|Year : 2019 | Volume
| Issue : 2 | Page : 139-143
Coping among caregivers of patients suffering from bipolar affective disorder
Abdul Majid Gania1, Harmanjeet Kaur1, Ajaz Ahmad Suhaff1, Sandeep Grover2, Abdul Wahid Khan1, Sajid Mohammad Wani1
1 Department of Psychiatry, SKIMS Medical College, Bemina, Srinagar, Jammu and Kashmir, India
2 Department of Psychiatry, PGIMER, Chandigarh, India
|Date of Web Publication||22-Jul-2020|
Ajaz Ahmad Suhaff
Department of Psychiatry, SKIMS Medical College, Bemina, Srinagar, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Introduction: Burden caused by bipolar affective disorder (BPAD) upon families and caregivers is a matter of increasing clinical concern. Stressors are coped with based on how significant they are for those involved. Coping means trying to overcome that which is causing stress and may refocus the significance associated with the difficulties, guide the individual's life, and keep him/her physically, psychologically, and socially healthy. Aims and Objectives: The aim and objective of the study was to explore ways of coping by caregivers of patients suffering from BPAD. Materials and Methods: The sample comprised 100 caregivers of 100 patients either outpatients or inpatients at the Department of Psychiatry, SKIMS, Bemina, Srinagar, diagnosed with BPAD using International Classification of Diseases, tenth revision. Results: Majority of caregivers were from the age group of 40–49 years, males, married, and with no formal education. In our study, majority of caregivers were from the age group of 40–49 years, males, unmarried, and with no formal education. Majority of caregivers had been providing care to the patients for the duration of 1–5 years. Majority of caregivers were spouses of the patients. The most common method of coping was consulting doctors, talking to friends/family, and seeking practical help. Majority of caregivers used avoidance, seeking social support, and problem-focused strategies. Collusion strategy was also frequently used. Coercion strategy was used less frequently. Conclusions: Majority of caregivers used avoidance, seeking social support, and problem-focused strategies. Collusion strategy was also frequently used. Coercion strategy was used less frequently. We need to better understand caregivers' views and personal perceptions of the stresses and demands arising from caring for someone with bipolar affective disorder. Family interventions are needed to increase the coping ability of caregivers of the patients.
Keywords: Bipolar disorder, caregiver burden, coping, social support
|How to cite this article:|
Gania AM, Kaur H, Suhaff AA, Grover S, Khan AW, Wani SM. Coping among caregivers of patients suffering from bipolar affective disorder. J Mental Health Hum Behav 2019;24:139-43
|How to cite this URL:|
Gania AM, Kaur H, Suhaff AA, Grover S, Khan AW, Wani SM. Coping among caregivers of patients suffering from bipolar affective disorder. J Mental Health Hum Behav [serial online] 2019 [cited 2020 Oct 27];24:139-43. Available from: https://www.jmhhb.org/text.asp?2019/24/2/139/290513
| Introduction|| |
Bipolar affective disorder (BPAD) is the sixth leading cause of disability worldwide. Its lifetime prevalence is about 3% in the general population., BPAD is reported to pose a significant burden on caregivers.,,, Caregiver burden can be defined as the presence of problems, difficulties affecting the lives of psychiatric patient's caregivers.
The family members experience a sequence of stressors that interfere in family unity, such as the diagnosis of the disease itself, the individual's inability to perform daily tasks, possible changes in economic and social status, uncertainty as to whether there is a cure, and the possibility that the disease may become chronic., Studies have found that caregivers often report feelings of powerlessness, hopelessness, and inability to change the situation.,
Stressors are coped with based on how significant they are for those involved. Coping means trying to overcome the factors, causing stress, and may refocus the significance associated with the difficulties, guide the individual's life, and keep him/her physically, psychologically, and socially healthy. Two major categories of coping strategies are widely recognized: problem-focused and emotion-focused strategies., Some studies also emphasized the association between relatives' coping strategies and the long-term outcome of patients with BPAD. There is a paucity of data evaluating caregiver burden and coping styles of caregivers of patients with BPAD. This study thus attempted to evaluate the coping strategies used in caregivers of BPAD patients.
