The burden of caregiving in families with a mental illness: a review of 2002

There has been a paradigm shift in professionals' perceptions of the caregiver. The challenges include: how best to support the family; improving caregiver perception of professionals; comparison of caregiver costs across illness groups; cross-cultural perspectives; longitudinal assessment for trait/statedependent characteristics; and practical assessment tools in the clinical setting. Purpose of review With a focus on publications around 2002, this paper attempts a synthetic overview of the broad range of issues in the field of family/informal caregiver burden for all categories of mental disorders. The paper seeks to answer the following questions: how far have publications advanced the field of caregiver burden; how far have they addressed the limitations of previous studies; what more needs to be done? Recent findings Although researchers accepted ‘burden’ as an ‘allencompassing’ term, many caregivers reported positive and uplifting experiences, and hence the term ‘care giving’ is proposed. Care giving is associated with emotional and cognitive transformations. The most important predictors of burden are problematical behaviour, disability and the severity of symptoms. Effective treatment is thus the first step to reduce burden. High expressed emotion may indicate the family's attempts to help the patient; and is mediated by controlling behaviour, stigma, burden, and caregiver perceptions of the patient's control over their own behaviour. New questionnaire measures of expressed emotion encourage cross-cultural research. Psycho-education is the most popular family intervention treatment. Outcome indicators that include caregiver attitudes and knowledge show more positive outcomes than readmission and caregiver burden. Encounters with health professionals are frustrating.