September 19, 2007

Battling stigma: A Caregiver's Perspective

Taking care of the mentally ill, as a family member, is no small task. It is exhausting both physically and emotionally. Some believe that the perception of stigma contributes to depressive symptoms developing in the caregivers themselves. In an article published by the British Journal of Psychiatry earlier this year, a group of researchers from Yale propose a possible link between the perceived stigma and the depressive symptoms that arise in caregivers of patients with Bipolar Disorder (we expect a similar result would be for caregivers of people with schizophrenia).

Method: 500 patients associated with a treatment program for Bipolar Disorder (Systematic Enhancement Program for Bipolar Disorder) from eight different locations agreed, on invitation, to take part in this study and identify their primary caregiver. Caregivers were then interviewed within 30 days. The interview focused on three main areas:
• What the caregiver perceptions of stigma were.
• Assessment of caregiver – depressive symptoms (using the Center for Epidemiological Studies – Depression scale; and given CES-D scores). The CES-D scores are meant to gage how depressed a caregiver is by attributing scores to the symptoms they describe. For our understanding, we can call this the ‘degree of depression’.
• Assessment of different types of behavioral and cognitive coping mechanisms recognized by the caregiver. They were also asked to identify how often they used each strategy to handle the most stressful situation with their relative in the past 30 days.

Results: To get a statistical perspective of the association between the different factors identified above, the authors used a hierarchal regression model. Here is what they found:

There was a statistically significant positive association between caregiver –stigma and degree of depression. This implies that the higher the level of stigma experienced by the caregiver, the more depressed they will be.

The contribution of stigma was reduced by 50% by the entry of social support measures. These explained about half of the contribution of stigma to CES-D score.

There is a significant association between stigma and social support (subjective support, Pearson r=-0.24; instrumental support, Pearson r= -0.19). This means that with either an increase in subjective support or instrumental support, the effect of stigma on the caregiver should reduce.

Social support and avoidance coping accounted for 63% of the relationship between stigma perceived by the caregiver and their depression.

Conclusion: The authors made it a point to note that their statistical analyses can only prove or disprove a link of some sort between two variables. But they cannot say for sure if the presence of one variable causes a change in the other. They are of the opinion that the stigma associated with mental illness in society adds to the stress of the family members who provide care. It is plausible that these family members withdraw themselves from any kind of family support and avoid dealing with underlying issues that could be contributing to their depression. The authors emphasize the need for further research in developing effective interventions to improve caregiver support.

Source Journal Article: Perceived stigma and depression among caregivers of patients with bipolar disorder, The British Journal of Psychiatry


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