title: Psychiatric symptoms in caregivers of patients with bipolar disorder: a review.
abstract: OBJECTIVE
  The burden experienced by caregivers of patients with bipolar disorder has been associated with increased caregiver depression, anxiety and mental health service use. As caregiver burden is also associated with poor patient outcome, these findings may indicate a source of distress not only for caregivers, but also for patients. This review presents what is currently known about psychiatric symptoms in this population and suggests directions for future research.
  
  
  METHODS
  Computerized databases Medline, Pubmed, PsychINFO and Google Scholar were searched using the keywords 'bipolar disorder', 'manic-depressive disorder', 'caregiver', 'caregiver burden', 'family', 'couple', 'spouse' and 'partner.' Of these, publications both measuring and reporting psychiatric symptoms or mental health service use in adult caregivers were included.
  
  
  RESULTS
  Twenty four (24) papers were analyzed. Thirteen (13) of these papers measured general psychiatric distress, 2 measured anxiety symptoms, 9 reported mood symptoms and 8 reported increased mental health service use. 21 total papers reported clinical significance of least one category of psychiatric distress. Significant findings include up to 46% of caregivers reporting depression and up to 32.4% reporting mental health service use. Data suggest that caregiver psychiatric symptoms depend on the nature of the caregiving relationship. Common methodological problems included: lack of control groups, small sample sizes and non-standardized caregiver and patient criteria.
  
  
  CONCLUSIONS
  While not all of the data are consistent, the majority of papers report the presence of psychiatric symptoms in caregivers, such as depression, anxiety and increased mental health service use. Future research is needed to address methodological issues and focus on distinguishing symptoms and identifying effects of mediators such as caregiver-patient relationship, coping styles and stigma. Interventions tailored towards the psychiatric needs of bipolar families may result in improved caregiver and patient outcomes, as well as in decreased health care costs.
authors.affiliation: Department of Psychiatry, Beth Israel Medical Center, NewYork, NY 10009, USA. annie.steele@gmail.com
authors.forename: Annie
authors.initials: A
authors.lastname: Steele
authors.forename: Nancy
authors.initials: N
authors.lastname: Maruyama
authors.forename: Igor
authors.initials: I
authors.lastname: Galynker
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis / Q000235:genetics / Q000523:psychology*; D001714:Bipolar Disorder / Q000235:genetics / Q000523:psychology* / Q000628:therapy; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000235:genetics / Q000523:psychology*; D006801:Humans; D010641:Phenotype; D011618:Psychotic Disorders / Q000175:diagnosis / Q000235:genetics / Q000523:psychology; D012106:Research; D012307:Risk Factors