Community Mental Health Journal (2020) 56:1262–1268

https://doi.org/10.1007/s10597-020-00581-z

ORIGINAL PAPER

Basic Family Relations, Parental Bonding, and Dyadic Adjustment in

Families with a Member with Psychosis
Mariona Roca1   · Anna Vilaregut1 · Carolina Palma1,2 · Francisco Javier Barón1,2 · Meritxell Campreciós1 ·
Laura Mercadal1

Received: 15 October 2018 / Accepted: 11 February 2020 / Published online: 21 February 2020
© Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
The aim of the current study is to describe and explore basic family relations, parental bonding, and dyadic adjustment in fam-
ilies with offspring diagnosed with a psychotic disorder. The sample was made up of 120 participants, 60 in the clinical group
(GCL) and 60 in the comparison group (GCP). All participants were assessed using the basic family relations evaluation
questionnaire (CERFB), the parental bonding instrument (PBI), and the dyadic adjustment scale (DAS). The results showed
differences between the clinical and comparison groups in terms of perceptions of basic family relations, dyadic adjustment
and parental bonding. The clinical group recorded less favorable results for all of these variables. More specifically, the study
observed significant differences between the groups in parental function, overprotection and caring. This study deepens our
understanding of how family assessment and relational diagnoses can serve as prevention and intervention tools for families
affected by a psychotic disorder.

Keywords  Dyadic adjustment · Marital functions · Parental bonding · Parental functions · Psychotic disorder · Relational
diagnosis

Introduction Research into psychosis has long paid a great deal of

attention to the variable of parental experiences, and a
Over the past decade, clinicians and theorists have shown an number of studies have gathered data on this variable
increasing interest in the role of the families of patients diag- using the Parental Bonding Instrument (PBI; Parker et al.
nosed with psychotic disorders. For example, a number of 1979). The results have shown that patients with psychotic
studies working in this vein have shown interest in the rela- disorders are more likely than non-clinical subjects to
tionships between the members of these families (Addington describe their parents (particularly their mothers) as less
et al. 2001; Brown et al. 1972; Caqueo-Urízar et al. 2017; caring and more overprotective (Ballús et al. 1991; Helge-
Leff et al. 1982; Onwumere et al. 2011). The World Health land and Torgersen 1997; Onstad et al. 1994; Parker et al.
Organization (2013) has even considered the potential ben- 1988; Willinger et al. 2002). Working along similar lines,
efits of involving family in the Mental Health Action Plan. other authors have observed that families with psychotic
members display greater levels of criticism, overprotec-
tion, double messages and disqualifying communication
* Mariona Roca
[email protected] (Palma et al. 2019), and that patients tend to label their
parents’ functioning as negative and to perceive difficul-
Anna Vilaregut
[email protected] ties in attachment with their parents (Gumley et al. 2014).
Meanwhile, other authors have focused on the quality of
Carolina Palma
[email protected] the marital functioning in these families. In general, mari-
tal partners in such families showed difficulties in dyadic
1
Facultat de Psicologia, Ciències de l’Educació i de l’Esport adjustment; less consensus and cohesion were observed
Blanquerna, Universitat Ramon Llull, 08022 Barcelona, in husbands; and less cohesion, satisfaction, and quality
Spain
of life were observed in wives (Espina et al. 2003). Addi-
2
Centro de Salud Mental de Adultos, Consorcio Sanitario del tionally, Linares (2012, 2019) showed that these families
Maresme, 08301 Barcelona, Spain

13
Vol:.(1234567890)

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Community Mental Health Journal (2020) 56:1262–1268 1263

