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Barbeito S, Vega P, Ruiz de Azúa S, González-Ortega I, Alberich S, González-Pinto A. Two-year evaluation of a multifamily psychoeducational program (PROTEC) in the family burden and prognosis of bipolar patients. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:225-234. [PMID: 34284154 DOI: 10.1016/j.rpsm.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bipolar disorder causes a significant burden on the lives of patients and their families. The family is one of the targets for therapeutic intervention, related to the prognosis in patients with bipolar disorder. AIM To assess the effectiveness of a multifamily psychoeducational program for people with bipolar disorder, in the family burden: objective and subjective and in the variables related to the course of the patients with bipolar disorder (symptoms, adherence, functionality, hospitalizations), comparing it with a control group (CG). MATERIALS AND METHODS A total of 148 relatives of bipolar patients and 148 bipolar patients were recruited. The sample was randomized (experimental group [EG] and CG) and with single-blind evaluations (baseline, at 5 months and one year). Clinical and sociodemographic variables were collected from families and patients (family burden self-report scale, Strauss-Carpenter Scale, Global Assessment of Functioning, Morisky Green adherence Scale). Both, EG and CG received 8 multifamily sessions, applied exclusively on the relatives of patients with bipolar disorder, but in the EG a psychoeducational treatment was carried out and in the CG only playful and current topics were discussed. Bivariate and logistic regression models were used, among others. RESULTS The caregivers and patients of the EG and CG did not differ in any of the baseline variables (sociodemographic and clinical) (P>.001). In the total sample, the baseline objective burden was light (mean 0.6±0.4) and the subjective ones was medium-moderate (mean 1.1±0.3). During the follow-up, in relation to the variables of the caregivers, there was a greater reduction in the objective burden in the EG compared to the CG (5 months P=.006; one year P=.002). It was found that the objective burden (P=.006) and the subjective burden (P=.003) were significantly reduced over a year in EG but not in the CG. During the follow-up, the patients whose caregivers belonged to the EG showed a greater increase in the frequency of social activity (P=.008), in the work activity (P=.002), and global functioning (P=.002), and reduced their symptoms (P≤.001). Longitudinal analyses, over a year, showed that patients in the EG had a greater improvement in functionality compared to patients in the CG (P=.001). After the intervention, adherence to pharmacological treatment improved more in EG than in the CG (P≤.001). Regarding hospitalizations, any patients in the CG were hospitalized during the 5 months after the intervention, while 27.8% of the patients in the CG were hospitalized (P≤.001); the difference between groups remained significant in the long term (one year: P≤.001; 2 years: P≤.001). There were no significant differences between groups in the pharmacological treatment of the patients in any of the evaluations. CONCLUSIONS The multifamily psychoeducational intervention group improved the family burden after the intervention. Likewise, bipolar patients, whose families attended the EG, improved significantly, over a year, the functionality, the frequency of social contacts, the work status, the adherence to treatment, and reduced their symptoms. In addition, in the EG, the percentage of hospitalizations during the 2 years of follow-up was significantly reduced.
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Affiliation(s)
- Sara Barbeito
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja (UNIR), Logroño, La Rioja, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) G10, Vitoria-Gasteiz, Álava, España.
| | - Patricia Vega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) G10, Vitoria-Gasteiz, Álava, España; Universidad del País Vasco, Leioa, Bizkaia, España; Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
| | | | - Itxaso González-Ortega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) G10, Vitoria-Gasteiz, Álava, España; Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
| | - Susana Alberich
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) G10, Vitoria-Gasteiz, Álava, España; Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) G10, Vitoria-Gasteiz, Álava, España; Universidad del País Vasco, Leioa, Bizkaia, España; Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
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van den Berg KC, Hendrickson AT, Hales SA, Voncken M, Keijsers GPJ. Comparing the effectiveness of imagery focussed cognitive therapy to group psychoeducation for patients with bipolar disorder: A randomised trial. J Affect Disord 2023; 320:691-700. [PMID: 36206888 DOI: 10.1016/j.jad.2022.09.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bipolar disorder is a severe, chronic mental disorder. Treatment options are limited, with pharmacological approaches continuing to dominate. However, relapse rates remain high. Several adjunctive psychosocial interventions, mostly psychoeducation (PE) and cognitive behavioural therapy (CBT), have been trialled, but treatment innovation is still needed. In the past, brief group PE has proven as beneficial as longer individual CBT in reducing levels of depression and increasing self-management strategies. We compared the relative effectiveness of group PE to an imagery focussed cognitive behavioural therapy (ImCT). STUDY DESIGN This was a randomised parallel group study with both daily and weekly measures. A total of 62 adult patients were randomly allocated to either ImCT or group PE. Daily, weekly and pre-and post-intervention measures were used to assess impact on (i) mood instability, (ii) overall levels of depression, anxiety and mania, and (iii) general functioning, hopelessness and imagery characteristics. A four-week baseline and 16-week follow-up period were included. RESULTS Mood instability reduced in both conditions after intervention. Levels of mania, depression and anxiety also reduced in both conditions, but on the daily measures, depression and anxiety significantly more so in the ImCT condition. Compared with the PE condition, the ImCT condition additionally showed increased level of functioning, reduced hopelessness, and a decrease in intrusive, problematic imagery. LIMITATIONS These findings need to be replicated in a larger trial. CONCLUSIONS Findings suggest that ImCT is a promising new avenue for management of bipolar disorder, an area in which treatment development is urgently needed.
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Affiliation(s)
- K C van den Berg
- Medical Psychiatric Research Group, Geestelijke Gezondheidszorg Eindhoven (GGzE), the Netherlands; Department of Clinical Psychological Sciences, Maastricht University, the Netherlands.
| | - A T Hendrickson
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, the Netherlands
| | - S A Hales
- Oxford Institute of Clinical Psychology Training, University of Oxford, UK; Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - M Voncken
- Department of Clinical Psychological Sciences, Maastricht University, the Netherlands
| | - G P J Keijsers
- Department of Clinical Psychological Sciences, Maastricht University, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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Shokrgozar S, Rouzbehan V, Zare R, Abdollahi E. Evaluation of patient social support, caregiver burden, and their relationship with the course of the disease in patients with bipolar disorder. Int J Soc Psychiatry 2022; 68:1815-1823. [PMID: 34881668 DOI: 10.1177/00207640211061984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bipolar disorder is a chronic disorder that causes significant effects on the patient and exerts a significant care burden on caregivers. This study aimed to investigate the social support of patients, caregivers' burden and their impact on the clinical course of the disease. METHODS The study included 85 patients with bipolar disorder type I and II (in the recovery phase of the disease) and their caregivers in the age range of 18 to 60 years. It was conducted in Shafa psychiatry Hospital in Rasht (Guilan, Iran, 2020). To assess social support and burden, patients and caregivers completed the Multidimensional Perceived Social Support Scale (MSPSS) and Caregiver Burden Inventory (CBI), respectively. Clinical variables were also obtained from patients' medical records; Then ANOVA, MANOVA, Independent T-test were used to compare the data and Regression Analysis and Spearman correlation coefficient were used to find the relationships between variables. RESULTS It was showed that increasing patient social support is associated with reducing caregiver burden. Among the clinical variables, less social support and more caregiver burden were associated with longer duration of illness (p < .0029, p < .012), decrease in last recurrence time (p < .0013, p < .0001), increased number of hospitalizations (p < .0001, r = -.43 and p < .0001, r = +.49), decreased response to treatment (p < .0001, p < .0001), and reduced follow-up (p = .001, OR = 1.12 and p = .001, OR = 0.95). CONCLUSION The relationship between low social support and high caregiver burden and their significant effect on the disease course indicates a vicious cycle that affects patients, caregivers, and the clinical course of the disease. Therefore, it seems that interventions to break this cycle can change the situation in favor of patients and caregivers and improve the clinical course of the disease.
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Affiliation(s)
- Somayeh Shokrgozar
- Department of Psychiatry, Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Vida Rouzbehan
- Department of Psychiatry, Shafa Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Roghayeh Zare
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Elahe Abdollahi
- Department of Psychiatry, Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Schramm E, Breuninger C, Zehender N, Hegerl U, Elsner A, Maun A, Schmölz M, Roick C, Grodd M, Graf E. An online program with individualized vs automated support for significant others of depressed individuals - study protocol of a randomized controlled trial. BMC Psychiatry 2022; 22:511. [PMID: 35902851 PMCID: PMC9331487 DOI: 10.1186/s12888-022-04035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/01/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Due to budget restrictions in mental health care, non-professional caregivers are increasingly burdened with the emotional and practical care for their depressed relatives. However, informal family caregiving is mostly a stressful role with negative consequences on the physical and mental health of the caretakers to the extent that they have an elevated risk of experiencing psychiatric disorders themselves. While psychoeducation for relatives of depressed individuals showed positive results both in terms of the caretakers' strain and the depressive symptoms of the affected person, there are major barriers to participate in presence in those programs. Digital programs might be a viable alternative. We found no empirically evaluated digital program available for informal caregivers of depressed patients. METHODS An online program for relatives of depressed individuals has been developed including four interactive modules on 1) psychoeducation, 2) how to strengthen the relationship with the depressed person, 3) how to deal with the depressive symptoms of the patient, and 4) find the right balance between caring for the depressed person and self-care. We investigate if this self-help program is more effective when used with individualized versus automated e-mail support, and if both supported conditions are more effective than treatment-as-usual (TAU in form of written information material) in terms of the risk of mental diseases in caregivers. The primary outcome is the reduction of the caregiver's nonspecific mental distress as measured by the change of the Kessler Psychological Distress Scale score from baseline to four weeks after randomization. Caregivers (n = 500:500:250) will be randomized to one of the three conditions. DISCUSSION Psychological support for caregivers of individuals with mental disorders such as depression should be offered as part of integrated services. There is a huge potential to develop and implement interactive online approaches to support informal caregivers of patients with depression to function in their multiple roles and to help them to remain healthy. TRIAL REGISTRATION DRKS, DRKS00025241 . Registered 5 Mai 2021.
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Affiliation(s)
- Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Christoph Breuninger
- grid.7708.80000 0000 9428 7911Department of Psychiatry and Psychotherapy, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nadine Zehender
- grid.7708.80000 0000 9428 7911Department of Psychiatry and Psychotherapy, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University Frankfurt (Distinguished Professorship Funded By Dr. Senckenbergische Stiftung), Frankfurt am Main, Germany ,grid.492161.90000 0004 8519 2872Stiftung Deutsche Depressionshilfe, Leipzig, Germany
| | - Anne Elsner
- grid.492161.90000 0004 8519 2872Stiftung Deutsche Depressionshilfe, Leipzig, Germany
| | - Andy Maun
- grid.7708.80000 0000 9428 7911Institute of General Practice / Family Medicine, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, Germany
| | - Marina Schmölz
- grid.7708.80000 0000 9428 7911Institute of General Practice / Family Medicine, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, Germany
| | - Christiane Roick
- grid.491710.a0000 0001 0339 5982AOK-Bundesverband, Berlin, Germany
| | - Marlon Grodd
- grid.5963.9Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erika Graf
- grid.5963.9Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Karambelas GJ, Filia K, Byrne LK, Allott KA, Jayasinghe A, Cotton SM. A systematic review comparing caregiver burden and psychological functioning in caregivers of individuals with schizophrenia spectrum disorders and bipolar disorders. BMC Psychiatry 2022; 22:422. [PMID: 35733174 PMCID: PMC9219207 DOI: 10.1186/s12888-022-04069-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Informal primary caregivers provide crucial supports to loved ones experiencing serious mental illnesses with profound outcomes for the caregivers themselves. A comprehensive understanding of how different serious mental illnesses change the caregiving experience may provide important insight into the ways in which caregivers can be better supported in their role. The aim of this review was to synthesize the comparative literature examining caregiver burden and psychological functioning (anxiety, depression, distress, and psychological wellbeing) between caregivers of people with schizophrenia spectrum disorders and bipolar disorder. METHODS Studies were included if they compared caregivers across both diagnostic groups and used measures assessing either caregiver burden or psychological functioning of caregivers. Databases searched up until 11th of January 2022 included: Medline COMPLETE, Embase, PsycINFO and CINAHL. Reference list scans and grey literature searches across government, organisational and dissertation databases were also conducted. RESULTS Twenty-eight studies comprising 6166 caregivers were included. Fourteen studies suggested that caregiving burden was comparable across both groups. The effects of caring on caregiver mental health and stress were comparable across both groups. However, methodological limitations were noted, including a reliance on cross-sectional studies, multiple and sometimes competing definitions of caregiving burden, variable sample sizes, and variation in measures used. CONCLUSION AND IMPLICATIONS The experience of providing care is multidimensional and complex. Symptoms and functional difficulties experienced by people being cared for may affect caregivers more so than diagnosis. Caregivers play a vital role in helping people with serious mental illness. Supporting caregivers by reducing their burden and improving their psychological functioning may help them to continue to provide support, and cope with, the challenges of providing care.
