Patient and Family Attitudes About Schizophrenia: Implications for Genetic Counseling

Abstract

Psychiatrists are giving increased attention to genetic counseling for mental illness. However, the burden of these illnesses are perceived by families and the degree to which families feel a need for genetic counseling have yet to be established. Attitudes and perceptions measured in this study focus on etiology, familial risk, and socioeconomic burden of schizophrenia, as well as childbearing plans and the acceptability of genetic counseling. Members of 17 families, each with a child diagnosed schizophrenic, were studied using the Family Attitudes Questionnaire. The results demonstrate that the well family members view schizophrenia as a severe and debilitating illness. The results also show that there is a disparity between the attitudes of well family members and patients: 92 percent of parents compared to 25 percent of patients identified schizophrenia as a disorder associated with extreme burden. Regarding childbearing decisions, 29 percent of parents compared to 66 percent of patients say they would have children (in hindsight or in future) based on what they now know about schizophrenia in their family. This result corroborates reports from genetic counselors for other illnesses: the wish for children appears to override considerations of risk and burden for those potentially genetically affected persons who have not reached their desired family size.

Perception of risk in genetic counseling

“…Particularly important is the motivation to bear children and reproductive intentions. These variables have been found to have a significant influence on outcomes of genetic counseling (Sorenson et al, 1984) and also on perception of recurrence risks (Schulz, 1982). The expected correlation is negative: the higher the motivation the lower the perceived risk.…”

Genetic Counseling in Psychiatry

“…Two early reports suggested that individuals affected with psychiatric illness may underestimate illness risk in their offspring. In a survey of patients with schizophrenia, Schulz and colleagues 29 reported that 58% estimated the risk of the illness in their offspring at less than 9%. In contrast, siblings of these patients tended to overestimate risks for their own children.…”

Public vs. professional conceptions of schizophrenia

“…Despite the existence of a substantial literature concerning public attitudes toward mental illness, there has been relatively little research assessing public knowledge of mental illness in general -of its symptoms, causes, and treatments. Investigations of knowledge about schizophrenia, specifically, are even more rare and have focused mainly on mental health professionals (Gallagher, 1977;Soskis, 1972) and on families with schizophrenic members (Hatfield, 1978;Schulz et al, 1982).…”