Self-blame attributions in relatives of people with recent-onset psychosis: associations with relatives’ distress and behavioural control

Objectives. There is evidence that self-blame is an important predictor of distress and depression in relatives of people with long-term psychosis, but there is limited research investigating the nature and correlates of self-blame in relatives of people with recent-onset psychosis. Self-blame motivates a tendency to engage with others and to repair wrongdoings; it might be that such cognitions also impact on relatives’ behaviours towards the patient. This study examined the association between selfblame and psychological distress, and tested the prediction that greater self-blame would be associated with more behavioural control attempts to patients in a sample of relatives of people with recent-onset psychosis.
Methods. Statements pertaining to self-blame and behavioural control were extracted and rated from 80 interviews with relatives, who also completed the General Health Questionnaire–28. Content analysis was used to examine the nature of self-blame attributions. Regression analyses were used to explore the links between self-blame attributions and distress, and between self-blame and behavioural control in this recent-onset population.
Results. Higher levels of self-blame were associated with more behavioural control attempts, and self-blame predicted relatives’ behavioural responses when adjusting for the contribution of control attributions. Self-blame was also linked with distress, but did not emerge as an independent predictor in multivariate analysis. Most relatives who blamed themselves did so for not overseeing their family member’s mental health problems properly or for perceiving themselves generally as poor carers.
Conclusions. This study extends findings related to self-blame to a population of relatives of people with recent-onset psychosis, and highlights the possible role of blaming cognitions in promoting interpersonal engagement through behavioural control.
Practitioner Points
Self-blaming beliefs were linked with increased distress in relatives of people with recent-onset psychosis;
Increased self-blame was associated with more behavioural control attempts;
Most relatives blamed themselves for not overseeing their family member’s
mental health problems properly, and for perceiving themselves generally as
poor carers.
The cross-sectional study design limits inferences about causality.

Keywords: Self-blame; Behavioural control; Attributions; Relatives; Psychosis.