Phase-based concerns of caregivers for individuals with a bipolar disorder

Background: Caregivers have a key role in providing social and practical support for individuals with bipolar disorder. As such, their perspectives are uniquely important when collaborative decisions are made on management priorities and potential treatment options. Aims: This study aims to identify common concerns that caregivers have in the management of an individual with a bipolar disorder. Method: 111 caregivers were recruited from online advertisements and social media support groups. They completed a questionnaire that obtained demographic and clinical feature details, in addition to whether a series of generic and phase-specific (i.e. depressive or hypo/manic) management concerns reflected their experiences of caregiving. Results: Concerns about work capacity and family impacts were almost ubiquitous, as were general feelings of ineffectiveness and irritation. Depressive phases were more likely to elicit fears of suicide by caregivers, while during hypo/manic phases caregivers were more likely to be angered, have concerns for their own safety, call emergency services or to take safety precautions. There were no differences between bipolar subtypes with regards to concerns during depressive phases, but concerns around safety, reputational damage and risky behaviours were more likely in relation to those experiencing bipolar I manic phases compared to bipolar II hypomanic phases. Conclusions: The concerns identified by caregivers in this paper are consistent with clinical expectations, with concerns regarding insularity and externalisation being prominent for depression and hypo/mania respectively. Not all of these caregivers’ concerns would necessarily be communicated in a healthcare setting, highlighting the need for an embracive approach to improve management outcomes. Additionally, caregivers’ emphasis on their distinctive altruistic concerns highlights their commitment to care despite the challenges, and thus further highlights the potential for clinicians to implement a more proactive role for them in patient care.