Purpose of reviewWith a focus on publications around 2002, this paper attempts a synthetic overview of the broad range of issues in the field of family/informal caregiver burden for all categories of mental disorders. The paper seeks to answer the following questions: how far have publications advanced the field of caregiver burden; how far have they addressed the limitations of previous studies; what more needs to be done? Recent findings Although researchers accepted 'burden' as an 'allencompassing' term, many caregivers reported positive and uplifting experiences, and hence the term 'care giving' is proposed. Care giving is associated with emotional and cognitive transformations. The most important predictors of burden are problematical behaviour, disability and the severity of symptoms. Effective treatment is thus the first step to reduce burden. High expressed emotion may indicate the family's attempts to help the patient; and is mediated by controlling behaviour, stigma, burden, and caregiver perceptions of the patient's control over their own behaviour. New questionnaire measures of expressed emotion encourage cross-cultural research. Psycho-education is the most popular family intervention treatment. Outcome indicators that include caregiver attitudes and knowledge show more positive outcomes than readmission and caregiver burden. Encounters with health professionals are frustrating. Summary There has been a paradigm shift in professionals' perceptions of the caregiver. The challenges include: how best to support the family; improving caregiver perception of professionals; comparison of caregiver costs across illness groups; crosscultural perspectives; longitudinal assessment for trait/statedependent characteristics; and practical assessment tools in the clinical setting.

BACKGROUND AND OBJECTIVES:There is rising interest in quality of life (QOL) research in Arabian countries. The aim of this study was to assess in a nationwide sample of Kuwaiti subjects the reliability and validity of the World Health Organization Quality of Life (WHOQOL-BREF), a shorter version of the widely used QOL assessment instrument that comprises 26 items in the domains of physical health, psychological health, social relationships, and the environment.METHODS:A one-in-three systematic random proportionate sample of consenting Kuwaiti nationals attending large cooperative stores and municipal government offices in the six governorates completed the Arabic translation of the questionnaire. The indices assessed included test-retest reliability, internal consistency, item internal consistency (IIC), item discriminant validity (IDV), known-groups and construct validity.RESULTS:There were 3303 participants (44.8% males, 55.2% females, mean age 35.4 years, range 16 to 87 years). The intra-class correlation for the test-retest statistic and the internal consistency values for the full questionnaire and the domains had a Cronbach's alpha≥0.7. Of the 24 items that constitute the domains, 21 met the IIC requirement of correlation ≥0.4 with the corresponding domain, while 16 met the IDV criterion of having a higher correlation with their corresponding domain than other domains. Domain scores discriminated significantly between well and sick groups. In the factor analysis, four strong factors emerged with the same construct as in the WHO report.CONCLUSION:The Arabic translation of the WHOQOL-BREF has impressive reliability and validity indices. The poor IDV findings are due to the multidimensional nature of the questionnaire. The highly significant validity indices should reassure researchers that the questionnaire represents the same constructs across cultures. Negatively worded items possibly need refinement.

BackgroundQuality of life (QOL) issues are of interest in cancer because effective methods of treatment and detection have led to an increase in the number of long-term survivors. The objectives of the study were: to assess the subjective QOL of stable Sudanese women cancer outpatients and their family caregivers, using the WHO 26-item QOL Instrument; compare with matched general population groups, as well as diabetic and psychiatric patient groups; examine patient-caregiver concordance in ratings; and assess the variables associated with their QOL, with a view to identifying factors that can enhance quality of care.MethodsResponses of oncology outpatients with breast cancer (117), cervical cancer (46) and ovarian cancer (18) (aged 44.6, SD 11.5) were compared with those of their family caregivers and matched general population groups. Data were analyzed by univariate and multivariate statistics.ResultsThe cancer groups had similar QOL domain scores, which were significantly lower than those of their caregivers, but higher than the control group as well as those of psychiatric and diabetic patients studied previously. Patients who were married, with higher education, better employment, and with longer duration of illness had higher QOL. Patients on radiotherapy and their caregivers had higher QOL scores. Correlations between patient's ratings and caregiver impression of patient's QOL were high. Caregiver impression was a significant predictor of patient's and caregiver's QOL. Other predictors for the patient were: currently feeling sick and duration of illness; for the caregiver: feeling sick, relationship to patient, and age.ConclusionCancer patients in stable condition and with psychosocial support can hope to enjoy good QOL with treatment. The findings constitute an evidence base for the country's cancer care program, to boost national health education about prognosis in cancer. Families living with women cancer patients are vulnerable and need support if the patient is recently diagnosed, less educated, single, not formally employed; and the caregiver is female, parent, younger, less educated, unemployed and feels sick. Clinicians need to invest in the education and support of family caregivers. The patient-caregiver dyad should be regarded as a unit for treatment in cancer care.

