Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD study

Jodi M. Gonzalez, Deborah A. Perlick, David J. Miklowitz, Richard Kaczynski, Melissa Hernandez, Robert A. Rosenheck, Jenifer L. Culver, Michael J. Ostacher, Charles L. Bowden, Joseph R. Calabrese, Terence A. Ketter, Mark Fossey, Lauren B. Marangell, Andrew A. Nierenberg, Jayendra Patel

Research output: Contribution to journalArticle

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Abstract

Objective: Little is known about the factors contributing to mental illness stigma among caregivers of people with bipolar disorder. Methods: A total of 500 caregivers of patients participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study were interviewed in a cross-sectional design on measures of stigma, mood, burden, and coping. Relatives and friends with bipolar disorder were assessed on measures of diagnosis and clinical status, determined by a days-well measure derived from psychiatrist ratings of DSM-IV episode status. Because patients' clinical status varied widely, separate models were run for patients who were euthymic for at least three-fourths of the past year (well group) and for those who met criteria for an affective episode for at least one-fourth of the previous year (unwell group). Stepwise multiple regression was used to identify patient, illness, and caregiver characteristics associated with caregiver stigma. Results: In the unwell group, greater mental illness stigma was associated with bipolar I (versus II) disorder, less social support for the caregiver, fewer caregiver social interactions, and being a caregiver of Hispanic descent. In the well group, greater stigma was associated with being a caregiver who is the adult child of a parent with bipolar disorder, who has a college education, who has fewer social interactions, and who cares for a female bipolar patient. Conclusions: Mental illness stigma was found to be prevalent among caregivers of persons with bipolar disorder who have active symptoms as well as for caregivers of those who have remitted symptoms. Stigma is typically associated with factors identifying patients as "different" during symptomatic periods. Research is needed to understand how the stigma experienced by caregivers during stable phases of illness differs from the stigma experienced during patients' illness states.

Original languageEnglish (US)
Pages (from-to)41-48
Number of pages8
JournalPsychiatric Services
Volume58
Issue number1
StatePublished - Jan 2007

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Bipolar Disorder
Caregivers
caregiver
Therapeutics
mental illness
illness
Interpersonal Relations
Group
Adult Children
psychiatrist
interaction
Hispanic Americans
Diagnostic and Statistical Manual of Mental Disorders
Social Support
mood
Psychiatry
social support
coping
parents
rating

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Gonzalez, J. M., Perlick, D. A., Miklowitz, D. J., Kaczynski, R., Hernandez, M., Rosenheck, R. A., ... Patel, J. (2007). Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD study. Psychiatric Services, 58(1), 41-48.

Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD study. / Gonzalez, Jodi M.; Perlick, Deborah A.; Miklowitz, David J.; Kaczynski, Richard; Hernandez, Melissa; Rosenheck, Robert A.; Culver, Jenifer L.; Ostacher, Michael J.; Bowden, Charles L.; Calabrese, Joseph R.; Ketter, Terence A.; Fossey, Mark; Marangell, Lauren B.; Nierenberg, Andrew A.; Patel, Jayendra.

In: Psychiatric Services, Vol. 58, No. 1, 01.2007, p. 41-48.

Research output: Contribution to journalArticle

Gonzalez, JM, Perlick, DA, Miklowitz, DJ, Kaczynski, R, Hernandez, M, Rosenheck, RA, Culver, JL, Ostacher, MJ, Bowden, CL, Calabrese, JR, Ketter, TA, Fossey, M, Marangell, LB, Nierenberg, AA & Patel, J 2007, 'Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD study', Psychiatric Services, vol. 58, no. 1, pp. 41-48.
Gonzalez JM, Perlick DA, Miklowitz DJ, Kaczynski R, Hernandez M, Rosenheck RA et al. Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD study. Psychiatric Services. 2007 Jan;58(1):41-48.
Gonzalez, Jodi M. ; Perlick, Deborah A. ; Miklowitz, David J. ; Kaczynski, Richard ; Hernandez, Melissa ; Rosenheck, Robert A. ; Culver, Jenifer L. ; Ostacher, Michael J. ; Bowden, Charles L. ; Calabrese, Joseph R. ; Ketter, Terence A. ; Fossey, Mark ; Marangell, Lauren B. ; Nierenberg, Andrew A. ; Patel, Jayendra. / Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD study. In: Psychiatric Services. 2007 ; Vol. 58, No. 1. pp. 41-48.
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abstract = "Objective: Little is known about the factors contributing to mental illness stigma among caregivers of people with bipolar disorder. Methods: A total of 500 caregivers of patients participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study were interviewed in a cross-sectional design on measures of stigma, mood, burden, and coping. Relatives and friends with bipolar disorder were assessed on measures of diagnosis and clinical status, determined by a days-well measure derived from psychiatrist ratings of DSM-IV episode status. Because patients' clinical status varied widely, separate models were run for patients who were euthymic for at least three-fourths of the past year (well group) and for those who met criteria for an affective episode for at least one-fourth of the previous year (unwell group). Stepwise multiple regression was used to identify patient, illness, and caregiver characteristics associated with caregiver stigma. Results: In the unwell group, greater mental illness stigma was associated with bipolar I (versus II) disorder, less social support for the caregiver, fewer caregiver social interactions, and being a caregiver of Hispanic descent. In the well group, greater stigma was associated with being a caregiver who is the adult child of a parent with bipolar disorder, who has a college education, who has fewer social interactions, and who cares for a female bipolar patient. Conclusions: Mental illness stigma was found to be prevalent among caregivers of persons with bipolar disorder who have active symptoms as well as for caregivers of those who have remitted symptoms. Stigma is typically associated with factors identifying patients as {"}different{"} during symptomatic periods. Research is needed to understand how the stigma experienced by caregivers during stable phases of illness differs from the stigma experienced during patients' illness states.",
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AU - Bowden, Charles L.

AU - Calabrese, Joseph R.

AU - Ketter, Terence A.

AU - Fossey, Mark

AU - Marangell, Lauren B.

AU - Nierenberg, Andrew A.

AU - Patel, Jayendra

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N2 - Objective: Little is known about the factors contributing to mental illness stigma among caregivers of people with bipolar disorder. Methods: A total of 500 caregivers of patients participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study were interviewed in a cross-sectional design on measures of stigma, mood, burden, and coping. Relatives and friends with bipolar disorder were assessed on measures of diagnosis and clinical status, determined by a days-well measure derived from psychiatrist ratings of DSM-IV episode status. Because patients' clinical status varied widely, separate models were run for patients who were euthymic for at least three-fourths of the past year (well group) and for those who met criteria for an affective episode for at least one-fourth of the previous year (unwell group). Stepwise multiple regression was used to identify patient, illness, and caregiver characteristics associated with caregiver stigma. Results: In the unwell group, greater mental illness stigma was associated with bipolar I (versus II) disorder, less social support for the caregiver, fewer caregiver social interactions, and being a caregiver of Hispanic descent. In the well group, greater stigma was associated with being a caregiver who is the adult child of a parent with bipolar disorder, who has a college education, who has fewer social interactions, and who cares for a female bipolar patient. Conclusions: Mental illness stigma was found to be prevalent among caregivers of persons with bipolar disorder who have active symptoms as well as for caregivers of those who have remitted symptoms. Stigma is typically associated with factors identifying patients as "different" during symptomatic periods. Research is needed to understand how the stigma experienced by caregivers during stable phases of illness differs from the stigma experienced during patients' illness states.

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