Elsevier

Psychiatry Research

Volume 243, 30 September 2016, Pages 439-445
Psychiatry Research

Factors related to physical violence experienced by parents of persons with schizophrenia in Japan

https://doi.org/10.1016/j.psychres.2016.06.036Get rights and content

Highlights

  • Study focused on violence by patients with schizophrenia towards their parents.

  • 34.3% of parents experienced physical violence in the past year.

  • High EE (hostility and criticism) related to physical violence toward parents.

Abstract

Most violence by patients with mental illness is perpetuated against family members rather than the general public. However, there is insufficient research to reach a consensus on factors related to family violence for this population. Thus, the current study aimed to clarify factors related to physical violence by patients with schizophrenia towards their parents in Japan. A self-administrated survey was distributed through family groups to families with a relative with a psychiatric disorder. Questionnaires completed by 400 parents of patients with schizophrenia were analyzed. Of the 400 parents, almost two-thirds experienced “no physical violence” and close to one-third experienced “physical violence” during the past year. Results of a mixed-effects logistic regression revealed that physical violence was significantly related to the patients’ gender (female rather than male), multiple patient hospitalizations (3 or more times as compared to never hospitalized), low annual household income (less than US$20 K as compared to over US$40 K), and higher hostility and criticism of family interactions. Family violence maybe reduced through education on communication strategies for both parents and patients.

Introduction

In 2002, the World Health Organization (WHO) issued a report declaring the need for a global effort to address violence as a serious public health concern (Krug et al., 2002). Research on the rate of violence among persons with mental illness, particularly those with schizophrenia, has indicated that there is a higher risk of violence for those with mental illness than for the general population. But this risk is only moderately elevated, especially when substance use or abuse is involved (Walsh et al., 2002, Corrigan and Watson, 2005, Fazel et al., 2009, Fleischman et al., 2014). Furthermore, persons with mental illness are more likely to be victims of violence than to victimize others (Desmarais et al., 2014, Tsigebrhan et al., 2014). In addition, the proportion of violent crimes committed by persons with mental illness is very low, and of those who engage in violence, more than half direct violence toward family members, not strangers (Arboleda-Florez et al., 1998, Steadman et al., 1998, Angermeyer, 2000, Desmarais et al., 2014, Imai et al., 2014). The authors of a recent review on the topic concluded that at least 40% of caregivers have experienced violence by a relative with a severe mental illness (SMI) since the onset of the illness (Labrum and Solomon, 2015). Although the WHO report recommended that public health research on violence become a priority (Krug et al., 2002), research regarding family violence by persons with SMI is limited, due primarily to fears of further stigmatization of those with mental illness (Solomon et al., 2005). It would be useful to examine the factors that are potentially related to family violence by individuals with SMI in order to prevent this type of violence.

This study employed the conceptual framework of risk of violence against family caregivers by relatives with SMI developed by Solomon and colleagues (2005), which was specifically designed to compensate for the sole reliance in prior research on confining predictors to clinical and sociodemographic characteristics. The risk factors were conceptualized into three categories: characteristics of relatives with psychiatric illness, characteristics of family caregivers, and family caregiver and ill relative relationship factors, as family violence is a complex phenomenon embedded within the family context of the relationship between victim and perpetrator and each person's life history (Solomon et al., 2005). The category characteristics of relatives with psychiatric illness consisted of socio-demographics, clinical characteristics, and psychosocial factors (e.g., living arrangements and medication adherence, history of violence and crime, including victimization). The category of family caregiver characteristics was comprised of socio-demographics, health and mental health status, social support/social network, and history of violence and crime. The category of family caregiver and ill relative relationship factors was comprised of expressed emotion (EE) or psychological aggression, attitudes toward each other, dependency of the ill relative, limit setting by the family caregiver, and contributions by the ill relative or gratification from the ill relative. The variables selected for the present study were based on this framework, while taking into account the culture and circumstances in Japan regarding this population, as well as on input from representatives of the sample population. The input came from preliminary interviews that were conducted with 14 family members regarding their experiences with violence from their ill relatives with schizophrenia and their assessment of the mental health status of their ill relative. For example, substance abuse was not included due to the fact that only 2% of those with schizophrenia in Japan have a co-morbid substance abuse disorder (Umeno et al., 2008). Similarly, since the rate of physical violent crime in Japan is extremely low (1.1% for 5 years), history of violence and crime was not included either (Research and Training Institute of the Ministry of Justice, 2008). In the case of caregiver characteristics, employment status was not included as the study sample consisted of almost 60% retirees (Zenkaren, 2006). The present study employed a multivariate analysis to compensate for the weaknesses of most prior studies, which primarily used descriptive statistics, with the exception of an older study by Swan and Lavitt (1988) and the research by Chan, 2008, Elbogen et al., 2005.

