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Use of mental health and primary care services by caregivers of patients with bipolar disorder: a preliminary study

Authors

  • Deborah A Perlick,

    1. Northeast Program Evaluation Center, West Haven VAMC and the Departments of Psychiatry and Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA
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  • Jill M Hohenstein,

    1. Department of Education and Professional Studies, Kings College London, London, UK
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  • John F Clarkin,

    1. Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, USA
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  • Richard Kaczynski,

    1. Northeast Program Evaluation Center, West Haven VAMC and the Departments of Psychiatry and Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA
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  • Robert A Rosenheck

    1. Northeast Program Evaluation Center, West Haven VAMC and the Departments of Psychiatry and Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA
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  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

Deborah A. Perlick, PhD, NEPEC/182, West Haven VAMC, 950 Campbell Avenue, West Haven, CT 06516, USA.
Fax: 203 937 3463;
e-mail: deborah.perlick@yale.edu

Abstract

Objectives:  Caring for a relative with schizophrenia or dementia has been associated with reports of caregiver burden, symptoms of anxiety, depression, poor self-rated health, and elevated health service use; however, comparable data for caregivers of relatives with bipolar disorder are lacking. This study reports preliminary data on the health, psychological distress and health service use of caregivers of patients with bipolar disorder. It additionally evaluates the relationship of the level of burden caregivers report experiencing to their use of health services, controlling for level of psychological distress and health status.

Methods:  Subjects were primary caregivers of 264 patients with Research Diagnostic Criteria-diagnosed bipolar disorder and their bipolar relatives. Caregiver mental health and primary care service use were assessed retrospectively for the 7-month period prior to inpatient or outpatient admission of the bipolar patient. Caregiver depression, anxiety, medical conditions and patient symptomatology were assessed as well.

Results:  Hierarchical logistic regression analysis demonstrated that caregiver burden significantly increased the likelihood of mental health service use (OR = 13.53, p < 0.001) even after controlling for caregiver psychological distress and medical conditions, while anxiety and depression level, but not burden, significantly increased the likelihood of primary care service use, controlling for other variables (OR = 1.72, p = 0.02).

Conclusions:  Burdens experienced by family caregivers appear to increase use of health services, and presumably cost, and may be reduced by psychosocial intervention.

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