Volume 34, Issue 130 (June 2021)                   IJN 2021, 34(130): 25-37 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Bahrami R, Khalifi T. Effect of Psychoeducation on the Resilience of the Family Caregivers of Patients with Bipolar Disorder. IJN 2021; 34 (130) :25-37
URL: http://ijn.iums.ac.ir/article-1-3411-en.html
1- Master of Psychiatry, School of Nursing and Midwifery,Kurdistan University of Medical Sciences, Sanandaj, Iran
2- Department of Psychiatric Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran (Corresponding Author) Tel: 09125531359 Email: talieh.khalifi@yahoo.com
Abstract:   (2796 Views)
Background & Aims: Bipolar disorder is one of the most common psychiatric disorders in the 21st century. It is a chronic, recurrent disorder causing mood swings, and patients alternate between episodes of mania and depression. Diagnosis of bipolar disorder is a stressful issue for the individual and his family. The disease not only causes anxiety and stress for the client, but also causes severe disturbances to his family. The family caregivers of clients with a psychiatric disorder and the resulting stress do not react in the same way and choose different ways to deal with the illness. Denial, anger, feelings of shame, as well as indifference and change in the relationships between family members are among the negative feelings in caregivers. Caregivers can only overcome the stress of caring for a client with a psychiatric disorder and maintain their health and that of their family when they are resilient. The concept of resilience in caregivers of clients with psychiatric disorders refers to the flexible and well-developed behavioral pattern of caregivers in response to the difficulties and challenges encountered while caring for the client. Resilience in caregivers of clients with psychiatric disorders is a dual concept. On the one hand, caregivers overcome the difficulties and challenges of caring for the client and take steps to maintain and improve his physical and mental health. On the other hand, by promoting their mental health, they are able to act stronger than before in the face of advanced troubles and problems. Therefore, this study aimed to determine the effect of a psychoeducation program on the resilience of caregivers of patients with bipolar disorder hospitalized in Sanandaj Psychiatric Center.
Materials & Methods: This is a quasi-experimental study conducted during autumn and winter, 2019. The samples included 64 caregivers of a client with bipolar disorder hospitalized in Sanandaj Psychiatric Center. Convenience sampling was employed, and the samples were randomly divided into experimental (32) and control (32) groups. For sampling, the researcher first visited the psychiatric center and identified caregivers of clients with bipolar disorder. Then, the researcher introduced the study and obtained written informed consent. In the next stage, the caregivers who met the inclusion criteria were selected. First, the caregivers of the control group and then the caregivers of the experimental group entered the study (to prevent the transfer of information in the groups). Caregivers were asked prior to the study to complete a demographic questionnaire and the Connor-Davidson resilience scale (CD-RISC). The caregivers of the experimental group underwent psychoeducation in groups of 4 to 5. The training lasted four weeks and was performed one a week for about 45 to 60 minutes. Psychoeducation followed a systematic and structured approach in order to raise awareness and change the attitude of families about the nature of the disease, how to treat it, increasing communication skills, and problem-solving skills during the training sessions. Some components of psychoeducation, which were appropriate to the community under study, were discussed by providing examples and past experiences. After 4 weeks of intervention, the questionnaire was completed again. During this period, the control group did not receive any program other than the usual hospital training program and, like the experimental group, took the post-test. Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (independent t-test and paired samples t-test) in SPSS 16.
Results: The results showed no difference between the experimental and control groups in terms of the distribution of background variables. The mean pre-test scores of resilience in the control and experimental groups were 22.65 ± 5.80 and 23.44 ± 5.61, respectively, which shows that the two groups were not statistically different (P=0.59). The mean scores of resilience post-test in the control group and the experimental group were 23.19 ± 6.12 and 33.97 ± 3.36 respectively, which shows a statistically significant difference (P<0.001). Comparison of resilience scores in the pre-test and post-test scores of both groups shows that resilience scores were not statistically different in the pre-test and post-test scores of the control group (P=0.11), while a statistically significant increase was observed in the post-test of the experimental group compared to the pre-test (P<0.001).
