ICMEDH

KnE Medicine
2nd International Conference on Medical Health Science
Volume 2023

Research Article

Coping Strategies of Caregivers of Patients

with Schizophrenia in Malang Districts
Faizatur Rohmi1,2 *, Ah. Yusuf 3 , Rizky Fitriasari3 , Hardiyanto1 , and Abdul
Rokhim1
1
Sekolah Tinggi Ilmu Kesehatan Kepanjen, Nursing, Malang, Indonesia
2
Doctoral Student, Faculty Nursing, Universitas Airlangga, Surabaya, Indonesia
3
Faculty of Nursing, Airlangga University, Surabaya, Indonesia
ORCID
Faizatur Rohmi: https://orcid.org/0000-0002-1918-2778

Abstract.
Schizophrenia is a disease that not only puts a burden on the afflicted individual
but also poses a significant challenge to their caregivers. Caregivers of patients with
schizophrenia use coping strategies to deal with these struggles. This study aimed to
identify coping strategies used by family caregivers of patients with schizophrenia. This
was a descriptive correlational study. Participants were 57 family caregivers of patients
Corresponding Author: Faizatur with schizophrenia who were referred to the general hospital in Malang Districts. They
Rohmi; email: were selected through a purposive sampling method. The data collection tools were
[email protected]
demographic and brief cope (BC). The scores of family caregivers using different types
Published 8 March 2023
of coping strategies were: Self Direction 41.23%, Active Coping 85.75%, Denial 26.32%,
Use of Emotional Support 89.25%, Use of Instrumental Support 96.49%, Behavioral
Publishing services provided by Disengagement 35.09%, Venting 28.95%, Positive Reframing 95.18%, Planning 95.18%,
Knowledge E
Humor 95.18%, Acceptance 94.30%, Religion 91.45%, Self-Blaming 26.54%. The results
Faizatur Rohmi et al. This
showed that the most used adaptive coping strategy was instrumental support. Family
article is distributed under the caregivers of patients with schizophrenia have used adaptive and maladaptive coping
terms of the Creative Commons strategies. Mental health professionals should make a program that supports family
Attribution License, which caregivers in making adaptive coping strategies.
permits unrestricted use and
redistribution provided that the Keywords: caregivers, family, schizophrenia
original author and source are
credited.
1. Introduction
Selection and Peer-review under
the responsibility of the ICMEDH
Schizophrenia is a disease that not only puts burden on the individuals who suffer but
Conference Committee.
also on the people who care for them. Caregivers of patients with schizophrenia who are
unable to cope with the overwhelming pressure of care will often lead to psychological
disturbances, and decreased quality of life [1]. Caring for family members with mental
disorders, especially patients with a diagnosis of schizophrenia, is often a stressor for
family life, especially for individuals who are in charge of caring for them directly that
the stressors faced cause stress and burden for the family [2].
Schizophrenia is a type of chronic mental disorder that often occurs in individuals
with a relatively young age range and this type of disease can affect brain function, such

How to cite this article: Faizatur Rohmi*, Ah. Yusuf , Rizky Fitriasari, Hardiyanto, and Abdul Rokhim, (2023), “Coping Strategies of Caregivers
of Patients with Schizophrenia in Malang Districts” in 2nd International Conference on Medical Health Science, KnE Medicine, pages 473–479. Page 473
DOI 10.18502/kme.v3i2.13082
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as disrupting thought patterns, perceptions, and behavior [3]. An estimated 21 million

people worldwide have schizophrenia. In Indonesia, from 2013 to 2018, the number of
people with schizophrenia increased from 5.3 per mile to 7 per mile [4].
This paradigm of stress faced in caring can use the paradigm of stress appraisal
coping (or stress coping) that was proposed by Lazarus and Folkman (1984). The concept
of this theory describes the process of dealing with stress. This theoretical model
was later developed and adopted by other researchers with the aim of explaining the
caregiving process carried out by family members with chronic psychiatric disorders,
especially those with a diagnosis of schizophrenia [5]. This model assumes that caring
for people with schizophrenia will cause stress for those who care for them directly, and
this stress is usually associated with changes in the patient’s behavior, the inability to
interact, and the burden of life felt by the family.

