Challenges of Family Caregivers of Patients with Mental Disorders in Iran: A Narrative Review Review

Mohammad Akbari, Mousa Alavi, Alireza Irajpour, Jahangir Maghsoudi


Background: Family caregivers of patients with mental disorders play the most important role in the care of psychiatric patients (PPs) and preventing their readmission. These caregivers face different challenges in different cultures. We conducted this study to determine the challenges of caregivers of patients with mental disorders in Iran.

Materials and Methods: This study is a narrative review with a matrix approach conducted by searching electronic databases, SID, IRANMEDEX, MAGIRAN, PUBMED, SCOPUS, Web of Sciences, from February 2000 to 2017. Searched keywords include challenges, family caregivers of psychiatric patient, family caregivers and psychiatric patient, mental illness, families of psychiatric patient, and Iran. One thousand two hundred articles were found in English and Farsi, and considering inclusion and exclusion criteria, 39 articles were examined.

Results: The results of the studies show that not meeting the needs of caregivers, burnout and high burden of care, high social stigma, low social support for caregivers, and low quality of life of caregivers were among the most important challenges faced by caregivers.

Conclusions: Despite the efforts of authorities in Iran, family caregivers of patients with mental disorders still face challenges. Therefore, the need for all‑inclusive support for family caregivers of patients with mental health problems is necessary.



Caregivers, Iran, literature review, mental disorders

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Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual Research Review: A meta‑analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 2015;56:345‑65.

Sadock BJ, Kaplan VA. Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Lippincott Williams & Wilkins; 2011.

Chang Y‑C, Chou F‑C. Effects of Home Visit Intervention on Re‑hospitalization Rates in Psychiatric Patients. Community Ment Health J 2015;5:595‑605.

Hengartner MP, Klauser M, Heim G, Passalacqua S, Andreae A, Rössler W, et al. Introduction of a Psychosocial Post Discharge Intervention Program Aimed at Reducing Psychiatric Rehospitalization Rates and at Improving Mental Health and Functioning. Perspect Psychiatr Care 2015;5:25‑34.

Awad AG, Voruganti LNP. The Burden of Schizophrenia on Caregivers. PharmacoEconomics 2012;26:149‑62.

Haresabadi M, Bibak B, Bayati H, Akbari M. Assessing burden of family caregivers of patients with schizophrenia Admitted in IMAM REZA hospital. Bojnurd J Med Univ North Khorasan 2013;4:165‑71.

Navidian A, Salar AR, Hashemi Nia A, A K. Study of mental exhaustion experienced by family caregivers of patients with mental disorders, Zahedan Psychiatric Hospital. J Babol Uni Med Sci 2001;3:33‑8.

Barker ET, Greenberg JS, Seltzer MM, Almeida DM. Daily stress and cortisol patterns in parents of adult children with a serious mental illness. Health Psychol 2012;31:130‑8.

Zendjidjian X, Richieri R, Adida M, Limousin S, Gaubert N, Parola N, et al. Quality of life among caregivers of individuals with affective disorders. J Affect Disord 2012;136:660‑5.

Lillis C, LeMone P, LeBon M, Lynn P. Study guide for fundamentals of nursing: The art and science of nursing care. Lippincott Williams & Wilkins; 2010.

Möller‑Leimkühler AM, Wiesheu A. Caregiver burden in chronic mental illness: The role of patient and caregiver characteristics. Eur Arch Psychiatry Clin Neurosci 2012;262:157‑66.

Hudson P, Trauer T, Kelly B, O’Connor M, Thomas K, Summers M, et al. Reducing the psychological distress of family caregivers of home‑based palliative care patients: Short‑term effects from a randomised controlled trial. Psychooncology 2013;22:1987‑93.

Schmid‑Büchi S, Halfens RJ, Dassen T, van den Borne B. Psychosocial problems and needs of posttreatment patients with breast cancer and their relatives. Eur J Oncol Nurs 2011;15:260‑6.

Friðriksdóttir N, Sævarsdóttir Þ, Halfdánardóttir SÍ, Jónsdóttir A, Magnúsdóttir H, Ólafsdóttir KL, et al. Family members of cancer patients: Needs, quality of life and symptoms of anxiety and depression. Acta Oncol 2011;50:252‑8.

Coughlan M, Cronin P. Doing a literature review in nursing, health and social care. 2 edition London: Sage;2016.

Shamsaee, Mohammadkhan, Vanaki. Needs of family caregivers of patients with bipolar disorder. J Hamadan University of Medical Sciences 2011;17:57‑63. [In Persian].

Shamsaei F, Cheraghi F, Esmaeilli R. The Family Challenge of Caring for the Chronically Mentally Ill: A Phenomenological Study. Iran J Psychiatry Behav Sci 2015;9:18‑26.

