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Family burden in bipolar disorders: Results from the Italian Mood Disorders Study (IMDS)

Published online by Cambridge University Press:  11 April 2011

Lorenza Magliano ,
Ada Orrico ,
Andrea Fiorillo ,
Heidegret Del Vecchio ,
Giuseppina Castiello ,
Claudio Malangone ,
Corrado De Rosa ,
Vittorio Capuano  and
Mario Maj
Lorenza Magliano*
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples (Italy)
Ada Orrico
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples (Italy)
Andrea Fiorillo
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples (Italy)
Heidegret Del Vecchio
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples (Italy)
Giuseppina Castiello
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples (Italy)
Claudio Malangone
Affiliation:
Mental Health Centre of Ravello, Salerno (Italy)
Corrado De Rosa
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples (Italy)
Vittorio Capuano
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples (Italy)
Mario Maj
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples (Italy)
*
Professor L. Magliano, Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples (Italy). Fax: +39-081-5666523 E-mail: [email protected]
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Summary

Aims – To explore: a) the burden of care, and the professional and social support in relatives of patients with bipolar disorders; b) the psychosocial interventions provided to patients and their families by Italian mental health centres. Methods – 342 outpatients with a bipolar disorder and their key-relatives were randomly recruited in 26 Italian mental health centres, randomly selected and stratified by geographical area and population density. Family burden was explored in relation to: a) patient's clinical status and disability; b) relatives’ social and professional support; c) interventions received by patients and their families; d) geographical area. Results – In the previous two months, global functioning was moderately impaired in 36% of the patients, and severely impaired in 34% of them. Twenty-one percent of patients attended a rehabilitative programme, and 3% of their families received a psychoeducational intervention. Burden was higher when patient's symptoms and disability were more severe, the relatives had poorer psychological support and help in emergencies by the social network, and the family lived in Southern Italy. Differences in family burden in relation to geographical area disappeared when psychosocial interventions were provided. Conclusion – This study highlights the need to increase the availability of rehabilitative interventions for patients with bipolar disorders and of psychological support for their families, especially in Southern Italy.

Keywords

bipolar disordersburden of illnesssocial supportfamily
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 18 , Issue 2 , June 2009 , pp. 137 - 146
Copyright
Copyright © Cambridge University Press 2009

