STRESS AND PSYCHOLOGICAL WELL-BEING IN FAMILIES TREATING SCHIZOPHRENIA PATIENTS

Introduction: Schizophrenia is a severe mental disorder characterized by decreased cognitive function and skills in social relations, inability to carry out self-care, and fulfilling the need for daily activities. The problems that occur in schizophrenic patients do not only affect the patients themselves, but also the families who care for the patients. Families have a burden in caring for schizophrenic patients. Families who are caregivers are vulnerable to stress which can affect their role as family companions. Various adjustments that must be faced in their role as caregivers are often a separate stressor, especially for families who lack adaptive coping skills. So that adaptive coping is needed to deal with stress and improve the psychological well-being of families in caring for schizophrenic patients. This study aims to determine the description of stress and psychological well-being in families who care for schizophrenic patients. Method: This type of research is quantitative descriptive with a cross-sectional approach, carried out at the Kembaran I Purwokerto Health Center. The number of samples of families caring for schizophrenic patients was 30 using the total sampling technique. The research instrument was the Perceived Stress Scale (PSS) questionnaire consisting of 10 items and the Psychological Well-Being Scale (PWBS) consisting of 42 items. The analysis used is descriptive quantitative. Result: The results of this study showed that most of the families who cared for schizophrenia patients had moderate stress levels are 28 families (93.3%) and moderate levels of psychological well-being in 25 families (83.3%). Conclusion: Stressful conditions can affect the level of psychological well-being in families who care for schizophrenic patients. Psychoeducation is needed to help families choose appropriate coping strategies in dealing with stressors and improve their psychological well-being.


INTRODUCTION
Schizophrenia is a chronic disease, a severe and disabling brain disorder, which is characterized by chaotic thoughts, delusions, hallucinations, and strange behavior (J A Pardede, 2019). According to Rofail, et. all (2016), schizophrenia is a severe mental disorder that leads to a decrease in the daily functioning of sufferers. Schizophrenia sufferers experience a decrease in cognitive capacity and skills in social relations, and an inability to perform selfcare, and meet the need to serve themselves (Rofail, Regnault, le Scouiller, Lambert, & Zarit, 2016).
Every year the number of schizophrenic patients increases and it is still a world problem, including in Indonesia. According to WHO (2019) the prevalence of schizophrenia patients is 20 million people in the world. Schizophrenia in Indonesia in 2013 was 1.7% per 1,000 population and increased in 2018 to 7% per 1,000 population. The prevalence of schizophrenia mental disorder in Central Java Province is 9% of cases per mile (Riskesdas, 2018).
Symptoms in schizophrenia are divided into positive symptoms (delusions, hallucinations), negative symptoms (lack of speech, flat affect, low motivation, withdrawal, lack of social care), and cognitive or low attention and memory.
Schizophrenia disorder causes personality changes and social incompatibility so sufferers need the help of others, especially family members as caregivers. Caregivers are defined as individuals who have primary responsibility for managing the welfare of other individuals who are diagnosed with certain physical illnesses or mental disorders in the capacity of unpaid individuals (Rofail et al., 2016).
Some of the problems experienced by caregivers with patients with severe mental disorders are increased family stress and anxiety due to the burden of care (Mubin & Andriani, 2017). Rofail et al. (2016) explained that the burden of caregivers with schizophrenia is related to various dimensions of caregiver life (social, physiological, behavioral, functional, mental, medical, and financial). The burden borne by caregivers with mental disorders raises psychological stress, which has an impact on the psychological well-being of caregivers (Apriliyani, Sugiarti, & Rahmawati, 2022;Mohammed & Ghaith, 2018). Stress is a condition of tension due to human interaction with work that affects emotions, thinking processes, and the ability to respond to an external demand compulsorily (Dwidiyanti, Meidiana;Pamungkas, Yanuar F;Ningsih, 2017;Rahmawati, AN dan Putri, 2020;Utami, Putri;Wahyuni, 2017). The results of another study stated that caregivers who experienced stress in caring for mental patients were 78.3% of a total of 23 respondents (Rochmawati, Susanto, & Ediati, 2022). The more severe the illness experienced by family members, the higher the stress experienced by the caregiver, and this can have an impact on the psychological decline of the caregiver (Fitriana & Budiarto, 2021). According to Ryff (1995) psychological well-being is a condition in which individuals can accept their strengths and weaknesses as they are even though the conditions are very difficult when chronic/acute patients act as family caregivers, still have positive relationships with others, can direct their behavior, can sustainably develop their potential, able to control the environment, and realize their potential continuously (Tasema, 2018). In caring for schizophrenic patients, caregivers certainly need a lot of support from their closest people such as family and the surrounding environment as a preventive strategy to reduce stress and discomfort felt by caregivers. From the background described above, the authors raised the research title "Stress and Psychological Well-being in Families Caring for Schizophrenia Patients".

