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