| Materials and Methods|| |
This was a cross-sectional study. The study sample comprised 100 primary caregivers of patients with BPAD attending either the outpatient or inpatient services of the Department of Psychiatry, SKIMS, Bemina, Srinagar, diagnosed with BPAD as be the International Classification of Diseases, tenth revision criteria. Intake data of each caregiver was recorded on a specially designed pro forma. The study was approved by the ethics committee of the institute, and all the participants were recruited after obtaining written informed consent. The caregivers were assessed by the following scale: 1. Family Burden Interview Schedule. It is a semi-structured interview schedule having 24 item scale and each item score ranges from 0 to 2 where 0 means no burden, 1 means moderate burden, and 2 means severe burden. Thus, the total score range of scale is 0–48. The objective burden is evaluated as financial burden, disruption of routine family activities, disruption of family leisure, disruption of family interaction, physical health, and mental health among the caregivers.
Coping check list
Coping checklist is a modified version of the coping check list of Scazufca and Kuipers and was adapted for the Indian population by Nehra et al. It consists of 14 items divided into four domains, i.e., problem-focused coping (3 items), seeking social support (4 items), avoidance (5 items), collusion (1 item), and coercion (1 item). The items are rated on a 3-point scale (1 – never, 2 – sometimes, and 3 – always). Psychometric properties including face validity, inter-rater reliability, and internal consistency had been determined. Cronbach's alpha of the scale was found to be 0.62.
To be included in the study, the caregivers were required to be aged ≥18 years, taking care of patients for a minimum period of 12 months or more, and were engaged in patient care actively. Caregivers diagnosed with major psychiatric illness and staying with the patient for <12 months were excluded from the study.
The recorded data were compiled and entered in a spreadsheet (Microsoft Excel) and then exported to the data editor of SPSS version 20.0 (SPSS Inc., Chicago, Illinois, USA). Continuous variables were summarized in the form of means and standard deviations and categorical variables were summarized as percentages. Student's independent t-test and ANOVA were employed for comparing caregiver burden with different variables.
| Results|| |
A detail of sociodemographic variables and caregiving profile of the caregivers is given in [Table 1]. Most of the caregivers were spouses of the patients, i.e., 55% (30% husbands and 25% wives), followed by parents, i.e., 33% (22% mothers and 11% fathers), and offsprings, i.e., 12% (n = 12).
Details of caregiver burden are given in [Table 2]. The maximum burden score was obtained for the financial burden, followed by disruption of family routine activities and disruption of family leisure, followed by disruption of family interactions. The mean total family burden scale score was 24.31 (standard deviation [SD]: 7.35). When the family burden was compared between parents (mean: 24.47; SD: 7.97), spouse (mean: 28.04; SD: 7.03), and offsprings (mean: 21.57; SD: 6.02), spouses reported significantly higher caregiver burden (P = 0.008).
When the caregiver burden was compared for the caregivers involved in the care of patients for 1–5 years (mean: 22.999; SD: 5.64), 6–10 years (mean: 33.06; SD: 6.0), and those caring for >10 years (mean: 35.57; SD: 5.99), those involved in caregiving for longer duration reported significantly higher caregiver burden (P < 0.001).
The frequency of use of various coping strategies by the caregivers is shown in [Table 3] and the mean scores are shown in [Table 4]. Caregivers were categorized into two groups depending on whether they ever (i.e., sometimes or always) or never having used a particular coping strategy. It was apparent that the caregivers were employing a mixture of both adaptive and nonadaptive coping strategies to cope with the patient's illness. The most common method of coping was consulting doctors which was present in 100% of caregivers, and talking to friends/family and seeking practical help were present in 92% of the caregivers. Collusion was also used quite frequently, i.e., 83% of caregivers used collusion. Avoidant strategy, i.e., “hoped for miracles/prayed for good times,” was used by 88% of the caregivers. This was followed by the use of various problem-focused strategies which was present in 80% of caregivers, in which caregivers worked out problems calmly with family/friends. Coercion strategy was least commonly used which was present in 69% of the caregivers.
|Table 4: The mean scores for various domains of coping strategies used by the caregivers|
Click here to view
Caregivers of female patients reported significant higher caregiver burden as compared to male patients (t = 3.26; P = 0.002). Significantly higher caregiver burden was found in caregivers of illiterate patients (P = 0.001).
| Discussion|| |
Caregivers provide assistance with activities of daily living and emotional support to the patient. The mean age of caregivers was 43.4 years in the present study which was almost similar to the study by Pompili et al. (46.0) and Vasudeva et al. (47.39 years).