METHOD
This type of research is quantitative descriptive research. The research design in this study is crosssectional, in which measurements and observations are carried out simultaneously at one time (one time). The population in this study were all 30 families who cared for schizophrenic patients in the working area of the Kembaran I Purwokerto Public Health Center, and 30 families were involved as samples using the total sampling technique. The research instrument used was the Perceived Stress Scale (PSS) questionnaire consisting of 10 items and the Psychological Well-Being Scale (PWBS) consisting of 42 items.. Table 2 illustrates that most of the research respondents had moderate levels of stress in some 28 families (93.3%).    Table 1 describes the characteristics of the respondents which include age, gender, education, occupation, and length of care. The results of this study revealed that 14 respondents (46.7%) were elderly. In general, the level of stress caused by the age factor occurs in adulthood compared to old age (Hilman Hermawan, Makaginsar, & Romadhona, 2022). Older individuals experience lower stress than younger ones because they have better experience in dealing with stress (Affandi & Ruhyana, 2017). The more mature a person ages, the way they adjust to life's problems will be better. The older a person is, the more they know the best conditions for him. Therefore, these individuals are also increasingly able to manage their environment to be the best according to their circumstances (Jannah, Haryanto, & Kartini, 2020).

DISCUSSION
Respondent characteristics in the form of gender were found to have a greater number of 16 female respondents. This is because at work women use more feelings, while men at work use reason and thoughts (Hilman Hermawan et al., 2022). Research conducted by Vellyana said that women experience stress more often than men, this is because women are more sensitive to their emotions, so they are more sensitive when experiencing stress (Vellyana, Lestari, & Rahmawati, 2017).
The education of the respondents in this study was mostly elementary school, with moderate levels of stress and psychological well-being. This shows that education can influence a person in using selfdefense mechanisms against a problem. The higher the level of education, the greater one's understanding of something, the higher the level of knowledge, the greater one's ability to absorb and receive information and have broader insights (Malau & Jannah, 2018). In addition, individuals who have a higher level of education will have more opportunities to learn to deal with problems in their lives so that they will be better able to use the environment to adapt to their problems (Jannah et al., 2020).
The work of the respondents in this study was mostly other, such as laborers, housemaids, and laundresses. Research on work relationships and stress levels conducted by Arif said that there was a relationship between work and the stress level of the respondents (Arif, Malaka, & Novrikasari, 2021). Based on research by Kate, et.al., (2013, p.386) work has an impact on caregiver stress levels. This can be caused by the increasing roles and tasks of caregivers while the coping skills they have remain so that an imbalance occurs.
Most of the families caring for schizophrenic patients are more than 10 years old. This shows that schizophrenic patients need long-term care at home. This is what makes the family burdened in caring for schizophrenic patients where the family will be disturbed in their activities, time is wasted caring for them, burdened their minds, and also burdened in the economy. This is corroborated by the results of a study by Pardede, JA et al which showed a relationship between the length of outpatient treatment of schizophrenia patients and the level of family stress at the Polyclinic of Prof. Mental Hospital. Dr. M. Ildrem Medan (Jek Amidos Pardede & Hasibuan, 2020). Darwin's research says that families who care for patients for more than one hour per day have high levels of stress (Darwin, Hadisukanto, & Elvira, 2013). Caring for schizophrenic patients requires patience because it lasts for a long time and is a chronic disease. Family members providing care spend more time caring for sick family members than caring for themselves. Table 2 illustrates that most of the research respondents had moderate levels of stress in some 28 families (93.3%). Research conducted by Dwi Heppy R, et al in 2022 is in accordance with the results of this study, which shows that as many as 60% of caregivers who care for schizophrenics experience stress, ranging from mild stress 11.8%, moderate stress 28.2%, severe stress 10 .9% and very severe stress 9.1% (Rochmawati et al., 2022). Stress is the body's reaction or response to the environment that can protect itself and is a natural self-defense mechanism or a natural self-rescue process to survive. Generally, the patient's family spends most of their time caring for the patient, providing support, and checking on medications and other aspects of the patient's daily life. Stress affects the ability to carry out daily activities, but stress can also be caused by one's daily activities (Malau & Jannah, 2018;Mubin & Andriani, 2017;Rochmawati et al., 2022). Research on stress and schizophrenia treatment shows that caregivers of schizophrenia experience stress related to the burden (mental, social and financial burden) they feel (Suryaningrum & Wardani, 2013). This is supported by Falloon (1986) Families feel stress as a natural thing because caring for schizophrenic patients takes a lot of time and disturbs their minds because they care for them every day. So it is also necessary to provide health education to families so that families can care for schizophrenia patients properly and no more severe stress occurs.

CONCLUSION
Schizophrenia is a mental health condition that requires the help of other people in meeting their basic needs. The family is the closest person who can help meet their basic needs. Various forms of treatment are carried out by the family so that schizophrenia patients can live their daily lives. Families who care for schizophrenic patients are not free from stressors during treatment. This study shows that most families who care for schizophrenic patients have moderate levels of stress and their psychological well-being is in the moderate category. Psychoeducation is urgently needed to assist families in determining effective coping strategies while caring for family members with schizophrenia. Adaptive coping strategies will greatly assist families in dealing with the stress experienced so are expected to improve psychological well-being.