The Coping Process of Family Caregivers in Caring for Family Member with Severe Mental Illness: A Grounded Theory Study
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Abstract: Introduction: Care giving for people with severe mental illness has shifted from institutions to families, where family members are now considered to be a valuable resource for providing care to the patient. Therefore, families are the vital link between home and community for mentally ill patients and allow continuity of care from a psychiatric centre to home and then community. Family involvement in the care of patients with chronic illness is essential to provide a backbone of support for them. Therefore, after a medical diagnosis of a chronic illness, family caregivers are faced with new situations that challenge their usual coping strategies. Caregivers employ all of their emotional and physical abilities to overcome this stressful condition, and to manage the problems associated with the disease. Since the adaptation is process, interactive, social, and culturally dependent concept, there is still a knowledge gap about how family caregivers of mentally ill patients coped with and adapted to challenges while taking care of them. Thus, this study was conducted with the aim of exploring the coping process of family caregivers in caring for their family members with severe mental illness. Methods: This qualitative study was conducted through a grounded theory approach during 2015-2017. The participants were family caregivers of mentally ill patients who referred to psychiatric clinic of Razi hospital in Tabriz. Recruiting participants was initiated using purposeful sampling. It followed by theoretical sampling until data saturation was achieved. The main tool for collecting data were comprehensive and unstructured interviews. A total of 26 interviews were performed with 24 participants. Data were analyzed using Corbin and Strauss approach (2008). Findings: Data analysis showed that main concern of participants was emerged as " inability to balance between the task of caring and other life domains. Contextual factors which caused creating the main concern in participants include "progressive and degenerative nature of the disorders", " indifference of mental health system ", "lack of mental health literacy in the society". Two main strategies which families used in confronting with their main concern were "cognitive escape-avoidance" and " Functional problem solving strategy ". Avoidance - involvement was the main and dominant psycho-social process among the data and includes two steps" neglect of mental illness " and " accessing normalcy". It will eventually lead to psychological distress or self-actualization and family integration. Conclusions: Family caregivers are confronted with various and multiple challenges in the care of their mentally ill family member. Constant caring, without supportive resources, forced them to do various roles and manage other issues within the family. Being unprepared for a caregiving role, financial burden, stigma related to the mebtal illness and pay no attention of mental health system to the family caregivers led to the psychological distress of family caregivers. They use different strategies of balancing in order to adapt to caring challenges and keeping family integration. The results of this study can be used by managers, Health-care system planners and the mental health professionals in order to facilitate the process of coping with the caring challenges.