Bipolar affective disorder is a severe mental illness associated with low utilization of outpatient psychiatric services, and high rates of relapse and utilization of inpatient services; naturalistic studies indicate that about 50% of bipolar patients discharge from inpatient care are readmitted within 15-18 months. These data are particularly striking when viewed in the context of recent advances in the pharmacotherapy of bipolar disorder, demonstrating the urgent need for studies examining psychosocial influences on service use and outcome of bipolar patients, influences which have received scant attention to date. Family factors such as caregiver burden, social support and expressed emotion are known to exert a major influence on outcome in other major psychiatric disorders, but research on family factors in bipolar illness is virtually non-existent. The proposed research aims to examine the direct and indirect effects of family burden on outpatient service utilization, relapse and community tenure in bipolar illness, and to evaluate the scope of burden and associated mental health costs to families. 375 SADS-diagnosed bipolar patients consecutively admitted to an urban or suburban outpatient clinic and their family caregivers will be assessed on measures of patient symptoms and behavior, and on measures of family burden, health and coping: 1) upon admission; 2) 7 and 15 months later. Data on outpatient service utilization (duration, frequency, modality) will be entered into a computerized data base on an ongoing basis, and monthly measures of level and type of symptoms, role functioning and treatment compliance will be obtained. Linear structural equation analytic techniques (LISREL) will be used to model the relationships among exogenous (bipolar symptoms), mediating (family burden, health, coping) and service utilization and community tenure variables. Event history analysis will be employed to model the extent to which bipolar symptoms predict the risk of hospitalization at varying burden levels. The results will be used to develop more precisely targeted treatments to enable families and mentally ill persons to cope more effectively with the burdens of bipolar illness.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
1R01MH051348-01
Application #
3390194
Study Section
Services Research Review Committee (SER)
Project Start
1993-09-01
Project End
1996-08-31
Budget Start
1993-09-01
Budget End
1994-08-31
Support Year
1
Fiscal Year
1993
Total Cost
Indirect Cost
Name
Weill Medical College of Cornell University
Department
Type
Schools of Medicine
DUNS #
201373169
City
New York
State
NY
Country
United States
Zip Code
10065
Perlick, Deborah A; Hohenstein, Jill M; Clarkin, John F et al. (2005) Use of mental health and primary care services by caregivers of patients with bipolar disorder: a preliminary study. Bipolar Disord 7:126-35
Perlick, Deborah A; Rosenheck, Robert A; Clarkin, John F et al. (2004) Impact of family burden and affective response on clinical outcome among patients with bipolar disorder. Psychiatr Serv 55:1029-35
Perlick, D A; Rosenheck, R R; Clarkin, J F et al. (2001) Impact of family burden and patient symptom status on clinical outcome in bipolar affective disorder. J Nerv Ment Dis 189:31-7
Perlick, D A (2001) Special section on stigma as a barrier to recovery: Introduction. Psychiatr Serv 52:1613-4
Perlick, D A; Rosenheck, R A; Clarkin, J F et al. (2001) Stigma as a barrier to recovery: Adverse effects of perceived stigma on social adaptation of persons diagnosed with bipolar affective disorder. Psychiatr Serv 52:1627-32
Struening, E L; Perlick, D A; Link, B G et al. (2001) Stigma as a barrier to recovery: The extent to which caregivers believe most people devalue consumers and their families. Psychiatr Serv 52:1633-8
Perlick, D; Clarkin, J F; Sirey, J et al. (1999) Burden experienced by care-givers of persons with bipolar affective disorder. Br J Psychiatry 175:56-62
Perlick, D A; Rosenheck, R A; Clarkin, J F et al. (1999) Symptoms predicting inpatient service use among patients with bipolar affective disorder. Psychiatr Serv 50:806-12