title: Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD study.
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.
authors.affiliation: Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA. gonzalezjm1@uthscsa.edu
authors.forename: Jodi M
authors.initials: JM
authors.lastname: Gonzalez
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Perlick
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.forename: Richard
authors.initials: R
authors.lastname: Kaczynski
authors.forename: Melissa
authors.initials: M
authors.lastname: Hernandez
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: Jenifer L
authors.initials: JL
authors.lastname: Culver
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ostacher
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bowden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000523:psychology* / Q000628:therapy*; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D011584:Psychology; D012720:Severity of Illness Index; D012944:Social Support; D013240:Stereotyping