Schizophrenia poses a major care giving burden on family caregivers in both developed and developing countries [1]. Schizophrenia is a common and severe disabling mental disorder with a huge threat to the public health with a prevalence of 0.3-0.7% globally [2]. The trend of estimated burden of schizophrenia rose from 25 million in 2002 [3] to 29 million in 2004 globally [1] which predicted the increasing tendency of caregiving burden in the caregivers.
There is no clear cut for the prevalence and burden of schizophrenia in Eritrea. However, schizophrenia is among the top prevalent mental disorders in the country. Considering the culture of the people of Eritrea, the burden of care for the mentally ill is often left on the family or close relatives or friends.
It has been several decades since the emergence of the concept of burden and several studies have mainly focused on the area of caregiving burden due to mental illnesses, including, schizophrenia [4]. Responsibilities of caregiving burden greatly influence the major life aspects of the caregivers, particularly, physical, social, emotional and financial areas [5]. The impact of caregiving burden in these areas can considerably influence the daily life activities of the caregivers. Generally, the effect of the burden on the caregivers in the aforementioned areas can be measured using objective and subjective burden to assess the quantifiable challenges and perceived burden of care respectively [6].
The burden of caring for a mentally ill individual, including a person with schizophrenia, often falls on the family or close relatives or friends, and it may expose them to emotional and physical challenges. Efforts to improve global mental health have been focused on improving care for individuals living with psychological disorders. However, WHO strongly recommends adherence and extension of comprehensive assessment beyond the definition of mental health to recognize the impact of public health implications of psychological disorders [2].
The launch of mental health service within primary care and locating the psychiatric inpatient units within general hospitals is due to meet the appropriate mental health service model [7]. The establishment and extension of psychiatric health services improves the health care access and reduce associated costs. Sufficient experience is already gained from the developed countries in terms of extension of health care to the community. High-income countries reduce the cost of care and increase the accessibility of their mentally ill people through decreased length of hospital stay with the deinstitutionalized movement and the development of community based mental healthcare [8]. Eritrea is a developing country and mental health services were limited to one hospital for many years, situated in the capital, Asmara. However, Eritrea follows the system of delivery and extension of mental health care to the community. Recently, mental health service is available within general hospitals in different cities of the country. In low-income countries like Eritrea, inadequate or absent community mental healthcare and lack of rehabilitation services remain major boundaries. This may increase shifting of the patients to the families rather than allowing patients to stay in community health services or rehabilitation. This phenomena intensifies the burden of care on the primary caregivers.
Despite all studies done in developed countries, demonstrated as caregivers of a person living with schizophrenia have always been subject to massive input of physical, social, psychological and financial burden. Studies on the factors associated with caregiver burden among families or close caregivers of a person living with schizophrenia in Africa are very few and sparse and majority of the already published reports still are evaluating the determinants of the various domains of caregiving burden on the families or caretakers [9]. In Eritrea, to the best of our knowledge, there was still no published study on this particular area.
Considerable work is needed to elucidate the specific factors that determine the extent of caregiving burden and to rigorously identify the influential factors and recommend appropriate measures. The challenges to be met in developing a baseline facts in this area relate to addressing the extension of care of the caregivers, and incorporating the domains of the objective burden due to the illness that the patients are experiencing. Therefore, the purpose of the present study was to understand the objective burden level of the family caregivers among the caregivers and the factors that affected caregiver burden.
Justifiable care of psychological disorders do not only require to focus on the care of the mentally ill people or the health care facility, but also the factors that affects the care giving burden on the caregivers. As such it can guarantee sustainable care for the target groups. The current study determined the characteristics of caregivers and patients associated with objective burden among caregivers of persons with schizophrenia in Eritrea. This study puts more emphasis on the basic sociodemographic and clinical variables that generate a vast mount of burden among the care providers. Therefore the mental health professionals can take into account or consider the common correlates and predictors of caregiving burden among the family/ primary caregivers of the people living with schizophrenia.
1.1 Thesis Statement
Caregiving burden exerts a considerable burden on patient, family and society [10]. It is a public health issue that has been linked to inevitably deleterious caregiving outcomes for the family caregivers [2]. Though, it is understood that caregiving burden due to mental illnesses including schizophrenia impacts daily lives, physical health, emotional well-being and financial burden, yet the level of burden experienced by the caregivers in Eritrea is unknown. Currently a number of patient and caregiver predictors of burden could potentially be identified in the country. However no research has investigated the contributions of sociodemographic and clinical characteristics. As such, it is a genuine demand to assess and measure the pattern of caregiving burden in Eritrea among the family caregivers. This study sought to assess the extent and pattern of family burden among family care givers of a person living with schizophrenia and its associated sociodemographic and clinical factors.
1.2 Objective of the study
General objective
This study is sought to explore the objective burden level of the primary family caregivers of a patient living with schizophrenia, the contents of the burden, and the factors that affected caregiver burden.
Specific objectives
1. To describe the socio-demographic characteristics of the patients and caregivers.
2. To describe the objective and subjective burden level on family caregiver
3. To compare caregiving burden differences between/among the sub groups of sociodemographic variables
4. To identify the demographic and clinical factors that correlate with caregiving burden among the caregivers of the person living with schizophrenia.
5. To assess the predictors of burden among caregivers
Significance/ implications of the study
Identifying the association between the caregiving burden and influential factors may increase the workforce for