In Japan, the government has rapidly implemented deinstitutionalization policies despite insufficient community support services (e.g., residential services) (Oshima et al., 2007). Many inpatients return to their parents’ home following release. Therefore, family violence has become a more serious issue. To find solutions to family violence, it would be useful to clarify family violence-related factors. The present study focused on patients with schizophrenia, as the majority of patients in inpatient settings in Japan are diagnosed with schizophrenia (almost 60%) (Ministry of Health Labour and Welfare, 2014). Thus, this population is most impacted by the recent deinstitutionalization policy. Parents are frequently the primary caregivers of these patients, and patients and parents usually cohabitate (Chiba Prefecture Family Association of Persons with Mental Disorders, 2009). Specifically, this study aimed to identify the factors related to parental physical violence committed by patients with schizophrenia.

Section snippets

Participants

The present analysis is part of a larger study entitled, “Japanese Family Violence and Mental Illness” (Kageyama et al., 2015). The objective of the larger study was to assess factors related to family violence among caregivers and siblings of individuals with mental illness. Eligible participants were family members from households belonging to a prefecture-level association (Japan is divided into 47 prefectural administrative entities) of a national family group association “Minna-Net”

Results

Two thirds of the respondents were mothers (66.8%), primary caregivers (67.7%), and most lived with the patient (83.8%). The average age of these respondents was 69.2 years. Two thirds of the patients were male (63.6%) and their average age was 39 years. Of patients who have disability certificate, 89.6% had severe grades that signifies severely limited ability for typical activities of daily living. The sample characteristics were similar to average family caregivers and their ill relatives of

Factors related to the experience of parental physical violence

Of the 400 parents, almost two-thirds experienced “no physical violence” and close to one-third experienced “physical violence” during the past year. Our study's rate of violence is consistent with a recent 20–35% estimation of family violence by patients with SMI within a 6–12 month time frame (Labrum and Solomon, 2015).

We aimed to clarify factors related to the experience of parental physical violence perpetrated by their relative with schizophrenia. The results determined that female

Conflict of interest

The authors declare that they have no conflicts of interest.

Contributors

MK, PS, SK, SN, KY, and YN designed the research project. PS, SK, and CF advised on the interpretations of results. All authors approved the final draft.

References (42)

  • L.B. Dixon et al.

    The 2009 Schizophrenia PORT psychosocial treatment recommendations and summary statements

    Schizophr. Bull.

    (2009)
  • E.B. Elbogen et al.

    Family representative payeeship and violence risk in severe mental illness

    Law Hum. Behav.

    (2005)
  • S. Fazel et al.

    Schizophrenia and violence: Systematic review and meta-analysis

    PLoS Med.

    (2009)
  • A. Fleischman et al.

    Schizophrenia and violent crime: A population-based study

    Psychol. Med.

    (2014)
  • M.F. Green

    What are the functional consequences of neurocognitive deficits in schizophrenia?

    Am. J. Psychiatry

    (1996)
  • M.F. Green et al.

    Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”?

    Schizophr. Bull.

    (2000)
  • M.C. Hsu et al.

    Adult patients with schizophrenia using violence towards their parents: A phenomenological study of views and experiences of violence in parent-child dyads

    J. Adv. Nurs.

    (2014)
  • Ibaragi family groups association on mental illness, 2007. [A Report of Research project for Independent Living of...
  • Y.H. Jeon et al.

    Respite care for caregivers and people with severe mental illness: literature review

    J. Adv. Nurs.

    (2005)
  • M. Kageyama et al.

    Rate of family violence among patients with schizophrenia in Japan

    Asia-Pacific Journal of Public Health

    (2015)
  • Krug, E.G., Dahlberg, L.L., Mercy, J.A., Zwi, A.B., Lozano, R., 2002. World Report on Violence and...
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