Hostname: page-component-848d4c4894-mwx4w Total loading time: 0 Render date: 2024-07-02T17:35:17.046Z Has data issue: false hasContentIssue false
  • English
  • Français

The need for closure in caregivers of people with psychosis

Published online by Cambridge University Press:  11 April 2011

Juliana Onwumere ,
Elizabeth Kuipers ,
Paul Bebbington ,
Graham Dunn ,
Daniel Freeman ,
David Fowler  and
Philippa Garety
Juliana Onwumere*
Affiliation:
Institute of Psychiatry at King's College London, London (United Kingdom)
Elizabeth Kuipers
Affiliation:
Institute of Psychiatry at King's College London, London (United Kingdom) In affiliation with the Biomedical Research Centre at the Institute of Psychiatry, King's College, London (United Kingdom)
Paul Bebbington
Affiliation:
Department of Mental Health Sciences, University College London, London (United Kingdom)
Graham Dunn
Affiliation:
Health Methodology Research Group, School of Community Based Medicine, University of Manchester, Manchester (United Kingdom)
Daniel Freeman
Affiliation:
Institute of Psychiatry at King's College London, London (United Kingdom)
David Fowler
Affiliation:
School of Medicine, Health Policy & Practice, Elizabeth Fry Building, University of East Anglia, Norwich (United Kingdom)
Philippa Garety
Affiliation:
Institute of Psychiatry at King's College London, London (United Kingdom) In affiliation with the Biomedical Research Centre at the Institute of Psychiatry, King's College, London (United Kingdom)
*
Address for correspondence: Dr. J. Onwumere, Institute of Psychiatry at King's College London, Box P077, Department of Psychology, Institute of Psychiatry, London SE5 8AF (United Kingdom). E-mail: juliana.l.onwumere@kcl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Summary

Aim – The aim of the study was to determine how carer need for closure relates to expressed emotion. It also examined the links between carer need for closure and patient functioning including patient need for closure. Methods – In a cross-sectional study, 70 caregivers of patients with psychosis completed the Need for Closure Scale (NFCS), the Camberwell Family Interview (CFI) and measures of distress, burden, coping and social network. The NFCS was assessed in terms of its two primary dimensions: a need for simple structure (NFSS) and Decisiveness. Patients also completed measures of psychotic symptoms and affect, and in 50 matched caregiver patient dyads, direct comparisons were undertaken between caregiver and patient NFCS scores. Results – No links were found between caregiver NFC and EE in this predominately low EE sample. More decisive carers had higher levels of self esteem, were less distressed, and resorted less to avoidant coping. The need for simple structure was greater in carers who lacked a confidante. As predicted, patients reported significantly higher NFSS and lower Decisiveness scores than carers, but no relationship was observed between caregiver NFC and patient symptoms of psychosis. Conclusions – Carers reporting confident decision making were also more likely to report adaptive functioning in terms of having lower levels of avoidant coping and distress, and higher levels of self esteem. The results suggest that this style of thinking might be a helpful way of coping with some of the difficulties involved in caring for someone with psychosis.