2. Materials and methods

The research was performed as a descriptive approach. The population was family
members who cared for patients with schizophrenia at Malang, Indonesia. This study
involved 57 family members with schizophrenia sufferers as respondents who were
obtained by purposive sampling technique. Inclusion criteria are family members who
are in charge of caring for the patient directly, and have cared for the patient for at least 6
months. The patient must be diagnosed with schizophrenia for at least one year, as evi-
denced by the medical record. The participant is a family member who accompanies the
patient in the outpatient unit of the Kepanjen Hospital. The participants were recruited
based on ethical principles. Participants who were involved in previous research had
received a written explanation regarding the research objectives, procedures, rights
and obligations, benefits, and disadvantages during the research. Only participants
who have given informed consent are involved in the study. This research has received
ethical approval from the Ethics Committee of the Kepanjen School of Health Sciences
number 072.1/EA.KEPK.007/35.07.208/2021

3. Results

Among 57 caregivers, a slightly higher proportion of caregivers were males 48 (84.2%).

Most caregivers were middle aged adults 34 (59.6%) and clustered in ‘per capita
income per month’ lower than Rp 2.000.000 (96.5%); the educational background of
all caregivers was almost evenly distributed across three categories, i.e., elementary

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Table 1: Descriptive characteristics of the caregivers (N=57).

Variables Frequency (%) (Median) Minimun-

Maximum
Gender Male Female Age ≤ 30 years old 9 (15.8%) 48 (84.2%) 1 (1-2 2 (1-3) 2 (1-3) 1 (1-2) 1 (1-3)
31-50 years old ≥ 51 years old Education 11 (19.3%) 34 (59.6%) 1 (1-2)
background Elementary school or below 12 (21.1%) 53 (94.0%)
Middle or high school Junior college 3 (5.3%) 1 (1.8%) 55
or above Per capita income per month (96.5%) 2 (3.5%) 4
Income ≤ Rp 2.000.000 Income > Rp (7.0%) 17 (29.8%) 36
2.000.000 The relationship with patients (63.2%) 26 (45.6%)
in care Child Spouse Parent Duration of 31 (54.4%)
caring 1-3 years > 3 years

school or below (94.0%), middle or high school (5.3%), and junior college and above
(1.8%); the relationships between the caregivers and patients in care included ‘parent’
caregivers (63.2%) , ‘child’ caregivers (7.0%)and ‘spouse’ caregivers (29.8%); Duration of
caring 1-3 years (45.6%), > 3 years (54.4%).

Table 2: Descriptive coping strategy of the caregivers (N=57).

Concepts and Number of Score range Frequency (%)

domains/subscales items per item
Coping strategy Strategy 2 2 2 2 2 2 1-4 1-4 1-4 1-4 1- (41,23%) (85,75%)
Self Direction Active 2 2 2 2 2 2 4 1-4 1-4 1-4 1-4 (26,32%) (89,25%)
Coping Denial Use of 2 1-4 1-4 1-4 1-4 (96,49%) (35,09%)
emotional support Use (28,95%) (95,18%)
Of instrumental support (95,18%) (95,18%)
Behavioral disengagement (94,30%) (91,45%)
Venting Positive reframing (26,54%)
Planing Humor Acceptance
Religion Self-Blaming

4. Discussion

The present study included 57 primary caregivers of patients with schizophrenia. Being
diagnosed with schizophrenia is a challenging time for the patient and especially for the
caregiver. Although literature on treatment abounds, literature on how best to support
caregivers is scarce. This review was conducted to better understand the experience
of coping strategies used by caregivers. Understanding coping strategy in primary
caregivers of schizophrenic patients is of great importance for developing innovative
interventions to promote their ability of providing care to schizophrenic patients.
Coping strategies are defined as individual responses when they experience stress
when levels of stress exposure increase. Coping strategies can be classified into
Problem-Focused Coping (PFC) and Emotion-Focused Coping (EFC). Family caregivers
who tend to use PFC will face the problems or burdens they face by looking for

