title: Caregiver burden as a predictor of depression among family and friends who provide care for persons with bipolar disorder.
abstract: OBJECTIVE
  Over one-third of caregivers of people with bipolar disorder report clinically significant levels of depressive symptoms. This study examined the causal relationship between depression and caregiver burden in a large sample of caregivers of adult patients with bipolar disorder.
  
  
  METHODS
  Participants were 500 primary caregivers of persons with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).This study evaluates the strength and direction of the associations between caregiver burden and depressive symptoms at baseline and at six- and 12-month follow-up using cross-lagged panel analyses, controlling for the clinical status of patients and sociodemographic variables.
  
  
  RESULTS
  Higher levels of overall caregiver burden at baseline were associated with increased levels of depressive symptoms among caregivers at follow-up (F = 8.70, df = 1,290, p < 0.001), after controlling for baseline caregiver depression, gender, race, age, social support, and patients' clinical status. By contrast, caregiver depression at baseline was not significantly associated with caregiver burden at follow-up (F = 1.65, p = 0.20).
  
  
  CONCLUSIONS
  Caregiver burden is a stronger predictor of caregiver depressive symptoms over time than the reverse. Interventions that help alleviate caregiver burden may decrease depressive symptoms.
authors.affiliation: James J. Peters Department of Veterans Affairs Medical Center and VISN 3 Mental Illness, Research, Education and Clinical Center (MIRECC), Bronx, NY, USA.|Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Perlick
authors.affiliation: Mental Health and Wellbeing Research Centre, Faculty of Health, Deakin University, Geelong, VIC, Australia.|Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Lesley
authors.initials: L
authors.lastname: Berk
authors.affiliation: Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, CT, USA.|Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Kaczynski
authors.affiliation: Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Jodi
authors.initials: J
authors.lastname: Gonzalez
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Link
authors.affiliation: Department of Psychiatry, Columbia University, New York, NY, USA.|Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dixon
authors.affiliation: James J. Peters Department of Veterans Affairs Medical Center and VISN 3 Mental Illness, Research, Education and Clinical Center (MIRECC), Bronx, NY, USA.|Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
authors.forename: Savannah
authors.initials: S
authors.lastname: Grier
authors.affiliation: Division of Child and Adolescent Psychiatry, UCLA Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy; D017028:Caregivers / Q000523:psychology*; D000068376:Compassion Fatigue / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D033062:Friends / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012944:Social Support; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology
keywords: bipolar disorder; burden; depression; family