title: Use of mental health and primary care services by caregivers of patients with bipolar disorder: a preliminary study.
abstract: OBJECTIVE
  Caring for a relative with schizophrenia or dementia has been associated with reports of caregiver burden, symptoms of anxiety, depression, poor self-rated health, and elevated health service use; however, comparable data for caregivers of relatives with bipolar disorder are lacking. This study reports preliminary data on the health, psychological distress and health service use of caregivers of patients with bipolar disorder. It additionally evaluates the relationship of the level of burden caregivers report experiencing to their use of health services, controlling for level of psychological distress and health status.
  
  
  METHODS
  Subjects were primary caregivers of 264 patients with Research Diagnostic Criteria-diagnosed bipolar disorder and their bipolar relatives. Caregiver mental health and primary care service use were assessed retrospectively for the 7-month period prior to inpatient or outpatient admission of the bipolar patient. Caregiver depression, anxiety, medical conditions and patient symptomatology were assessed as well.
  
  
  RESULTS
  Hierarchical logistic regression analysis demonstrated that caregiver burden significantly increased the likelihood of mental health service use (OR = 13.53, p < 0.001) even after controlling for caregiver psychological distress and medical conditions, while anxiety and depression level, but not burden, significantly increased the likelihood of primary care service use, controlling for other variables (OR = 1.72, p = 0.02).
  
  
  CONCLUSIONS
  Burdens experienced by family caregivers appear to increase use of health services, and presumably cost, and may be reduced by psychosocial intervention.
authors.affiliation: Northeast Program Evaluation Center, West Haven VAMC and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06516, USA. deborah.perlick@yale.edu
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Perlick
authors.forename: Jill M
authors.initials: JM
authors.lastname: Hohenstein
authors.forename: John F
authors.initials: JF
authors.lastname: Clarkin
authors.forename: Richard
authors.initials: R
authors.lastname: Kaczynski
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001714:Bipolar Disorder; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003710:Demography; D003863:Depression / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012919:Social Behavior