Although the family burden of mental health problems on patients’ close relatives was widely acknowledged, little was known about how mental health problems affected the quality of life of other types of social relationships of patients, through what mechanisms, and under what conditions. The study aims to explore the burden on all types of relationships of mental health patients and explain why and when the burden is unequal across different relationships.
The association between different types of relationships and the levels of burden was examined with dyadic data of 1178 patient-acquaintance relationships in the United States and random effects multilevel models. Frequency of contacts was tested as a mediator. The severity of mental health problems was tested as a moderator.
All types of relationships of patients borne a significant burden. Close relatives including parents, spouses, children, and siblings suffered a greater burden than distant relatives and non-relatives. The unequal burden was partly explained by the frequency of contacts with patients. The burden of close relatives significantly increased when patients’ mental health problems were more severe.
Mental health patients put a burden on their frequent contacts outside core families, especially when their problems were more severe. Public health policies should attend to the quality of life of mental health patients’ all types of acquaintances in the wider society.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
The data used in the study are publicly available on the NORC General Social Survey website: https://gss.norc.org
STATA codes available upon request from the authors.
Adelman, R. D., Tmanova, L. L., Delgado, D., Dion, S., & Lachs, M. S. (2014). Caregiver Burden: A Clinical Review. JAMA, 311(10), 1052. https://doi.org/10.1001/jama.2014.304.
Caqueo-Urízar, A., & Gutiérrez-Maldonado, J. (2006). Burden of care in families of patients with schizophrenia. Quality of Life Research, 15(4), 719–724. https://doi.org/10.1007/s11136-005-4629-2.
Caqueo-Urízar, A., Gutiérrez-Maldonado, J., & Miranda-Castillo, C. (2009). Quality of life in caregivers of patients with schizophrenia: A literature review. Health Qual Life Outcomes., 7(1), 84. https://doi.org/10.1186/1477-7525-7-84.
Hsiao, C.-Y., Lu, H.-L., & Tsai, Y.-F. (2020). Caregiver burden and health-related quality of life among primary family caregivers of individuals with schizophrenia: a cross-sectional study. Quality of Life Research. https://doi.org/10.1007/s11136-020-02518-1.
Alexander, B. H. G., Bebee, C.-E., Chen, K.-M., et al. (2016). Burden of caregivers of adult patients with schizophrenia in a predominantly African ancestry population. Quality of Life Research, 25(2), 393–400. https://doi.org/10.1007/s11136-015-1077-5.
Argyriou, A. A., Karanasios, P., Ifanti, A. A., et al. (2011). Quality of life and emotional burden of primary caregivers: a case–control study of multiple sclerosis patients in Greece. Quality of Life Research, 20(10), 1663–1668. https://doi.org/10.1007/s11136-011-9899-2.
Sales, E. (2003). Family burden and quality of life. Quality of Life Research, 12(1), 33–41. https://doi.org/10.1023/A:1023513218433.
Shiraishi, N., & Reilly, J. (2019). Positive and negative impacts of schizophrenia on family caregivers: a systematic review and qualitative meta-summary. Social Psychiatry and Psychiatric Epidemiology, 54(3), 277–290. https://doi.org/10.1007/s00127-018-1617-8.
Byrom, N. C. (2019). Supporting a friend, housemate or partner with mental health difficulties: The student experience. Early Interv Psychiatry., 13(2), 202–207. https://doi.org/10.1111/eip.12462.
Platt, S. (1985). Measuring the burden of psychiatric illness on the family: an evaluation of some rating scales. Psychological Medicine, 15(2), 383–393. https://doi.org/10.1017/S0033291700023680.
Rhee, T. G., & Rosenheck, R. A. (2019). Does improvement in symptoms and quality of life in chronic schizophrenia reduce family caregiver burden? Psychiatry Research, 271, 402–404. https://doi.org/10.1016/j.psychres.2018.12.005.
Behler, R., Donnelly, R., & Umberson, D. (2019). Psychological distress transmission in same-sex and different-sex marriages. Journal of Health and Social Behavior, 60(1), 18–35. https://doi.org/10.1177/0022146518813097.
