Impact of bipolar affective disorder on family and partners

Successful management of major mental illness in the community relies significantly on an informal or non-professional network of caregivers. The needs and experiences of such caregivers have been little studied with respect to major chronic mood disorders.

A sample of caregivers (n=41) of RDC bipolar disorder was systematically interviewed to determine how this role affected them.

Caregivers reported significant difficulties in their relationships with the patient when s/he was unwell, with considerable impact on their own employment, finances, legal matters, co-parenting and other social relationships. Violence was a particular worry for partner/parent caregivers of both male and female patients when the patient was manic. The caregiver's own mental health appeared unaffected. Despite this, the caregivers appeared emotionally committed to the patients and showed considerable tolerance of problem behaviours, which they rank-ordered for difficulty. Among nonfamily partners, knowledge of the illness before cohabitation was poor.

The sampling does not capture caregivers who have abandoned their role, such as spouses who have divorced the bipolar sufferer.

Management of this illness requires a partnership between mental health professionals and the informal caregivers and the authors suggest that each group needs to understand the difficulties encountered by the other. Although erosion of relationships is a well-known complication of bipolar disorder, findings indicate that treating clinicians can rely on caregivers committed to the welfare of the patient.