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Affiliation(s)
- George J. Karambelas
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia ,grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, Victoria Australia
| | - Kate Filia
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Linda K. Byrne
- grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, Victoria Australia
| | - Kelly A. Allott
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Anuradhi Jayasinghe
- grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, Victoria Australia
| | - Sue M. Cotton
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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6
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Ching CRK, Hibar DP, Gurholt TP, Nunes A, Thomopoulos SI, Abé C, Agartz I, Brouwer RM, Cannon DM, de Zwarte SMC, Eyler LT, Favre P, Hajek T, Haukvik UK, Houenou J, Landén M, Lett TA, McDonald C, Nabulsi L, Patel Y, Pauling ME, Paus T, Radua J, Soeiro‐de‐Souza MG, Tronchin G, van Haren NEM, Vieta E, Walter H, Zeng L, Alda M, Almeida J, Alnæs D, Alonso‐Lana S, Altimus C, Bauer M, Baune BT, Bearden CE, Bellani M, Benedetti F, Berk M, Bilderbeck AC, Blumberg HP, Bøen E, Bollettini I, del Mar Bonnin C, Brambilla P, Canales‐Rodríguez EJ, Caseras X, Dandash O, Dannlowski U, Delvecchio G, Díaz‐Zuluaga AM, Dima D, Duchesnay É, Elvsåshagen T, Fears SC, Frangou S, Fullerton JM, Glahn DC, Goikolea JM, Green MJ, Grotegerd D, Gruber O, Haarman BCM, Henry C, Howells FM, Ives‐Deliperi V, Jansen A, Kircher TTJ, Knöchel C, Kramer B, Lafer B, López‐Jaramillo C, Machado‐Vieira R, MacIntosh BJ, Melloni EMT, Mitchell PB, Nenadic I, Nery F, Nugent AC, Oertel V, Ophoff RA, Ota M, Overs BJ, Pham DL, Phillips ML, Pineda‐Zapata JA, Poletti S, Polosan M, Pomarol‐Clotet E, Pouchon A, Quidé Y, Rive MM, Roberts G, Ruhe HG, Salvador R, Sarró S, Satterthwaite TD, Schene AH, Sim K, Soares JC, Stäblein M, Stein DJ, Tamnes CK, Thomaidis GV, Upegui CV, Veltman DJ, Wessa M, Westlye LT, Whalley HC, Wolf DH, Wu M, Yatham LN, Zarate CA, Thompson PM, Andreassen OA. What we learn about bipolar disorder from large-scale neuroimaging: Findings and future directions from the ENIGMA Bipolar Disorder Working Group. Hum Brain Mapp 2022; 43:56-82. [PMID: 32725849 PMCID: PMC8675426 DOI: 10.1002/hbm.25098] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022] Open
Abstract
MRI-derived brain measures offer a link between genes, the environment and behavior and have been widely studied in bipolar disorder (BD). However, many neuroimaging studies of BD have been underpowered, leading to varied results and uncertainty regarding effects. The Enhancing Neuro Imaging Genetics through Meta-Analysis (ENIGMA) Bipolar Disorder Working Group was formed in 2012 to empower discoveries, generate consensus findings and inform future hypothesis-driven studies of BD. Through this effort, over 150 researchers from 20 countries and 55 institutions pool data and resources to produce the largest neuroimaging studies of BD ever conducted. The ENIGMA Bipolar Disorder Working Group applies standardized processing and analysis techniques to empower large-scale meta- and mega-analyses of multimodal brain MRI and improve the replicability of studies relating brain variation to clinical and genetic data. Initial BD Working Group studies reveal widespread patterns of lower cortical thickness, subcortical volume and disrupted white matter integrity associated with BD. Findings also include mapping brain alterations of common medications like lithium, symptom patterns and clinical risk profiles and have provided further insights into the pathophysiological mechanisms of BD. Here we discuss key findings from the BD working group, its ongoing projects and future directions for large-scale, collaborative studies of mental illness.
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Affiliation(s)
- Christopher R. K. Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Tiril P. Gurholt
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of OsloOsloNorway
- Division of Mental Health and Addicition, Oslo University HospitalOsloNorway
| | - Abraham Nunes
- Department of PsychiatryDalhousie UniversityHalifaxNova ScotiaCanada
- Faculty of Computer ScienceDalhousie UniversityHalifaxNova ScotiaCanada
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Christoph Abé
- Faculty of Computer ScienceDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of OsloOsloNorway
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- Center for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Rachel M. Brouwer
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Dara M. Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland
| | - Sonja M. C. de Zwarte
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Lisa T. Eyler
- Department of PsychiatryUniversity of CaliforniaLa JollaCaliforniaUSA
- Desert‐Pacific MIRECCVA San Diego HealthcareSan DiegoCaliforniaUSA
| | - Pauline Favre
- INSERM U955, team 15 “Translational Neuro‐Psychiatry”CréteilFrance
- Neurospin, CEA Paris‐Saclay, team UNIACTGif‐sur‐YvetteFrance
| | - Tomas Hajek
- Division of Mental Health and Addicition, Oslo University HospitalOsloNorway
- National Institute of Mental HealthKlecanyCzech Republic
| | - Unn K. Haukvik
- Division of Mental Health and Addicition, Oslo University HospitalOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT)Oslo University HospitalOsloNorway
| | - Josselin Houenou
- INSERM U955, team 15 “Translational Neuro‐Psychiatry”CréteilFrance
- Neurospin, CEA Paris‐Saclay, team UNIACTGif‐sur‐YvetteFrance
- APHPMondor University Hospitals, DMU IMPACTCréteilFrance
| | - Mikael Landén
- Department of Neuroscience and PhysiologyUniversity of GothenburgGothenburgSweden
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Tristram A. Lett
- Department for Psychiatry and PsychotherapyCharité Universitätsmedizin BerlinBerlinGermany
- Department of Neurology with Experimental NeurologyCharité Universitätsmedizin BerlinBerlinGermany
| | - Colm McDonald
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Leila Nabulsi
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Yash Patel
- Bloorview Research InstituteHolland Bloorview Kids Rehabilitation HospitalTorontoOntarioCanada
| | - Melissa E. Pauling
- Desert‐Pacific MIRECCVA San Diego HealthcareSan DiegoCaliforniaUSA
- INSERM U955, team 15 “Translational Neuro‐Psychiatry”CréteilFrance
| | - Tomas Paus
- Bloorview Research InstituteHolland Bloorview Kids Rehabilitation HospitalTorontoOntarioCanada
- Departments of Psychology and PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Joaquim Radua
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)BarcelonaSpain
- Early Psychosis: Interventions and Clinical‐detection (EPIC) lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Marcio G. Soeiro‐de‐Souza
- Mood Disorders Unit (GRUDA), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil
| | - Giulia Tronchin
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Neeltje E. M. van Haren
- Department of Child and Adolescent Psychiatry/PsychologyErasmus Medical CenterRotterdamThe Netherlands
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)BarcelonaSpain
- Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of NeurosciencesUniversity of BarcelonaBarcelonaSpain
| | - Henrik Walter
- Department for Psychiatry and PsychotherapyCharité Universitätsmedizin BerlinBerlinGermany
| | - Ling‐Li Zeng
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- College of Intelligence Science and TechnologyNational University of Defense TechnologyChangshaChina
| | - Martin Alda
- Division of Mental Health and Addicition, Oslo University HospitalOsloNorway
| | - Jorge Almeida
- Dell Medical SchoolThe University of Texas at AustinAustinTexasUSA
| | - Dag Alnæs
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of OsloOsloNorway
| | - Silvia Alonso‐Lana
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- CIBERSAMMadridSpain
| | - Cara Altimus
- Milken Institute Center for Strategic PhilanthropyWashingtonDistrict of ColumbiaUSA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical FacultyTechnische Universität DresdenDresdenGermany
| | - Bernhard T. Baune
- Department of PsychiatryUniversity of MünsterMünsterGermany
- Department of PsychiatryThe University of MelbourneMelbourneVictoriaAustralia
- The Florey Institute of Neuroscience and Mental HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human BehaviorUniversity of CaliforniaLos AngelesCaliforniaUSA
- Department of PsychologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Marcella Bellani
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Francesco Benedetti
- Vita‐Salute San Raffaele UniversityMilanItaly
- Division of Neuroscience, Psychiatry and Psychobiology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Michael Berk
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
- IMPACT Institute – The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon HealthDeakin UniversityGeelongVictoriaAustralia
| | - Amy C. Bilderbeck
- The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of MelbourneOrygenMelbourneVictoriaAustralia
- P1vital LtdWallingfordUK
| | | | - Erlend Bøen
- Mood Disorders Research ProgramYale School of MedicineNew HavenConnecticutUSA
| | - Irene Bollettini
- Division of Neuroscience, Psychiatry and Psychobiology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Caterina del Mar Bonnin
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)BarcelonaSpain
- Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of NeurosciencesUniversity of BarcelonaBarcelonaSpain
| | - Paolo Brambilla
- Psychosomatic and CL PsychiatryOslo University HospitalOsloNorway
- Department of Neurosciences and Mental HealthFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Erick J. Canales‐Rodríguez
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- CIBERSAMMadridSpain
- Department of RadiologyCentre Hospitalier Universitaire Vaudois (CHUV)LausanneSwitzerland
- Signal Processing Lab (LTS5), École Polytechnique Fédérale de LausanneLausanneSwitzerland
| | - Xavier Caseras
- MRC Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityCardiffUK
| | - Orwa Dandash
- Melbourne Neuropsychiatry Centre, Department of PsychiatryUniversity of Melbourne and Melbourne HealthMelbourneVictoriaAustralia
- Brain, Mind and Society Research Hub, Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityClaytonVictoriaAustralia
| | - Udo Dannlowski
- Department of PsychiatryUniversity of MünsterMünsterGermany
| | | | - Ana M. Díaz‐Zuluaga
- Research Group in Psychiatry GIPSI, Department of PsychiatryFaculty of Medicine, Universidad de AntioquiaMedellínColombia
| | - Danai Dima
- Department of Psychology, School of Social Sciences and ArtsCity, University of LondonLondonUK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | | | - Torbjørn Elvsåshagen
- Norwegian Centre for Mental Disorders Research (NORMENT)Oslo University HospitalOsloNorway
- Department of NeurologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Scott C. Fears
- Center for Neurobehavioral GeneticsLos AngelesCaliforniaUSA
- Greater Los Angeles Veterans AdministrationLos AngelesCaliforniaUSA
| | - Sophia Frangou
- Centre for Brain HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Janice M. Fullerton
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- School of Medical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - David C. Glahn
- Department of PsychiatryBoston Children's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Jose M. Goikolea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)BarcelonaSpain
- Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of NeurosciencesUniversity of BarcelonaBarcelonaSpain
| | - Melissa J. Green
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Oliver Gruber
- Department of General PsychiatryHeidelberg UniversityHeidelbergGermany
| | - Bartholomeus C. M. Haarman
- Department of Psychiatry, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Chantal Henry
- Department of PsychiatryService Hospitalo‐Universitaire, GHU Paris Psychiatrie & NeurosciencesParisFrance
- Université de ParisParisFrance
| | - Fleur M. Howells
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | | | - Andreas Jansen
- Core‐Facility Brainimaging, Faculty of MedicineUniversity of MarburgMarburgGermany
- Department of Psychiatry and PsychotherapyPhilipps‐University MarburgMarburgGermany
| | - Tilo T. J. Kircher
- Department of Psychiatry and PsychotherapyPhilipps‐University MarburgMarburgGermany
| | - Christian Knöchel
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyGoethe University FrankfurtFrankfurtGermany
| | - Bernd Kramer
- Department of General PsychiatryHeidelberg UniversityHeidelbergGermany
| | - Beny Lafer
- Laboratory of Psychiatric Neuroimaging (LIM‐21), Departamento e Instituto de PsiquiatriaHospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São PauloSão PauloSPBrazil
| | - Carlos López‐Jaramillo
- Research Group in Psychiatry GIPSI, Department of PsychiatryFaculty of Medicine, Universidad de AntioquiaMedellínColombia
- Mood Disorders ProgramHospital Universitario Trastorno del ÁnimoMedellínColombia
| | - Rodrigo Machado‐Vieira
- Experimental Therapeutics and Molecular Pathophysiology Program, Department of PsychiatryUTHealth, University of TexasHoustonTexasUSA
| | - Bradley J. MacIntosh
