In contrast to schizophrenia, coping strategies of caregivers of bipolar disorder patients have not received much attention, according to the researchers.

Investigators Subho Chakrabarti and Sapna Gill at the Postgraduate Institute of Medical Education and Research in Chandigarh, India, set out to examine coping styles and factors correlating to coping in caregivers of bipolar patients, in comparison to those adopted by carers of schizophrenia patients.

The researchers carried out structured assessments of dysfunction, burden, appraisal, social support available, and coping styles in caregivers of 38 bipolar patients and 20 patients with schizophrenia (ICD – 10 diagnoses). All of the patients had suffered from their illness for two years or more and a caregiver was defined as someone who had been staying with the patients for some time (for the last two years) and was intimately involved in his/her care.

Scores for patient dysfunction and caregiver burden were significantly higher among caregivers of patients with schizophrenia, who, in terms of appraisal, were also significantly less aware of their relative’s illness, and less likely to believe that the patient’s behavior was under their or the patient’s control, compared to bipolar disorder carers.

Chakrabarti and Gill found a wide variety of coping strategies, but, most significantly, problem-focused coping strategies – positive communication and increasing social involvement – were more common in caregivers of bipolar patients and emotion-focused strategies – coercion, collusion, resignation, avoidance and seeking spiritual help – were more common in caregivers of schizophrenic patients.

They suggest that the variations in coping styles between the two groups were due to differences in burden on caregivers, which was lower in those caring for bipolar patients, and to differences in appraisal.

“Differences in stress, and its appraisal by caregivers, could in turn be the result of the episodic nature of BPAD (bipolar affective disorder), ability of caregivers to distinguish symptoms from normal behavior, and improved coping of caregivers with time,” they write in the journal Bipolar Disorders.

While acknowledging the need for further study, the researchers say the effect of burden and appraisal on coping styles has important implications for treatment, and that reducing burden on caregivers and enhancing their awareness of illness could lead to more adaptive coping styles.

Reference: Chakrabarti S and Gill S, Bipolar Disorders 2002:4:50-60

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