Zeinalian P, Mottaghipour Y, Samimi M. Validity and the cultural adaptation of the carers’needs assessment for schizophrenia and assessing the needs of family members of bipolar mood disorder and schizophrenia spectrum patients. J Ment Health Principles 2011;12:684‑91.

Behpagoh A, Mahmodi M. Need Assessment for Social Support in Mothers of Children with Autism. J Psychol growth 2016;11:3‑22.

Chimeh N, Malakoti S, Panaghi L, Ahmad Abadi Z, Nojomi M, Ahmadi Tonkaboni A. Care giver burden and mental health in schizophrenia. J Fam Res 2008;4:277‑92.

Sharifi M, Fatehizade M. The effectiveness of group problem‑solving training on burnout in women caregivers of family patient member in Falavarjan, Isfahan, IR Iran. J Shahrekord Univ Med Sci 2013;14:38‑47.

Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24:105‑12.

Saleh S, Zahedi Asl M. Correlation of Social Support with Social Health of Psychiatry Veterans Wives. Iran J War Public Health 2014;6:201‑6.

Abdollahpour I, Noroozian M, Nedjat S, Majdzadeh R. Caregiver burden and its determinants among the family members of patients with dementia in Iran. Int J Prev Med 2012;3:544‑51

Navidian A, Bahari F. Burden experienced by family caregivers of patients with mental disorders. Pak J Psychol Res 2008;23:19‑28.

Shamsaei F, Cheraghi F, Bashirian S. Burden on Family Caregivers Caring for Patients with Schizophrenia. Iran J Psychiatry 2015;10:239‑45.

Hosseini S, Sheykhmounesi F, Shahmohammadi S. Evaluation of mental health status in caregivers of patients with chronic psychiatric disorders. Pakistan journal of biological sciences 2010;13:325‑9.

Vaghee S, Salarhaji A. Stigma in family caregivers of patients with schizophrenia hospitalized in ibn‑sina psychiatric hospital of mashhad in 2014‑2015. J Torbat Heydariyeh Uni Med Sci 2015;3:10‑7.

Shamsaee F, Mohammadkhan S, Vanaki Z. Meaning of Health from the perspective of family caregivers Patients with Bipolar Disorder: A Qualitative Study. J Mazandaran Univ Med Sci Health Serv 2013;1:52‑65.

Sadeghi M, Kaviani H, Rezaee R. Comparison of the stigma of mental illness in families of patients with depression, bipolar disorder and schizophrenia. J Cogn Sci News 2004;5:16‑25.

Shahveisi B, Shoja S, Fadaee F, Dolatshahi B. Compare the stigma of mental illness in families of patients with schizophrenia and major depressive disorder without a psychiatric traits. J Rehab Ment Disord 2008;8:21‑7.

Beirami M, Andalib M, Poresmaeel A, Mohammadibakhsh L. Comparison of perceived social support and religiosity in PTSD patients, Their wives and control group. J Med Sci 2014;17:68‑75.

Mami S, kaikhavani S, amirian K, neyazi E. The effectiveness of family psychoeducation (Atkinson and coia model) on mental health family members of patients with psychosis. Scientific Journal of Ilam University of Medical Sciences. 2016;24:8‑17.

Sheikholeslami F, Khalatbary J, Ghorbanshiroudi S. Effectiveness of Stress Coping Skills Training With Psycho‑Educational Approach among Caregiversof Schizophrenic Patients on Family Function And Psychological Wellbeing. Holistic Nurs Midwif J 2016;26:46‑54.

Karamlou S, Mazaheri A, Mottaghipour Y. Effectiveness of family psycho‑education program on family environment improvement of severe mental disorder patients. Int J Behav Sci 2010;4:123‑8.

Sharif F, Shaygan M, Mani A. Effect of a psycho‑educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz, Iran. BMC Psychiatry 2012;12:48‑57.

Pahlavanzadeh S, Navidian A, Yazdani M. The effect of psycho‑education on depression, anxiety and stress in family caregivers of patients with mental disorders. J Kermanshah Univ Med Sci 2010;14:228‑36.

Mottaghipour Y, Woodland L, Bickerton A, Sara G. Working with families of patients within an adult mental health service: Development of a programme model. Australas Psychiatry 2006;14:267‑71.

Koolaee AK, Etemadi A. The outcome of family interventions for the mothers of schizophrenia patients in Iran. Int J Soc Psychiatry 2010;56:634‑46.

Omranifard V, Esmailinejad Y, Maracy MR, Jazi AHD. The Effects of Modified Family Psychoeducation on the Relative’s Quality of Life and Family Burden in Patients with Bipolar Type I Disorder. J Isfahan Med Sch 2009;27:100‑8.

Sharifi M, Fatehizade M. The relationship between religious coping with depression and burnout in in family caregivers. Modern Care. J Sch Nurs Mid Birjand Univ Med Sci 2012;9:327‑35.

Muralidharan A, Lucksted A, Medoff D, Fang LJ, Dixon L. Stigma: A Unique Source of Distress for Family Members of Individuals with Mental Illness. J Behav Health Serv Res 2016;43:484‑93.