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alternative solutions. PFC consists of planned problem solving, confrontational coping,

and seeking social support. Another study showed that the most frequently used
coping strategy by family caregivers was seeking social support, while the least used
coping strategy was confrontation. Family caregivers tended to seek social support
and planned problem-solving to reduce their burden in sharing the difficulties they face
their loved ones another can reduce the perceived pressure and another advantage
that family caregivers may have when using this coping strategy is obtaining additional
information to resolve them [2]. Other study that have higher religiousness spirituality or
a strong personal belief system more frequently used positive reappraisal to cope with
their illness becomes important, positive reappraisal is described as a dimension that
includes giving positive meaning to a situation by focusing on one’s personal growth
experience [6]
This study expands on the existing literature on coping with families caring for people
with schizophrenia by examining their coping strategies. Overall the strategy he uses
consists of positive and negative coping, which consists of Self Direction, Active Coping,
Denial, use of emotional support, use of instrumental support, Behavioral disengage-
ment, Venting, Positive reframing, Planning, Humor, Acceptance, Self-Blaming. The use
of coping strategies by caregivers of people with schizophrenia is associated with a
better perception of the existence of social support in the form of having sources to
get advice and guidance from those closest to them, either from close family or people
around them considered influential in their family. In contrast, the use of disengagement
strategies was associated with lower perceptions of family support and increased
family tension. In addition, disengagement strategies are associated with symptoms
of anxiety and depression [7]. Based on a study of high-risk adolescents with a family
history of psychosis, a positive family environment had a significant protective effect
on the development of psychosis perceived by sufferers [8], [9]. Being in a positive
family environment and having good parenting characteristics can create a harmonious
family climate and healthy emotions [10]. Constructive communication and problem-
solving skills and problem-oriented are often associated with a decrease in symptoms
in sufferers and an increase in social functioning [11]. In another study, it was also
stated that in families with highly functional relationships in carrying out family functions
and roles, individuals with schizophrenia will be more obedient to the treatment they
are undergoing and Parenting knowledge and skills in people with schizophrenia are
reliable predictors of psychological well-being and active coping among primary family
caregivers [12].

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Other caregivers of schizophrenia stated that the coping strategy used was that
more frequent use of adaptive coping mechanisms (such as seeking social support,
accepting responsibility, planned problem solving, and positive reassessment) was
associated with lower rates of sequelae and patient functioning. better, and lower
rates of psychological morbidity as per GHQ-12 among caregivers. Based on the level
of symptoms experienced by sufferers such as higher negative symptoms, general
psychopathology, and total PANSS scores were associated with lower use of positive
religious coping, which means that caregivers of schizophrenic patients relatively used
a mixture of adaptive and maladaptive coping strategies including coping strategies.
religious. The use of adaptive coping is associated with better patient-related outcomes
and lower rates of psychological morbidity/stress among caregivers. More frequent use
of maladaptive coping was associated with patient and caregiver outcomes [1]. This
study consistent with the main caregivers of schizophrenic patients are larger and
often use positive coping styles [13] and gathering information followed by positive
communication and patient’s social involvement [14]. This is to reduce the burden and
stigma which are risk factors that must be managed by the family in order to survive,
rise, and become better in caring for schizophrenic patients [15].

5. Conclusion

This study describes the coping strategies used by caregivers in treating people with
schizophrenia. Nurses as health care workers have a central role in assessing coping
used by families as well as assessing problems that may be experienced by family
members in order to assist families in caring for people with schizophrenia properly.

Acknowledgments

We would like to thank our participants who kindly volunteered their time for this
research

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