4
20
these disorders is crucial to provision of optimal care in
these countries. The Family APGAR Score and the Zarit
Burden Interview (ZBI) Score are two instruments that,
have been validated and found reliable, are useful in the
assessment5,o6 f family function and caregiver burden re-
spectively.
partnership and growth while scores of 1 and 2 were
recorded in affection and resolve respectively.
Concerning the ZBI Scores the mother had a higher
mean score (80), though not significant (P=0.12), than
the father’s (79.7±0.6). The areas associated with high
burdensome scores(3-4) by the parents were with re-
gards to; quality and cost of care offered, stress and
other negative attributes such as embarrassment associ-
ated with providing care, inability to meet other parental
obligations and uncertainty about the future.
This is the first case, out of the 600 cases seen in the
first year of the newly inaugurated child and adolescent
mental health (CAMH) unit of the Federal Neuro Psy-
chiatric Hospital Kaduna (FNPHK), of three siblings
presenting with the same mental health disorder in a non
consanguineous monogamous setting.
Family therapy, in addition to management of schizo-
phrenia, was instituted in the family.
The aim of this study was to assess family function and
parental burden in a family having three children with a
mental health disorder.
Discussion
Case report
The study showed high family dysfunction and parental
burden in a family that had three children with child-
hood onset schizophrenia. There has been a previous
report on 11 cases of families having 5 to 11members
affected by the disorder but this was in an ethnically
This case report is about a monogamous family with
four female children and three of the children, aged 12,
1
5 and 17 years, diagnosed as having schizophrenia us-
ing the International Classification of Diseases version
7
7
1
0 (ICD 10) classification. Father is a 49 year clergy-
isolated community with a history of endogamy. The
man while mother a 44 year old petty trader with a his-
tory of schizophrenia and receiving treatment in the
same hospital. There was no history of the disorder in
the extended family. The parents are the sole providers
of care for their children with, occasional financial sup-
port from well wishers. They have neither received nor
are they aware of any form of governmental or institu-
tional support.
history of mental health disorder in the family supports
the reported strong association between parent psycho-
pathology and childhood mental health disorders. How-
ever genetic studies would be required to provide further
information. High caregiver burden, using the ZBI
Score, have been reported in the provision of care for
8
children and adolescents with mental health disorders.
The number of children with the disorder in the family,
maternal history of the disorder, the family’s socio eco-
nomic status and insufficient family support would have
contributed to the degree of burden felt. Furthermore the
history of maternal schizophrenia coupled with a
woman’s pivotal role in providing home care in the Af-
rican setting could have contributed to the higher mean
Family function and parental burden were assessed us-
ing the Family APGAR and ZBI Scores respectively.
The Family APGAR Score uses the family’s member
perception of satisfaction to assess 5 dimensions of fam-
ily functioning namely Adapt5ability, Partnership,
Growth, Affection, and Resolve. Each parameter is
assessed on a 3-point scale ranging from 0(hardly ever)
to 2(almost always). The final grading is thus: 0-3
9
ZBI Score in the mother. Family dysfunction, using
Family APGAR Score, have been reported in families
1
0
caring for members with a chronic debilitating illness.
(
Highly dysfunctional family), 4-6(Moderately dysfunc-
It would appear that a high level of parental burden cor-
relates positively with family dysfunction but the popu-
lation size of this study makes the observation inconclu-
sive. However, it provides a basis for further research
into this association in our environment.
tional family) and 7-10(Highly functional family). The
Family APGAR Score has been found valid and reliable.
The mean of each parental Family APGAR Score for the
children was used as an indicator score for assessing
family dysfunction. The ZBI Score, whose test-retest
reliability and face validity has been established in Nige-
ria, is a 22-item self-report inventory that examines bur-
den associated with functional/behavioural impairments
and the home care situation. Each question is scored on
a 5 point-scale ranging from never(0) to nearly always
present(4). Total scores range from 0 (lowest burden) to
8
Score for the children was used as the indicator score for
assessing burden in this study.
The impact of having highly burdened parents or a dys-
functional family is far-reaching and adverse. The fam-
ily could suffer communal isolation as a result of stig-
matization or a breakdown as a result of a member or
members abdicating their responsibilities. Coping par-
ents could experience; less productivity, inability to
meet other obligations and potentially incapacitating
stress. The children could end up receiving suboptimal
care, subjected to stigmatization as well, discriminated
against, abused or neglected7,,1s1uffer deterioration in the
clinical state and even death.
6
8 (highest burden). The mean of each parental ZBI
The parental Family APGAR Scores and their mean
scores were the same for all children. Father’s and
mother’s score for each child was 3(highly dysfunc-
tional family). The parameters associated with the low-
est possible score (0) in the family were in adaptability,
Relieving parental burden and supporting affected fami-
lies limit development of these consequences. Identifica-
tion of susceptible families and their burdens, as has