Determinants of Stress and Stigma Among Caregivers of Psychiatric Patients: The Effect of a Video-Based Orientation Intervention and Feature Importance Analysis Using SVR
Phase: NA
Conditions: Family Members of Psychiatric Patients
Sponsor: Karadeniz Technical University

The Effect of a Video-Based Orientation Intervention and Feature Importance 
Analysis Using Support Vector Regression 
Method 
Study Design 
This study was designed as a randomized controlled experimental study to evaluate the 
effect of a video-based orientation training on stress and stigma levels among caregivers 
of psychiatric patients. Participants were randomly assigned to either the intervention 
group (receiving video training) or the control group (receiving routine care). 
Research Questions and Hypotheses 
This study aimed to address the following research questions: 
- Is video-based orientation training effective in reducing perceived stress levels among 
caregivers of psychiatric patients? 
- Is the intervention effective in reducing stigmatizing attitudes and beliefs toward 
psychiatric disorders? 
- What are the most important variables that determine perceived stress and stigma 
levels? 
Accordingly, the following hypotheses were tested: 
- H1: Video-supported orientation training reduces the perceived stress level of 
caregivers of psychiatric patients. 
- H2: Video-supported orientation training reduces stigmatizing attitudes and beliefs 
toward psychiatric disorders. 
- H3: Perceived stress and stigma levels are influenced by various factors such as the 
caregiver's demographic characteristics, psychiatric diagnoses, and the caregiving 
relationship. 
18.07.2025

Place and Time of the Study 
The study will be conducted between July 15 and September 30, 2025, in the closed 
psychiatric ward of a university hospital located in northeastern Türkiye. The psychiatric 
unit is a mixed-gender service with a capacity of 16 beds, structured to provide 
evaluation, treatment, and follow-up for patients with severe psychiatric symptoms. The 
unit is designed to support both acute intervention and stabilization, ensuring adequate 
safety and observation. It also organizes educational and social activities to enhance 
patients' insight, social skills, and adaptation to society. Psychosocial skills training is 
primarily provided by nurses in collaboration with occupational therapists. 
Study Population and Sample 
The study population consisted of relatives of patients admitted to the psychiatric unit 
between July and September 2023 (n=60). Sample size was determined using power 
analysis with the G*Power 3.1.9.7 software. Based on the perceived stress scale (PSS) 
mean scores reported in Zimmerman et al. (2023), the sample was calculated with a 5% 
type I error, 95% power, and an effect size of 0.924. Statistical analysis indicated that the 
study should include at least 56 participants (28 in each group). To account for potential 
data loss, 10% more participants were recruited, resulting in a total of 60 participants (30 
in each group). Inclusion criteria: first-degree relatives (parent, spouse, or child) of 
admitted patients, aged 18 or older, willing to participate, and having sufficient reading, 
writing, and verbal communication skills. Exclusion criteria included individuals with a 
psychiatric diagnosis, history of alcohol or substance use, dementia, or other organic 
mental disorders based on DSM-5. 
Randomization 
A total of 60 caregivers were randomly assigned to either the intervention or control 
group (30 each). Group assignment was carried out using the envelope method to prevent 
bias. Each envelope contained a note stating either "Intervention Group" or "Control 
Group" and was randomly selected by the participants themselves. 

Data Collection Tools 
Data were collected through face-to-face interviews using a researcher-developed 
questionnaire, the Perceived Stress Scale-14 (PSS-14), and the Parents’ Internalized 
Stigma of Mental Illness Scale (PISMI). 
Perceived Stress Scale (PSS-14) 
Developed by Cohen et al. (1983), this scale assesses perceived stress over the past 
month. The Turkish adaptation was done by Eskin et al. (2013). It includes 14 items rated 
on a 5-point Likert scale. Higher scores indicate higher levels of perceived stress. In the 
current study, Cronbach’s alpha was 0.91. 
Parents’ Internalized Stigma of Mental Illness Scale (PISMI) 
Developed by Boyd-Ritsher et al. (2003) and adapted to Turkish by Gül-Dikeç et al. 
(2019), this 29-item scale evaluates internalized stigma in parents of individuals with 
mental illness. It includes five subscales and uses a 4-point Likert scale. In this study, 
Cronbach’s alpha was 0.96. 
Procedure 
This randomized controlled trial was conducted in accordance with the CONSORT 
guidelines. The PSS-14 and PISMI were administered before (pre-test) and one week 
after (post-test) the video-based orientation intervention. The intervention included four 
45–60-minute video-supported sessions conducted in a suitable meeting room. Training 
was provided by a psychiatric nurse in collaboration with a psychiatric nursing associate 
professor. 
Control 
group 
participants 
received 
traditional 
verbal 
orientation. 
 
Session 
Content: 
1. Introduction to the research and psychiatric unit via video and Q&A. 
2. Explanation and discussion of stigma and personal caregiver experiences. 
3. Basic knowledge about psychiatric disorders, treatment, and caregiving. 
4. Understanding and coping with stigma, including influencing factors and family 
impact. 

Statistical Analysis 
Statistical analyses were performed using R version 4.5.0. Descriptive statistics were 
computed, and appropriate tests (t-tests, Mann-Whitney U, Wilcoxon signed-rank, Chi-
square, Fisher’s exact, Pearson correlation) were applied based on data characteristics. 
Relationships were visualized with heat maps. 
Support Vector Regression-Based Feature Importance Analysis 
Support Vector Regression (SVR) was used to identify clinical and sociodemographic 
predictors of PSS and PISMI scores. SVR is suitable for small, nonlinear, and high-
dimensional datasets common in psychiatry. Feature importance was evaluated using 
permutation-based analysis, with RMSE increases indicating variable contribution. 
Ethical Considerations 
Ethical approval was obtained from the Scientific Research Ethics Committee of 
Karadeniz Technical University (Date: , Number: ). Participants were informed about the 
study, and written consent was obtained, including permission to use demographic and 
scale data for research purposes.