Tailored Health Self-Management Interventions for Highly Distressed Family Caregivers In the United States, family members serve as unpaid informal caregivers for more than 10 million adults with bipolar disorder. These family caregivers are highly distressed as they experience the fluctuating moods, intensity, and unpredictability associated with bipolar disorder. Bipolar symptom exacerbation, relapse, inability to manage daily activities, and need for ongoing treatment for the person with bipolar disorder, put family caregivers at great risk for compromised mental and physical health. These caregivers have been found to experience greater distress than caregivers of persons with diabetes, hypertension, asthma or dementia and have significantly more mental and physical health problems than the general population, leading to greater use of mental health and primary care services. When their health declines, symptom exacerbation, affective episodes, and re-hospitalization of the diagnosed family member increase. Existing family therapy and education interventions for these caregivers have had little effect on their own health. Health self-management interventions, particularly those tailored to address caregivers' needs and preferences for education, stress management, or resourcefulness skills, have not been examined in this population. This randomized controlled trial will evaluate how varying levels of participation by family caregivers in selecting self-management interventions (ranging from no input into the selection to selection based on caregiver need or preference) affect their health risks and physical and mental health over time. Caregivers will be randomized to: 1) a control group (no intervention); 2) education (usual care); 3) self-management intervention based on need (SM-need); or 4) self-management intervention of their preference (SM-preference). The study aims to: 1) examine differences across the four groups on caregiver health over time; 2) explore relationships between caregiver needs and preferences and relevant contextual factors (care recipient symptoms, caregiver reactions, and caregiving involvement); and 3) build caregiver profiles that are associated with their needs and preferences for intervention. Caregivers in the SM-need and SM-preference groups will receive one of three interventions tailored to match their need or preference: 1) education; 2) biofeedback; or 3) resourcefulness training. Family caregivers will be assessed at baseline (T1), 6 months (T2) and one year (T3). Repeated measures multivariate analyses will address the study aims. The findings from this study will generate new scientific knowledge about the effectiveness of novel, easy to use, independently performed interventions that can be self-tailored to promote caregiver health through education, biofeedback, or resourcefulness. Once established, these health self-management interventions can be tailored to match the needs and preferences of other comparably distressed family caregivers of persons with other chronic mental or physical conditions.
Research suggests that the mostly highly distressed family caregivers are those who provide care and support for persons with unpredictable and challenging illness trajectories, such as those with bipolar disorder. Health self-management interventions for caregivers that can be tailored to address their specific needs or preferences, including bipolar education, resourcefulness skills training, or biofeedback, have not been previously examined. Our findings will generate new scientific knowledge about the effectiveness of novel, easy to use, independently performed interventions that can be individualized and self-tailored to promote the health of other comparably distressed family caregivers.