Conclusion: The results of the present study showed that psychoeducation is effective on the resilience of caregivers of clients with bipolar disorder. Accepting the fact that a family member is diagnosed with a psychiatric disorder scares the family. Caregivers find it difficult to talk about the client they are caring for, and caring for a client with a psychiatric disorder causes despair, helplessness, and ultimately depression in the caregiver. Considering that in our country the only sources of support for patients are families and short-term hospitalization centers and family plays the main role of caring and treatment, in case of recurrence of the disease, the client is hospitalized which will exert more pressure and stress on the family. In this regard, resilient caregivers show more independence, are able to think well, and believe in their abilities to change their environment. When family members feel that they too are part of the treatment team, they can provide adequate support to the client. Thus, psychoeducation, as an effective method with the intervention of caregivers to help the client needing care is an important step towards the challenges and tragedies in the family. On the one hand, psychoeducation will change the family's attitude towards the client and the disease, and on the other hand, it also significantly affects the client's view of his current situation. Therefore, this educational program can be implemented alongside family-based programs in psychiatric centers, and it is necessary to consider programs such as psychoeducation as one of the ways to promote resilience in clients and their caregivers.
Full-Text [PDF 1092 kb]   (775 Downloads)    
Type of Study: Research | Subject: nursing
Received: 2021/03/8 | Accepted: 2021/06/8 | Published: 2021/06/8

References
1. Michalak E, Livingston JD, Hole R, Suto M, Hale S, Haddock C. 'It's something that I manage but it is not who I am': reflections on internalized stigma in individuals with bipolar disorder. Chronic Illness. 2011;7(3):209-24. [DOI:10.1177/1742395310395959]
2. Miklowitz DJ, Chung B. Family‐focused therapy for bipolar disorder: Reflections on 30 years of research. Family process. 2016;55(3):483-99. [DOI:10.1111/famp.12237]
3. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1789-858. [DOI:10.1016/S0140-6736(18)32279-7]
4. Shamsaei F, Cheraghi F, Esmaeilli R. The family challenge of caring for the chronically mentally ill: A phenomenological study. Iranian journal of psychiatry and behavioral sciences. 2015;9(3):e1898.
5. Livingston J. Self‐stigma and quality of life among people with mental illness who receive compulsory community treatment services. J Commun Psychol. 2012;40(6):699-714. [DOI:10.1002/jcop.21476]
6. Chan KK, Mak WW. The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community. Quality of Life Research. 2014;23(9):2559-68. [DOI:10.1007/s11136-014-0695-7]
7. Kaakinen JR, Coehlo DP, Steele R, Robinson M. Family health care nursing: Theory, practice, and research. FA Davis. 2010: 449-69.
8. Voss C, Tasmania C. Hope, Empowerment, Resilience and Outcomes for Carers. Carers NSW Biennial Conference; 2011.
9. Zauszniewski JA, Bekhet AK, Suresky MJ. Indicators of resilience in family members of adults with serious mental illness. Psychiatric Clinics. 2015;38(1):131-46. [DOI:10.1016/j.psc.2014.11.009]
10. Haghranjbar F, Kakavand A, Borjali A, Bermas H. Resilience and quality of life of mothers with mentally retarded children. Quarterly journal of health and psychology. 2011;1:179-89.
11. Saunders JC. Families living with severe mental illness: A literature review. Issu Ment Health Nurs. 2003;24(2):175-98. [DOI:10.1080/01612840305301]
12. Chang CC, Yen CF, Jang FL, Su JA, Lin CY. Comparing affiliate stigma between family caregivers of people with different severe mental illness in Taiwan. J Nerv Ment Dis. 2017;205(7):542-9. [DOI:10.1097/NMD.0000000000000671]
13. Chang CC, Su JA, Chang KC, Lin CY, Koschorke M, Thornicroft G. Perceived stigma of caregivers: Psychometric evaluation for Devaluation of Consumer Families Scale. Int J Clin Health Psychol. 2018;18(2):170-8. [DOI:10.1016/j.ijchp.2017.12.003]
14. Smith-Osborne A. Life span and resiliency theory: A critical review. Advances in social work. 2007;8(1):152-68. [DOI:10.18060/138]
15. Girma E, Möller-Leimkühler AM, Dehning S, Mueller N, Tesfaye M, Froeschl G. Self-stigma among caregivers of people with mental illness: toward caregivers' empowerment. J Multidiscipl Health Care. 2014;7:37. [DOI:10.2147/JMDH.S57259]
16. Macleod SH, Elliott L, Brown R. What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature. Int J Nurs Stud. 2011;48(1):100-20. [DOI:10.1016/j.ijnurstu.2010.09.005]
17. Glynn SM, Cohen AN, Niv N. New challenges in family interventions for schizophrenia. Expert review of neurotherapeutics. 2007;7(1):33-43. [DOI:10.1586/14737175.7.1.33]
18. Rahmani F, Ebrahimi H, Ranjbar F, Asghari E. The effect of group psychoeducational program on attitude toward mental illness in family caregivers of patients with bipolar disorder. Hayat. 2016;21(4):65-79.
