth, Affection and Resolve Index scale (APGAR); and their caregivers were surveyed using the Family Burden Interview Schedule (FBIS). RESULTS Among the 101 patients, 92 lived with their immediate family members, 74 had clinically significant disability, and 73 were unemployed. The level of disability was associated with the severity of symptoms (r=0.50, p<0.001), duration of illnesses (r=0.22, p=0.028), age of onset (r=-0.22, p=0.024) and patients' level of satisfaction with family support (r=-0.30, p=0.020). Disability was also associated with the overall level of family burden (r=0.40, p<0.001), and with several subtypes of family burden: financial burden (r=0.21, p=0.040), the degree of disruption in family routines (r=0.33, p=0.001), the effect on family leisure activities (r=0.31, p=0.001) and the quality of family interactions (r=0.43, p< 0.001). Four variables remained significantly associated with the level of disability in the stepwise multivariate linear regression: duration of illness, severity of symptoms, patient satisfaction with family support, and the overall burden of the illness on the family. CONCLUSIONS Even after adjusting for the severity of patients' symptoms, patient disability is independently associated with family burden. This highlights the importance of targeting both symptoms and disability in treatment strategies for this severe, often lifelong, condition. In countries like China where most individuals with schizophrenia live with their families, family burden is an important component of the impact of the illness on the community that should be included in measures of the relative social and economic importance of the condition.