- Hurvitz Brain SciencesSunnybrook Research InstituteTorontoOntarioCanada
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
| | - Elisa M. T. Melloni
- Vita‐Salute San Raffaele UniversityMilanItaly
- Division of Neuroscience, Psychiatry and Psychobiology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Philip B. Mitchell
- School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | - Igor Nenadic
- Department of Psychiatry and PsychotherapyPhilipps‐University MarburgMarburgGermany
| | - Fabiano Nery
- University of CincinnatiCincinnatiOhioUSA
- Universidade de São PauloSão PauloSPBrazil
| | | | - Viola Oertel
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyGoethe University FrankfurtFrankfurtGermany
| | - Roel A. Ophoff
- UCLA Center for Neurobehavioral GeneticsLos AngelesCaliforniaUSA
- Department of PsychiatryErasmus Medical Center, Erasmus UniversityRotterdamThe Netherlands
| | - Miho Ota
- Department of Mental Disorder ResearchNational Institute of Neuroscience, National Center of Neurology and PsychiatryTokyoJapan
| | | | - Daniel L. Pham
- Milken Institute Center for Strategic PhilanthropyWashingtonDistrict of ColumbiaUSA
| | - Mary L. Phillips
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Sara Poletti
- Vita‐Salute San Raffaele UniversityMilanItaly
- Division of Neuroscience, Psychiatry and Psychobiology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Mircea Polosan
- University of Grenoble AlpesCHU Grenoble AlpesGrenobleFrance
- INSERM U1216 ‐ Grenoble Institut des NeurosciencesLa TroncheFrance
| | - Edith Pomarol‐Clotet
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- CIBERSAMMadridSpain
| | - Arnaud Pouchon
- University of Grenoble AlpesCHU Grenoble AlpesGrenobleFrance
| | - Yann Quidé
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | - Maria M. Rive
- Department of PsychiatryAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Gloria Roberts
- School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | - Henricus G. Ruhe
- Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands
- Donders Institute for Brain, Cognition and BehaviorRadboud UniversityNijmegenThe Netherlands
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- CIBERSAMMadridSpain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- CIBERSAMMadridSpain
| | - Theodore D. Satterthwaite
- Department of PsychiatryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Aart H. Schene
- Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands
| | - Kang Sim
- West Region, Institute of Mental HealthSingaporeSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Jair C. Soares
- Center of Excellent on Mood DisordersUTHealth HoustonHoustonTexasUSA
- Department of Psychiatry and Behavioral SciencesUTHealth HoustonHoustonTexasUSA
| | - Michael Stäblein
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyGoethe University FrankfurtFrankfurtGermany
| | - Dan J. Stein
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
- SAMRC Unit on Risk & Resilience in Mental DisordersUniversity of Cape TownCape TownSouth Africa
| | - Christian K. Tamnes
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of OsloOsloNorway
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- PROMENTA Research Center, Department of PsychologyUniversity of OsloOsloNorway
| | - Georgios V. Thomaidis
- Papanikolaou General HospitalThessalonikiGreece
- Laboratory of Mechanics and MaterialsSchool of Engineering, Aristotle UniversityThessalonikiGreece
| | - Cristian Vargas Upegui
- Research Group in Psychiatry GIPSI, Department of PsychiatryFaculty of Medicine, Universidad de AntioquiaMedellínColombia
| | - Dick J. Veltman
- Department of PsychiatryAmsterdam UMCAmsterdamThe Netherlands
| | - Michèle Wessa
- Department of Neuropsychology and Clinical PsychologyJohannes Gutenberg‐University MainzMainzGermany
| | - Lars T. Westlye
- Department of PsychologyUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Department of Mental Health and AddictionOslo University HospitalOsloNorway
| | | | - Daniel H. Wolf
- Department of PsychiatryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Mon‐Ju Wu
- Department of Psychiatry and Behavioral SciencesUTHealth HoustonHoustonTexasUSA
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Carlos A. Zarate
- Chief Experimental Therapeutics & Pathophysiology BranchBethesdaMarylandUSA
- Intramural Research ProgramNational Institute of Mental HealthBethesdaMarylandUSA
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Ole A. Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of OsloOsloNorway
- Division of Mental Health and Addicition, Oslo University HospitalOsloNorway
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7
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Zhang B, Conner KO, Meng H, Tu N, Liu D, Chen Y. Social support and quality of life among rural family caregivers of persons with severe mental illness in Sichuan Province, China: mediating roles of care burden and loneliness. Qual Life Res 2021; 30:1881-1890. [PMID: 33646478 DOI: 10.1007/s11136-021-02793-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the relationship between social support and quality of life (QoL) among family caregivers of persons with severe mental illness (SMI) and examine the mediating roles of care burden and loneliness. METHODS A cross-sectional study was carried out between December 2017 and May 2018. A random sample of 256 family caregivers of persons with SMI in rural areas of Sichuan Province, China was recruited for participation. Survey data on socio-demographics, social support, care burden, loneliness, and QoL were collected via in-person interviews. Multiple linear regression analysis and structural equation modeling (SEM) were used to test the hypothesized relationships. RESULTS The majority (72.7%) of family caregivers of persons with SMI in this study reported having low QoL. Social support was positively associated with QoL and negatively associated with care burden and loneliness. The findings suggested the mediating roles of care burden and loneliness on the association between social support and QoL. CONCLUSION The hypothesized model was found to be a suitable model for predicting QoL among family caregivers of persons with SMI. The findings can help inform the design of future interventions aimed at enhancing social support, reducing care burden and loneliness, which may be helpful to improve caregivers' QoL. Future study is required to find a causal path to promote QoL among family caregivers of persons with SMI.
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Affiliation(s)
- Baiyang Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Kyaien O Conner
- Department of Mental Health Law & Policy, College of Behavioral & Community Sciences, University of South Florida, Tampa, FL, USA
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, FL, USA
| | - Naidan Tu
- Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, USA
| | - Danping Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| | - Yeli Chen
- Department of Hospital Management, West China Hospital, Sichuan University, Chengdu, China.
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8
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Altınay Kırlı E, Türk Ş, Kırlı S. The Burden of Urinary Incontinence on Caregivers and Evaluation of Its Impact on Their Emotional Status. ALPHA PSYCHIATRY 2021; 22:43-48. [PMID: 36426208 PMCID: PMC9590664 DOI: 10.5455/apd.119660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/27/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to evaluate caregivers of children with urinary incontinence in terms of the caregiving burden and its associated manifestations. METHODS Caregivers of children who are being treated for urinary incontinence secondary to neurogenic and non-neurogenic lower urinary tract dysfunction (LUTD) were evaluated for caregiver burden (Zarit score), depression (Beck Depression Inventory [BDI]), and anxiety (Beck Anxiety Inventory [BAI]). Additionally, children were evaluated for dysfunctional voiding score. All scores were statistically analyzed for correlation with and relation to the caregiver's emotional status. RESULTS Zarit score was equal in caregivers of children with neurogenic and non-neurogenic LUTD. BDI score was higher in caregivers of patients with neurogenic LUTD, whereas BAI score was higher in caregivers of patients with non-neurogenic LUTD. In the evaluation performed, considering the etiological difference, Zarit score in the group with non-neurogenic LUTD correlated positively with BAI and BDI scores. In the neurogenic bladder group, Zarit score correlated with BDI score. CONCLUSION It is important not only in psychiatric patients, but also in those with other chronic disease processes, to evaluate the mental status of caregivers and to support them in dealing with the problem.
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Affiliation(s)
| | - Şeyda Türk
- Department of Psychiatry, Uludağ University School of Medicine,
Bursa,
Turkey
| | - Selçuk Kırlı
- Department of Psychiatry, Uludağ University School of Medicine,
Bursa,
Turkey
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9
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Maleki N, Sadeghian E, Shamsaei F, Tapak L, Ghaleiha A. Comparative Analysis of Spouse’s Burden and Quality of Life in Major Depressive Disorder and Bipolar I Disorder. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1874464812666190819151039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Spouses of patients with bipolar disorder may experience a different quality
of life and burden than seen with major depressive disorder.
Objective:
This study was conducted to comparatively analyse spouse’s burden and quality of life in
major depressive and bipolar disorders.
Methods:
This cross-sectional study was conducted on 220 spouses of patients with major depressive
and bipolar disorders in the city of Hamadan in Iran, in 2018. Data collection tools included
Zarit Burden and QOL-BREF questionnaires. Data were analyzed by a t-test using SPSS -16.
Results:
The findings showed that 11.8% of spouses of patients with depression and 85.5% of
spouses of patients with bipolar disorder experienced severe burden (P < 0.001). The quality of life
of spouses of patients with bipolar disorder was lower than with depressive disorder (P < 0.05). In
both the groups, a negative correlation was found between burden and QOL.
Conclusion:
The spouses of patients with bipolar disorder experience more burden and lower quality
of life than depression. In both the groups, burden has a negative impact on the quality of life.
Professional help and supportive intervention can be provided to the spouses of patients with major
depressive and bipolar I disorders to reduce their burden, strengthen their coping skill and thus improve
their QOL.
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Affiliation(s)
- Nayereh Maleki
- Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Effat Sadeghian
- Chronic Diseases (Home Care) Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Shamsaei
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Lily Tapak
- Department of Biostatistics, School of Public, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Ghaleiha
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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10
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Perlick DA, Jackson C, Grier S, Huntington B, Aronson A, Luo X, Miklowitz DJ. Randomized trial comparing caregiver-only family-focused treatment to standard health education on the 6-month outcome of bipolar disorder. Bipolar Disord 2018. [PMID: 29528180 DOI: 10.1111/bdi.12621] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Caregivers of people with bipolar disorder often have depression and health problems. This study aimed to evaluate the sustained effects of a 12-15 week psychoeducational intervention on the health and mental health of caregivers of persons with bipolar disorder. We also evaluated the effects of the intervention on patients' mood symptoms over 6 months post-treatment. METHODS Caregivers of 46 persons with bipolar disorder were randomized to 12-15 weeks of a caregiver-only adaptation of family-focused treatment (FFT), in which caregivers were instructed on self-care strategies and ways to assist the patient in managing the illness, or to 8-12 sessions of standard health education. Independent evaluators assessed caregivers' depression and physical health and patients' mood symptoms before treatment, immediately after the treatment, and at 6 months post-treatment. RESULTS Randomization to FFT was associated with greater decreases in depression for both caregivers and patients over a 6-month follow-up period post-treatment. Reductions in patients' depression scores over 6 months post-treatment were mediated by reductions in caregivers' depression scores (z = -2.74, P < .01). CONCLUSIONS Interventions that are effective in reducing mood symptoms and improving health behavior in caregivers may have important health and mental health benefits for patients with bipolar disorder. Specifically, a treatment focused on caregiver education about bipolar disorder and the need for the caregiver to attend to his/her own health and mental health can benefit patients, even without their direct participation.