Keywords

psychosiscaregiversreasoningexpressed emotion
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 19 , Issue 2 , June 2010 , pp. 159 - 167
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barrowclough, C. & Tarrier, N. (1992). Families of Schizophrenic Patients: Cognitive Behavioural Intervention. Chapman and Hall: London.Google Scholar
Bebbington, P. & Kuipers, L. (1994). The predictive utility of expressed emotion in schizophrenia – an aggregate analysis. Psychological Medicine 24, 707–718.CrossRefGoogle ScholarPubMed
Beck, A.T., Brown, G., Epstein, N. & Steer, R.A. (1988). An inventory for measuring clinical anxiety – psychometric properties. Journal of Consulting and Clinical Psychology 56, 893–897.CrossRefGoogle ScholarPubMed
Beck, A.T., Steer, R.A. & Brown, G.K. (1996). Manual for the Revised Beck Depression Inventory. Psychological Corporation: San Antonio, TX.Google Scholar
Bentall, R.P. & Swarbrick, R. (2003). The best laid schemas of paranoid patients: Autonomy, sociotropy and need for closure. Psychology and Psychotherapy-Theory Research and Practice 76, 163–171.CrossRefGoogle ScholarPubMed
Berenbaum, H., Bredemeier, K. & Thompson, R.J. (2008). Intolerance of uncertainty: Exploring its dimensionality and associations with need for cognitive closure, psychopathology, and personality. Journal of Anxiety Disorders 22, 117–125.CrossRefGoogle ScholarPubMed
Butzlaff, R.L. & Hooley, J.M. (1998). Expressed emotion and psychiatric relapse – A meta analysis. Archives of General Psychiatry 55, 547–552.CrossRefGoogle ScholarPubMed
Carver, C.S., Scheier, M.F. & Weintraub, J.K. (1989). Assessing coping strategies – a theoretically based approach. Journal of Personality and Social Psychology 56, 267–283.CrossRefGoogle ScholarPubMed
Carver, C.S., Kus, L.A. & Scheier, M.F. (1994a). Effects of good versus bad mood and optimistic versus pessimistic outlook on social acceptance versus rejection. Journal of Social and Clinical Psychology 13, 138–151.CrossRefGoogle Scholar
Carver, C.S., Reynolds, S.L. & Scheier, M.F. (1994b). The possible selves of optimists and pessimists. Journal of Research in Personality 28, 133–141.CrossRefGoogle Scholar
Colbert, S.M. & Peters, E.R. (2002). Need for closure and jumping-to-conclusions in delusion-prone individuals. Journal of Nervous and Mental Disease 190, 27–31.CrossRefGoogle ScholarPubMed
Colbert, S.M., Peters, E.R. & Garety, P.A. (2006). Need for closure and anxiety in delusions: A longitudinal investigation in early psychosis. Behaviour Research and Therapy 44, 1385–1396.CrossRefGoogle ScholarPubMed
Dickens, C.M., McGowan, L., Percival, C., Douglas, J., Tomenson, B., Cotter, L., Heagerty, A. & Creed, F.H. (2004). Lack of a close confidant, but not depression, predicts further cardiac events after myocardial infarction. Heart 90, 518–522.CrossRefGoogle Scholar
Fleury, M.J., Grenier, G., Caron, J. & Lesage, A. (2008). Patients' report of help provided by relatives and services to meet their needs. Community Mental Health Journal 44, 271–281.CrossRefGoogle ScholarPubMed
Freeman, D., Garety, P., Kuipers, E., Colbert, S., Jolley, S., Fowler, D., Dunn, G. & Bebbington, P. (2006). Delusions and decision-making style: Use of the Need for Closure Scale. Behaviour Research and Therapy 44, 1147–1158.CrossRefGoogle ScholarPubMed
Garety, P.A., Fowler, D.G., Freeman, D., Bebbington, P., Dunn, G. & Kuipers, E. (2008). Cognitive behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised controlled trial. British Journal of Psychiatry 192, 412–423.CrossRefGoogle ScholarPubMed
Germeijs, V. & De Boeck, P. (2002). A measurement scale for indecisiveness and its relationship to career indecision and other types of indecision. European Journal of Psychological Assessment 18, 113–122.CrossRefGoogle Scholar
