IMPACT OF FAMILY BURDEN IN BIPOLAR DISORDER

双相情感障碍是一种与低血压相关的严重精神疾病。 精神科门诊服务使用率高，复发率高 和住院服务的利用；自然主义研究表明 大约50%的双相情感障碍患者从住院治疗出院 在15-18个月内再次入院。这些数据尤其令人震惊 在药物治疗的最新进展的背景下来看待 双相情感障碍，表明迫切需要研究检查 心理社会对双相情感障碍患者服务利用和结局的影响 到目前为止还很少受到关注的影响。 家庭因素，如照顾者负担、社会支持和表达 众所周知，情绪对其他专业的成绩有很大影响 精神障碍，但双相情感障碍的家庭因素研究 实际上是不存在的。这项拟议的研究旨在研究 家庭负担对门诊服务的直接和间接影响 双相情感障碍的利用、复发和社区保有权，以及 评估负担的范围和相关的心理健康费用 家人。 375名被诊断为SADS的双相情感障碍患者连续住进城市 或郊区门诊部和他们的家庭照顾者 根据患者症状和行为的衡量标准进行评估，并根据衡量标准进行评估 家庭负担、健康和应对：1)入院；2)7和15 几个月后。门诊服务利用数据(持续时间、 频率、方式)将输入计算机化数据库 持续的基础上，每月衡量症状的级别和类型、作用 将获得功能和治疗依从性。线性结构 将使用方程分析技术(LISREL)对 外源性(躁郁症)、中介(家族)之间的关系 负担、健康、应对)以及服务利用和社区保有权 变量。将使用事件历史分析对范围进行建模 在不同的情况下，双相症状预测住院的风险 负担水平。结果将被用来更精确地开发 有针对性的治疗，使家庭和精神病患者能够应对 更有效地应对躁郁症的负担。

Bipolar affective disorder is a severe mental illness associated with low utilization of outpatient psychiatric services, and high rates of relapse and utilization of inpatient services; naturalistic studies indicate that about 50% of bipolar patients discharge from inpatient care are readmitted within 15-18 months. These data are particularly striking when viewed in the context of recent advances in the pharmacotherapy of bipolar disorder, demonstrating the urgent need for studies examining psychosocial influences on service use and outcome of bipolar patients, influences which have received scant attention to date. Family factors such as caregiver burden, social support and expressed emotion are known to exert a major influence on outcome in other major psychiatric disorders, but research on family factors in bipolar illness is virtually non-existent. The proposed research aims to examine the direct and indirect effects of family burden on outpatient service utilization, relapse and community tenure in bipolar illness, and to evaluate the scope of burden and associated mental health costs to families. 375 SADS-diagnosed bipolar patients consecutively admitted to an urban or suburban outpatient clinic and their family caregivers will be assessed on measures of patient symptoms and behavior, and on measures of family burden, health and coping: 1) upon admission; 2) 7 and 15 months later. Data on outpatient service utilization (duration, frequency, modality) will be entered into a computerized data base on an ongoing basis, and monthly measures of level and type of symptoms, role functioning and treatment compliance will be obtained. Linear structural equation analytic techniques (LISREL) will be used to model the relationships among exogenous (bipolar symptoms), mediating (family burden, health, coping) and service utilization and community tenure variables. Event history analysis will be employed to model the extent to which bipolar symptoms predict the risk of hospitalization at varying burden levels. The results will be used to develop more precisely targeted treatments to enable families and mentally ill persons to cope more effectively with the burdens of bipolar illness.