tend to exhibit deteriorations in marital function, issues Method

that in turn affect parenting. Furthermore, poor conjugal
functioning has been found not to lend to itself a good Participants
prognosis for patients.
Elsewhere, the literature on the role of family in psy- A quasi-experimental design was implemented, using a
chosis has also emphasized the major impact of family comparison group selected by intentional non-probabilistic
stress, anxiety, and caregiver burden (Awad and Voruganti sampling. Forty families (120 participants) were included in
2008; Kate et al. 2014) and highlighted how these factors the study: 20 families in the clinical group (n = 60) and 20
affect quality of life and undermine family dynamics dur- families in the comparison group (n = 60).
ing everyday life (Baronet 2003; Hayes et al. 2015; Miller The inclusion criteria for the two groups were: (a) fami-
et al. 1986; Ribé et al. 2017). lies must be of Spanish heritage; (b) families must be living
In light of these findings, it is essential to incorporate together; (c) parents must take on parental roles; (d) families
interventions centered upon conjugal functioning as a must have common biological offspring over 11 years old;
complement to family intervention programs, since those and (e) patients must not have any offspring. Meanwhile, the
parents who show mutual support, the capacity for joint following criteria were used to select participants in the clini-
problem-solving in periods of stress and greater coping cal group: (a) families must have offspring diagnosed with a
skills tend to play a more positive role in the well-being of psychotic disorder according to the criteria of the Diagnostic
their offspring (Zemp et al. 2016). It is also worth noting and Statistical Manual of Mental Disorders (5th ed.; DSM-5;
that several authors have found gender differences in the American Psychiatric Association 2013); and (b) patients must
way mothers and fathers perceive their parental behavior, have exhibited clinical stability over the previous 3 months,
a fact which may be relevant and suggests that mothers according to the criteria of the Positive and Negative Syn-
and fathers should be assessed separately (Bersabé et al. drome Scale (PANSS; Kay et al. 1987, validated for use with
2001; Campreciós et al. 2014; Espina et al. 2003; Hidalgo the Spanish population by Peralta and Cuesta 1994).
and Menéndez 2003).
In summary, the results of most of the literature
reviewed focus on basic family relationships, parental Sample Description
bonding, and marital functions in people affected by psy-
chotic disorders. Despite this existing body of research, In the GCL, the average age of the offspring was 29.65
we found no prior studies evaluating marital and parental (SD = 7.15), while the age of the parents averaged 60.28
functions at the same time. In fact, there was even a lack (SD = 7.32). The couples had been married for 34.06 years on
of studies considering these two factors as independent average (SD = 6.95). In terms of clinical variables, 30% of the
variables but examining how they influence one another. patients had been diagnosed with a brief psychotic disorder,
45% with schizophrenia, 20% with schizoaffective disorder,
The Present Study and 5% with an unspecified psychotic disorder. The average
age of the first psychotic episode was 21.65 (SD = 4.6), treat-
The main objective of the current study is to describe and ment time was on average 9.1 years (SD = 6.95), and the aver-
explore basic family relationships, parental bonding, and age number of hospitalizations in a psychiatric unit was 4.1
dyadic adjustment of families with offspring diagnosed (SD = 3.11). In the GCP, the average age of offspring was 22.75
with a psychotic disorder and to compare these families (SD = 1.89), the average age of parents was 55.43 (SD = 5.56),
(clinical group; GCL) with a comparison group (GCP). and the average length of marriage was 29.6 years (SD = 6.33).
Additionally, the study will conduct a comparison based
on gender. To this end, the researchers posed the following
two hypotheses: Measures

1. The GCL will show lower levels of marital and paren- Basic Family Relations Evaluation Questionnaire (Ibáñez
tal functioning, high overprotection, low care, and et al. 2012)
lower levels of dyadic adjustment than the GCP.
2. A concordance will be observed between the couples’ The CERFB consists of 25 items answered using a Likert
relationship scores (dyadic adjustment and marital scale. It assesses marital and parental relations. The instru-
function) and their parental relationship scores (paren- ment consists of two scales: marital functioning (α = 0.91)
tal function and parental bonding). and parental functioning (α = 0.92). The scores for each are

13

Content courtesy of Springer Nature, terms of use apply. Rights reserved.


1264 Community Mental Health Journal (2020) 56:1262–1268

obtained from the sum of the items, indicating the degree of collected from the parents included the sociodemographic
marital and parental functionality, with higher scores indicat- and clinical questionnaires, the CERFB, the DAS, and the
ing greater functionality. PBI. In both groups, the patient block utilized the sociode-
mographic and clinical questionnaires and the PBI to answer
Parental Bonding Instrument (PBI) questions related to their parents.

