Hospital Practices and Research

The Effectiveness of Family-Focused Therapy on the Caregiver Burden of Parents with Children Diagnosed with Bipolar II Disorder

Document Type : Original Article

Authors

Hoda Hasani 1
Mahmoud Goudarzi 2
Parviz Karimisani 3

1 Department of Counseling, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran

2 Department of Family Counseling, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran

3 Department of Family Counseling, Shabestar Branch, Islamic Azad University, Shabestar, Iran

https://doi.org/10.30491/hpr.2025.491272.1459
Abstract
Background: Parents of children with bipolar II disorder often experience a substantial caregiver burden, encompassing emotional, psychological, and practical challenges. This burden can negatively affect both the parents' well-being and the overall family functioning.
Objectives: This study investigated the effectiveness of family-focused therapy in reducing caregiver burden among parents of children with bipolar II disorder.
Methods: This quasi-experimental pre-test-post-test control group study investigated the effects of family-focused therapy on caregiver burden. Thirty parents of children with bipolar II disorder, recruited from counseling services in Isfahan, Iran in 2023, were randomly assigned to either a family-focused therapy group (n = 15) receiving nine 120-minute sessions or a waiting-list control group (n = 15). All participants completed the Caregiver Burden Inventory at pre-test, post-test, and follow-up. Data were analyzed using descriptive and inferential statistics, including repeated measures ANOVA in SPSS v.26.
Results: In the family-focused therapy group, the mean caregiver burden scores showed a significant reduction from the pre-test (81.78 ± 8.63) to the post-test (54.50 ± 7.52), with partial maintenance of this reduction observed at the three-month follow-up (58.36 ± 6.63). Family-focused therapy had a statistically significant impact on caregiver burden (P <0.01), specifically on the time-related, developmental, and social burden subscales, as well as the total caregiver burden score at both post-test and follow-up assessments.
Conclusion: This study found that family-focused therapy effectively reduced caregiver burden in parents of children with bipolar II disorder. These results suggest that family-focused therapy is a valuable tool for enhancing the quality of life for caregivers.

