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Caregiver distress in first-episode psychosis: the role of subjective appraisal, over-involvement and symptomatology

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Caregivers of persons with first-episode psychosis (FEP) often report high levels of distress. Preventing long-term or chronic distress within the whole family is an important focus of early intervention for psychosis. However, a more comprehensive understanding of the psychological factors involved is needed.


To examine the impact of subjective appraisals and expressed emotion on caregiver distress in FEP.


Within a cross-sectional design, 154 caregivers of 99 persons with FEP in a clinical epidemiological sample completed a series of questionnaires to examine potential predictors of caregiver distress.


Thirty-seven percent of caregivers were suffering from clinically significant distress. A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service-user symptoms and global functioning, emotional over-involvement and subjective appraisal of caregiving were significant predictors of caregiver distress.


Caregiver distress is significant in the early phase of illness, and this seems to be more related to their subjective appraisal and over-involvement, than to variations in symptoms and global functioning of the person diagnosed with FEP. This lends further support to the stress-appraisal coping model and the cognitive model of caregiving in FEP, and highlights supportive interventions aimed at handling unhelpful cognitions and behaviors.

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We are grateful to all of the patients and their caregivers who consented to participate, and to the clinicians in Opus Region Zealand, who provided access to their clients. The Region Zealand Health Scientific Research Foundation provided funding for this research, but had no involvement in the production of this paper.

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Correspondence to Jens Einar Jansen.

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Jansen, J.E., Haahr, U.H., Harder, S. et al. Caregiver distress in first-episode psychosis: the role of subjective appraisal, over-involvement and symptomatology. Soc Psychiatry Psychiatr Epidemiol 50, 371–378 (2015).

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  • Caregivers
  • Distress
  • Emotional over-involvement
  • First-episode psychosis