Goldberg, D.P. & Williams, P. (1988). The User's Guide to the General Health Questionnaire. NFER-Nelson: Windsor.Google Scholar
Hooley, J.M. (1998). Expressed emotion and locus of control. Journal of Nervous and Mental Disease 186, 374–378.CrossRefGoogle ScholarPubMed
Hooley, J.M. (2004). Do psychiatric patients do better clinically if they live with certain kinds of families? Current Directions in Psychological Science 13, 202–205.CrossRefGoogle Scholar
Hooley, J.M. & Campbell, C. (2002). Control and controllability: beliefs and behaviour in high and low expressed emotion relatives. Psychological Medicine 32, 1091–1099.CrossRefGoogle ScholarPubMed
Hooley, J.M. & Hiller, J.B. (2000). Personality and expressed emotion. Journal of Abnormal Psychology 109, 40–44.CrossRefGoogle ScholarPubMed
Irani, F., Platek, S.M., Panyavin, I.S., Calkins, M.E., Kohler, C., Siegel, S.J., Schachter, M., Gur, R.E. & Gur, R.C. (2006). Self-face recognition and theory of mind in patients with schizophrenia and first-degree relatives. Schizophrenia Research 88, 151–160.CrossRefGoogle ScholarPubMed
Janssen, I., Krabbendam, L., Jolles, J. & van Os, J. (2003). Alterations in theory of mind in patients with schizophrenia and non-psychotic relatives. Acta Psychiatrica Scandinavica 108, 110–117.CrossRefGoogle ScholarPubMed
Kay, S.R., Fiszbein, A. & Opler, L.A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.Google Scholar
Klein, C.T.F. & Webster, D.M. (2000). Individual differences in argument scrutiny as motivated by need for cognitive closure. Basic and Applied Social Psychology 22, 119–129.CrossRefGoogle Scholar
Kruglanski, A.W. & Mayseless, O. (1988). Contextual effects in hypothesis-testing – the role of competing alternatives and epistemic motivations. Social Cognition 6, 1–20.CrossRefGoogle Scholar
Kruglanski, A.W. & Webster, D.M. (1996). Motivated closing of the mind: “Seizing” and “Freezing”. Psychological Review 103, 263–283.CrossRefGoogle ScholarPubMed
Kruglanski, A.W., Webster, D.M. & Klem, A. (1993). Motivated resistance and openness to persuasion in the presence or absence of prior information. Journal of Personality and Social Psychology 65, 861–876.CrossRefGoogle ScholarPubMed
Kuipers, E., Leff, J. & Lam, D. (2002). Family Work for Schizophrenia: A Practical Guide. Gaskell Press: London.Google Scholar
Kuipers, E., Bebbington, P., Dunn, G., Fowler, D., Freeman, D., Watson, P., Hardy, A. & Garety, P. (2006). Influence of carer expressed emotion and affect on relapse in non-affective psychoses. British Journal of Psychiatry 188, 173–179.CrossRefGoogle Scholar
Leff, J. & Vaughn, C. (1985). Expressed Emotion in Families. Guildford Press: London.Google Scholar
Magliano, L., Fiorillo, A., Malangone, C., De Rosa, C., & Maj, M. (2006). Social network in long-term diseases: A comparative study in relatives of persons with schizophrenia and physical illnesses versus a sample from the general population. Social Science and Medicine 62, 1392–1402.CrossRefGoogle Scholar
Mannetti, L., Pierro, A., Kruglanski, A., Taris, T. & Bezinovic, P. (2002). A cross-cultural study of the need for cognitive closure scale: Comparing its structure in Croatia, Italy, USA and the Netherlands. British Journal of Social Psychology 41, 139–156.CrossRefGoogle ScholarPubMed
McKay, R., Langdon, R. & Coltheart, M. (2006). Need for closure, jumping to conclusions, and decisiveness in delusion-prone individuals. Journal of Nervous Mental Disease 194, 422–426.CrossRefGoogle ScholarPubMed
McNab, C., Haslam, N. & Burnett, P. (2007). Expressed emotion, attributions, utility beliefs, and distress in parents of young people with first episode psychosis. Psychiatry Research 151, 97–106.CrossRefGoogle ScholarPubMed
Mubarak, A.R. & Barber, J.G. (2003). Emotional expressiveness and the quality of life of patients with schizophrenia. Journal of Social Psychiatry and Psychiatric Epidemiology 38, 380–384.CrossRefGoogle ScholarPubMed
