Tailored Health Self-Management Interventions for Highly Distressed Family Caregivers

为高度痛苦的家庭照顾者量身定做的健康自我管理干预 在美国，家庭成员作为1000多万成年人的无偿非正式照顾者 双相情感障碍。这些家庭照顾者在经历情绪波动时非常痛苦， 与双相情感障碍相关的强度和不可预测性。躁郁症加重、复发、无力 为了管理日常活动，并需要对双相情感障碍患者进行持续治疗，请将家庭 照顾者的心理和身体健康面临极大的风险。这些照顾者被发现 经历比糖尿病、高血压、哮喘或痴呆症患者的照顾者更大的痛苦 明显比一般人有更多的心理和身体健康问题，导致更多 利用心理健康和初级保健服务。当他们的健康状况下降时，症状加重，情绪化 确诊的家庭成员的发病和再次住院增加。现有的家庭治疗和 对这些照顾者的教育干预对他们自己的健康几乎没有影响。健康自我管理 干预措施，特别是针对照顾者的需求和教育偏好的干预措施，压力 管理，或足智多谋的技能，还没有在这群人中得到检验。这个随机对照 试验将评估家庭照顾者在选择自我管理方面的不同参与程度 干预措施(从不参与选择到根据照顾者的需要或偏好进行选择) 随着时间的推移，影响他们的健康风险和身心健康。照顾者将随机分为：1)对照组 2)教育(常规护理)：3)基于需要的自我管理干预(SM-Need)； (4)自我管理偏好干预(SM偏好)。本研究的目的是：1)考察 四组照顾者健康随时间的差异；2)探讨照顾者之间的关系 需求和偏好以及相关的背景因素(受照方症状、照顾者反应和 护理参与)；以及3)建立与其需求和偏好相关联的护理人员配置文件 进行干预。SM-Need和SM-偏好组的照顾者将接受三种干预之一 根据他们的需要或偏好量身定做：1)教育；2)生物反馈；或3)足智多谋的培训。家庭 照顾者将在基线(T1)、6个月(T2)和一年(T3)进行评估。反复采取措施 多变量分析将解决研究目标。这项研究的发现将产生新的科学 了解新的、易于使用的、独立执行的干预措施的有效性 自我定制，通过教育、生物反馈或足智多谋促进照顾者健康。一次 建立了这些健康自我管理干预措施，可以根据需要和偏好进行量身定制 对患有其他慢性精神或身体疾病的人的其他类似痛苦的家庭照顾者。

Tailored Health Self-Management Interventions for Highly Distressed Family Caregivers In the United States, family members serve as unpaid informal caregivers for more than 10 million adults with bipolar disorder. These family caregivers are highly distressed as they experience the fluctuating moods, intensity, and unpredictability associated with bipolar disorder. Bipolar symptom exacerbation, relapse, inability to manage daily activities, and need for ongoing treatment for the person with bipolar disorder, put family caregivers at great risk for compromised mental and physical health. These caregivers have been found to experience greater distress than caregivers of persons with diabetes, hypertension, asthma or dementia and have significantly more mental and physical health problems than the general population, leading to greater use of mental health and primary care services. When their health declines, symptom exacerbation, affective episodes, and re-hospitalization of the diagnosed family member increase. Existing family therapy and education interventions for these caregivers have had little effect on their own health. Health self-management interventions, particularly those tailored to address caregivers' needs and preferences for education, stress management, or resourcefulness skills, have not been examined in this population. This randomized controlled trial will evaluate how varying levels of participation by family caregivers in selecting self-management interventions (ranging from no input into the selection to selection based on caregiver need or preference) affect their health risks and physical and mental health over time. Caregivers will be randomized to: 1) a control group (no intervention); 2) education (usual care); 3) self-management intervention based on need (SM-need); or 4) self-management intervention of their preference (SM-preference). The study aims to: 1) examine differences across the four groups on caregiver health over time; 2) explore relationships between caregiver needs and preferences and relevant contextual factors (care recipient symptoms, caregiver reactions, and caregiving involvement); and 3) build caregiver profiles that are associated with their needs and preferences for intervention. Caregivers in the SM-need and SM-preference groups will receive one of three interventions tailored to match their need or preference: 1) education; 2) biofeedback; or 3) resourcefulness training. Family caregivers will be assessed at baseline (T1), 6 months (T2) and one year (T3). Repeated measures multivariate analyses will address the study aims. The findings from this study will generate new scientific knowledge about the effectiveness of novel, easy to use, independently performed interventions that can be self-tailored to promote caregiver health through education, biofeedback, or resourcefulness. Once established, these health self-management interventions can be tailored to match the needs and preferences of other comparably distressed family caregivers of persons with other chronic mental or physical conditions.