Caregiver Burden and Health in Bipolar Disorder

Department of Psychiatry, Mount Sinai School of Medicine, New York, New York 10019, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 06/2008; 196(6):484-91. DOI: 10.1097/NMD.0b013e3181773927
Source: PubMed


To identify caregivers at risk for adverse health effects associated with caregiving, the stress, coping, health and service use of 500 primary caregivers of patients with bipolar disorder were assessed at baseline, 6, and 12 months. K-means cluster analysis and ANOVA identified and characterized groups with differing baseline stress/coping profiles. Mixed effects models examined the effects of cluster, time, and covariates on health outcomes. Three groups were identified. Burdened caregivers had higher burden and avoidance coping levels, and lower mastery and social support than effective and stigmatized caregivers; stigmatized caregivers reported the highest perceived stigma (p < 0.05). Effective and stigmatized groups had better health outcomes and less service use than the burdened group over time; stigmatized caregivers had poorer self-care than effective caregivers. Cluster analysis is a promising method for identifying subgroups of caregivers with different stress and coping profiles associated with different health-related outcomes.

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Available from: Deborah Perlick, Nov 20, 2014
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    • "Although some caregivers see a positive side to caring, most experience some degree of burden due to illness-related problem behaviors (89% to 91.9% of caregivers), the disruptive effects of the illness on their work, social and leisure activities (61% to 82% of caregivers) and the person’s role dysfunction (52% to 65%) [6,14,15]. Highly burdened caregivers tend to neglect their basic self-care and risk depression and physical health problems that increases their reliance on health services [16]. Many people with bipolar disorder have commented on the valuable role close family or friends can play in helping them to manage their illness and maintain a good quality of life, but caregivers need information about ways to do this without jeopardizing their own health [17,18]. "
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    ABSTRACT: Bipolar disorder is associated with extreme mood symptoms, disability and suicide risk. Close family or friends often have a primary role in supporting an adult with bipolar disorder. However, not all support is helpful and there is little publicly accessible evidence-based information to guide caregivers. Caregiver burden increases the risk of caregiver depression and health problems. To help fill the information gap, expert clinicians, caregivers and consumers contributed to the development of guidelines for caregivers of adults with bipolar disorder using the Delphi consensus method. This paper reports on an evaluation of the acceptability and usefulness of the online version of the guidelines, Visitors to the website responded to an initial online survey about the usefulness of the information (N = 536). A more detailed follow-up feedback survey was emailed to webusers who were adult caregivers of adults with bipolar disorder a month later (N = 121). The feedback was analyzed quantitatively and qualitatively to establish user appraisals of the online information, whether and how caregivers applied the information and ways it could be improved. The majority of users (86.4% to 97.4%) found the various sections of the website useful. At follow-up, nearly 93% of caregivers reported that the information was relevant to them and 96% thought it would help others. Most respondents said that the information was supportive and encouraged adaptive control appraisals. However, a few respondents who were experiencing complex family problems, or who cared for a person with severe chronic bipolar disorder did not appraise it as positively. Nevertheless, over two-thirds of the caregivers reported using the information. Optional interactive features were recommended to maximize benefits. Overall, was appraised positively and used. It appears useful to close family and friends seeking basic information and reassurance, and may be an inexpensive way to disseminate guidelines for caregivers. Those who care for people with more severe and chronic bipolar disorder, or who have complex family problems might benefit from more specialized interventions, suggesting the importance of a stepped-care approach to supporting caregivers. The potential of evidence-based, collaboratively developed information websites to enhance caregiver and consumer outcomes merits further investigation.
    BMC Medicine 07/2013; 11(1):162. DOI:10.1186/1741-7015-11-162 · 7.25 Impact Factor
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    • "Research done by Dore and colleagues, focuses on the influence of relatives and family members on patient's occupation, financial and residential status, marital status, child care, social and even recreational activities. (Dore & Romans, 2001) It was found that burden of the disease on family members may affect outcome of the disease (Perlick et al., 2008). Several long term and short term programs have been designed for family members of patients. "

    Clinical, Research and Treatment Approaches to Affective Disorders, 02/2012; , ISBN: 978-953-51-0177-2
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    ABSTRACT: The burden experienced by caregivers of patients with bipolar disorder has been associated with increased caregiver depression, anxiety and mental health service use. As caregiver burden is also associated with poor patient outcome, these findings may indicate a source of distress not only for caregivers, but also for patients. This review presents what is currently known about psychiatric symptoms in this population and suggests directions for future research. Computerized databases Medline, Pubmed, PsychINFO and Google Scholar were searched using the keywords 'bipolar disorder', 'manic-depressive disorder', 'caregiver', 'caregiver burden', 'family', 'couple', 'spouse' and 'partner.' Of these, publications both measuring and reporting psychiatric symptoms or mental health service use in adult caregivers were included. Twenty four (24) papers were analyzed. Thirteen (13) of these papers measured general psychiatric distress, 2 measured anxiety symptoms, 9 reported mood symptoms and 8 reported increased mental health service use. 21 total papers reported clinical significance of least one category of psychiatric distress. Significant findings include up to 46% of caregivers reporting depression and up to 32.4% reporting mental health service use. Data suggest that caregiver psychiatric symptoms depend on the nature of the caregiving relationship. Common methodological problems included: lack of control groups, small sample sizes and non-standardized caregiver and patient criteria. While not all of the data are consistent, the majority of papers report the presence of psychiatric symptoms in caregivers, such as depression, anxiety and increased mental health service use. Future research is needed to address methodological issues and focus on distinguishing symptoms and identifying effects of mediators such as caregiver-patient relationship, coping styles and stigma. Interventions tailored towards the psychiatric needs of bipolar families may result in improved caregiver and patient outcomes, as well as in decreased health care costs.
    Journal of Affective Disorders 06/2009; 121(1-2):10-21. DOI:10.1016/j.jad.2009.04.020 · 3.38 Impact Factor
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