Neuberg, S.L., Judice, T.N. & West, S.G. (1997). What the need for closure scale measures and what it does not: Toward differentiating among related epistemic motives. Journal of Personality and Social Psychology 72, 1396–1412.CrossRefGoogle Scholar
O'Brien, M.P, Zingberg, J.L., Ho, L., Rudd, A., Kopelowicz, A., Daley, M., Bearden, C.E. & Cannon, T.D. (2009). Family problem solving interactions and 6-month symptomatic and functional outcomes in youth at ultra-high risk for psychosis and with recent onset psychotic symptoms: a longitudinal study. Schizophrenia Research 107, 198–205.CrossRefGoogle ScholarPubMed
Oyebode, J. (2003). Assessment of carers' psychological needs. Advances in Psychiatric Treatment 9, 45–53.CrossRefGoogle Scholar
Peterson, E.C. & Docherty, N.M. (2004). Expressed emotion, attribution, and control in parents of schizophrenic patients. Psychiatry-Interpersonal and Biological Processes 67, 197–207.CrossRefGoogle ScholarPubMed
Raune, D., Kuipers, E. & Bebbington, P.E. (2004). Expressed emotion at first-episode psychosis: investigating a carer appraisal model. British Journal of Psychiatry 184, 321–326.CrossRefGoogle ScholarPubMed
Reed, G.F. (1985). Obessional Experience and Compulsive Behaviour: A Cognitive Approach. Academic Press: New York.Google Scholar
Roberts, G. (1991). Delusional belief systems and meaning in life – a preferred reality. British Journal of Psychiatry 159, 19–28.CrossRefGoogle Scholar
Roest, A., Van Hiel, A. & Cornelis, I. (2006). The dimensional structure of the need for cognitive closure scale: relationships with “seizing” and “freezing” process. Social Cognition 24, 22–45.Google Scholar
Rose, L.E., Mallinson, R.K. & Gerson, L.D. (2006). Mastery, burden, and areas of concern among family caregivers of mentally ill persons. Archives of Psychiatric Nursing 20, 41–51.CrossRefGoogle ScholarPubMed
Rosenberg, M. (1965). Society and the Adolescent Self-image. Princeton University Press: Princeton, N.J.CrossRefGoogle Scholar
McKay, R., Langdon, R. & Coltheart, M. (2006). Need for closure, jumping to conclusions, and decisiveness in delusion-prone individuals. Journal of Nervous and Mental Disease 194, 422–426.CrossRefGoogle ScholarPubMed
Szmukler, G.I., Burgess, P., Herrman, H., Benson, A., Colusa, S. & Bloch, S. (1996). Caring for relatives with serious mental illness: The development of the experience of caregiving inventory. Social Psychiatry and Psychiatric Epidemiology 31, 137–148.CrossRefGoogle ScholarPubMed
Van Hiel, A. & Mervielde, I. (2002). Effects of ambiguity and need for closure on the acquisition of information. Social Cognition 20, 380–408.CrossRefGoogle Scholar
Van Humbeeck, G., Van Audenhove, C., Pieters, G., De Hert, M., Storms, G., Vertommen, H., Peuskens, J. & Heyrman, J. (2002). Expressed emotion in the client-professional caregiver dyad: are symptoms, coping strategies and personality related? Social Psychiatry and Psychiatric Epidemiology 37, 364–371.CrossRefGoogle ScholarPubMed
Vaughn, C. & Leff, J. (1976). Measurement of expressed emotion in families of psychiatric-patients. British Journal of Social and Clinical Psychology 15, 157–165.CrossRefGoogle ScholarPubMed
Versmissen, D., Janssen, I., Myin-Germeys, I., Mengelers, R., Campo, J.A., van Os, J. & Krabbendam, L. (2008). Evidence for a relationship between mentalising deficits and paranoia over the psychosis continuum. Schizophrenia Research 99, 103–110.CrossRefGoogle ScholarPubMed
Vitaliano, P.P., Zhang, J.P. & Scanlan, J.M. (2003). Is caregiving hazardous to one's physical health? A meta-analysis. Psychological Bulletin 129, 946–972.CrossRefGoogle ScholarPubMed
Webster, D. & Kruglanski, A. (1994). Individual differences in need for cognitive closure. Journal of Personality and Social Psychology 67, 1049–1062.CrossRefGoogle ScholarPubMed