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Affiliation(s)
- Deborah A Perlick
- JJ Peters, Department of Veterans Affairs Medical Center and VISN 2, South Mental Illness Research, Education and Clinical Center, Bronx, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlos Jackson
- JJ Peters, Department of Veterans Affairs Medical Center and VISN 2, South Mental Illness Research, Education and Clinical Center, Bronx, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Savannah Grier
- JJ Peters, Department of Veterans Affairs Medical Center and VISN 2, South Mental Illness Research, Education and Clinical Center, Bronx, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brittney Huntington
- JJ Peters, Department of Veterans Affairs Medical Center and VISN 2, South Mental Illness Research, Education and Clinical Center, Bronx, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew Aronson
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xiaodong Luo
- JJ Peters, Department of Veterans Affairs Medical Center and VISN 2, South Mental Illness Research, Education and Clinical Center, Bronx, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David J Miklowitz
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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11
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Sampogna G, Luciano M, Vecchio VD, Malangone C, De Rosa C, Giallonardo V, Borriello G, Pocai B, Savorani M, Steardo L, Lampis D, Veltro F, Bartoli F, Bardicchia F, Moroni AM, Ciampini G, Orlandi E, Ferrari S, Biondi S, Iapichino S, Pompili E, Piselli M, Tortorella A, Carrà G, Fiorillo A. The effects of psychoeducational family intervention on coping strategies of relatives of patients with bipolar I disorder: results from a controlled, real-world, multicentric study. Neuropsychiatr Dis Treat 2018; 14:977-989. [PMID: 29692615 PMCID: PMC5903484 DOI: 10.2147/ndt.s159277] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Psychoeducational family intervention (PFI) has been proven to be effective in improving the levels of family burden and patients' personal functioning in schizophrenia and bipolar disorders (BDs). Less is known about the impact of PFI on relatives' coping strategies in BD. Methods A multicenter, controlled, outpatient trial funded by the Italian Ministry of Health and coordinated by the Department of Psychiatry of the University of Campania "Luigi Vanvitelli" has been conducted in patients with bipolar I disorder (BD-I) and their key relatives consecutively recruited in 11 randomly selected Italian community mental health centers. We aim to test the hypothesis that PFI improves problem-oriented coping strategies in relatives of BD-I patients compared to the Treatment As Usual (TAU) group. Results The final sample was constituted of 123 patients and 139 relatives. At baseline assessment (T0), the vast majority of relatives already adopted problem-oriented coping strategies more frequently than the emotion-focused ones. At the end of the intervention, relatives receiving PFI reported a higher endorsement of adaptive coping strategies, such as "maintenance of social interests" (odds ratio [OR]=0.309, CI=0.04-0.57; p=0.023), "positive communication with the patient" (OR=0.295, CI=0.13-0.46; p=0.001), and "searching for information" (OR=0.443, CI=0.12-0.76; p=0.007), compared to TAU relatives, after controlling for several confounders. As regards the emotion-focused coping strategies, relatives receiving the experimental intervention less frequently reported to adopt "resignation" (OR=-0.380, CI=-0.68 to -0.08; p=0.014) and "coercion" (OR=-0.268, CI=-0.46 to -0.08; p=0.006) strategies, compared to TAU relatives. Conclusion PFI is effective in improving the adaptive coping strategies of relatives of BD-I patients, but further studies are needed for evaluating the long-term benefits of this intervention.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples
| | - Mario Luciano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples
| | | | - Claudio Malangone
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples
- Mental Health Centre of Ravello, Mental Health Unit, Ravello
| | - Corrado De Rosa
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples
| | | | | | - Benedetta Pocai
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples
| | - Micaela Savorani
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples
| | - Luca Steardo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples
| | - Debora Lampis
- Mental Health Centre of Lanusei, Mental Health Unit, Lanusei
| | | | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Monza
| | | | | | - Giusy Ciampini
- Mental Health Centre of Lanciano, Mental Health Unit, Lanciano
| | | | - Silvia Ferrari
- University of Modena and Reggio Emilia, Department of Psychiatry, Reggio Emilia
| | - Silvia Biondi
- Mental Health Centre of Montecatini, Mental Health Unit, Montecatini
| | - Sonia Iapichino
- Mental Health Centre of Montecatini, Mental Health Unit, Montecatini
- Auditor Psychiatrist, for the activities of Clinical Risk Management and safety of treatments, Tuscany Region
| | | | | | - Alfonso Tortorella
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Monza
- Division of Psychiatry, University College of London, London, UK
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples
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12
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Vieta E, Berk M, Schulze TG, Carvalho AF, Suppes T, Calabrese JR, Gao K, Miskowiak KW, Grande I. Bipolar disorders. Nat Rev Dis Primers 2018. [PMID: 29516993 DOI: 10.1038/nrdp.2018.8] [Citation(s) in RCA: 425] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bipolar disorders are chronic and recurrent disorders that affect >1% of the global population. Bipolar disorders are leading causes of disability in young people as they can lead to cognitive and functional impairment and increased mortality, particularly from suicide and cardiovascular disease. Psychiatric and nonpsychiatric medical comorbidities are common in patients and might also contribute to increased mortality. Bipolar disorders are some of the most heritable psychiatric disorders, although a model with gene-environment interactions is believed to best explain the aetiology. Early and accurate diagnosis is difficult in clinical practice as the onset of bipolar disorder is commonly characterized by nonspecific symptoms, mood lability or a depressive episode, which can be similar in presentation to unipolar depression. Moreover, patients and their families do not always understand the significance of their symptoms, especially with hypomanic or manic symptoms. As specific biomarkers for bipolar disorders are not yet available, careful clinical assessment remains the cornerstone of diagnosis. The detection of hypomanic symptoms and longtudinal clinical assessment are crucial to differentiate a bipolar disorder from other conditions. Optimal early treatment of patients with evidence-based medication (typically mood stabilizers and antipsychotics) and psychosocial strategies is necessary.
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Affiliation(s)
- Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Parkville, Victoria, Australia.,The Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.,Human Genetics Branch, National Institute of Mental Health, NIH, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
| | - Trisha Suppes
- Bipolar and Depression Research Program, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA.,Bipolar and Depression Research Program, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Joseph R Calabrese
- Mood and Anxiety Clinic, The Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Keming Gao
- Mood and Anxiety Clinic, The Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Kamilla W Miskowiak
- Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Iria Grande
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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13
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Blanthorn-Hazell S, Gracia A, Roberts J, Boldeanu A, Judge D. A survey of caregiver burden in those providing informal care for patients with schizophrenia or bipolar disorder with agitation: results from a European study. Ann Gen Psychiatry 2018; 17:8. [PMID: 29456588 PMCID: PMC5810188 DOI: 10.1186/s12991-018-0178-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Agitation is a common feature of bipolar disorder and schizophrenia. Previous research indicates that specific symptoms impact caregiver burden in these conditions, but the impact of agitation on caregiver experience is poorly understood. The aim of this study was to characterise caregiver burden in providers of informal care for patients with bipolar disorder and schizophrenia who experience agitation. METHODS In total, 297 matched patient and caregiver surveys were collected across the UK, Germany and Spain between October 2016 and January 2017. To be eligible, caregivers needed to provide informal care to a patient with a diagnosis of bipolar disorder or schizophrenia with agitation managed in a community setting and participating in the patient survey. The caregiver survey captured information on demographics and their role in managing the patient's agitation. Caregiver burden was assessed using the Involvement Evaluation Questionnaire. Descriptive analysis was conducted. RESULTS Caregivers provided 38.3 h (SD ± 40.34) a week of support to the patient with 20% providing 50 h or more. Most caregivers reported that they recognised an episode of agitation all of the time (44%, n = 130) or sometimes (40%, n = 119). Verbal de-escalation techniques (talking (80%, n = 239) and soothing (73%, n = 218) were the most commonly reported strategies used by caregivers during an episode of agitation; 14% (n = 43) reported resorting to physically restraining the patient. Caregivers supervised rescue medication administration regularly (41%, n = 69) or occasionally (49%, n = 82). Mean Involvement Evaluation Questionnaire score was 32.2 (± 15.27), equivalent to 28.4 (± 13.56) in Germany, 35.6 (± 16.55) in Spain and 33.3 (± 15.15) in the UK. Involvement Evaluation Questionnaire scores were higher for caregivers who reported hostile (41.7 ± 17.07) lack of control (40.3 ± 16.35) and violent (39.5 ± 16.40) patient behaviours when agitated. Over excitement (31.8 ± 15.05), restless (32.6 ± 14.77) and tense (32.9 ± 15.64) behaviours were associated with a lower Involvement Evaluation Questionnaire score. CONCLUSIONS Caregivers are active participants in the recognition and management of agitation episodes. The substantial burden reported by these caregivers is impacted by factors including the number of hours of care provided, patient behaviours and country. These may be viable targets for effective interventions to reduce caregiver burden.
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Comparing Affiliate Stigma Between Family Caregivers of People With Different Severe Mental Illness in Taiwan. J Nerv Ment Dis 2017; 205:542-549. [PMID: 28291058 DOI: 10.1097/nmd.0000000000000671] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The family caregivers of people with mental illness may internalize the public stereotypes into the affiliate stigma (i.e., the self-stigma of family members). This study aimed to compare the affiliate stigma across schizophrenia, bipolar disorder, and major depressive disorder, and to investigate potential factors associated with affiliate stigma. Each caregiver of family members with schizophrenia (n = 215), bipolar disorder (n = 85), and major depressive disorder (n = 159) completed the Affiliate Stigma Scale, Rosenberg Self-Esteem Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, and Beck Anxiety Inventory. After controlling for potential confounders, the hierarchical regression models showed that caregivers of a family member with schizophrenia had a higher level of affiliate stigma than those of bipolar disorder (β = -0.109; p < 0.05) and major depressive disorder (β = -0.230; p < 0.001). Self-esteem, developmental burden, and emotional burden were significant factors for affiliate stigma. The affiliate stigma of caregivers is associated with their self-esteem, caregiver burden, and by the diagnosis.
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15
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Molteni S, Carbon M, Lops J, Soto EC, Cervesi C, Sheridan EM, Galling B, Saito E, Krakower S, Dicker R, Foley C, Fornari V, Balottin U, Correll CU. Correlates of Subjective Caregiver Strain in Caregivers of Youth Evaluated in a Pediatric Psychiatric Emergency Room. J Child Adolesc Psychopharmacol 2017; 27:451-461. [PMID: 26978127 DOI: 10.1089/cap.2015.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although caregiver burden is relevant to the outcome for psychiatrically ill youth, most studies have focused on caregiver burden in the community or research settings. Therefore, we aimed at evaluating the subjective caregiver strain (SCS) at the time of presentation of youth to a pediatric psychiatric emergency room (PPER), assessing potential correlates to provide leads for improvements in formal support systems. METHODS In this retrospective cohort study, the internalized, externalized, and total SCS were assessed in caregivers of youth <18 years of age consecutively evaluated at a PPER during a 1 year period using the Caregiver Strain Questionnaire. Sociodemographic and a broad range of clinical data were collected during the PPER visit using a 12-page semistructured institutional evaluation form. The Appropriateness of Pediatric Psychiatric Emergency Room Contact scale, incorporating acuity, severity and harm potential, was used to rate appropriateness of the visit. RESULTS In caregivers of 444 youth, the internalized SCS was significantly higher than the externalized SCS (p < 0.001). Multivariable analyses indicated that higher total and externalized SCS were associated with disruptive behavior or substance abuse/dependent disorder diagnosis, presenting complaint of aggression, and discharge plan to the police. Higher total and internalized SCS were associated with lower child functioning, whereas total and internalized SCS were lower in adopted children. In addition, higher externalized SCS was associated with investigator-rated inappropriateness of the emergency visit, presenting complaint of defiance, and a lack of prior psychiatric ER visits. CONCLUSIONS High levels of CS in PPER highlight the necessity to adhere to existing guidelines regarding the inclusion of caregivers' perceptions into comprehensive psychiatric assessments. The particularly high strain in caregivers of children with externalizing disorders and in families with low-functioning youth may need to prompt PPER staff to provide efficient information on appropriate treatment options for these children and on support facilities for the parents.
