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Background: Caring for individuals with mental illness is stressful, with challenges like stigma, unequal responsibilities, and patient aggression. These stressors impact caregivers' mental health and treatment outcomes, yet little is known about coping strategies in Ethiopia. Therefore, this mixed-methods study assessed the coping strategies, lived experiences, and determinants for coping among family caregivers of patients with mental illness northwest Ethiopia.
Methods: A convergent parallel mixed-methods study was conducted between Jun and July 2024. Caregivers were selected through systematic random sampling. Coping strategies were assessed using the Brief-COPE tool, while qualitative data were collected via tape-recorded in-depth interviews. Quantitative data were analyzed with SPSS AMOS Version 23 software using structural equation modeling, and qualitative data were analyzed with inductive thematic analysis using NVivo-15.
Results: The mean score for adaptive and maladaptive coping was 34.65 (SD = ±7.70) and 21.10 (SD=±5.00), respectively. Factors negatively associated with adaptive coping included being a farmer (β = -0.21), female sex (β = -0.10), longer illness duration (β = -0.10), higher number of patient’s hospital admissions (β = -0.07), and older age (β = -0.07). A history of physical abuse and more hospital admissions also had an indirect negative effect on adaptive coping. In contrast, perceived stigma had a positive effect on adaptive coping (β = 0.09). Factors positively influencing maladaptive coping included caregiving burden (β = 0.39) and psychological distress (β = 0.13). Comorbid illnesses and abuse experiences also had positive indirect effects. Negative indirect effects on maladaptive coping were seen in farmers, females, literate caregivers, and those experiencing job loss due to caregiving. Social support had a significant negative indirect effect on maladaptive coping (β = -0.09). Family caregivers face emotional, financial, and social challenges and cope through faith, advice, withdrawal, and social support.
Conclusion: Family caregivers exhibited lower coping strategies than the general population. Factors such as farming, being female, prolonged illness, and frequent hospitalizations hindered adaptive coping. Caregiving burden and psychological distress increased maladaptive coping, while social support mitigated it. Targeted interventions are needed to help caregivers develop diverse coping strategies. Initiatives to alleviate burden and distress should be implemented to reduce maladaptive coping. Policymakers must integrate caregiver support into mental health policies to ensure sustainable and effective assistance.