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References

Chadda, R.K., Singh, T.B. & Ganguly, K.K. (2007). Caregiver burden and coping. A prospective study of relationship between burden and coping in caregivers of patients with schizophrenia and bipolar affective disorder. Social Psychiatry and Psychiatric Epidemiology 42, 923–930.CrossRefGoogle ScholarPubMed
Chakrabarti, S. & Gill, S. (2002). Coping and its correlates among caregivers of patients with bipolar disorder: a preliminary study. Bipolar Disorders 4, 50–60.CrossRefGoogle ScholarPubMed
Chakrabarti, S., Nehra, R. & Sharma, S. (2003). Distress associated with symptoms of schizophrenia and bipolar disorder: the caregiver's perspective. Journal of Mental Health and Human Behaviour 8, 39–50.Google Scholar
Chessick, C., Perlick, D.A., Miklowitz, D.J., Kaczynski, R., Allen, M.H., Morris, C.D., Marangell, L.B., & the STED-BD Family Experience Collaborative Study Group (2007). Current suicide ideation and prior suicide attempts of bipolar patients as influences on caregiver burden. Suicide and Life-Threatening Behavior 37, 482–491.CrossRefGoogle ScholarPubMed
Clark, R.E. (1994). Family costs associated with severe mental illness and substance abuse. Hospital and Community Psychiatry 45, 808–813.Google Scholar
Coryell, W., Scheftner, W., Keller, M., Endicott, J., Maser, J. & Klerman, G.L. (1993). The enduring psychosocial consequences of mania and depression. American Journal of Psychiatry 150, 720–727.Google ScholarPubMed
Costa, G., Marinacci, C., Caiazzo, A. & Spadea, T. (2003). Individual and contextual determinants of inequalities in health: the Italian case. International Journal of Health Services 33, 635–667.CrossRefGoogle ScholarPubMed
Cuellar, A.K., Johnson, S.L. & Winters, R. (2005). Distinctions between bipolar and unipolar depression. Clinical Psychology Review 25, 307–339.CrossRefGoogle ScholarPubMed
de Girolamo, G., Bassi, M., Neri, G., Ruggeri, M., Santone, G. & Picardi, A. (2007). The current state of mental health care in Italy: problems, perspectives and lessons to learn. European Archives of Psychiatry and Clinical Neuroscience 257, 83–91.CrossRefGoogle ScholarPubMed
Dean, B.B., Gerner, D. & Gerner, R.H. (2004). A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in bipolar disorder. Current Medical Research Opinions 20, 139–154.CrossRefGoogle ScholarPubMed
Di, Bartolomeo S., Valent, F., Rossi, C., Beltrame, F., Anghileri, A. & Barbone, F. (2008). Geographical differences in mortality of severely injured patients in Italy. European Journal of Epidemiology 23, 89–294.Google Scholar
Dore, G. & Romans, S.E. (2001). Impact of bipolar affective disorder on family and patients. Journal of Affective Disorders 67,147–158.CrossRefGoogle Scholar
Folkman, S. & Lazarus, R.S. (1980). An analysis of coping in a middleaged community sample. Journal of Health and Social Behaviour 21, 219–239.CrossRefGoogle Scholar
Gitlin, M.J., Swendsen, J., Heller, T.L. & Hammen, C. (1995). Relapse and impairment in bipolar disorder. American Journal of Psychiatry 152, 1635–1640.Google ScholarPubMed
Gonzales, J.M., Perlick, D.A., Mikowitz, D.J., Kaczynski, R., Hernandez, M., Rosenheck, R.A., Culver, J.L., Ostacher, M.J., Bowden, C.L. & the STEP-BD Family Experience Study Group (2007). Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD Study. Psychiatric Services 58, 41–48.CrossRefGoogle Scholar
Hammen, C., Burge, D., Burney, D. & Adrian, C. (1990). Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder. Archives of General Psychiatry 47, 1112–1117.CrossRefGoogle ScholarPubMed
Heru, A.M. & Ryan, C.E. (2004). Burden, reward and family functioning of caregivers for relatives with mood disorders: 1-year follow-up. Journal of Affective Disorders 83, 221–225.CrossRefGoogle Scholar
Judd, L.L., Schettler, P.J., Akiskal, H.S., Maser, J., Coryell, W., Solomon, D., Endicott, J. & Keller, M. (2003). Long-term symptomatic status of bipolar I vs. bipolar II disorders. International Journal of Neuropsychopharmacology 6,127–137.CrossRefGoogle ScholarPubMed
Kessler, R.C., Chiu, W.T., Demler, O. & Walters, E.E. (2005). Prevalence, severity and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kleinman, L., Lowin, A., Flood, E., Gandhi, G., Edgeli, E. & Revicki, D. (2003). Costs of bipolar disorder. Pharmacoeconomics 21, 601–622.CrossRefGoogle ScholarPubMed