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Affiliation(s)
- Silvia Molteni
- 1 Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia , Pavia, Italy .,2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York
| | - Maren Carbon
- 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York
| | - Johnny Lops
- 3 Department of Psychiatry, Maimonides Medical Center , Brooklyn, New York
| | - Erin C Soto
- 4 Department of Psychiatry, Presbyterian Hospital, Columbia University , New York, New York
| | - Chiara Cervesi
- 5 Institute for Maternal and Child Health , Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) "Burlo Garofolo," Trieste, Italy .,6 Paediatrics Department, University of Padua , Padua, Italy
| | - Eva M Sheridan
- 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York
| | - Britta Galling
- 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York
| | - Ema Saito
- 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.,7 Department of Psychiatry, Hofstra North Shore LIJ School of Medicine , Hempstead, New York
| | - Scott Krakower
- 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York
| | - Robert Dicker
- 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York
| | - Carmel Foley
- 7 Department of Psychiatry, Hofstra North Shore LIJ School of Medicine , Hempstead, New York
| | - Victor Fornari
- 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.,7 Department of Psychiatry, Hofstra North Shore LIJ School of Medicine , Hempstead, New York
| | - Umberto Balottin
- 1 Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia , Pavia, Italy .,8 Child Neuropsychiatry Unit, C. Mondino National Neurological Institute , Pavia, Italy
| | - Christoph U Correll
- 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.,7 Department of Psychiatry, Hofstra North Shore LIJ School of Medicine , Hempstead, New York.,9 The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence , Manhasset, New York.,10 Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine , Bronx, New York
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16
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Zhou Y, Rosenheck R, Mohamed S, Ning Y, He H. Factors associated with complete discontinuation of medication among patients with schizophrenia in the year after hospital discharge. Psychiatry Res 2017; 250:129-135. [PMID: 28160655 DOI: 10.1016/j.psychres.2017.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 11/18/2016] [Accepted: 01/10/2017] [Indexed: 11/19/2022]
Abstract
Medication discontinuation is a major risk factor for relapse in schizophrenic patients. The present study investigated the rate and clinical correlates of complete medication discontinuation in the year after hospital discharge. Data collected from 236 schizophrenia patients who were prescribed anti-psychotics documented socio-demographic characteristics, symptom severity, insight, and attitudes towards medication in the week before their discharge and the experience of caregiver burden for their primary caregiver as recorded at the time of hospitalization. Follow-up telephones call one-year after discharge documented whether they were regularly taking prescribed psychotropic medication or not. Logistic regression analysis was used to investigate factors that were independently associated with medication discontinuation. Altogether 25.8% of the sample discontinued medication in the one-year after discharge. Logistic regression analysis showed that shorter duration of illness, lack of health insurance, and poor insight at the time of discharge were significantly associated with complete discontinuation of medication (p<0.05). Patients discontinued their medication within a year after psychiatric hospitalization which was associated with a lack of insurance coverage, less insight into their illness and shorter duration of illness. Interventions that strengthen patient engagement in treatment through insurance coverage and insight, fostered through psychoeducational intervention, may increase medication compliance.
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Affiliation(s)
- Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Robert Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, USA
| | - Somaia Mohamed
- Department of Psychiatry, Yale University School of Medicine, New Haven, USA
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Hongbo He
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
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17
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Raymond KY, Willis DG, Sullivan-Bolyai S. Parents Caring For Adult Children With Serious Mental Illness. J Am Psychiatr Nurses Assoc 2017; 23:119-132. [PMID: 28060601 DOI: 10.1177/1078390316685404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Parents often become the caregivers for their adult children with serious mental illness (SMI) due to the chronic and debilitating course of the illness and shortages in funding for community mental health services and residential placements. OBJECTIVE To examine parents' management styles when caring for adult children with SMI and parents' perspectives on what type of community-based mental health interventions would support and/or enhance overall family functioning. DESIGN A qualitative descriptive study using semistructured interviews with parents caring for adult children with SMI. The study was undergirded by Knafl and Deatrick's Family Management Style Framework. RESULTS Four major themes emerged from the data describing prolonged and difficult phases that parents and the family undergo in caring for an adult child with SMI. CONCLUSIONS Successful management of these phases must include increasing access to mental health information, mental health screening, early interventions, and violence prevention for adult children and their families.
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Affiliation(s)
- Kathryn Y Raymond
- 1 Kathryn Y. Raymond, PhD, RN, APRN, University of Massachusetts Medical School, Worcester, MA, USA
| | - Danny G Willis
- 2 Danny G. Willis, DNS, RN, PMHCNS-BC, FAAN, Boston College, Chestnut Hill, MA, USA
| | - Susan Sullivan-Bolyai
- 3 Susan Sullivan-Bolyai, DNSc, RN, CNS, FAAN, New York University, New York, NY, USA
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18
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Marimbe BD, Cowan F, Kajawu L, Muchirahondo F, Lund C. Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe. Afr J Disabil 2016; 5:209. [PMID: 28730046 PMCID: PMC5433451 DOI: 10.4102/ajod.v5i1.209] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 03/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background Mental health service resources are inadequate in low-income countries, and families are frequently expected to provide care for their relative with a mental disorder. However, research on the consequences of caregiving has been limited in low-income countries, including Zimbabwe. Objective The study explored the perceived impact of mental illness, reported coping strategies and reported needs of the family members of persons diagnosed with bipolar affective disorder or schizophrenia attending a psychiatric hospital in Harare, Zimbabwe. Methods A purposive sample of 31 family members participated in in-depth interviews and focus group discussions using standardised study guides. Participants were also screened for common mental disorders (CMDs) using the 14-item Shona Symptom Questionnaire. Qualitative data were analysed thematically using NVivo 8 qualitative data analysis software. Statistical Package for Social Sciences (SPSS version 16) was used for descriptive quantitative data analysis. Results Caregivers experienced physical, psychological, emotional, social and financial burdens associated with caregiving. They used both emotion-focused and problem-focused coping strategies, depending on the ill family members’ behaviours. Seeking spiritual assistance emerged as their most common way of coping. Twenty-one (68%) of the caregivers were at risk of CMDs (including three participants who were suicidal) and were referred to a psychiatrist for further management. Caregivers required support from healthcare professionals to help them cope better. Conclusion Caregivers of patients attending psychiatry hospitals in Zimbabwe carry a substantial and frequently unrecognised burden of caring for a family member with a mental disorder. Better support is needed from health professionals and social services to help them cope better. Further research is required to quantitatively measure caregiver burden and evaluate potential interventions in Zimbabwe.
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Affiliation(s)
- Bazondlile D Marimbe
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Zimbabwe.,Research Department of Infection and Population Health, University College London, United Kingdom
| | - Frances Cowan
- Research Department of Infection and Population Health, University College London, United Kingdom.,Centre for Sexual Health and HIV/AIDS Research: Zimbabwe, Zimbabwe
| | - Lazarus Kajawu
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Florence Muchirahondo
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Perlick DA, Berk L, Kaczynski R, Gonzalez J, Link B, Dixon L, Grier S, Miklowitz DJ. Caregiver burden as a predictor of depression among family and friends who provide care for persons with bipolar disorder. Bipolar Disord 2016; 18:183-91. [PMID: 27004622 DOI: 10.1111/bdi.12379] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 11/18/2015] [Accepted: 01/12/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Over one-third of caregivers of people with bipolar disorder report clinically significant levels of depressive symptoms. This study examined the causal relationship between depression and caregiver burden in a large sample of caregivers of adult patients with bipolar disorder. METHODS Participants were 500 primary caregivers of persons with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).This study evaluates the strength and direction of the associations between caregiver burden and depressive symptoms at baseline and at six- and 12-month follow-up using cross-lagged panel analyses, controlling for the clinical status of patients and sociodemographic variables. RESULTS Higher levels of overall caregiver burden at baseline were associated with increased levels of depressive symptoms among caregivers at follow-up (F = 8.70, df = 1,290, p < 0.001), after controlling for baseline caregiver depression, gender, race, age, social support, and patients' clinical status. By contrast, caregiver depression at baseline was not significantly associated with caregiver burden at follow-up (F = 1.65, p = 0.20). CONCLUSIONS Caregiver burden is a stronger predictor of caregiver depressive symptoms over time than the reverse. Interventions that help alleviate caregiver burden may decrease depressive symptoms.
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Affiliation(s)
- Deborah A Perlick
- James J. Peters Department of Veterans Affairs Medical Center and VISN 3 Mental Illness, Research, Education and Clinical Center (MIRECC), Bronx, NY, USA.,Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Lesley Berk
- Mental Health and Wellbeing Research Centre, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Richard Kaczynski
- Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jodi Gonzalez
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Bruce Link
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, New York, NY, USA.,Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Savannah Grier
- James J. Peters Department of Veterans Affairs Medical Center and VISN 3 Mental Illness, Research, Education and Clinical Center (MIRECC), Bronx, NY, USA.,Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - David J Miklowitz
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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20
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Reinares M, Bonnín C, Hidalgo-Mazzei D, Sánchez-Moreno J, Colom F, Vieta E. The role of family interventions in bipolar disorder: A systematic review. Clin Psychol Rev 2016; 43:47-57. [DOI: 10.1016/j.cpr.2015.11.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/01/2015] [Accepted: 11/09/2015] [Indexed: 12/19/2022]
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21
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Kolostoumpis D, Bergiannaki JD, Peppou LE, Louki E, Fousketaki S, Patelakis A, Economou MP. Effectiveness of Relatives’ Psychoeducation on Family Outcomes in Bipolar Disorder. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2015. [DOI: 10.1080/00207411.2015.1076292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Bauer R, Spiessl H, Helmbrecht MJ. Burden, reward, and coping of adult offspring of patients with depression and bipolar disorder. Int J Bipolar Disord 2015; 3:2. [PMID: 25642405 PMCID: PMC4312320 DOI: 10.1186/s40345-015-0021-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/05/2015] [Indexed: 01/01/2023] Open
Abstract
Background In previous years, research has focused on the situation of psychiatric patients' minor children. The aims of this qualitative study were to describe the experience of adult children of depressed and bipolar patients, including positive and negative factors as well as coping mechanisms, and to investigate possible predictors of burden in order to identify children in need of professional support. Methods A total of 30 adult children were interviewed using a semi-structured interview. In addition, all children completed the Freiburg Questionnaire of Coping with Disease (Freiburger Fragebogen zur Krankheitsverarbeitung, FKV). Regression analysis indicated the most relevant predictors of burden. Results All (100%) of the children reported emotional burden due to the illness of their parent, 90% suffered from impaired family life, and 77% experienced burden due to the parent's symptoms. Reward (positive experience) was reported regarding the intensification of the parent-child relationship. Linear regression analysis shows predictors for highly burdened children as well as for children who are more prone to maladaptive ways of coping. Higher burden was significantly associated with the child's age, severity of illness of the parent, and specific diagnosis. Conclusions Although some positive aspects of parental affective disorder exist, this study underlines that children primarily suffer from their parent's disorder and that this burden does not stop in adulthood. Providing professional support to adult as well as to minor children of affected individuals should become standard of care in clinical settings.
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Affiliation(s)
- Rita Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany ; Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Hermann Spiessl
- State Hospital for Psychiatry, Psychotherapy and Psychosomatics, Prof.-Buchner-Strasse 22, 84034 Landshut, Germany
| | - Marina J Helmbrecht
- Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
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23
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Yang LH, Lai GY, Tu M, Luo M, Wonpat-Borja A, Jackson VW, Lewis-Fernández R, Dixon L. A brief anti-stigma intervention for Chinese immigrant caregivers of individuals with psychosis: adaptation and initial findings. Transcult Psychiatry 2014; 51:139-57. [PMID: 24318864 PMCID: PMC3993525 DOI: 10.1177/1363461513512015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mental illness stigma has adverse effects on both the caregivers' psychological well-being and the effectiveness of care that consumers receive. While anti-stigma interventions for family caregivers from Western settings have recently shown efficacy, these interventions may not be equally applicable across culturally diverse groups. Specifically, Chinese immigrant caregivers experience heightened internalized stigma, which predisposes the adoption of harmful coping strategies and reduced quality of social networks. We present an anti-stigma intervention based on a peer-family group format, co-led by a clinician and a trained family caregiver, to counter stigma among Chinese immigrants. Data are presented from a brief intervention administered to a pilot sample of 11 Chinese immigrant caregivers that provides: psychoeducation, strategies to counter experienced discrimination, and techniques to resist internalized stigma. Case vignettes illustrate implementation of this intervention, and how the peer-family format via interactive contact counteracts internalized stereotypes, encourages adaptive coping strategies, and reinvigorates social networks. Quantitative results further suggest preliminary efficacy in reducing internalized stigma for caregivers who evidenced at least some prior internalized stigma. This study constitutes an initial but important step towards reducing mental illness stigma among Asian Americans, for whom stigma has played a powerful role in the delay and underuse of treatment.