The Parental Bonding Instrument (PBI) is a self-adminis- Data Analysis

tered instrument created by Parker et al. (1979) and adapted
to the Spanish population by Ballús-Creus (1991). It con- The sociodemographic and clinical data were analyzed
sists of 25 items that evaluate two dimensions of parenting, descriptively by member (father, mother, son/daughter),
yielding scores for the following scales: care (α = .88) and group and gender. A descriptive analysis was also conducted
overprotection (α = .74). for the CERFB variables (marital and parental functioning),
the PBI variables (care and overprotection) related to parents
Dyadic Adjustment Scale (DAS) and children, and the DAS variables (consensus, cohesion,
satisfaction, affectional expression, and total dyadic adjust-
The Dyadic Adjustment Scale (DAS) is a self-administered ment). The Mann–Whitney U test was used for intergroup
questionnaire created by Spanier (1976) and adapted to analysis to compare the means of the independent samples.
the Spanish population by Santos-Iglesias et al. (2009). It Finally, for the purpose of intragroup analysis of the vari-
consists of 32 items that measure the perceptions of dyadic ables, a correlation study was carried out using the Spear-
adjustment (α = .96) of both members of a couple. This man correlation coefficient. The results were analyzed with
instrument is divided into four subscales: consensus (agree- IBM SPSS software Statistics 22.
ment on tasks and values; α = .90), satisfaction (current state
of the relationship; α = .94), affectional expression (satis- Ethical Approval
faction with intimacy and sexuality; α = .96) and cohesion
(shared activities and interests; α = .86). The research presented in this article was approved by the
Clinical Research Ethics Committee of the Hospital de
Sociodemographic and Clinical Data Questionnaire Mataró with reference E04PRNG7B200-1023-001. The
purpose of the study was explained to the family members,
These two ad-hoc questionnaires were designed to collect and they were told that participation was voluntary. All par-
data on the families’ socio-demographic and clinical vari- ticipants involved in the study gave informed consent, and
ables. One questionnaire gathered information related to the participants’ anonymity has been preserved.
parents, including age, gender, marital status, education and
employment status. The other collected each patient’s age,
gender, education level, employment status, psychopatho- Results
logical diagnosis and current treatment regime.
As can be seen in Table 1, marital and parental functioning
Procedure were lower in the GCL than in the GCP, with a significant
difference between men in in terms of parental functioning.
Psychiatrists and psychologists from the outpatient psychi- With regard to the “care” variable, parents and children in
atric unit at the Hospital de Mataró selected families who the GCL recorded lower scores than those in the GCP. With
met the inclusion criteria for the clinical group. They then regard to overprotectiveness, parents from the GCL had
asked for their participation in the study and obtained signed lower scores than those in the GCP, who exhibited a more
consent. The comparison group was made up of 20 families, adaptive parental link. In contrast, patients from the GCL
chosen from a total sample of 175 families from a previ- perceived a higher degree of overprotectiveness of the part
ous study. The sociodemographic variables (age, gender of their fathers. In terms of mother/son and son/mother rela-
and place of residence) of the comparison group largely tionships, the perception of overprotectiveness was higher
matched those of the clinical group. The two groups were in the GCL than in the GCP. Finally, both men and women
comparable (p > 0.05) in terms of the age of the patients and in the GCL had lower scores than those in the GCP for the
their parents, gender composition, length of conjugal rela- DAS variables.
tionship, number of children, level of education and place As can be seen in Table 2, there were significant dif-
of residence. ferences between the scores for the variables of care and
Data collection was carried out through interviews with overprotectiveness for fathers and those for children, evi-
the family and by administering questionnaires. The data dence of discordance between the perceptions of these

13

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Community Mental Health Journal (2020) 56:1262–1268 1265

Table 1  Descriptive analyses Variable GCL (nfamilies = 20) GCP (nfamilies = 20) U p

for variables according to the (ntotal = 60) (ntotal = 60)
parental bonding instrument,
PBI Dyadic Adjustment Scale, M DT M DT
DAS basic family relations
evaluation questionnaire, PBI
CERFB) and comparative  Care
analysis between the clinical   Father–child 24.8 6.13 25.6 6.32  − .556 .57
group (GCL) and the
comparison group (GCP)   Mother–child 25.7 4.9 27.55 6.05  − 1.12 .26
  Child–father 21.05 6.04 25.15 6.99  − 2.3 .02*
  Child–mother 24.6 7.16 29.95 4.85  − 2.38 .01*
 Overprotection
  Father–child 8.6 5.81 8.75 3.97  − 0.461 .64
  Mother–child 10.2 6.44 7.5 3.92  − 1.34 .16
  Child–father 13.25 7.23 7.75 6.01  − 2.46 .01*
  Child–mother 13.05 6.11 9 6.11  − 1.86 .06
DAS
 Consensus
  Men 50.55 10.74 52.65 5.3 194 .87
  Women 47.6 13.6 49.25 9.29 197.5 .94
 Cohesion
  Men 16.3 5.06 18.3 4.19 158 .25
  Women 14.75 6.13 17.1 5.5 158.5 .26
 Satisfaction
  Men 40.20 7.53 41.9 5.54 182 .62
  Women 36.05 9.7 40.1 6.25 147 .15
 Affectional expression
  Men 8.6 3.39 9.35 1.78 197.5 .94
  Women 8.65 2.75 9.2 2.09 182 .62
 Total
  Men 115.65 21.67 122.2 14.11 172 .44
  Women 107.05 28.45 115.65 21.42 171.5 .44
CERFB
 Marital function
  Men 52.65 13.91 55.75 8.29  − .460 .64
  Women 51.4 10.85 51.9 10.85  − .054 .95
 Parental function
  Men 41.6 5.6 45.25 5.82  − 2.15 .03*
  Women 41.4 6.68 43.6 5.65  − 0.989 .32

