The consequences of schizophrenic illness extend beyond the ill individual to the family, as relatives play an important role in caring for the family sufferer with schizophrenia (Zahid and Ohaeri, 2010). It affects 20million people worldwide (Global Burden of Diseases, 2017). Lifetime prevalence of schizophrenia is high, ranging from 0.4 to 1.4%, due to the early age of onset and chronic course of the disease (Beck, 2014). It is associated with considerable disability and may affect educational and occupational performance (WHO, 2019)). More than 69% of people with schizophrenia are not receiving appropriate care (Lora et al, 2012). Ninety per cent of people with untreated schizophrenia live in low- and middle- income countries (WHO, 2019).
Family members often play a vital role as caregivers in the lives of individuals with schizophrenia and other serious mental illnesses (Avasthi, 2010) consequently, constant caregiving has impact on the caregivers themselves, and in turn directly affect the care they provide to their relative patients (Rosland, 2012). Caregivers of patients with schizophrenia have experienced chronic stress in their daily lives due to the destructive and progressive nature of the condition. Some studies showed that constant care for patients with schizophrenia could have a negative impact on family members' mental health (Iseselo, 2016) and could result in missed work, financial strain (Lasebikan & Ayinde, 2013) negative impact on leisure and social activities and family relationships (Chan, 2011) which in turn could create more psychological distress and to influence the ability of the family to cope and function effectively (Shah, Wadoo, & Latoo, 2010). Caregivers staying with their patients live in the same social, cultural and economic environment exhibit tremendous stress due to handling the symptoms of patient with financial insufficiency and stigmatized attitude of the society with less cooperation from the neighbors (Eag, 2014; Lesselo, Kajula & Malema, 2016;Raj, Shiri & Jangam, 2016;Chadda, 2014).
Assuming these responsibilities is often difficult and research shows that caregiving demands lead to caregiver anxiety, depression, sadness, and anger, as well as physical problems including headaches, stomach pains, and problems with sleep (Small, Harrison, & Newell, 2010). Family caregivers for persons with schizophrenia are also shown to have decreased quality of life, increased stress, and several competing priorities such as maintaining their careers or providing care for other family members (e.g. other dependent children or ailing parents) (Sapouna et al., 2013).
Family caregivers report decreased quality of life as a consequence of their role and responsibilities, and quality of life is mediated through a number factors including time spent caregiving, symptom severity of the care recipient, and psychological distress experienced by the caregiver (Kate et al 2014; Quah, 2014). Social consequences, such as less engagement in activities, increases in household arguments, and economic difficulties are all contributing factors to reduced quality of life (Pshuk & Pshuk, 2015; Kate et al 2014; Sapouna et al., 2013).
Psychological distress is widely used as an indicator of the mental health of the population in public health, in population surveys and in epidemiological studies and, as an outcome, in clinical trials and intervention studies. Yet the concept of psychological distress is still vague for some. Indeed, a closer look at the scientific literature shows that the expression “psychological distress” is often applied to the undifferentiated combinations of symptoms ranging from depression and general anxiety symptoms to personality traits, functional disabilities and behavioural problems (Aline, 2014).
Individuals can react to stressful situations using adaptive or maladaptive coping strategies. Some studies have reported that caregivers use both adaptive and maladaptive coping strategies to deal with problems caused by family members' mental illness (Pompeo et al, 2016). Grover and Pradyumna (2015) also argue that caregivers' coping mechanisms can affect patient-related outcomes including relapses, readmission and quality of life.
While there is an abundance of literature that explores family caregiving in mental illness generally (Chang & Horrocks, 2006; Chien, Chan, & Morrissey, 2007; Hsiao & Tsai, 2014; National Alliance for Caregiving, 2016; Onwumere, Larmonth, & Kuipers, 2016), less is known about the experiences of family caregivers of persons with schizophrenia (Young, 2018).
Unlike in the west, where paid informal caregivers take up the role of looking after patients with chronic illness, the family of the mentally ill in sub-Saharan Africa are actively involved in rendering care to their psychiatrically ill relative. Therefore, understanding the coping strategies employed by a particular group such as family caregivers can provide valuable information for designing interventions to help them adapt to the problems caused by living with a mentally ill family member (Kartalova et al, 2008).