Aali S, Amin A, Abdekhodaee M, Ghanaee A, Moharrari F. Function of families with children with autism spectrum disorders compared to Families with children healthy. Med J Mashhad Uni Med Sci 2015;1:32‑41.

Toubaei S, Mani A. Life satisfaction and mental health in depressed patients’ families. Int J Behav Sci 2010;4:177‑82.

Peyman N, Bahrami M, Yousef S, Vahedian M. Investigating the problems and the family willing to accept and care of mental patient: At home after discharge from the hospital Psychiatric city of Mashhad. Qua J Fund Ment Health 2005;25:63‑9.

Keighobadi S, Neishabouri M, Haghighi N, Sadeghi T. Assessment of Quality of life in Caregivers of Patients with Mental Disorder in Fatemie hospitals of Semnan city. Adv Nurs Mid 2013;22:36‑44.

Sharif Ghaziani Z, Ebadollahi Chanzanegh H, Fallahi Kheshtmasjedi M, Baghaie M. Quality of Life and Its Associated Factors among Mental Patients Families. J Health Care 2015;17:166‑77.

Ploeg J, Biehler L, Willison K, Hutchison B, Blythe J. Perceived support needs of family caregivers and implications for a telephone support service. Can J Nurs Res Arch 2016;33:28‑35.

Wancata J, Krautgartner M, Berner J, Scumaci S, Freidl M, Alexandrowicz R, et al. The Carers’ needs assessment for Schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2006;41:221‑9.

Chan SW. Global perspective of burden of family caregivers for persons with schizophrenia. Arch Psychiatr Nurs 2011;25:339‑49.

Yin Y, Zhang W, Hu Z, Jia F, Li Y, Xu H, et al. Experiences of stigma and discrimination among caregivers of persons with schizophrenia in China: A Field Survey. PLoS One 2014;9:e108527.

van der Sanden RL, Bos AE, Stutterheim SE, Pryor JB, Kok G. Experiences of stigma by association among family members of people with mental illness. Rehabil Psychol 2013;58:73‑85.

Jacobsson L, Ghanean H. Internalized stigma of mental illness in Sweden and Iran—A comparative study. Open J Psychiatr 2013;3:370‑4.

Ogilvie AD, Morant N, Goodwin GM. The burden on informal caregivers of people with bipolar disorder. Bipolar Disord 2005;7:25‑32.

Steele A, Maruyama N, Galynker I. Psychiatric symptoms in caregivers of patients with bipolar disorder: A review. J Affect Disord 2010;121:10‑21.

Alexander G, Bebee C‑E, Chen K‑M, Vignes R‑MD, Dixon B, Escoffery R, et al. Burden of caregivers of adult patients with schizophrenia in a predominantly African ancestry population. Qual Life Res 2016;25:393‑400.

Marimbe BD, Kajawu L, Muchirahondo F, Marimbe BD, Cowan F, Lund C. Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe: Original research. Africa J Disabil 2016;5:1‑9.

Chien WT, Chan SW, Morrissey J. The perceived burden among Chinese family caregivers of people with schizophrenia. J Clin Nurs 2007;16:1151‑61.

Padierna A, Martín J, Aguirre U, González N, Muñoz P, Quintana JM. Burden of caregiving amongst family caregivers of patients with eating disorders. Soc Psychiatry Psychiatry Epidemiol 2013;48:151‑61.

Zahid MA, Ohaeri JU. Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia. BMC Psychiatry 2010;10:71‑80.

Pahlavanzadeh S, Dalvi‑Isfahani F, Alimohammadi N, Chitsaz A. The effect of group psycho‑education program on the burden of family caregivers with multiple sclerosis patients in Isfahan in 2013‑2014. Iranian J Nurs Midwifery Res 2015;20:420‑5.

Gafari S, Khoshknab MF, Nourozi K, Mohamadi E. Informal caregivers’ experiences of caring of multiple sclerosis patients: A qualitative study. Iranian J Nurs Midwifery Res 2017;22:243‑9.

Boyer L, Caqueo‑Urízar A, Richieri R, Lancon C, Gutiérrez‑Maldonado J, Auquier P. Quality of life among caregivers of patients with schizophrenia: A cross‑cultural comparison of Chilean and French families. BMC Fam Pract 2012;13:42‑50.

Wong DFK, Lam AYK, Chan SK, Chan SF. Quality of life of caregivers with relatives suffering from mental illness in Hong Kong: Roles of caregiver characteristics, caregiving burdens, and satisfaction with psychiatric services. Health Qual Life Outcomes 2012;10:15‑23.

Hayes L, Hawthorne G, Farhall J, O’Hanlon B, Harvey C. Quality of life and social isolation among caregivers of adults with schizophrenia: Policy and outcomes. Community Ment Health J 2015;51:591‑7.


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