Al-Rawashdeh, S., Alshraifeen, A., Rababa, M., & Ashour, A. (2020). Hope predicted quality of life in dyads of community-dwelling patients receiving hemodialysis and their family caregivers. Quality of Life Research, 29(1), 81–89. https://doi.org/10.1007/s11136-019-02378-4.
Cheng, G. H. L., Malhotra, R., Chan, A., Østbye, T., & Lo, J. C. (2018). Weak social networks and restless sleep interrelate through depressed mood among elderly. Quality of Life Research, 27(10), 2517–2524. https://doi.org/10.1007/s11136-018-1895-3.
Aubeeluck, A. V., Buchanan, H., & Stupple, E. J. N. (2012). ‘All the burden on all the carers’: exploring quality of life with family caregivers of Huntington’s disease patients. Quality of Life Research, 21(8), 1425–1435. https://doi.org/10.1007/s11136-011-0062-x.
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., et al. (2009). The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc., 18(1), 23–33. https://doi.org/10.1017/s1121189x00001421.
Granovetter, M. (1973). The strength of weak ties: A network theory revisited. Sociol Theory., 1, 201–233.
Fowler, J. H., & Christakis, N. A. (2008). Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. BMJ, 337, a2338. https://doi.org/10.1136/bmj.a2338.
Kadushin, C. Understanding social networks: Theories, concepts, and findings. OUP USA; 2012.
Smith, K. P., & Christakis, N. A. (2008). Social networks and health. Annu. Rev. Sociol., 34, 405–429.
Liu, K. Y., Marissa, K., & Bearman, P. S. (2010). Social influence and the autism epidemic. AJS., 115(5), 1387–1434.
Tooth, L., Russell, A., Lucke, J., et al. (2008). Impact of cognitive and physical impairment on carer burden and quality of life. Quality of Life Research, 17(2), 267–273. https://doi.org/10.1007/s11136-007-9300-7.
Maguire, R., Hanly, P., & Maguire, P. (2019). Beyond care burden: associations between positive psychological appraisals and well-being among informal caregivers in Europe. Quality of Life Research, 28(8), 2135–2146. https://doi.org/10.1007/s11136-019-02122-y.
Smith, T. W., Davern, M., Freese, J., & Morgan, S. L. (2019). General Social Surveys, 1972–2018: Cumulative Codebook. Chicago: NORC.
Azur, M. J., Stuart, E. A., Frangakis, C., & Leaf, P. J. (2011). Multiple imputation by chained equations: what is it and how does it work? Multiple imputation by chained equations. Int J Methods Psychiatr Res., 20(1), 40–49. https://doi.org/10.1002/mpr.329.
Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., et al. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88, 879–903.
Mustillo, S. A., Lizardo, O. A., & McVeigh, R. M. (2018). Editors’ Comment: A Few Guidelines for Quantitative Submissions. American Sociological Review, 83(6), 1281–1283. https://doi.org/10.1177/0003122418806282.
Uher, R., Perlis, R. H., Placentino, A., et al. (2012). Self-report and clinician-rated measures of depression severity: can one replace the other? Depress Anxiety, 29(12), 1043–1049. https://doi.org/10.1002/da.21993.
Gutiérrez-Maldonado, J., & Caqueo-Urízar, A. (2007). Effectiveness of a psycho-educational intervention for reducing burden in latin american families of patients with schizophrenia. Quality of Life Research, 16(5), 739–747. https://doi.org/10.1007/s11136-007-9173-9.
The authors appreciate comments on the draft from Florencia Torche, Amy L. Johnson, Joshua Hurwitz, Jonathan Atwell, and Xueguang Zhou.
We declare no funding.
Conflicts of interest
We declare no potential, perceived, or real conflicts of interest or competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Below is the link to the electronic supplementary material.
About this article
Cite this article
Li, L.Z., Bian, J.Y. & Wang, S. Moving beyond family: unequal burden across mental health patients’ social networks. Qual Life Res (2021). https://doi.org/10.1007/s11136-021-02782-9
- Family burden
- Social networks
- Stress process
- United states