*p > .05, **p ≥ .005, ***p ≥ .001

family members. In contrast, no statistically significant

Table 2  Parental bonding differences between father/patient and differences were observed between mothers and children.
mother/patient for the clinical group (GCL)
Father/mother differences in the GCP were calculated by
Child Fathers (n = 20) Mothers (n = 20) a comparison of means; the results did not show signifi-
(n = 20)
Care Overprotec- Care Overprotec- cant differences between parents in terms of basic family
tion tion relations (marital function U =  − .47, p = 0.63, parental
r (p) r (p) r (p) r (p) function (U =  − .07, p = 0.94), PBI (care U =  − .51, p = 0.6;
overprotection U =  − .89, p = 0.37), or dyadic adjustment
Care .509 (.022*) .114 (.63) .44 (.052) .082 (.73) (U =  − .85, p = 0.39).
Overprotec- .072 (.76) .609 (.004**) .104 (.66)  − .332 (.15) Table 3 shows the bivariate correlations between study
tion
variables in the GCL. Marital functioning (CERFB)
*p > .05, **p ≥ .005, ***p ≥ .001 showed a positive and significant correlation with parental

13

Content courtesy of Springer Nature, terms of use apply. Rights reserved.


1266 Community Mental Health Journal (2020) 56:1262–1268

Table 3  Bivariate correlations 1 2 3 4 5 6 7 8
between study variables
according to the parental CERFB
bonding instrument, PBI;
 1. Marital function − 
dyadic adjustment scale, DAS;
basic family relations evaluation  2. Parental function .45** − 
questionnaire, CERFB) in the PBI
clinical group (GCL)  3. Care .16 .43**  − 
 4. Overprotection  − .26  − .39*  − .09  − 
DAS
 5. Total 80** .51** .24  − .25  − 
 6. Consensus .65** .50** .30  − .18 .84**  − 
 7. Cohesion .58** .29 .04  − .12 .78** .52**  − 
 8. Satisfaction .83** .46** .13  − .30 .82** .58** .54**  − 
 9. Affectional expression .57** .51**  − .01  − .27 .56** .49** .27 .56**

