Interventions to Improve Caregiver Health Also Improve Symptoms of Patients
Caregiver psychoeducation intervention consists of 2 phases: the psychoeducation and goal setting phase, and the behavioral analysis of self-care barriers.
Family-focused treatment interventions that effectively improve health behavior and reduce mood symptoms for caregivers of individuals with bipolar disorder also improved the symptoms of the associated individuals, according to a study published in Bipolar Disorders.
Participants in this randomized, double-arm, controlled trial with an active control group included caregivers 18 years old and older who were the primary caregiver for individuals with bipolar disorder, as well as the individuals themselves. Participants who were randomly assigned into the active control group received 8 to 12 sessions of health education on bipolar disorder and common health problems experienced by caregivers, such as anxiety, depression, and sleep disorders.
Participants randomly assigned into the experimental treatment group received 12 to 15 weeks of Family-Focused Treatment-Health Promoting Intervention (FFT-HPI), a form of caregivers-only family-focused therapy developed by study investigators. FFT-HPI targets the mental and physical health needs of caregivers by teaching cognitive behavioral techniques for implementing self-care, setting self-care goals, and instructing caregivers on methods for helping patients with bipolar disorder manage their illness.
The 43 caregiver-patient pairs who completed the study were assessed pre-treatment, immediately post-treatment, and 6 months after treatment. Of the 3 pairs who did not finish, 1 withdrew after the caregiver moved out of state, 1 withdrew after the caregiver died, and 1 withdrew because the family changed their mind about participation very early in the study.
Caregivers in the FFT-HPI group experienced a 48% reduction in depressive symptoms, both during treatment and at follow-up, compared with 22% reductions in the health education group. The FFT-HPI group also experienced a 41% improvement in overall psychological health both during treatment and at follow-up, compared with a 21% improvement during treatment for the health education group, which leveled off after treatment. Furthermore, the individuals associated with the caregivers in the FFT-HPI group experienced a 2.5 times greater reduction in depressive symptoms and a 4 times higher reduction in manic symptoms than individuals associated with the health education group caregivers.
Study investigators conclude, “[our] findings that treating the caregiver alone, without participation of the patient, can lead to sustained symptomatic improvement in both depression and mania for the patient, as well as improvement in depression for the caregiver, are novel.” It is valuable for clinicians to know that efforts to improve the mental and physical health of caregivers can benefit patients with bipolar disorder as well, with no direct participation from the patient required.
Perlick DA, Jackson C, Grier S, et al. Randomized trial comparing caregiver‐only family‐focused treatment to standard health education on the 6‐month outcome of bipolar disorder [published online March 12, 2018] Bipolar Disord. doi: 10.1111/bdi.12621