Keywords

Family Therapy
Caregiver Burden
Parents
Bipolar Disorder
  1. Goes FS. Diagnosis and management of bipolar disorders. BMJ. 2023;381:e073591. doi:10.1136/bmj-2022-073591
  2. Jaggi P, Branford DML, Alexander RT. Bipolar Disorders. In: Branford DML, Gangadharan SK, Barrett M, Alexander RT, editors. The Frith Prescribing Guidelines for People with Intellectual Disability. 4 ed. Cambridge: Cambridge University Press; 2024. pp. 102-17.
  3. Geniş B, Coşar B, Candansayar S, Grhan N. Voluntary/Involuntary Admissions/Readmissions of Psychiatric Patients in a University Hospital in Turkey From 2008 to 2016. Hosp Pract Res. 2018;3(4):123-9. doi:10.15171/hpr.2018.27
  4. Tondo L, H. Vazquez G, J. Baldessarini R. Depression and mania in bipolar disorder. Curr Neuropharmacol. 2017;15(3):353-8. doi:10.2174/1570159X146661606 06210811
  5. Carvalho AF, Firth J, Vieta E. Bipolar Disorder. N Engl J Med. 2020;383(1):58-66. doi:10.1056/NEJMra 1906193
  6. Chatterton ML, Ke X, Lewis BE, Rajagopalan K, Lazarus A. Impact of bipolar disorder on the family: utilization and cost of health care resources. P T. 2008;33(1):15.
  7. Ha K, Ha TH, Hong KS. Bipolar I and Bipolar II: It's Time for Something New for a Better Understanding and Classification of Bipolar Disorders. Can J Psychiatry. 2019;64(8):548-9. doi:10.1177/07067437 19861279
  8. Speirs B, Hanstock TL, Kay-Lambkin FJ. The lived experience of caring for someone with bipolar disorder: A qualitative study. PloS One. 2023;18(1): e0280059. doi:10.1371/journal.pone.0280059
  9. Mirhosseini S, Parsa FI, Gharehbaghi M, Minaei-Moghadam S, Basirinezhad MH, Ebrahimi H. Care burden and associated factors among caregivers of patients with bipolar type I disorder. BMC Prim Care. 2024;25(1):321. doi:10.1186/s12875-024-02583-2
  10. Liu Z, Heffernan C, Tan J. Caregiver burden: A concept analysis. Int J Nurs Sci. 2020;7(4):438-45. doi:10.1016/j.ijnss.2020.07.012
  11. Girdhar A, Patil R. Caregivers’ burden in patients with bipolar disorder and schizophrenia and its relationship with anxiety and depression in caregivers: A narrative review. Cureus. 2023;15(10):e47497. doi:10.7759/cureus.47497
  12. Vargas-Huicochea I, Berenzon S, Rascón ML, Ramos L. A bittersweet relationship: What does it mean to be the caregiver of a patient with bipolar disorder?. Int J Soc Psychiatry. 2018;64(3):207-16. doi:10.1177/ 0020764018758124
  13. Lekoadi RG, Temane MA, Poggenpoel M, Myburgh C. Lived experiences of family members caring for individuals living with bipolar disorder. Afr J Nurs Midwifery. 2019;21(1):19. doi:10.25159/2520-5293/ 5819
  14. Tanna KJ. Evaluation of burden felt by caregivers of patients with schizophrenia and bipolar disorder. Ind Psychiatry J. 2021;30(2):299-304. doi:10.4103/ipj. ipj_28_21
  15. Su IJ, Liu H, Li A, Chen JF. Investigation into the psychological resilience of family caregivers burdened with in-home treatment of patients with bipolar disorder. J Affect Disord Rep. 2021;3:100059. doi:10.1016/j.jadr.2020.100059
  16. Ebrahim OS, Al-Attar GS, Gabra RH, Osman DM. Stigma and burden of mental illness and their correlates among family caregivers of mentally ill patients. J Egypt Public Health Assoc. 2020;95:31. doi:10.1186/s42506-020-00059-6
  17. Latifian M, Abdi K, Raheb G, Islam SM, Alikhani R. Stigma in people living with bipolar disorder and their families: a systematic review. Int J Bipolar Disord. 2023;11(1):9. doi:10.1186/s40345-023-00290-y
  18. Miklowitz DJ, Chung B. Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research. Fam Process. 2016;55(3):483-99. doi:10.1111/famp. 12237
  19. Miklowitz DJ, Schneck CD, Walshaw PD, Singh MK, Sullivan AE, Suddath RL, et al. Effects of family-focused therapy vs enhanced usual care for symptomatic youths at high risk for bipolar disorder: a randomized clinical trial. JAMA Psychiatry. 2020; 77(5):455-63. doi:10.1001/jamapsychiatry.2019.4520
  20. Fackina KA. Family Focused Therapy for Bipolar Disorder. In: Lebow JL, Chambers AL, Breunlin DC, editors. Encyclopedia of Couple and Family Therapy. Cham: Springer International Publishing; 2019. pp. 1051-9.
  21. Mekap T. Family focused therapy on frequently relapsing bipolar disorder: A study of care giver’s stress and quality of life. Int J Psychiatry Res. 2024;6(2):01-5. doi:10.33545/26648962.2024.v6.i2 a.68
  22. Yosefi Tabas M, Momeni F, Bakhshani N, Pourshahbaz A, Rezaei O. Effectiveness of Family-Focused Therapy in Bipolar Disorder: A Randomized Controlled Trial. Iran J Psychiatry Behav Sci. 2023; 17(4):e138878. doi:10.5812/ijpbs-138878
  23. Reinares M, Bonnn CM, Hidalgo-Mazzei D, Snchez-Moreno J, Colom F, Vieta E. The role of family interventions in bipolar disorder: A systematic review. Clin Psychol Rev. 2016;43:47-57. doi:10.1016/ j.cpr.2015.11.010
  24. Reinares M, Colom F, Rosa AR, Bonnn CM, Franco C, SolB, et al. The impact of staging bipolar disorder on treatment outcome of family psychoeducation. J Affect Disord. 2010;123(1-3):81-6. doi:10.1016/j.jad.2009. 09.009
  25. Perlick DA, Miklowitz DJ, Lopez N, Chou J, Kalvin C, Adzhiashvili V, et al. Family‐focused treatment for caregivers of patients with bipolar disorder. Bipolar Disord. 2010;12(6):627-37. doi:10.1111/j.1399-5618. 2010.00852.x
  26. Dou W, Yu X, Fang H, Lu D, Cai L, Zhu C, et al. Family and Psychosocial Functioning in Bipolar Disorder: The Mediating Effects of Social Support, Resilience and Suicidal Ideation. Front Psychol. 2021;12:807546. doi:10.3389/fpsyg.2021.807546
  27. Du Y, Liu J, Lin R, Chattun MR, Gong W, Hua L, et al. The mediating role of family functioning between childhood trauma and depression severity in major depressive disorder and bipolar disorder. J Affect Disord. 2024;365:443-50. doi:10.1016/j.jad.2024. 08.155
  28. Novak M, Guest C. Application of a multidimensional caregiver burden inventory. Gerontologist. 1989;29(6):798-803. doi:10.1093/geront/29.6.798
  29. Abbasi A, Shamsizadeh M, Asayesh H, Rahmani H, Hosseini S, Talebi M. The relationship between caregiver burden with coping strategies in Family caregivers of cancer patients. Iran J Psychiatry Nurs. 2013;1(3):62-71.
  30. Lee HJ, Lin EC, Chen MB, Su TP, Chiang LC. Randomized, controlled trial of a brief family-centred care programme for hospitalized patients with bipolar disorder and their family caregivers. Int J Ment Health Nurs. 2018;27(1):61-71. doi:10.1111/inm.12294
  31. Perlick DA, Jackson C, Grier S, Huntington B, Aronson A, Luo X, et al. Randomized trial comparing caregiver‐only family‐focused treatment to standard health education on the 6‐month outcome of bipolar disorder. Bipolar Disord. 2018;20(7):622-33. doi:10.1111/bdi.12621
  32. Padmavathi N, Gandhi S, Manjula M, Viswanath B, Jain S. Family focused therapy for family members of patients with bipolar disorder: case reports of its impact on expressed emotions. Indian J Psychol Med. 2021;43(3):261-4. doi:10.1177/0253717620950253
Hospital Practices and Research
Volume 9, Issue 4 - Serial Number 36
Autumn 2024
Pages 549-555

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us