Psychological factors of sibling caregivers of patients with severe mental disorders: an observational study

  • Francesca Pierazzuoli Department of Mental Health, Asst Bergamo Ovest, Bergamo, Italy.
  • Elisa Gatti Department of Psychology, University of Milano-Bicocca, Milan, Italy.
  • Maria Rosa Castelli Department of Mental Health, Asst Bergamo Ovest, Bergamo, Italy.
  • Giuseppe Primerano Department of Mental Health, Asst Bergamo Ovest, Bergamo, Italy.
  • Osmano Oasi Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.
  • Giacomo Tognasso | Department of Psychology, University of Milano-Bicocca, Milan, Italy.
  • Livio Finos Department of Developmental Psychology and Socialisation, University of Padua, Italy.
  • Alessandra Santona Department of Psychology, University of Milano-Bicocca, Milan, Italy.


The goal of the present study is to explore the perception of the relationship with parental figures, traumatic experiences, personality traits and psychosocial characteristics of the participant sibling caregivers. The sample was composed of 30 sibling caregivers recruited at psychiatric facilities in Italy, and of 30 control siblings. The battery of instruments administered included Parental Bonding Instrument (PBI), Minnesota Multiphasic Personality Inventory 2 (MMPI-2), and The Inventory of Traumatic Experiences (TEC). This research found that sibling caregivers of patients with severe psychiatric pathologies are distinctly different from the siblings of the control group with respect to the perception of their relationship with parental figures more frequently regarded as dysfunctional, and were also characterized by a higher presence of traumatic experiences. The problematic relationship with parental figures, some traumatic experiences, and the burden of taking care of a sibling with psychiatric disorders are probably important variables with regards to the individual’s overall psychological condition.



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Albus, M., & Maier, W. (1995). Lack of gender differences in age at onset in familial schizophrenia. Schizophrenia Research, 18: 51-57.

Amaresha, A.C., Venkatasubramanian, G., & Muralidahr, D. (2014). Needs of siblings of persons with psychosis: a systematic descriptive review. Clinical Psychopharmacoly and Neuroscience,12(2):111-23.

Appels, M. (2004). Elevated Level of schizotypal features in parents of patients with a family history of schizophrenia spectrum disorders. Schizophrenia Bulletin, 30(4): 781-790.

Arajärvi, R., Ukkola, J., Haukka, J., Suvisaari, J., Hintikka, J., Partonen, T., & Lönnqvist, J. (2006). Psychosis among "healthy" siblings of schizophrenia patients. BMC Psychiatry Journal, 6(6). DOI:

Argyropoulos, S.V, Landau, S., Kalidindi, S., Toulopoulou, T., Castle, D.J.,Murray, R.M., & Picchioni, M.M. (2008). Twins discordant for schizophrenia: psychopathology of the non-schizophrenic co-twins. Acta Psychiatrica Scandinava, 118(3): 214-9.

Awad, A.G., & Voruganti, L.N. (2008). The burden of schizophrenia on caregivers: a review. PharmacoEconomics, 26(2): 149-62.

Bandura, A. (1982). Psychology of chance encounters and life paths. American Psychologist, 37: 747-755.

Barak, D., & Solomon, Z. (2005). In the shadow of schizophrenia: a study of siblings’ perceptions. Israel Journal of Psychiatry and Related Sciences 2005, 42(4):234-41.

Bonaiuto, M., Parrucchini, P., & Pierro, A. (1997). L’adolescente e i membri significativi della sua rete sociale. Qualità delle relazioni interpersonali. Età Evolutiva, 57: 40-56.

Bonanno, G. (2004). Loss, trauma and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1): 20-28. DOI:

Calati, R., Oasi, O., De Ronchi, D., & Serretti, A. (2010). The use of the defence style questionnaire in major depressive and panic disorders: A comprehensive meta-analysis. Psychology and Psychotherapy: Theory, Research and Practice, 83: 1-13.

