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      Burden and Expressed Emotion of Caregivers in Cases of Adult Substance Use Disorder with and Without Attention Deficit/Hyperactivity Disorder or Autism Spectrum Disorder

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          Abstract

          Objective

          To identify and compare caregiver burden and expressed emotion (EE) in adult substance use disorder (SUD) patients with and without co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). To examine possible differences in correlations between caregiver burden and EE across patient groups.

          Design and Methods

          Cross-sectional study with measures of perceived burden (Involvement Evaluation Questionnaire: IEQ), subjective stress (General Health Questionnaire: GHQ) and perceptions of expressed emotion (Level of Expressed Emotion: LEE) in informal caregivers for patients with SUD, SUD+ADHD or SUD+ASD.

          Findings

          No differences in caregiver burden or expressed emotion when caregivers for patients with SUD were compared to caregivers for patients with SUD+ADHD. A moderate but non-significant difference for caregivers of patients with SUD versus SUD+ASD, which disappeared when the number of contact hours between patient and caregiver for the SUD only group was controlled for. The IEQ sum scores also substantially correlated with the LEE sum scores.

          Conclusion

          Informal caregivers for patients with only SUD show higher levels of burden and EE than informal caregivers for patients with SUD and a co-occurring ASD. This difference was largely explained by the higher number of contact hours between patient and caregiver in the SUD only group.

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          Most cited references38

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          Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis.

          Substance use disorders (SUD) are a major public health problem. Attention deficit hyperactivity disorder (ADHD) is a comorbid condition associated with both onset and prognosis of SUD. Prevalence estimates of ADHD in SUD vary significantly. To obtain a best estimate of the prevalence of ADHD in SUD populations. A literature search was conducted using MEDLINE, PsycINFO and EMBASE. Search terms were ADHD, substance-related disorders, addiction, drug abuse, drug dependence, alcohol abuse, alcoholism, comorbidity, and prevalence. Results were limited to the English language. After assessing the quality of the retrieved studies, 29 studies were selected. Studies in which nicotine was the primary drug of abuse were not included. All relevant data were extracted and analysed in a meta-analysis. A series of meta-regression analyses was performed to evaluate the effect of age, primary substance of abuse, setting and assessment procedure on the prevalence of ADHD in a variety of SUD populations. Overall, 23.1% (CI: 19.4-27.2%) of all SUD subjects met DSM-criteria for comorbid ADHD. Cocaine dependence was associated with lower ADHD prevalence than alcohol dependence, opioid dependence and other addictions. Studies using the DICA or the SADS-L for the diagnosis of ADHD showed significantly higher comorbidity rates than studies using the KSADS, DISC, DIS or other assessment instruments. ADHD is present in almost one out of every four patients with SUD. The prevalence estimate is dependent on substance of abuse and assessment instrument. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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            Expressed emotion and psychiatric relapse: a meta-analysis.

            Expressed emotion (EE) is a measure of the family environment that has been demonstrated to be a reliable psychosocial predictor of relapse in schizophrenia. However, in recent years some prominent nonreplications of the EE-relapse relationship have been published. To more fully address the question of the predictive validity of EE, we conducted a meta-analysis of all available EE and outcome studies in schizophrenia. We also examined the predictive validity of the EE construct for mood disorders and eating disorders. An extensive literature search revealed 27 studies of the EE-outcome relationship in schizophrenia. Using meta-analytic procedures, we combined the findings of these investigations to provide an estimate of the effect size associated with the EE-relapse relationship. We also used meta-analysis to provide estimates of the effect sizes associated with EE for mood and eating disorders. The results confirmed that EE is a significant and robust predictor of relapse in schizophrenia. Additional analyses demonstrated that the EE-relapse relationship was strongest for patients with more chronic schizophrenic illness. Interestingly, although the EE construct is most closely associated with research in schizophrenia, the mean effect sizes for EE for both mood disorders and eating disorders were significantly higher than the mean effect size for schizophrenia. These findings highlight the importance of EE in the understanding and prevention of relapse in a broad range of psychopathological conditions.
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              Caregiver burden as people with autism spectrum disorder and attention-deficit/hyperactivity disorder transition into adolescence and adulthood in the United Kingdom.

              There is increasing recognition that autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are associated with significant costs and burdens. However, research on their impact has focused mostly on the caregivers of young children; few studies have examined caregiver burden as children transition into adolescence and young adulthood, and no one has compared the impact of ASD to other neurodevelopmental disorders (e.g., ADHD).
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                Author and article information

                Contributors
                +31 384565851 , l.kronenberg@dimencegroep.nl
                p.goossens@dimencegroep.nl
                J.T.van.busschbach@umcg.nl
                theo.vanachterberg@med.kuleuven.be
                w.vandenbrink@amc.uva.nl
                Journal
                Int J Ment Health Addict
                Int J Ment Health Addict
                International Journal of Mental Health and Addiction
                Springer US (New York )
                1557-1874
                1557-1882
                21 July 2015
                21 July 2015
                2016
                : 14
                : 49-63
                Affiliations
                [ ]Department of Residency Training MANP Mental Health, Dimence, Deventer, The Netherlands
                [ ]Expertise Centre Developmental Disorders, Dimence, Deventer, The Netherlands
                [ ]GGZVS, Institute for the Education of Clinical Nurse Specialists in Mental Health, Utrecht, The Netherlands
                [ ]SCBS, Dimence, Deventer, The Netherlands
                [ ]Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
                [ ]University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
                [ ]Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium
                [ ]Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
                [ ]Amsterdam Institute for Addiction Research, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands
                [ ]Dimence, P.O. Box 5003, 7400 GC Deventer, The Netherlands
                [ ]Department of Public Health, University Centre for Nursing and Midwifery, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
                Article
                9567
                10.1007/s11469-015-9567-9
                4710653
                61b7445a-8a7e-48b5-83cb-4f8e88b98248
                © The Author(s) 2015

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                © Springer Science+Business Media New York 2016

                Health & Social care
                burden,expressed emotions,substance use disorder,attention deficit/hyperactivity disorder,autism spectrum disorder

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