Lam, D., Donaldson, C., Brown, Y. & Malliaris, Y. (2005). Burden and marital and sexual satisfaction in the partners of bipolar patients. Bipolar Disorders 7, 431–440.CrossRefGoogle ScholarPubMed
Lukoff, D., Nuechterlein, K.H. & Ventura, J. (1986). Manual for the expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin 112, 594–602.Google Scholar
Magliano, L. & Fiorillo, A. (2007). Psychoeducational family interventions for schizophrenia in the last decade: from explanatory to pragmatic trials. Epidemiologia e Psichiatria Sociale 16, 22–34.CrossRefGoogle ScholarPubMed
Magliano, L., Fadden, G., Madianos, M., Caldas de Almeida, J.M., Held, T., Guarneri, M., Marasco, C., Tosini, P. & Maj, M. (1998). Burden on the families of patients with schizophrenia: results of the BIOMED I study. Social Psychiatry and Psychiatric Epidemiology 33, 405–412.CrossRefGoogle ScholarPubMed
Magliano, L., Marasco, C., Fiorillo, A., Malangone, C., Guarneri, M., Maj, M. & Working Group of the Italian National Study on Families of Persons with Schizophrenia (2002). The impact of professional and social network support on the burden of families of patients with schizophrenia. Acta Psychiatrica Scandinavica 106, 291–298.CrossRefGoogle ScholarPubMed
Magliano, L., Fiorillo, A., De Rosa, C., Malangone, C., Maj, M. & National Mental Health Project Working Group (2005). Family burden in long-term diseases: a comparative study in schizophrenia vs. physical disorders. Social Science and Medicine 61, 313–322.CrossRefGoogle Scholar
Magliano, L., Fiorillo, A., Malangone, C., De Rosa, C., Maj, M. & National Mental Health Project Working Group (2006). Social network in long-term diseases: a comparative study in relatives of persons with schizophrenia and physical illnesses versus a sample from the general population. Social Science and Medicine 62, 1392–1402.CrossRefGoogle Scholar
Merikangas, K.R., Akiskal, H.S., Angst, J., Greenberg, P.E., Hirschfeld, R.M.A., Petukhova, M. & Kessler, R.C. (2007). Lifetime and 12- month prevalence of bipolar spectrum disorder in the national comorbidity survey replication. Archives of General Psychiatry 64, 543–552.CrossRefGoogle ScholarPubMed
Michalak, E.E., Murray, G., Young, A.H. & Lam, R.W. (2008). Burden of bipolar disorder. Impact of Disorder and Medication on Quality of Life. CNS Drugs 22, 389–406.CrossRefGoogle ScholarPubMed
Miklowitz, D.J. & Johnson, S.L. (2006). The psychopathology and treatment of bipolar disorder. Annual Review of Clinical Psychology 2, 199–235.CrossRefGoogle ScholarPubMed
Morosini, P.L., Veltro, F., Cerreta, A., Gaio, R.Palomba, U. & Ventra, C. (1988). Disabilità sociale e carico familiare. Studio di riproducibilità di un nuovo strumento di valutazione. Rivista Sperimentale di Freniatria 3, 541–563.Google Scholar
Morosini, P.L., Roncone, R., Veltro, F., Palomba, U. & Casacchia, M. (1991). Routine assessment tool in psychiatry: the questionnaire of family attitudes and burden. Italian Journal of Behavioural Sciences 1, 95–101.Google Scholar
Murray, C.L.J. & Lopez, A.D. (1996). The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Harvard University Press: Boston.Google Scholar
Nehra, R., Chakrabarti, S., Kulhara, P. & Sharma, R. (2005). Caregivercoping in bipolar disorder and schizophrenia. A re-examination. Social Psychiatry and Psychiatric Epidemiology 40, 329–336.CrossRefGoogle Scholar
Ogilvie, A.D., Morant, N. & Goodwin, G.M. (2005). The burden on informal caregivers of people with bipolar disorder. Bipolar Disorders 7, 25–32.CrossRefGoogle ScholarPubMed
Ostman, M. & Hansson, L. (2002). Children in families with a severely mentally ill member: prevalence and needs for support. Social Psychiatry and Psychiatric Epidemiology 37, 243–248.CrossRefGoogle ScholarPubMed
Perlick, D.A., Rosenheck, R.A., Clarkin, J.F., Maciejewski, P.K., Sirey, J., Struening, E. & Link, B.G. (2004). Impact of family burden and affective response on clinical outcome among patients with bipolar disorder. Psychiatric Services 55, 1029–1035.CrossRefGoogle ScholarPubMed