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Hoertel N, Crochard A, Limosin F, Rouillon F. La consommation excessive d’alcool : un lourd fardeau pour l’entourage. L'ENCEPHALE 2014; 40 Suppl 1:S1-10. [DOI: 10.1016/j.encep.2014.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/07/2014] [Indexed: 10/25/2022]
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25
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Pompili M, Harnic D, Gonda X, Forte A, Dominici G, Innamorati M, Fountoulakis KN, Serafini G, Sher L, Janiri L, Rihmer Z, Amore M, Girardi P. Impact of living with bipolar patients: Making sense of caregivers' burden. World J Psychiatry 2014; 4:1-12. [PMID: 24660140 PMCID: PMC3958651 DOI: 10.5498/wjp.v4.i1.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/19/2013] [Accepted: 01/13/2014] [Indexed: 02/05/2023] Open
Abstract
The aim of the present review was to examine objective and subjective burdens in primary caregivers (usually family members) of patients with bipolar disorder (BD) and to list which symptoms of the patients are considered more burdensome by the caregivers. In order to provide a critical review about caregiver's burden in patients with bipolar disorder, we performed a detailed PubMed, BioMedCentral, ISI Web of Science, PsycINFO, Elsevier Science Direct and Cochrane Library search to identify all papers and book chapters in English published during the period between 1963 and November 2011. The highest levels of distress were caused by the patient's behavior and the patient's role dysfunction (work, education and social relationships). Furthermore, the caregiving role compromises other social roles occupied by the caregiver, becoming part of the heavy social cost of bipolar affective disorder. There is a need to better understand caregivers' views and personal perceptions of the stresses and demands arising from caring for someone with BD in order to develop practical appropriate interventions and to improve the training of caregivers.
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Measuring the internalized stigma of parents of persons with a serious mental illness: the factor structure of the parents' internalized stigma of mental illness scale. J Nerv Ment Dis 2013; 201:183-7. [PMID: 23443038 DOI: 10.1097/nmd.0b013e3182845d00] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research has revealed that approximately one third of persons with a serious mental illness (SMI) experience elevated internalized stigma, which is associated with a large number of negative outcomes. Family members of persons with SMI are also often subject to stigma, but the degree to which these experiences are internalized and lead to self-stigma has rarely been studied. The present study investigated the factor structure of a modification of the Internalized Stigma of Mental Illness (ISMI) scale by Ritsher, Otilingam, and Grajales (Psychiatry Res 121:31-49, 2003). A central assumption of this investigation was that the factor structure of the Parents' Internalized Stigma of Mental Illness (PISMI) scale would be similar to the factor structure of the ISMI scale. A total of 194 parents of persons with SMI completed the PISMI scale. The results revealed that the PISMI scale has high internal consistency and that it is made up of three distinctive factors: discrimination experience, social withdrawal and alienation, and stereotype endorsement. These factors are similar, but not identical, to the factors that underlie the ISMI scale. This study's findings also indicate that parents' prominent reaction to self-stigma is stereotype endorsement.
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27
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Scott J, Colom F, Pope M, Reinares M, Vieta E. The prognostic role of perceived criticism, medication adherence and family knowledge in bipolar disorders. J Affect Disord 2012; 142:72-6. [PMID: 22944191 DOI: 10.1016/j.jad.2012.04.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND In schizophrenia, high levels of critical comments by significant others are associated with early relapse, especially if medication adherence is sub-optimal. Levels of criticism may be influenced by family knowledge about both the disorder and its treatment. No study has explored whether this combination factors influence outcome in adults with bipolar disorders. METHODS Medication adherence was assessed in 81 individuals with bipolar disorder of whom 75 rated perceived criticism by an identified 'significant other' as well as their own perceived sensitivity. 33 (of the 75) had a close family member who agreed to completed an assessment of their knowledge and understanding of bipolar disorders. Psychiatric admissions were then recorded prospectively over 12 months. RESULTS Perceived criticism and medication adherence were significant predictors of admission. In the patient-family member dyads (n=33), the odds ratio (OR) for admission was 3.3 (95% confidence intervals 1.3-8.6) in individuals with low levels of medication adherence, high perceived criticism, and a family member with poor knowledge and understanding. LIMITATIONS The small sub-sample of patient-family member dyads means those findings require replication. Sensitivity to criticism by professional caregivers may not equate to that by relatives. CONCLUSIONS Perceived criticism may be a simple but robust clinical predictor of relapse in mood disorders. High levels of perceived criticism, poor understanding of bipolar disorder by a significant other, and sub-optimal treatment adherence are risk factors for hospitalization in adults with bipolar disorders that are potentially modifiable through the use of strategic psychosocial interventions.
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Affiliation(s)
- Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK.
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Beentjes TAA, Goossens PJJ, Poslawsky IE. Caregiver burden in bipolar hypomania and mania: a systematic review. Perspect Psychiatr Care 2012; 48:187-97. [PMID: 23005586 DOI: 10.1111/j.1744-6163.2012.00328.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Bipolar mania is characterized by marked impairment in social, occupational, or other important areas of functioning. One should expect to see an equally severe burden in informal caregivers. The literature was reviewed in order to provide a foundation upon which to build nursing interventions. CONCLUSIONS Several characteristics of bipolar mania-patient aggressiveness, lack of insight, and financial problems-were identified as severe burdens to caregivers. Professionals might not have a total view of the extent of the burden in caregivers. This review could not link the patients' mania or hypomania to factors that were described in other literature on caregiver burden related to bipolar disorder, regardless of the type of episode. PRACTICE IMPLICATIONS There is a need for further research in this area to make more explicit the burden on caregivers during times of mania or hypomania.
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Affiliation(s)
- Titus A A Beentjes
- University of Utrecht, Utrecht, the Netherlands and Clinical Nurse Specialist, Dimence Mental Health Care Centre, Deventer, The Netherlands.
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Long-term follow-up of informal caregivers after allo-SCT: a systematic review. Bone Marrow Transplant 2012; 48:469-73. [PMID: 22732697 DOI: 10.1038/bmt.2012.123] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Currently, more than 40000 patients undergo allogeneic hematopoietic SCT (HSCT) annually throughout the world, and the numbers are increasing rapidly. Long-term survival after allogeneic-HSCT (allo-HSCT) has also improved significantly since its inception over 40 years ago due to improved supportive care and early recognition of long-term complications. In long-term follow-up after transplantation, the focus of care moves beyond cure of the original disease to late effects and quality of life. Nearly one-fourth of the long-term survivors are likely to have chronic consequences of HSCT, which require frequent help by caregivers, particularly informal caregivers such as spouses, partners or children. The physical and psychosocial consequences for patients undergoing HSCT have been extensively reported. There has, however, been far less investigation into the long-term follow-up of caregivers of HSCT recipients. This article provides an overview on addressing caregiver issues after HSCT. The rapidly growing population of long-term HSCT survivors creates an obligation not only to educate patients and physicians about the late complications observed in patients but also to follow up caregivers for their psychosocial support needs.
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Maji KR, Sood M, Sagar R, Khandelwal SK. A follow-up study of family burden in patients with bipolar affective disorder. Int J Soc Psychiatry 2012; 58:217-23. [PMID: 21421638 DOI: 10.1177/0020764010390442] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Research in the last two decades has documented a high level of burden in caregivers of bipolar disorder. The present study is aimed at studying family burden among relatives of patients with bipolar affective disorder. METHODS Thirty four consecutive hospitalized patients with bipolar affective disorder currently in mania and their relatives were assessed twice: at the time of admission and during follow-up four weeks after discharge. A semi-structured performa designed for the study was completed. Patients were assessed on Young's Mania Rating Scale and relatives were assessed on Family Burden Assessment Scale. RESULTS More than 90% of family members reported severe subjective (rated by relative) and objective burden (rated by interviewer) at admission; none of them was free of burden. At the time of follow-up, about one quarter (23.5%) and two thirds (64.7%) of family members did not experience any objective and subjective burden respectively; subjective and objective family burden was moderate in about one third (35.3%) and a half (52.9%), respectively. None of the family members reported severe burden subjectively, while the objective burden was rated to be severe in a quarter (23.5%) of family members. LIMITATIONS The study was limited by the lack of a control group from an outpatient setting as hospitalization increases family burden. Also, the rater at the second assessment was not blind to ratings at the first assessment. CONCLUSIONS Almost all the family members experienced severe burden initially. Even when symptoms subsided, family members continued to experience burden specifically related to finances. OBJECTIVE burden was significantly higher than subjective burden.
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Affiliation(s)
- K R Maji
- Paras Hospital, Gurgaon, Haryana, India
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Martorell A, Gutiérrez-Recacha P, Irazábal M, Marsà F, García M. Family impact in intellectual disability, severe mental health disorders and mental health disorders in ID. A comparison. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:2847-2852. [PMID: 21641769 DOI: 10.1016/j.ridd.2011.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 05/10/2011] [Accepted: 05/10/2011] [Indexed: 05/30/2023]
Abstract
Family impact (or family burden) is a concept born in the field of mental health that has successfully been exported to the ambit of intellectual disability (ID). However, differences in family impact associated with severe mental health disorders (schizophrenia), to ID or to mental health problems in ID should be expected. Seventy-two adults with intellectual disability clients of the Carmen Pardo-Valcarce Foundation's sheltered workshops and vocational employment programmes in Madrid (Spain), 203 adults diagnosed with schizophrenia from four Spanish Community Mental Health Services (Barcelona, Madrid, Granada and Navarra) and 90 adults with mental health problems in ID (MH-ID) from the Parc Sanitari Sant Joan de Déu Health Care Site in Sant Boi de Llobregat, Barcelona (Spain) were asked to participate in the present study along with their main caregivers. Family impact experienced by caregivers was assessed with the ECFOS-II/SOFBI-II scale (Entrevista de Carga Familiar Objetiva y Subjetiva/Objective and Subjective Family Burden Interview). In global terms, results showed that the higher family impact was found between caregivers to people with MH-ID. The interaction of both conditions (ID and mental health problems) results in a higher degree of burden on families than when both conditions are presented separately. There was also an impact in caregivers to people with schizophrenia, this impact being higher than the one detected in caregivers to people with intellectual disability. Needs of caregivers to people with disability should be addressed specifically in order to effectively support families.
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Affiliation(s)
- Almudena Martorell
- Fundación Carmen Pardo-Valcarce, Monasterio de las Huelgas 15, 28049 Madrid, Spain.
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Berk L, Jorm AF, Kelly CM, Dodd S, Berk M. Development of guidelines for caregivers of people with bipolar disorder: a Delphi expert consensus study. Bipolar Disord 2011; 13:556-70. [PMID: 22017224 DOI: 10.1111/j.1399-5618.2011.00942.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Close family and friends are often a primary source of support for a person with bipolar disorder. However, there is a lack of information for caregivers about ways to provide helpful support and take care of themselves. Rates of caregiver burden are high and increase the risk of caregiver depression and health problems. This study aimed to develop guidelines to assist caregivers of adults with bipolar disorder to be informed about bipolar disorder and to support the person without neglecting their own wellbeing. METHODS The Delphi method was used to assess consensus between international expert panels of 45 caregivers, 47 consumers, and 51 clinicians about what information to include in the caregiver guidelines. Initial online survey items were based on the existing literature. Subsequent surveys included new or reworded items suggested by panel members and items that needed re-rating. Items endorsed by at least 80% of all three panels formed the content of the guidelines. RESULTS Nearly 86% of the 626 survey items were endorsed. The items covered information on the illness, treatment, and suggestions on ways caregivers can provide support and take care of themselves in the different phases of illness and wellness, and information on dealing with specific real-life challenges. Although consensus rates were high, meaningful areas of difference between panels were found (e.g., collaboration issues). CONCLUSIONS The guidelines provide comprehensive introductory information, suggestions, and resources for caregivers. Access to relevant information may help caregivers to cope constructively with the person's bipolar disorder and their caregiving situation. The content of the guidelines could be used to help formulate a stepped-care approach to supporting caregivers, ranging from basic information and pamphlets to brief training courses and specialized family or caregiver interventions based on need and accessibility.
