Caregiving experiences of caregivers for people with psychosis in Blantyre, Malawi

Caregivers play a pivotal role in supporting individuals living with psychosis, contributing to their well-being, treatment adherence, and overall quality of life. In low-income countries like Malawi, where mental health resources are limited, the role of caregivers [1] becomes even more critical due to the scarcity of formal mental health services and the prominence of traditional healing practices [2]. Understanding the experiences and challenges faced by caregivers of people living with psychosis is essential for informing interventions and support systems tailored to their needs. This study aimed to explore the experiences of caregivers for people living with psychosis in Blantyre, Malawi. This secondary qualitative analysis included 12 caregivers of people with lived experience (PWLE) of psychosis who participated in in-depth interviews as part of a larger qualitative study conducted at Queen Elizabeth Central Hospital in Blantyre, Malawi. Interview transcripts and caregiving-related coded extracts were analyzed using a codebook approach to thematic analysis. Existing caregiving-related codes provided the initial deductive framework, while review of the full transcripts supported the development of additional themes relevant to caregivers’ experiences. Eight of the 12 caregivers were women, and their average age was 44 years old. Caregivers reported considerable life disruptions due to caregiving responsibilities. The unpredictable nature of psychosis symptoms forced them to abandon daily routines, risking livelihoods and well-being. Caregivers also described disruptions affecting other household members. Caregivers also described emotional and economic strain associated with caregiving responsibilities. When asked about resources needed to support caregiving, participants primarily identified food, medication, and financial resources for the person with psychosis. Caregivers described considerable disruption to daily life because of caregiving for PWLE but expressed optimism for improvement of the mental health of the PWLE. Caregivers described substantial disruptions to daily life, economic activity, and household functioning, alongside experiences of acceptance, hope, and fulfilment. These coping experiences may support adaptation to caregiving responsibilities but should not be interpreted as a substitute for formal mental health, social, or financial support. Strengthening mental health services and access to practical and financial resources may help address the challenges caregivers described.