*p > .05, **p ≥ .005, ***p ≥ .001

functioning (CERFB). This same effect was also observed Specifically, members of the clinical group were found to
in the DAS and all its subscales (consensus, cohesion, sat- be more overprotective and controlling and less likely to
isfaction, and affectional expression). Regarding parental encourage the independence and autonomy of their children.
functioning measured by the CERFB, results showed a sig- They also perceived themselves as less caring and more
nificant correlation with the PBI. It should be noted that emotionally distant and indifferent. Their offspring agreed,
parental functioning also presented a positive and significant as they also described their parents as less caring and more
correlation with the DAS and its subscales, with the excep- overprotective. However, they were more likely to perceive
tion of the cohesion subscale. All DAS variables showed higher levels of overprotection from their fathers. This result
a positive and significant correlation among them, except was not expected, because in general fathers tend to be less
for affectional expression and cohesion, which did not show overprotective and intrusive than mothers (Parker et  al.
such a correlation. 1988). More broadly, it should be noted that marital and
parental functioning can be affected by family stress and car-
egiver burden (Awad and Voruganti 2008; Kate et al. 2014),
Discussion affecting quality of life and family dynamics (Baronet 2003;
Hayes et al. 2015; Infurna et al. 2016; Ribé et al. 2017).
The findings confirm the first hypothesis of the study. The Finally, the results of the DAS show that parents in the
CERFB results indicate that parents of patients with psy- GCL reported a lower degree of dyadic adjustment with their
chotic disorders tend to perceive a greater degree of dete- partners than families in the non-clinical group. While the
rioration in their parental and marital function than parents differences found in this study did not reach the level of
without any offspring diagnosed with these pathologies. statistical significance, the scores for all the factors associ-
More specifically, men in the GCL perceived their parental ated with the quality of the marital relationship were lower
function as more deteriorated and closer to a dysfunctional in the GCL. At the same time, it is worth highlighting that
level, but fewer differences were found between the women our results are in concordance with Espina et al. (2003), who
in the two groups. The same effect was observed for marital also found that both men and women in clinical families tend
function. In other words, the differences between the clini- to perceive a lesser degree of cohesion with their partners,
cal and comparison groups were greater among men than and that women in these families tend to be less satisfied
women. Overall, these results suggest that these families with their marital relationships. These findings shed some
tend to display more dysfunctional relationships, a finding light on the impact of the spousal relationship on family
that echoes the results in the literature (Brown et al. 1972; dynamics, as a deteriorated marital relationship can affect
Linares 2012, 2019; Miller et al. 1986). the relations between parents and children (Linares 2012,
Meanwhile, the results obtained using the PBI are also 2019).
in agreement with those of prior studies. For example, With regard to the second hypothesis, we observed a con-
the parents in the GCL perceived their degree of parental cordance between the couples’ relationship scores recorded
bonding as more deteriorated than those in the comparison using the CERFB and those obtained via the DAS. There
group (Ballús et al. 1991; Helgeland and Torgersen 1997; was also consistency between the parental relationship
Onstad et al. 1994; Parker et al. 1988; Willinger et al. 2002). scores assessed by the CERFB and those collected via the

13

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Community Mental Health Journal (2020) 56:1262–1268 1267