19. Sadeqi M, Ghadampour E, Esmaeili A. The effect of healthy family model training on resiliency mothers of children with outism spectrum disorder. Journal of Counseling Research. 2015;15(60):84-99.
20. Taghavilarijani T, Noughani F, Danandehfard S. The Effect of Family Psychological Group Training on Resilience of the Families of Schizophrenic Patients. Iran J Psychiatr Nurs. 2019;7(2):83-9.
21. Ozkan B, Erdem E, Ozsoy SD, Zararsiz G. Effect of psychoeducation and telepsychiatric follow up given to the caregiver of the schizophrenic patient on family burden, depression and expression of emotion. Pak J Med Sci. 2013;29(5):1122-7. [DOI:10.12669/pjms.295.2613]
22. Martin-Carrasco M, Fernandez-Catalina P, Dominguez-Panchon AI, Gonçalves-Pereira M, Gonzalez-Fraile E, Munoz-Hermoso P, Ballesteros J. A randomized trial to assess the efficacy of a psychoeducational intervention on caregiver burden in schizophrenia. European Psychiatry. 2016;33(1):9-17. [DOI:10.1016/j.eurpsy.2016.01.003]
23. Dalvand H, Rassafiani M, Bagheri H. Family Centered Approach: A literature review. Modern Rehabilitation. 2014;8(1):1-9.
24. Seyedfatemi N, Ahmadzad Asl M, Bahrami R, Haghani H. The Effect of Virtual Social Network Based Psycho-education on Resilience of Family Caregivers of Clients with Severe Mental Disorders. Iranian Journal of Psychiatric Nursing. 2019;6(6):1-8. [DOI:10.21859/ijpn-06061]
25. Connor KM, Davidson JR. Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depression and anxiety. 2003;18(2):76-82. [DOI:10.1002/da.10113]
26. Campbell‐Sills L, Stein MB. Psychometric analysis and refinement of the connor-davidson resilience scale (CD‐RISC): Validation of a 10‐item measure of resilience. J Traum Stress: Official Publication of The International Society for Traumatic Stress Studies. 2007;20(6):1019-28. [DOI:10.1002/jts.20271]
27. Keyhani M, Taghvaei D, Rajabi A, Amirpour B. Internal consistency and confirmatory factor analysis of the Connor-Davidson Resilience Scale (CD-RISC) among nursing female. Iranian journal of medical education. 2015;14(10):857-65.
28. Almasi A, Hatami F, Sharifi A, Ahmadijouybari T, Kaviannezhad R, Ebrahimzadeh F. Effectiveness of stress coping skills training on the resiliency of mothers of handicapped children. Scientific journal of Kurdistan university of medical sciences. 2016;21(2):34-42.
29. Naimi A. The Effectiveness of Family-Based Education on Mental Health and Resilience of Women with Addicted Wife. Woman in Development and Politics. 2015;1(13):40-52.
30. Fallahi Khoshknab M, Sheikhona M, Rahgouy A, Rahgozar M, Sodagari F. The effects of group psychoeducational programme on family burden in caregivers of I ranian patients with schizophrenia. Journal of psychiatric and mental health nursing. 2014;21(5):438-46. [DOI:10.1111/jpm.12107]
31. Omranifard V, Yari A, Kheirabadi GR, Rafizadeh M, Maracy MR, Sadri S. Effect of needs-assessment-based psychoeducation for families of patients with schizophrenia on quality of life of patients and their families: A controlled study. Journal of education and health promotion. 2014;3.