Caqueo-Urízar, A., Gutiérrez-Maldonado, J., & Miranda-Castillo, C. (2009). Quality of life in caregivers of patients with schizophrenia: a literature review. Health Quality Life Outcomes, 11(7): 84.

Carli, L. L., Anzelmo, E., Pozzi, S., Feeney, J., Gallucci, M., Santona, A., & Tagini, A. (2019). Attachment Network Structure in Committed Couples. Frontiers in psychology, 10, 1105. DOI:

Cassidy, J. (1994). Emotion regulation: Influences of attachment relationships. In N.A. Fox (Ed.), The development of emotion regulation: Biological and behavioral considerations. Monographs of the Society for Research in Child Development, 59. (Serial No. 240).

Coles, P. (2003). The Importance of Sibling Relationships in psychoanalysis. London: Karnac Book.

Dixon, L., Lyles, A., & Scott, J. (1999). Services to families of adults with schizophrenia: from treatment recommendations to dissemination. Psychiatric Services, 50: 233–238.

Dunn, J., & Plomin, R. (1996). Sibling Relationships: Their Causes and Consequences. Westport CT: Praeger.

Eagly, AH, & Chaiken, S (1993): The psychology of attitudes. Orlando, FL: College Publishers.

Finos, L. (2014). flip: Multivariate Permutation Tests. R package version 2.4. 3.

Fortunato Pesarin (2001) Multivariate Permutation Tests : With Applications in Biostatistics. Wiley, Chichester.

Friedrich, R.M., Lively, S., & Buckwalter, K.C. (1999). Well siblings living with schizophrenia. Impact of associated behaviours. Journal of Psychosocial Nursing and Mental Health Services, 37: 11-19.

Gerace, L., M., Camilleri, D., & Ayres, L. (1993). Sibling Perspectives on Schizophrenia and the Family. Schizophrenia Bulletin; 19(3): 637-647.

Gilbert, P., Allan, S., & Goss, K. (1996). Parental representations, shame, interpersonal problems, and vulnerability to psychopathology. Clinical Psychology and Psychotherapy; 3(1): 23-34 DOI:<23::AID-CPP66>3.0.CO;2-O

Glozman, J.M. (2004). Quality of life of caregivers. Neuropsychology Review, 14: 183-96.

Grandón, P., Jenaro, C., & Lemos, S. (2008). Primary Caregivers of Schizophrenia Outpatients: Burden and Predictor Variables. Psychiatry Research; 158(3): 335-43.

Greenberg, J.S., Seltzer, M.M., & Orsmond, G.I. (1999). Siblings of adults with mental illness or mental retardation: current involvement and expectation of future caregiving. Psychiatric Services, 50: 1214–1219.

Hatfield, A.B., & Lefley, H.P. (2005). Future involvement of siblings in the lives of persons with mental illness. Community Mental Health Journal, 41: 327–338.

Hathaway, S.R., & McKinley, J.C. (1995). MMPI-2. Minnesota Multiphasic Personality Inventory-2 (Adattamento Italiano di Paolo Pancheri e Saulo Sirigatti). Firenze: Giunti O.S.

Horwitz, A.V. (1994). Predictors of adult sibling social support for the seriously mentally ill, Journal of Family Issues, 15: 272-289. DOI:

Horwitz, A.V., Reinhard, S.C., & Howell-White, S. (1996). Caregiving as reciprocal exchange in families with seriously mentally ill members. Journal of Health and Social Behavior, 37: 149-162.

Horwitz, A.V., Tessler, R.C., & Fisher, G.A. (1992). The role of adult siblings in providing social support to the severely mentally ill. Journal of Marriage and Family, 54: 233–241.

Kallert, T.W., & Nitsche, I. (2008). Assessing the opinions of relatives on the causes and social consequences of different mental disorders: are instruments cross-culturally valid?. Psychiatry Research, 158(3): 344-55.