PBI. It should be noted that parental function (as measured Government of Spain for the aid to R + D + i projects with reference
by the CERFB) showed a correlation with the scores for number PSI 2017-83146-R
marital functioning and with several subscales of the DAS.
These results suggest us that parental and marital functions
have similarities and influence each other, and that aspects References
involved in marital functioning influence parental function-
Addington, J., Addington, D., Jones, B., & Ko, T. (2001). Family inter-
ing, and vice versa. For this reason, health professionals and
vention in an early psychosis program. Psychiatric Rehabilitation
clinical researchers should involve marital and parental treat- Skills, 5(2), 272–286. https​://doi.org/10.1080/15487​76010​84154​
ment in psychotherapeutic measures (Caqueo-Urízar et al. 33.
2017; Espina et al. 2003; Palma et al. 2019). Awad, A. G., & Voruganti, L. N. P. (2008). The burden of Schizophre-
nia on caregivers. PharmacoEconomics, 26(2), 149–162. https​://
doi.org/10.2165/00019​053-20082​6020-00005​.
Limitations Ballús, C., Llovet, J. M., Boada, J. C., & Cabrero, L. J. (1991). La
Orientación terapéutica familiar en la esquizofrenia: Un modelo
psicoeducativo sistémico. Revista de Psiquiatría de la Facultad
The main limitation of the study was the difficulty in recruit-
de Medicina de Barcelona, 18(2), 71–78.
ing a sample. Firstly, in order to collect data on family rela- Ballús-Creus, C. (1991). Adaptación del parental bonding instrument.
tionships, researchers must persuade family members to Barcelona: Escuela Profesional de Psicología Clínica.
open themselves up and share intimate details about them- Baronet, A. M. (2003). The impact of family relations on caregiv-
ers’ positive and negative appraisal of their caretaking activi-
selves and their families, something they are not always will-
ties. Family Relations, 52(2), 137–142. https​://doi.org/10.111
ing to do. This is one reason why family assessment poses a 1/j.1741-3729.2003.00137​.x.
special challenge to researchers. A number of also failed to Bersabé, R., Fuentes, M. J., & Motrico, E. (2001). Análisis psicomé-
meet the inclusion criteria for the study because the parents trico de dos escalas para evaluar estilos educativos parentales.
Psicothema, 13(4), 678–684.
were separated.
Brown, G., Birley, J., & Wing, J. (1972). Influence of family life on the
course of Schizophrenic illness. British Journal of Preventive and
Conclusions and Implications for Practice: Future Social Medicine, 16(2), 55–68.
Campreciós, M., Vilaregut, A., Virgili, C., & Mercadal, L. (2014). Vali-
Directions dación y aplicabilidad clínica del Cuestionario de Evaluación de
las Relaciones Familiares Básicas (CERFB) en los trastornos de
In conclusion, the results confirmed the theoretical hypoth- la conducta alimentaria. Anuario de Psicología, 44(3), 311–326.
eses posed and are in accordance with most of the literature Caqueo-Urízar, A., Rus-Calafell, M., Craig, T. K. J., Irarrazaval, M.,
Urzúa, A., Boyer, L., et al. (2017). Schizophrenia: Impact on fam-
reviewed. Nonetheless, this study has taken a new approach ily dynamics. Current Psychiatry Reports. https:​ //doi.org/10.1007/
to family evaluation by assessing marital and parental func- s1192​0-017-0756-z.
tions at the same time. We are convinced that these func- Espina, A., Ortego, A., Ochoa de Alda, I., & González, P. (2003).
tions should be examined together, because family relations Dyadic adjustment in parents of schizophrenics. European
Psychiatry, 18(5), 233–240. https ​ : //doi.org/10.1016/S0924​
influence each member in a different way, affecting interac- -9338(03)00063​-4.
tions and family dynamics. Therefore, marital and parental Gumley, A. I., Taylor, H. E. F., Schwannauer, M., & MacBeth, A.
evaluations can shed essential light on relational and familial (2014). A systematic review of attachment and psychosis: Meas-
diagnoses. This information can have an impact on the pre- urement, construct validity and outcomes. Acta Psychiatrica Scan-
dinavica, 129(4), 257–274. https​://doi.org/10.1111/acps.12172​.
vention, assessment and treatment of psychotic disorders. Hayes, L., Hawthorne, G., Farhall, J., O’Hanlon, B., & Harvey, C.
For this reason, we would advocate taking the family as a (2015). Quality of life and social isolation among caregivers of
whole into account as a clinical variable when determin- adults with Schizophrenia: Policy and outcomes. Community
ing a treatment approach or a therapeutic plan. In the same Mental Health Journal, 51(5), 591–597. https​://doi.org/10.1007/
s1059​7-015-9848-6.
vein, we are working on the creation of a CERFB subscale Helgeland, M. I. W., & Torgersen, S. (1997). Maternal representa-
to evaluate co-parenting and separate or divorced parents’ tions of patients with schizophrenia as measured by the parental
relationships. With this tool, researchers and clinical pro- bonding instrument. Scandinavian Journal of Psychology, 38(1),
fessionals will be able to include new family modalities in 39–43.
Hidalgo, M. V., & Menéndez, S. (2003). La pareja ante la llegada de los
their assessment. In conclusion, the results allowed us to hijos e hijas Evolución de la relación conyugal durante el proceso
underline the importance of using family assessment instru- de convertirse en padre y madre. Infancia y Aprendizaje, 26(4),
ments to perform family evaluations and interventions. We 469–483. https​://doi.org/10.1174/02103​70033​22553​851.
believe these actions will directly lead to improvement in Ibáñez, N., Linares, J. L., Vilaregut, A., Virgili, C., & Campreciós, M.
(2012). Propiedades psicométricas del cuestionario de evaluación
both patients and their families, in line with current recom- de las relaciones familiares Básicas (CERFB). Psicothema, 24(3),
mendations in the mental health field. 489–494.
Infurna, M. R., Brunner, R., Holz, B., Parzer, P., Giannone, F., Reichl,
Acknowledgements  We would like to thank the State Research Agency C., et al. (2016). The specific role of childhood abuse, paren-
of the Ministry of Economy, Industry, and Competitiveness of the tal bonding, and family functioning in female adolescents with

13

Content courtesy of Springer Nature, terms of use apply. Rights reserved.