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Affiliation(s)
- Lesley Berk
- Orygen Youth Health Research Centre, Centre for Youth Mental Health Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
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Predictors of patient and caregiver distress in an adult sample with bipolar disorder seeking family treatment. J Nerv Ment Dis 2011; 199:18-24. [PMID: 21206242 DOI: 10.1097/nmd.0b013e3182043b73] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about the potentially unique sources of distress in populations seeking family-oriented treatment for bipolar disorder. The present study aimed to characterize this new treatment population by measuring depression, anxiety, quality of life, knowledge of bipolar disorder, therapeutic alliance, and mental illness stigma in 43 bipolar patients and 41 caregivers at family treatment intake. In all, 50% of patients and 27.6% of caregivers had significant depressive symptoms, whereas 51.2% of patients and 45.5% of caregivers had significant anxiety symptoms. Caregiver anxiety was inversely related to patient anxiety, stigma, and poor alliance. Treatment nonadherence was associated with more anxiety and stigma in patients and less anxiety in caregivers. In summary, family-oriented bipolar treatment seekers are significantly distressed at intake, and may benefit from lowering anxiety and stigma in patients and raising awareness and concern in caregivers. Future research should further clarify the complex relationships between caregiver and patient symptoms and attitudes.
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Perlick DA, Miklowitz DJ, Lopez N, Chou J, Kalvin C, Adzhiashvili V, Aronson A. Family-focused treatment for caregivers of patients with bipolar disorder. Bipolar Disord 2010; 12:627-37. [PMID: 20868461 PMCID: PMC2947337 DOI: 10.1111/j.1399-5618.2010.00852.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Family members of patients with bipolar disorder experience high rates of subjective and objective burden which place them at risk for adverse physical health and mental health outcomes. We present preliminary efficacy data from a novel variation of Family Focused Treatment [Miklowitz DJ. Bipolar Disorder: A Family-Focused Treatment Approach (2(nd) ed.). New York: The Guilford Press, 2008] that aimed to reduce symptoms of bipolar disorder by working with caregivers to enhance illness management skills and self-care. METHODS The primary family caregivers of 46 patients with bipolar I (n = 40) or II (n = 6) disorder, diagnosed by the Structured Clinical Interview for DSM-IV Axis I Disorders, were assigned randomly to receive either: (i) a 12-15-session family-focused, cognitive-behavioral intervention designed to provide the caregiver with skills for managing the relative's illness, attaining self-care goals, and reducing strain, depression, and health risk behavior [Family-Focused Treatment-Health Promoting Intervention (FFT-HPI)]; or (ii) an 8- to 12-session health education (HE) intervention delivered via videotapes. We assessed patients pre- and post-treatment on levels of depression and mania and caregivers on levels of burden, health behavior, and coping. RESULTS Randomization to FFT-HPI was associated with significant decreases in caregiver depressive symptoms and health risk behavior. Greater reductions in depressive symptoms among patients were also observed in the FFT-HPI group. Reduction in patients' depression was partially mediated by reductions in caregivers' depression levels. Decreases in caregivers' depression were partially mediated by reductions in caregivers' levels of avoidance coping. CONCLUSIONS Families coping with bipolar disorder may benefit from family interventions as a result of changes in the caregivers' ability to manage stress and regulate their moods, even when the patient is not available for treatment.
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Affiliation(s)
- Deborah A Perlick
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
| | - David J Miklowitz
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Norma Lopez
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | - James Chou
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | - Carla Kalvin
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | | | - Andrew Aronson
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
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Disorder-specific psychosocial interventions for bipolar disorder—A systematic review of the evidence for mental health nursing practice. Int J Nurs Stud 2010; 47:896-908. [DOI: 10.1016/j.ijnurstu.2010.02.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 02/08/2010] [Accepted: 02/14/2010] [Indexed: 11/21/2022]
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Perlick DA, Rosenheck RA, Kaczynski R, Swartz MS, Canive JM, Lieberman JA. Impact of antipsychotic medication on family burden in schizophrenia: longitudinal results of CATIE trial. Schizophr Res 2010; 116:118-25. [PMID: 19864114 DOI: 10.1016/j.schres.2009.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 09/18/2009] [Accepted: 09/22/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study evaluated the effectiveness of first- and second-generation antipsychotics in reducing family burden associated with schizophrenia. METHODS The family caregivers of 623 SCID-diagnosed patients enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) randomly assigned to a first-generation antipsychotic (perphenazine) or one of four second-generation drugs (olanzapine, quetiapine, risperidone or ziprasidone) were interviewed about resources provided and stresses experienced at baseline and followed for 18 months. Patient symptoms, side effects and service use were assessed as well. Hierarchical regression analyses evaluated the effect of treatment assignment on four burden factors: problem behavior, resource demands and disruption, impairment in activities of daily living and patient helpfulness. Intention-to-treat analyses with all available observations classified based on initial treatment assignment, including observations after medications changed were followed by secondary analyses excluding observations after the first medication change, i.e. only considering initial medication. RESULTS Despite significant reductions on the problem behavior and resource demands/disruption factors, there were no significant differences between perphenazine and any of the second-generation medications. When only initial treatment period observations were included, patients were perceived as more helpful when medicated with perphenazine as compared to risperidone. In comparisons between second-generation drugs, patients on quetiapine were perceived as more helpful than those on risperidone (p=0.004). CONCLUSION In this 18-month randomized trial, there was no evidence of superiority of second-generation antipsychotics in relieving family burden.
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Affiliation(s)
- Deborah A Perlick
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, New York 10029-6574, USA.
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van Wijngaarden B, Koeter M, Knapp M, Tansella M, Thornicroft G, Vázquez-Barquero JL, Schene A. Caring for people with depression or with schizophrenia: are the consequences different? Psychiatry Res 2009; 169:62-9. [PMID: 19625087 DOI: 10.1016/j.psychres.2008.06.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 10/19/2007] [Accepted: 06/12/2008] [Indexed: 11/24/2022]
Abstract
Attention to caregiver consequences has been mainly restricted to caregivers of patients with schizophrenia. The few studies done in depression were conducted on small samples and/or with non-validated instruments. Caregiver consequences in depression and schizophrenia were measured with the validated Involvement Evaluation Questionnaire (IEQ). IEQ scores of caregivers of 252 mainly outpatients with depression and caregivers of 151 mainly outpatients with schizophrenia were compared. IEQ scores were quite similar for depression and schizophrenia. Caregivers of patients with schizophrenia worry more and have more nursing tasks; in case of depression caregivers experience more tension between spouses. In case of many consequences caregivers live close to a patient who has more acute symptoms. They have more additional expenses on behalf of the patient, and report higher distress scores. In case of depression caregivers report less social support, and less coping abilities. Caregiver consequences of depression and schizophrenia are very similar. Differences reflect the context in which caregiving takes place: In schizophrenia mostly elderly mother caring for their ill (adult) child, in depression mostly spouses caring for their partner. Caregivers of patients with depression should be given more attention and support by professionals.
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Affiliation(s)
- Bob van Wijngaarden
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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Martire LM, Hinrichsen GA, Morse JQ, Reynolds CF, Gildengers AG, Mulsant BH, Schulz R, Frank E, Kupfer DJ. The Mood Disorder Burden Index: a scale for assessing the burden of caregivers to adults with unipolar or bipolar disorder. Psychiatry Res 2009; 168:67-77. [PMID: 19427705 PMCID: PMC2727157 DOI: 10.1016/j.psychres.2008.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 03/17/2008] [Accepted: 04/10/2008] [Indexed: 02/05/2023]
Abstract
We present a brief measure of caregiver burden, the Mood Disorder Burden Index (MDBI), for use with family members and close friends of adults with major depressive disorder (MDD) or bipolar disorder (BD). The MDBI assesses burden in three core domains (patients' mood symptoms, caregivers' worry about the future, and caregivers' interpersonal difficulties with the patient) and includes an optional module that assesses caregiver burden associated with patients' pharmacotherapy or psychotherapy. The MDBI was administered to caregivers of older individuals (i.e., 58 years and older) with MDD (n=123) or BD (n=38) who were receiving treatment through a research study. Analyses indicated evidence of convergent and discriminant validity of the new measure well as internal consistency within both caregiver groups. It will be important for future research to administer the MDBI to caregivers of middle-aged and older patients as well as those receiving treatment through inpatient settings or community outpatient clinics.
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Affiliation(s)
- Lynn M. Martire
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA, University Center for Social and Urban Research, Pittsburgh, PA,contact information: 121 University Place, Room 508, University Center for Social & Urban Research, Pittsburgh PA 15260. Telephone: (412) 624-6172. FAX: (412) 624-4810. E-mail:
| | | | - Jennifer Q. Morse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Ariel G. Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Benoit H. Mulsant
- Center for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Richard Schulz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA, University Center for Social and Urban Research, Pittsburgh, PA
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Cleary M, Hunt GE, Matheson S, Walter G. The association between substance use and the needs of patients with psychiatric disorder, levels of anxiety, and caregiving burden. Arch Psychiatr Nurs 2008; 22:375-85. [PMID: 19026926 DOI: 10.1016/j.apnu.2008.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 12/19/2007] [Accepted: 02/05/2008] [Indexed: 10/21/2022]
Abstract
The influence of substance use on patient's needs and caregiving consequences has received insufficient research attention. We sought to determine whether patients with comorbid substance use have higher levels of need, anxiety, depression, and caregiving consequences than those of patients who do not use substances. A total of 520 patients participated, and those who used substances (n = 216) reported higher levels of unmet needs, anxiety, and caregiving consequences than did patients who did not use substances. Carers of patients who used substances also reported higher anxiety and more caregiving consequences. Very few patients were actively involved in treatment programs to reduce their substance use.
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Affiliation(s)
- Michelle Cleary
- Faculty of Nursing and Midwifery, University of Sydney, Australia.
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Goossens PJJ, Van Wijngaarden B, Knoppert-van Der Klein EAM, Van Achterberg T. Family caregiving in bipolar disorder: caregiver consequences, caregiver coping styles, and caregiver distress. Int J Soc Psychiatry 2008; 54:303-16. [PMID: 18720891 DOI: 10.1177/0020764008090284] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS This study investigated the consequences caregivers of outpatients with bipolar disorder are confronted with, the distress they experience and their coping styles. METHODS Caregivers (n = 115) were asked to complete the Involvement Evaluation Questionnaire (IEQ) to measure caregivers' consequences, the Utrecht Coping List (UCL) to measure caregivers' coping styles, and the 12-item General Health Questionnaire (GHQ-12) to measure caregiver distress. Scale (sub)scores were calculated and relationships between the results were explored. RESULTS Caregiver consequences were found to be limited, although approximately 30% reported distress. Male caregivers used a more avoiding coping style and undertook activities to provide diversion. Female caregivers used a less active approach and sought less social support. Correlations were found between the IEQ overall score and its subscales 'tension' and 'worrying' and the UCL subscales 'palliative reaction pattern' and 'passive reaction pattern'. Distress appears to occur more often in caregivers who report more consequences, tend to use a more avoiding coping style, and have a more passive reaction pattern. CONCLUSIONS Clinicians should assess symptoms of caregiver distress. When caregiver distress is noticed, efforts should be undertaken to support the caregiver and teach them skills to cope effectively with the consequences they experience in order to stay well.
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Affiliation(s)
- P J J Goossens
- Adhesie Mental Health Care Midden-Overijssel, Deventer, The Netherlands.
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Ostacher MJ, Nierenberg AA, Iosifescu DV, Eidelman P, Lund HG, Ametrano RM, Kaczynski R, Calabrese J, Miklowitz DJ, Sachs GS, Perlick DA. Correlates of subjective and objective burden among caregivers of patients with bipolar disorder. Acta Psychiatr Scand 2008; 118:49-56. [PMID: 18582347 DOI: 10.1111/j.1600-0447.2008.01201.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We examined the relationship between mood symptoms and episodes in patients with bipolar disorder and burden reported by their primary caregivers. METHOD Data on subjective and objective burden reported by 500 primary caregivers for 500 patients with bipolar disorder participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were collected using semistructured interviews. Patient data were collected prospectively over 1 year. The relationship between patient course and subsequent caregiver burden was examined. RESULTS Episodes of patient depression, but not mood elevation, were associated with greater objective and subjective caregiver burden. Burden was associated with fewer patient days well over the previous year. Patient depression was associated with caregiver burden even after controlling for days well. CONCLUSION Patient depression, after accounting for chronicity of symptoms, independently predicts caregiver burden. This study underscores the important impact of bipolar depression on those most closely involved with those whom it affects.