Kendler, K.S.(1996). Parenting: A genetic-epidemiologic perspective. The American Journal of Psychiatry, 153: 11-20.

Kendler, K.S., McGuire, M., Gruenberg, A.M., O'Hare, A., Spellman, M., & Walsh, D. (1993). The Roscommon Family Study. IV. Affective illness, anxiety disorders, and alcoholism in relatives. Archives of General Psychiatry, 50(12): 952–960.

Kendler, K.S., Thacker, L., & Walsh, D. (1996). Self-report measures of schizotypy as indexes of familial vulnerability to schizophrenia. Schizophrenia Bulletin, 22(3): 511-520.

Maier, W., Lichtermann, D., Franke, P., Heun, R., Falkai, P., & Rietschel, M. (2002). The dichotomy of schizophrenia and affective disorders in extended pedigrees. Schizophrenia Research, 57(2–3): 259–266.

Marsh, D.T., Appleby, N.F., Dickens, R.M., Owens, M., & Young, N.O. (1993). Anguished voices: impact of mental illness on siblings and children. Innovations and Research, 2: 25–34.

Martens, L., & Addington, J. (2001). The psychological well-being of family members of individuals with schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 36(3): 128-133.

Nechmad, A., Fenning, S., Ternochiano, S., Treves, I., Fennig-Naisberg, S., & Levkovich, Y. (2000). Siblings of schizophrenic patients – a review. The Israel Journal of Psychiatry and Related Science, 37: 3-11.

Nijenhuis, E.R.S., Van der Hart, O., & Kruger, K. (2002). The psychometric characteristics of the traumatic experiences checklist (TEC): First findings among psychiatric outpatients. Clinical Psychology and Psychotherapy, 9: 200-210.

Parker, G., Tupling, H., & Brown, L.B. (1979). Parental Bonding Instrument. British Journal of Medical Psychology, 52: 1-10.

Provencher, E., & Fincham, F. (2000). Attributions of causality, responsibility and blame for positive and negative symptom behaviours in caregivers of persons with schizophrenia. Psychological Medicine, 30(4):899-910.

Pynoos, R.S., Steinberg, A.M., & Piacentini, J.C. (1999). A Developmental Psychopathology Model of Childhood Traumatic Stress and Intersection with Anxiety Disorders, Biological Psychiatry, 46: 1542-1554. DOI:

Rajji, T.K., Ismail, Z., & Mulsant, B.H. (2009). Age at onset and cognition in schizophrenia: meta-analysis. The British Journal of Psychiatry, 195(4): 286-93.

Reiss, D., & Oliveri, M.E. (1991). The family's conception of accountability and competence: A new approach to the conceptualization and assessment of family stress. Family Process, 30 (2): 193-214.

Reiss, D., Neiderhiser, J.H., Hetherington, E.M., & Plomin, R. (2000). The relationship code. Harvard: University Press.

Richieri, R., Boyer, L., Reine, G., Loundou, A., Auquier, P., Lançone, C., & Simeoni, M.C. (2011). The Schizophrenia Caregiver Quality of Life questionnaire (S-CGQoL): Development and validation of an instrument to measure quality of life of caregivers of individuals with schizophrenia. Schizophrenia Research, 126: 192–201.

Roncone, R., Mazza, M., Ussorio, D., & Pollice, R. (2007). The questionnaire of family functioning: a preliminary validation of a standardized instrument to evaluate psychoeducational family treatments. Community Mental Health Journal, 43(6): 591-607.

Rutter, M. (1985). Resiliency in the face of adversity. Protective factors and resistance to psychiatric disorders. British Journal of Psychiatry, 147: 598-611.

Sander, L. (2007). Living Systems, Evolving Consciousness, and the Emerging Person: A Selection of Papers from the Life Work of Louis Sander. London: Routledge.