32. Colom F, Vieta E, Martinez-Aran A, Reinares M, Benabarre A, Gasto C. Clinical factors associated with treatment noncompliance in euthymic bipolar patients. J Clin Psych. 2000 31;61(8):549-55.
33. Vieta E, Colom F. Psychological interventions in bipolar disorder: From wishful thinking to an evidence‐based approach. Acta Psychiat Scandin. 2004;110:34-8. [DOI:10.1111/j.1600-0447.2004.00411.x]
34. Clarkin JF, Carpenter D, Hull J, Wilner P, Glick I. Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses. Psychiatric Services. 1998;49(4):531-3. [DOI:10.1176/ps.49.4.531]
35. Miklowitz DJ, Simoneau TL, George EL, Richards JA, Kalbag A, Sachs-Ericsson N, Suddath R. Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biological psychiatry. 2000;48(6):582-92. [DOI:10.1016/S0006-3223(00)00931-8]
36. Reinares M, Colom F, Martinez-Aran A, Benabarre A, Vieta E. Therapeutic interventions focused on the family of bipolar patients. Psychoth Psychosom. 2002;71(1):2-10. [DOI:10.1159/000049338]
37. Reinares M, Vieta E, Colom F, Martinez-Aran A, Torrent C, Comes M, Goikolea JM, Benabarre A, Sanchez-Moreno J. Impact of a psychoeducational family intervention on caregivers of stabilized bipolar patients. Psychoth Psychosom. 2004;73(5):312-9. [DOI:10.1159/000078848]
38. Colom F, Vieta E, Martinez-Aran A, Reinares M, Goikolea JM, Benabarre A, Torrent C, Comes M, Corbella B, Parramon G, Corominas J. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch General Psych. 2003;60(4):402-7. [DOI:10.1001/archpsyc.60.4.402]
39. Colom F, Vieta E, Sánchez‐Moreno J, Martínez‐Arán A, Torrent C, Reinares M, Goikolea JM, Benabarre A, Comes M. Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disorders. 2004;6(4):294-8. [DOI:10.1111/j.1399-5618.2004.00127.x]
40. Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch General Psych. 2003;60(9):904-12. [DOI:10.1001/archpsyc.60.9.904]
41. Gonzalez‐Pinto A, Gonzalez C, Enjuto S, Fernandez de Corres B, Lopez P, Palomo J, Gutierrez M, Mosquera F, Perez de Heredia JL. Psychoeducation and cognitive‐behavioral therapy in bipolar disorder: an update. Acta Psychiat Scandin. 2004;109(2):83-90. [DOI:10.1046/j.0001-690X.2003.00240.x]
42. Frank E, Swartz HA, Mallinger AG, Thase ME, Weaver EV, Kupfer DJ. Adjunctive psychotherapy for bipolar disorder: effects of changing treatment modality. J Abnormal Psychol. 1999;108(4):579. [DOI:10.1037/0021-843X.108.4.579]
43. Lam DH, Bright J, Jones S, Hayward P, Schuck N, Chisholm D, Sham P. Cognitive therapy for bipolar illness-a pilot study of relapse prevention. Cognit Therapy Res. 2000;24(5):503-20. [DOI:10.1023/A:1005557911051]
44. Lam DH, Watkins ER, Hayward P, Bright J, Wright K, Kerr N, Parr-Davis G, Sham P. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch General Psych. 2003;60(2):145-52. [DOI:10.1001/archpsyc.60.2.145]
45. Patelis-Siotis I, Young LT, Robb JC, Marriott M, Bieling PJ, Cox LC, Joffe RT. Group cognitive behavioral therapy for bipolar disorder: a feasibility and effectiveness study. J Affec Disord. 2001;65(2):145-53. [DOI:10.1016/S0165-0327(00)00277-9]

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2015 All Rights Reserved | Iran Journal of Nursing

Designed & Developed by : Yektaweb