Most of the caregivers were male, i.e., 52% (n = 52), which was similar to the study by Vasudeva et al. (54.9%) and Nallapaneni et al. (52%), in contrast to the study by Perlick et al. where majority of the caregivers were females. Most of the caregivers were of lower socioeconomic status in the present study which is similar to study by Suriyamoorthi et al., but Vasudeva et al. observed that only 2% of patients belonged to low socioeconomic status. The mean duration of care of the patients was 4.8 years similar to the study by Suriyamoorthi et al. in which the mean duration of care was 5 years (46.2%), but in the study by Vasudeva et al., the mean duration of caregiving was 8.67 years.
In our study, caregiver burden was experienced in the major four areas, i.e., financial difficulties, disruption of family routine activities, disruption of family leisure, and disruption in family interactions. Similar results were reported in another study from India.
In the present study, the most common method of coping was consulting doctors which was present in 100% of the caregivers. Majority of caregivers reported using avoidance, seeking social support, and problem-focused coping strategies. Collusion strategy was also frequently used. Coercion strategy was used less frequently. Talking to friends/family and seeking practical help were present in 92% of the caregivers. Collusion was also used quite frequently in 83% of the caregivers. Avoidant strategy, i.e., “hoped for miracles/prayed for good times,” was used by 88% of the caregivers. This was followed by the use of various problem-focused strategies which was present in 80% of the caregivers, in which caregiver worked out problems calmly with family/friends. Coercion strategy was least commonly used which was present in 69% of the caregivers. Similar results were observed in a previous study from India. They found that the most common method of coping was consulting doctors, talking to friends/family, and seeking practical help, with 96%–100% of caregivers. Collusion was also used quite frequently in 92% of the caregivers. A cognitive avoidant strategy, i.e., “hoped for miracles/prayed for good times,” was used by 82% of the caregivers. This was followed by the use of various problem-focused and seeking-support types of strategies, coercive strategies generally being used less frequently.
| Conclusion|| |
BPAD is one of the most burdensome disorders and caregiver burden associated with it was experienced in the major five areas, i.e., financial difficulties, disruption of family routine activities, disruption of family leisure, disruption in family interactions, and subjective burden. Caregivers with more social support experienced less burden. We need to better understand caregivers' views and personal perceptions of the stresses and demands arising from caring for someone with BPAD. This will be necessary to develop practical, appropriate, and acceptable interventions and to improve the training of professionals working with caregivers. Family interventions are needed to increase the coping ability of caregivers of the patients. The formation of self-help groups will help the caregivers in coping with the problems.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Schmitt A, Malchow B, Hasan A, Falkai P. The impact of environmental factors in severe psychiatric disorders. Front Neurosci 2014;8:19.
Boland EM, Alloy LB. Sleep disturbance and cognitive deficits in bipolar disorder: Toward an integrated examination of disorder maintenance and functional impairment. Clin Psychol Rev 2013;33:33-44.
Pompili M, Harnic D, Gonda X, Forte A, Dominici G, Innamorati M, et al
. Impact of living with bipolar patients: Making sense of caregivers' burden. World J Psychiatry 2014;4:1-2.
Lim L, Nathan P, O'Brien-Malone A, Williams S. A qualitative approach to identifying psychosocial issues faced by bipolar patients. J Nerv Ment Des 2004;192:810-7.
Dore G, Romans SE. Impact of bipolar affective disorder on family and partners. J Affect Disord 2001;67:147-58.