Santona, A., & Zavattini, G.C. (2005). Partnering and parenting expectations in adoptive couple. Sexual and Relationship Therapy, 20(3): 309-322.

Santona, A., De Cesare, P., Tognasso, G., De Franceschi, M., & Sciandra, A. (2019). The mediating role of romantic attachment in the relationship between attachment to parents and aggression. Frontiers in psychology, 10, 1824. DOI:

Sin J., Jordan C.D., Barley E.A., Henderson C., & Norman I. (2015). Psychoeducation for siblings of people with severe mental illness. Cochrane Database of Systematic Review, 8;(5). DOI:

Sin J., Murrells T., Spain D., Norman I., & Henderson C., (2016). Wellbeing, mental health knowledge and caregiving experiences of siblings of people with psychosis, compared to their peers and parents: an exploratory study. Social Psychiatry and Psychiatric Epidemiology; 51(9):1247-55.

Smith, J., Greenberg, J.S., & Seltzer, M.M. (2007). Siblings of Adults With Schizophrenia: Expectations About Future Caregiving Roles. American Journal of Orthopsychiatry, 77(1): 29–37.

Smith, M.J., & Greenberg, J.S. (2007). The effects of the quality of sibling relationships on the life satisfaction of adults with schizophrenia. Psychiatric Services, 58: 1222–1224.

Solari, A., Finos, L., & Goeman, J. J. (2014). Rotation-based multiple testing in the multivariate linear model. Biometrics, 70(4), 954-961. DOI:

Stalberg, G., Ekerwald, H., & Hultman, C.M. (2004). At issue: siblings of patients with schizophrenia: sibling bond, coping patterns, and fear of possible schizophrenia heredity. Schizophrenia Bulletin, 30: 445–458.

Taylor, V., Fuggle, P., & Charman, T. (2001). Well sibling psychological adjustment to chronic physical disorder in a sibling: How important is maternal awareness of their illness attitudes and perceptions?. Journal of Child Psychology and Psychiatric and Allied Discipline, 42: 953-962.

Team, R. C. (2013). R: A language and environment for statistical computing.

Tsuang, M.T., Stone, W.S., Tarbox, S.I., & Faraone, S.V. (2002). An integration of schizophrenia with schizotypy: Identification of schizotaxia and implications for research on treatment and prevention. Schizophrenia Research, 54(1-2): 169-175.

Van der Kolk, B.A., McFarlane, A.C., & Weisaeth, L. (2006). Traumatic stress: the effects of overwhelming experience on mind, body and society. New York: Guilford Press.

Van Os, J., Linscott, R.J., Myin-Germeys, I., Delespaul, P., & Krabbendam, L. (2009). A systematic review and meta-analysis of the psychosis continuum: Evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine, 39(2): 179-195.

Vu, V. Q. (2011). ggbiplot: A ggplot2 based biplot. R package version 0.55.

Westfall, P. H. & Young, S. S. (1993) Resampling-based multiple testing: examples and methods for p-value adjustment. Wiley, New York.

Wong, F.K.D., Lam, K.Y.A., Chan, K.S., & Chan, F.S. (2012). Quality of life of caregivers with relatives suffering from mental illness in Hong Kong: roles of caregiver characteristics, caregiving burdens, and satisfaction with psychiatric services. Health and Quality of Life Outcomes, 10: 15.

Xinjun, L., Sundquista, J., Hemminkia, K., & Sundquista, K. (2009). Familial Risks of Psychotic Disorders and Schizophrenia among Siblings Based on Hospitalizations in Sweden. Psychiatry Research, 166(1): 1–6.

Caregiver, Mental health, Parental relationship, Traumatic experiences, Personality characteristics
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How to Cite
Pierazzuoli, F., Gatti, E., Castelli, M. R., Primerano, G., Oasi, O., Tognasso, G., Finos, L., & Santona, A. (2020). Psychological factors of sibling caregivers of patients with severe mental disorders: an observational study. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(1).