Mental Health and Relationships

Family Functioning

There is growing awareness that family dysfunction and mental health problems such as psychiatric disorders are often associated with one another. On one hand, the need for emotional and instrumental support that accompanies mental health problems, as well as the symptoms of mental health problems (e.g., negative mood), may be taxing and burdensome for family members. On the other hand, family members may influence the course of mental health problems through such means as treatment adherence and promotion of behaviors that facilitate recovery. Indeed, poor family functioning is associated with a variety of psychiatric disorders, including mood disorders, anxiety disorders, substance use disorders, eating disorders, and schizophrenia spectrum disorders.

Furthermore, the level of family dysfunction observed in the families of psychiatric patients is higher than in families with a medically ill member; however, there is little difference between families with different specific psychiatric diagnoses in their level of family dysfunction. Compared with nonclinical families, families in which one member has a psychiatric diagnosis appear to be particularly impaired in communication and in resolving problems.

Although the research design for much of the research on family functioning and mental health is cross-sectional (i.e., measures of family functioning and mental health are collected at the same point in time), some research shows that family functioning assessed at one point in time is associated with changes in measures of mental health collected at a later time. For example, results from longitudinal or prospective studies indicate that family functioning is associated with the course of mood disorders. Specifically, compared with people with better family functioning, those with poorer family functioning report higher levels of depression, lower recovery, and lower levels of overall adjustment over time. Furthermore, families with a depressed member report worse family functioning than do control families, both during an episode and at remission, suggesting that family problems are not just a consequence of depression.

To the extent that poor family functioning is associated with the onset and course of mental health problems, improving family functioning through interventions such as family-based therapy should result in improvements in psychiatric functioning. In support of this perspective, family-based treatment approaches have been shown to be effective for a variety of mental health problems, including schizophrenia, bipolar disorder, conduct disorder, eating disorders, alcoholism, and adolescent substance abuse. Studies comparing family-based treatments with other types of intervention generally suggest that family-based treatment is as effective as other approaches to treatment. Furthermore, family-based interventions affect not only the person with the mental health problem, but also have the added benefit of improving functioning in other family members. For example, family-based interventions have positive effects on relatives' caregiver burden, psychological distress, and overall family functioning. [Page 1093]Thus, it appears that family therapy, singly or in combination with other psychiatric interventions such as medication or individual psychotherapy, may be an important part of a comprehensive approach to the treatment of mental health problems.

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