Blairy S, Linotte S, Souery D, Papadimitriou GN, Dikeos LB, et al
. Social adjustment and self-esteem of bipolar patients: A multicentric study. J Affect Disord 2004;79:97-103.
Hoenig J, Hamilton MW. The schizophrenic patient in the community and his effect on the household. Int J Soc Psychiatry 1966;12:165-76.
Caqueo-Urízar A, Miranda-Castillo C, Lemos Giráldez S, Lee Maturana SL, Ramírez Pérez M, Mascayano Tapia F. An updated review on burden on caregivers of schizophrenia patients. Psicothema 2014;26:235-43.
Kate N, Grover S, Kulhara P, Nehra R. Relationship of caregiver burden with coping strategies, social support, psychological morbidity, and quality of life in the caregivers of schizophrenia. Asian J Psychiatr 2013;6:380-8.
Folkman S, Lazarus RS. If it changes it must be a process: Study of emotion and coping during three stages of a college examination. J Pers Soc Psychol 1985;48:150-70.
Taylor SE. Health psychology. The science and the field. Am Psychol 1990;45:40-50.
Roth S, Cohen LJ. Approach, avoidance, and coping with stress. Am Psychol 1986;41:813-9.
Jönsson PD, Wijk H, Danielson E, Skärsäter I. Outcomes of an educational intervention for the family of a person with bipolar disorder: A 2-year follow-up study. J Psychiatr Ment Health Nurs 2011;18:333-41.
Goossens PJ, Van Wijngaarden B, Knoppert-van Der Klein EA, Van Achterberg T. Family caregiving in bipolar disorder: Caregiver consequences, caregiver coping styles, and caregiver distress. Int J Soc Psychiatry 2008;54:303-16.
Rea MM, Tompson MC, Miklowitz DJ, Goldstein MJ, Hwang S, Mintz J. Family focused treatment vs. individual treatment for bipolar disorder: Results of a randomized clinical trial. J Consult Clin Psychol 2003;71:482-92.
ICD 10 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO; 1992.
Pai S, Kapur RL. The burden on the family of a psychiatric patient: Development of an interview schedule. Br J Psychiatry 1981;138:332-5.
Scazufca M, Kuipers E. Coping strategiesin relatives of people with schizophrenia before and after psychiatric admission. Br J Psychiatry 1999;174:154-8.
Nehra R, Chakrabarti S, Sharma R, Kaur R. Psychometric properties of the Hindi version of the coping checklist of Scazufca and Kuipers. Indian Journal of Clinical Psychology 2002;29:79-84.
Vasudeva S, Sekhar CK, Rao PG. Caregivers burden of patients with schizophrenia and bipolar disorder: A sectional study. Indian J Psychol Med 2013;35:352-7.
] [Full text]
Nallapaneni NR, Yendluri P, Gupta Paritala CB, Racharla BN. A study of caregiver burden in bipolar affective disorder. J Evol Med Dent Sci 2015;4:8499-515.
Perlick DA, Rosenheck RA, Miklowitz DJ, Kaczynski R, Link B, Ketter T, et al
. Caregiver burden and health in bipolar disorder: A cluster analytic approach. J Nerv Ment Dis 2008;196:484-91.
Suriyamoorthi M, Pakkiyalakshmi N, Ravishankar J. A study on coping skills of caregivers of patients with bipolar disorder. Int J Res Med Sci 2018;6:3647-51.
Nehra R, Chakrabarti S, Kulhara P, Sharma R. Family burden and its correlates among caregivers of schizophrenia and bipolar affective disorder. J Ment Health Hum Behav 2006;11:76-84.
Nehra R, Chakrabarti S, Kulhara P, Sharma R. Caregiver-coping in bipolar disorder and schizophrenia – A re-examination. Soc Psychiatry Psychiatr Epidemiol 2005;40:329-36.
Bauer R, Gottfriedsen GU, Binder H, Dobmeier M, Cording C, Hajak G, et al
. Burden of caregivers of patients with bipolar affective disorders. Am J Orthopsychiatry 2011;81:139-48.
[Table 1], [Table 2], [Table 3], [Table 4]