1268 Community Mental Health Journal (2020) 56:1262–1268

borderline personality disorder. Journal of Personality Disorders, Parker, G., Tupling, H., & Brown, L. B. (1979). Parental bonding
30(2), 177–192. https​://doi.org/10.1521/pedi_2015_29_186. instrument (PBI). British Journal of Medical Psychology, 52(1),
Kate, N., Grover, S., Kulhara, P., & Nehra, R. (2014). Relationship 1–10. https​://doi.org/10.1111/j.2044-8341.1979.tb024​87.x.
of quality of life with coping and burden in primary caregivers Peralta, V., & Cuesta, M. J. (1994). Psychometric properties of the
of patients with schizophrenia. International Journal of Social positive and negative syndrome scale (PANSS) in schizophrenia.
Psychiatry, 60(2), 107–116. https​://doi.org/10.1177/00207​64012​ Psychiatry Research, 53(1), 31–40.
46759​8. Ribé, J. M., Salamero, M., Pérez-Testor, C., Mercadal, J., Aguilera, C.,
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and nega- & Cleris, M. (2017). Quality of life in family caregivers of schizo-
tive syndrome scale (PANSS) for Schizophrenia. Schizophrenia phrenia patients in Spain: Caregiver characteristics, caregiving
Bulletin, 13(2), 261–276. burden, family functioning, and social and professional support.
Leff, J., Kuipers, L., Berkowitz, R., Eberlein-Fries, R., & Sturgeon, D. International Journal of Psychiatry in Clinical Practice. https​://
(1982). A controlled trial of social intervention in schizophrenia doi.org/10.1080/13651​501.2017.13605​00.
families. British Journal of Psychiatry, 141, 121–134. https​://doi. Santos-Iglesias, P., Vallejo-Medina, P., & Sierra, J. C. (2009). Propie-
org/10.1192/bjp.141.2.121. dades psicométricas de una versión breve de la Escala de Ajuste
Linares, J. L. (2012). Terapia familiar ultramoderna. Barcelona: Diádico en muestras españolas. International Journal of Clinical
Herder. and Health Psychology, 9(3), 501–517.
Linares, J. L. (2019). Terapia familiar de la psicosis. Entre la des- Spanier, G. B. (1976). Measuring dyadic adjustment: New scales
triangulación y la reconfirmación. San Sebastián de los Reyes: for assessing the quality of marriage and similar dyads. Jour-
Ediciones Morata. nal of Marriage and the Family, 38(1), 15–28. https​: //doi.
Miller, I. W., Kabacoff, R. I., Keitner, G. I., Epstein, N. B., & Bishop, org/10.2307/35054​7.
D. S. (1986). Family functioning in the families of psychiatric Willinger, U., Heiden, A. M., Meszaros, K., Formann, A. K., &
patients. Comprehensive Psychiatry, 27(4), 302–312. https​://doi. Aschauer, H. N. (2002). Maternal bonding behaviour in Schizo-
org/10.1016/0010-440X(86)90006​-4. phrenia and Schizoaffective disorder, considering premorbid per-
Onstad, S., Skre, I., Torgersen, S., & Kringlen, E. (1994). Family inter- sonality traits. Australian & New Zealand Journal of Psychiatry,
action: Parental representation in schizophrenic patients. Acta 36(5), 663–668.
Psychiatrica Scandinavica, 90, 67–70. World Health Organization. (2013). Mental health action plan 2013–
Onwumere, J., Bebbington, P., & Kuipers, E. (2011). Family inter- 2020. Retrieved March 11, 2017, from https:​ //www.who.int/menta​
ventions in early psychosis: Specificity and effectiveness. Epi- l_healt​h/actio​n_plan_2013/en/.
demiology and Psychiatric Sciences, 20(2), 113–119. https​://doi. Zemp, M., Bodenmann, G., Backes, S., Sutter-Stickel, D., & Revenson,
org/10.1017/S2045​79601​10001​87. T. A. (2016). The importance of parents’ dyadic coping for chil-
Palma, C., Gomis, O., Farriols, N., Frías, Á., Gregorio, M., Palacio, A., dren. Family Relations, 65(2), 275–286. https​://doi.org/10.1111/
et al. (2019). La Intervención familiar Domiciliaria en Psicosis: fare.12189​.
Análisis cualitativo de los cambios observados tras la Psicotera-
pia. Clínica y Salud, 30(3), 147–154. https:​ //doi.org/10.5093/clysa​ Publisher’s Note Springer Nature remains neutral with regard to
2019a​21. jurisdictional claims in published maps and institutional affiliations.
Parker, G., Johnston, P., & Hayward, L. (1988). Prediction of schizo-
phrenic relapse using the parental bonding instrument. The Aus-
tralian and New Zealand Journal of Psychiatry, 22(3), 283–292.
https​://doi.org/10.3109/00048​67880​91612​09.

13

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:

1. use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
2. use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
3. falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
4. use bots or other automated methods to access the content or redirect messages
5. override any security feature or exclusionary protocol; or
6. share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at

[email protected]