Disturbed behaviour is a greater determinant of severity of burden than psychiatric diagnosis; hence adequacy of treatment is a first step in reducing caregiver burden. The tolerance shown by this group of relatives implies that they have strong potentials for playing useful roles in community care. Research and policy should consider measures to strengthen extended family network ties in developing countries.

BackgroundAlthough the burden experienced by families of people with schizophrenia has long been recognized as one of the most important consequences of the disorder, there are no reports from the Arab world. Following the example of the five - nation European (EPSILON) study, we explored the following research question: How does the relationship between domains of caregiving (as in the Involvement Evaluation Questionnaire - IEQ-EU) and caregiver psychic distress on the one hand, and caregiver's/patient's socio-demographics, clinical features and indices of quality of care, on the other hand, compare with the pattern in the literature?MethodConsecutive family caregivers of outpatients with schizophrenia were interviewed with the IEQ-EU. Patients were interviewed with measures of needs for care, service satisfaction, quality of life (QOL) and psychopathology.ResultsThere were 121 caregivers (66.1% men, aged 39.8). The IEQ domain scores (total: 46.9; tension: 13.4; supervision: 7.9; worrying: 12.9; and urging: 16.4) were in the middle of the range for the EU data. In regression analyses, higher burden subscale scores were variously associated with caregiver lower level of education, patient's female gender and younger age, as well as patient's lower subjective QOL and needs for hospital care, and not involving the patient in outdoor activities. Disruptive behavior was the greatest determinant of global rating of burden.ConclusionOur results indicate that, despite differences in service set-up and culture, the IEQ-EU can be used in Kuwait as it has been used in the western world, to describe the pattern of scores on the dimensions of caregiving. Differences with the international data reflect peculiarities of culture and type of service. Despite generous national social welfare provisions, experience of burden was the norm and was significantly associated with patient's disruptive behavior. The results underscore the need for provision of community - based programs and continued intervention with the families in order to improve the quality of care.

The findings support the impression that, despite the conservative culture, child abuse is being experienced by a significant number of children in the Arab world. Preventive education in this culture should include limits on child disciplinary measures, the vulnerable groups identified, the impact on psychosocial functioning, and the protective effect of parental harmony.

Our data support the impression that effective medical treatment is the first step to ensure QOL. Subjective QOL ratings realistically reflect the strengths and weaknesses of socio-cultural circumstances and patients' perceived personal qualities. High subjective sense of well-being should be a tool in public mental health education to dispel the gloom of psychiatric outcome and combat stigma.

BackgroundThe Kuwaiti perspective on quality of life (QOL) in breast cancer is important because it adds the contribution from a country where the disease affects women at a relatively younger age and seems to be more aggressive. We used the EORTC QLQ – C30 and its breast-specific module (BR-23) to highlight the health-related QOL of Kuwaiti women with breast cancer, in comparison with the international data, and assessed the socio-demographic and clinical variables that predict the five functional scales and global QOL (GQOL) scale of the QLQ – C30.MethodsParticipants were consecutive clinic attendees for chemotherapy, in stable condition, at the Kuwait Cancer Control Center.ResultsThe 348 participants were aged 20–81 years (mean 48.3, SD 10.3); 58.7% had stages III and IV disease. Although the mean scores for QLQ – C30 (GQOL, 45.3; and five functional scales, 52.6%–61.2%) indicated that the patients had poor to average functioning, only 5.8% to 11.2% had scores that met the 66% criterion for more severe symptoms. Most (47.8%–70.1%) met the >66% criterion for "good functioning" on the BR-23 functional scales. The mean scores of the QLQ – C30 indicated that, despite institutional supports, Kuwaiti women had clinically significantly poorer global QOL and functional scale scores, and more intense symptom experience, in comparison with the international data (i.e.,