Caregiver Burden and Health in Bipolar Disorder

Abstract

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 selfcare 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. Copyright Caring for a relative with bipolar disorder poses both objective burdens such as increased expenditure of time and money, and emotional burdens such as worry, tension, and grief (Chakrabarti and Gill, 2002;Fadden et al., 1987;Perlick et al., 1999;Reinares and Vieta, 2004). Perlick et al. (2001) found that 93% of caregivers of patients with bipolar disorder reported a moderate or higher degree of caregiving strain when their relative was admitted to a psychiatric facility, and that 70% continued to report moderate or higher burden 15 months later.In addition to its impact on quality of life, caregiving strain has been associated with compromised health and mental health among caregivers of patients with major affective and other chronic mental disorders. For example, caregivers who report high levels of caregiving strain also report experiencing poorer general health and a higher number of chronic medical conditions relative to the general population (Gallagher and Mechanic, 1996), as well as increased primary care visits (Perlick et al., 2005), more sleep problems (Perlick et al., 2007), greater use of psychotropic drugs such as tranquilizers and antidepressants (Dyck et al., 1999), and increased risk of medical hospitalization (Gallagher and Mechanic, 1996). Finally, studies have shown that high levels of caregiving strain are associated with clinically significant levels of depressive symptoms (Coyne et al., 1987;Dyck et al., 1999;Struening et al., 1995).The causal links between caregiving strain, adverse health effects and increased service use have not been clearly elucidated. Studies have demonstrated an association between various forms of psychological stress and health complaints and/or use of primary care services (e.g., Katon, 1984;Olfson and Klerman, 1992;Salovey et al., 2000), and studies among caregivers have suggested that those who experience high levels of strain are low in coping self-efficacy or employ less effective coping strategies, whi...

Resilience in Family Members of Persons with Serious Mental Illness

“…24 They may perceive caregiving as burdensome or stressful, [25][26][27] and they report greater feelings of strain, 27 more stressful life events, 28 and greater disruption in family functioning. 27 Perlick and colleagues 25 found a high use of avoidance coping strategies by family members of persons with mental illness. Although avoidance coping may be a less-than-optimal method for coping, it is possible that this coping method may also be protective; thus, risk factors in one context may be protective in another.…”

“…51 In family caregivers, greater mastery has been associated with lower caregiver burden and psychological distress and a greater sense of competence in the caregiving role. 25,52 Five studies of family members of persons with mental illness have examined mastery, which may be viewed as an indicator of resilience. Murray-Swank and colleagues 22 studied 83 caregivers of persons with serious mental illness to examine whether religiosity was associated with psychosocial adjustment and caregiver burden.…”

Caregiver Burden and Coping in Schizophrenia and Bipolar Disorder: A Qualitative Study

“…Coping strategies include problem solving, support seeking, and avoidance (Scazufca & Kuipers, 1996, 1999Nehra, Chakrabarti, Kulhara, & Sharma, 2005). A positive correlation has been observed between caregiver burden and use of avoidance as a coping strategy (Chadda, Singh, & Ganguly, 2007;Perlick et al, 2008). A higher perception of burden has been reported to be associated with poor outcome in persons with BAD, the relationship probably being mediated through families' affective response and patients' medication adherence (Perlick et al, 2004(Perlick et al, , 2007.…”

Psychoeducation for Bipolar Mood Disorder

“…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.…”