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Affiliation(s)
- M J Ostacher
- Massachusetts General Hospital, Bipolar Clinic and Research Program, Boston, MA, and Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA.
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Reinares M, Colom F, Sánchez-Moreno J, Torrent C, Martínez-Arán A, Comes M, Goikolea JM, Benabarre A, Salamero M, Vieta E. Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial. Bipolar Disord 2008; 10:511-9. [PMID: 18452447 DOI: 10.1111/j.1399-5618.2008.00588.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Although there are some randomized controlled trials that highlight the positive role of family-focused treatment added to pharmacotherapy in bipolar disorder, no trials using contemporary methodologies have analyzed the specific effect of working with caregiver-only groups. The aim of this study was to assess the efficacy of a psychoeducational group intervention focused on caregivers of euthymic bipolar patients. METHOD A total of 113 medicated euthymic bipolar outpatients who lived with their caregivers were randomized into an experimental and a control group. Caregivers in the experimental group received twelve 90-min group psychoeducation sessions focused on knowledge of bipolar disorder and training in coping skills. The patients did not attend the groups. Caregivers assigned to the control group did not receive any specific intervention. Patients were assessed monthly during both the intervention and the 12 months of follow-up. The primary outcome was time to any mood recurrence. RESULTS Psychoeducation group intervention focused on the caregivers of bipolar patients carried a reduction of the percentage of patients with any mood recurrence (chi2 = 6.53; p = 0.011) and longer relapse-free intervals (log-rank chi(2) = 4.04; p = 0.044). When different types of episodes were analyzed separately, the effect was significant for both the number of patients who experienced a hypomanic/manic recurrence (chi2 = 5.65; p = 0.017) and the time to such an episode (log-rank chi2 = 5.84; p = 0.015). The differences in preventing depressive and mixed episodes were not significant. CONCLUSIONS A psychoeducation group intervention for the caregivers of bipolar patients is a useful adjunct to usual treatment for the patients in reducing the risk of recurrences, particularly mania and hypomania, in bipolar disorder.
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Affiliation(s)
- María Reinares
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBER-SAM, University of Barcelona, Barcelona, Spain [corrected]
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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 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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Chessick CA, Perlick DA, Miklowitz DJ, Kaczynski R, Allen MH, Morris CD, Marangell LB. Current suicide ideation and prior suicide attempts of bipolar patients as influences on caregiver burden. Suicide Life Threat Behav 2007; 37:482-91. [PMID: 17896888 DOI: 10.1521/suli.2007.37.4.482] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We examined whether caregivers of bipolar patients reporting current suicidal ideation and/or a history of a suicide attempt reported higher levels of burden and/or poorer health compared to caregivers of patients without these suicidality indices. In a cross-sectional design, caregivers (N = 480) associated with (a) patients with current suicidal ideation or (b) patients with a positive lifetime history of at least one suicide attempt, reported lower general health scores than caregivers associated with patients with neither of these indices. Parents of patients with at least one lifetime attempt reported more burden secondary to role dysfunction than spouses. Levels of depression in caregivers varied with whether the caregiver was a spouse or a parent, and whether patients had a history of suicide attempts, current suicidal ideation, or both.
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Affiliation(s)
- Cheryl A Chessick
- Department of Psychiatry, University of Colorado Health Sciences Center, Denver, Colorado 80220, USA.
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Perlick DA, Rosenheck RA, Miklowitz DJ, Chessick C, Wolff N, Kaczynski R, Ostacher M, Patel J, Desai R. Prevalence and correlates of burden among caregivers of patients with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder. Bipolar Disord 2007; 9:262-73. [PMID: 17430301 DOI: 10.1111/j.1399-5618.2007.00365.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Caring for a relative with schizophrenia or dementia is associated with reports of high caregiver burden, symptoms of depression, poor physical health, negligence of the caregiver's own health needs, elevated health service use, low use of social supports, and financial strain. This study presents the design and preliminary data on the costs and consequences of caring for a relative or friend with bipolar disorder from the Family Experience Study, a longitudinal study of the primary caregivers to 500 patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder. METHODS Subjects were primary caregivers of 500 patients with bipolar disorder diagnosed by the Mini International Neuropsychiatric Interview and the Affective Disorder Evaluation. Caregivers were evaluated within 1 month after patients entered Systematic Treatment Enhancement Program using measures of burden, coping, health/mental health, and use of resources and costs. RESULTS Eighty-nine percent, 52%, and 61% of caregivers, respectively, experienced moderate or higher burden in relation to patient problem behaviors, role dysfunction, or disruption of household routine. High burden caregivers reported more physical health problems, depressive symptoms, health risk behavior and health service use, and less social support than less burden caregivers. They also provided more financial support to their bipolar relative. CONCLUSIONS Burdens experienced by family caregivers of people with bipolar disorder are associated with problems in health, mental health, and cost. Psychosocial interventions targeting the strains of caregiving for a patient with bipolar disorder are needed.
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Affiliation(s)
- Deborah A Perlick
- Department of Psychiatry, Mt. Sinai School of Medicine, New York, NY 10029, USA.
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Manguno-Mire G, Sautter F, Lyons J, Myers L, Perry D, Sherman M, Glynn S, Sullivan G. Psychological distress and burden among female partners of combat veterans with PTSD. J Nerv Ment Dis 2007; 195:144-51. [PMID: 17299302 DOI: 10.1097/01.nmd.0000254755.53549.69] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psychological distress among cohabitating female partners of combat veterans with posttraumatic stress disorder (PTSD) was examined in a cross-sectional study using a modified version of the Health Belief Model. A convenience sample of 89 cohabitating female partners of male veterans in outpatient PTSD treatment was interviewed by telephone using a structured interview. Partners endorsed high levels of psychological distress with elevations on clinical scales at or exceeding the 90th percentile. Severe levels of overall psychological distress, depression, and suicidal ideation were prevalent among partners. Multivariate analyses revealed that perceived threat, recent mental health treatment, and level of involvement with veterans predicted global partner psychological distress. Partner burden was predicted by partner self-efficacy, perceived threat, barriers to mental health treatment, and partner treatment engagement. These findings are compelling since they demonstrate that partners of veterans with combat-related PTSD experience significant levels of emotional distress that warrant clinical attention. Psychological distress and partner burden were each associated with a unique combination of predictors, suggesting that although these constructs are related, they have distinct correlates and potentially different implications within the family environment. Future research should examine these constructs separately using causal modeling analyses to identify modifiable targets for interventions to reduce psychological distress among partners of individuals with PTSD.
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Affiliation(s)
- Gina Manguno-Mire
- VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Little Rock, Arkansas, USA
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Abstract
Functional recovery, the goal of treatment, has long been overlooked in the assessment of effectiveness of pharmacological treatments. However, with the recent shift in paradigm, from syndromal-symptomatic recovery to functional recovery, there appears to be a new interest in the definition and evaluation of functional recovery. Since functional recovery lags symptomatic recovery, sometimes by months or years, the attainment of functional recovery will be determined by both efficacy and long-term compliance. Quetiapine, due to its efficacy in both mania and depression, and effect on cognition may lead to improved functioning in patients with bipolar disorder.
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Affiliation(s)
- Charles Bowden
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
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Bernhard B, Schaub A, Kümmler P, Dittmann S, Severus E, Seemüller F, Born C, Forsthoff A, Licht RW, Grunze H. Impact of cognitive-psychoeducational interventions in bipolar patients and their relatives. Eur Psychiatry 2006; 21:81-6. [PMID: 16380236 DOI: 10.1016/j.eurpsy.2005.09.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 09/13/2005] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In recent years, several controlled studies could show that psychoeducational interventions have been effective for relapse prevention in bipolar disorders. We therefore established a cognitive-psychoeducational group intervention with 14 sessions providing information about the illness, early warning signs, cognitive and behavioural strategies for stress management and social rhythm. Additionally we offered a group intervention for the patients' relatives. The objective of this study was to describe the outcome associated with our psychoeducational intervention in bipolar patients and their relatives. METHODS Sixty-two bipolar patients attended 14 sessions (à 90 min) of cognitive-psychoeducational group therapy. Patients' knowledge of bipolar disorder and their satisfaction with the treatment were assessed using self-developed questionnaires before and after the group intervention. Additionally, 49 relatives of bipolar patients received two psychoeducational workshops of 4 hours each. We assessed demographic variables, burden, high expressed emotion and depressive symptoms of the relatives before and after the two workshops and at 1-year follow-up. RESULTS Patients significantly improved their knowledge of bipolar disorder. They also have benefited from the discussions and the exchange of useful coping strategies. Burden and high expressed emotions showed no significant reductions at post-assessment, however they were significantly reduced at 1-year follow-up. Relatives also felt significantly better informed about the illness. CONCLUSIONS These findings show that psychoeducational interventions in bipolar patients and their relatives improve patients' and their relatives' knowledge of the illness and the burden of the disorder as well as high expressed emotions are reduced in relatives at 1-year follow-up.
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Affiliation(s)
- Britta Bernhard
- Bipolar Disorder Program, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80806 Munich, Germany.
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Abstract
Caregivers of people with bipolar disorder may experience a different quality of burden than is seen with other illnesses. A better understanding of their concerns is necessary to improve the training of professionals working with this population. Conceptualizing caregiver burden in a conventional medical framework may not focus enough on issues important to caregivers, or on cultural and social issues. Perceptions of caregivers about bipolar disorder have important effects on levels of burden experienced. It is important to distinguish between caregivers' experience of this subjective burden and objective burden as externally appraised. Caregivers' previous experiences of health services may influence their beliefs about the illness. Caregiver burden is associated with depression, which affects patient recovery by adding stress to the living environment. The objective burden on caregivers of patients with bipolar disorder is significantly higher than for those with unipolar depression. Caregivers of bipolar patients have high levels of expressed emotion, including critical, hostile, or over-involved attitudes. Several measures have been developed to assess the care burden of patients with depressive disorders, but may be inappropriate for patients with bipolar disorder because of its cyclical nature and the stresses arising from manic and hypomanic episodes. Inter-episode symptoms pose another potential of burden in patients with bipolar disorder. Subsyndromal depressive symptoms are common in this phase of the illness, resulting in severe and widespread impairment of function. Despite the importance of assessing caregiver burden in bipolar disorder, relevant literature is scarce. The specific effects of mania and inter-episode symptoms have not been adequately addressed, and there is a lack of existing measures to assess burden adequately, causing uncertainty regarding how best to structure family interventions to optimally alleviate burden. The relatively few studies into caregiver burden in bipolar disorder may largely reflect experiences in the US Veterans Affairs health service, but the findings may be limited in their generalizability. Nevertheless, available data suggest that caregiver burden is high and largely neglected in bipolar disorder. Clinically effective, well-targeted and practically viable interventions are needed. However, services cannot be enhanced on a rational basis without an improved understanding and capacity to measure and target caregiver burden the impact of any change in services be evaluated.
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Affiliation(s)
- Alan D Ogilvie
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
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Kessing LV, Hansen HV, Ruggeri M, Bech P. Satisfaction with treatment among patients with depressive and bipolar disorders. Soc Psychiatry Psychiatr Epidemiol 2006; 41:148-55. [PMID: 16456641 DOI: 10.1007/s00127-005-0012-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients' satisfaction with care may be an important factor in relation to adherence to treatment and continued psychiatric care. Few studies have focused on satisfaction in patients with depressive and bipolar disorders. METHOD A comprehensive multidimensional questionnaire scale, the Verona Service Satisfaction Scale-Affective, was mailed to a large population of patients with depressive or bipolar disorders representative of outpatients treated at their first contact to hospital settings in Denmark. RESULTS Among the 1,005 recipients, 49.9% responded to the letter. Overall, patients were satisfied with the help provided, but satisfaction with the professionals' contact to relatives was low. Younger patients (age below 40 years) were consistently more dissatisfied with care especially with the efficacy of treatment, professionals' skills and behaviour and the information given. There was no difference in satisfaction between genders or between patients with depressive disorder and patients with bipolar disorder. CONCLUSION There is a need to strengthen outpatient treatment for patients discharged from a psychiatric hospital diagnosed of having affective disorders, focusing more on information and psychoeducation for patients and relatives.
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Affiliation(s)
- Lars Vedel Kessing
- Dept. of Psychiatry, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
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