title: Correlates of subjective and objective burden among caregivers of patients with bipolar disorder.
abstract: OBJECTIVE
  We examined the relationship between mood symptoms and episodes in patients with bipolar disorder and burden reported by their primary caregivers.
  
  
  METHODS
  Data on subjective and objective burden reported by 500 primary caregivers for 500 patients with bipolar disorder participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were collected using semistructured interviews. Patient data were collected prospectively over 1 year. The relationship between patient course and subsequent caregiver burden was examined.
  
  
  RESULTS
  Episodes of patient depression, but not mood elevation, were associated with greater objective and subjective caregiver burden. Burden was associated with fewer patient days well over the previous year. Patient depression was associated with caregiver burden even after controlling for days well.
  
  
  CONCLUSIONS
  Patient depression, after accounting for chronicity of symptoms, independently predicts caregiver burden. This study underscores the important impact of bipolar depression on those most closely involved with those whom it affects.
authors.affiliation: Massachusetts General Hospital, Bipolar Clinic and Research Program, Boston, MA, and Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA. mostacher@partners.org
authors.forename: M J
authors.initials: MJ
authors.lastname: Ostacher
authors.forename: A A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: D V
authors.initials: DV
authors.lastname: Iosifescu
authors.forename: P
authors.initials: P
authors.lastname: Eidelman
authors.forename: H G
authors.initials: HG
authors.lastname: Lund
authors.forename: R M
authors.initials: RM
authors.lastname: Ametrano
authors.forename: R
authors.initials: R
authors.lastname: Kaczynski
authors.forename: J
authors.initials: J
authors.lastname: Calabrese
authors.forename: D J
authors.initials: DJ
authors.lastname: Miklowitz
authors.forename: G S
authors.initials: GS
authors.lastname: Sachs
authors.forename: D A
authors.initials: DA
authors.lastname: Perlick
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000523:psychology* / Q000628:therapy; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012931:Social Environment