Coping strategies for stress and its determinants among family care givers of patients with mental illness at University of Gondar Comprehensive and Specialized Hospital, northwest Ethiopia

Abstract

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 treatmentoutcomes,yetlittleisknownaboutcopingstrategiesinEthiopia. Objective:Thismixed-methodsstudyaimed toassessthecopingstrategies anditsdeterminantsamong family caregivers of psychiatric patients at the University of Gondar Comprehensive and Specialized Hospital,NorthwestEthiopia,in2024. Methods: A cross-sectional design was conducted between February and September 2024. Caregivers were selected through systematic random sampling. Coping strategies were assessed using the BriefCOPE 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 qualitativedatawereanalyzedwithinductivethematicanalysisinNVivo-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 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, andsocialsupport. 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 andeffectiveassistance.