Perlick, D.A., Miklowitz, D.J., Link, B.G., Struening, E., Kaczyinski, R., Gonzalez, J., Manning, L.N., Wolff, N. & Rosenheck, R.A. (2007 a). Perceived stigma an depression among caregivers of patients with bipolar disorder. British Journal of Psychiatry 190, 535–536.CrossRefGoogle ScholarPubMed
Perlick, D.A., Rosenheck, R.A., Miklowitz, D.J., Chessick, C., Wolff, N., Kaczynski, R., Ostacher, M., Patel, J., Desai, R. & STEP-BD Family Experience Collaborative Study Group (2007 b). Prevalence and correlates of burden among caregivers of patients with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder. Bipolar Disorders 9, 262–273.CrossRefGoogle ScholarPubMed
Perlick, D.A, Rosenheck, R.A., Miklowitz, D.J., Kaczyinski, R., Link, B., Ketter, T., Wisniewski, S., Wolff, N., Sachs, G. & the STEP-BD Family Experience Collaborative Study Group (2008). Caregiver burden and health in bipolar disorder. A cluster analytic approach. Journal of Nervous and Mental Disease 196, 484–491.CrossRefGoogle ScholarPubMed
Preti, A., Rucci, P., Santone, G., Picardi, A., Miglio, R., Bracco, R., Norcio, B. & de Girolamo, G. (2008). Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy. Psychological Medicine 38, 1–12.Google Scholar
Rea, M.M., Tompson, M.C., Miklowitz, D.J., Goldstein, M.J., Hwang, S., Mintz, J. (2003). Family-focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 71, 482–492.CrossRefGoogle ScholarPubMed
Reinares, M., Vieta, E., Colom, F., Martinez-Aràn, A., Torrent, C., Comes, M., Goikolea, J.M., Benabarre, A., Daban, C. & Sanchez-Moreno, J. (2006). What really matters to bipolar patients’ caregivers: sources of family burden. Journal of Affective Disorders 94, 157–163.CrossRefGoogle ScholarPubMed
Revicki, D.A, Matza, L.S., Flood, E. & Lloyd, A. (2005). Bipolar disorder and health-related quality of life. Review of burden of disease and clinical trials. Pharmacoeconomics 23, 583–594.CrossRefGoogle ScholarPubMed
Ruggeri, M.Koeter, M., Schene, A., Bonetto, C., Vazquez-Barquero, J.L., Becker, T., Knapp, M., Knudsen, H.C., Tansella, M., Thronicroft, G. & Epsilon Study Group (2005). Factor solution of the BPRS-expanded version in schizophrenic outpatients living in five European countries. Schizophrenia Research 75, 107–117.CrossRefGoogle ScholarPubMed
Schweitzer, I., Maguire, K. & Ng, C. (2005). Should bipolar disorder be viewed as manic disorder? Implications for bipolar depression. Bipolar Disorder, 9, 453–461.Google Scholar
Simon, G.E. (2002). Why we care about the economic and social burden of bipolar disorder. In Bipolar Disorder (ed. M., Maj, H., Akiskal, J.J., Lopez-Ibor and N., Sartorius), p.441. Wiley: Chichester.Google Scholar
Solomon, P. & Draine, J. (1995). Adaptive coping among family members of persons with serious mental illness. Psychiatric Services 46, 1156–1160.Google ScholarPubMed
Van der Voort, T.Y.G., Goossens, P.J.J. & Van der Bijl, J.J. (2007). Burden, coping and needs for support of caregivers for patients with a bipolar disorder: a systematic review. Journal of Psychiatric and Mental Health Nursing 14, 679–687.CrossRefGoogle ScholarPubMed
Van Wijngaarden, B., Schene, A.H. & Koeter, M.W.J. (2004). Family caregiving in depression: impact on caregivers’ daily life, distress, and help seeking. Journal of Affective Disorders 81, 211–222.CrossRefGoogle ScholarPubMed
Weber-Rouget, B. & Aubry, J.-M. (2007). Efficacy of psychoeducational approaches on bipolar disorders: a review of the literature. Journal of Affective Disorders 98, 11–27.CrossRefGoogle Scholar
Weissman, M.M., Bland, R.C., Canino, G.J., Faravelli, C., Greenwald, S., Hwu, H.G., Joyce, P.R., Karam, E.G., Lee, C.K., Lellouch, J., Lepine, J.P., Newman, S.C., Rubio-Stipec, M., Wells, J.E., Wickramaratne, P.J., Wittchen, H. & Yeh, E.H. (1996). Cross-national epidemiology of major depression and bipolar disorder. Journal of American Medical Association 276, 293–299.CrossRefGoogle ScholarPubMed
Wolff, N., Perlick, D.A., Kaczynski, R., Calabrese, J., Nierenberg, A. & Miklowitz, D.J. (2006). Modeling costs and burden of informal caregiving for persons with bipolar disorder. Journal of Mental Health Policy and Economics 9, 99–110.Google ScholarPubMed
World Health Organization (1988). Psychiatric Disability Assessment Schedule (DAS). WHO: Geneva.Google Scholar