Resilience Factors Among Caretakers Of Patients With Bipolar Disorder

Caring for a person with bipolar disorder poses both emotional burdens such as grief, worry, tension etc and objective burdens such as increased expenditure of money and time. Resilience in a family members/caretakers of persons with mental illness can help overcome the burden and stress of caretaking that may otherwise compromise their health and quality of life.

Aims

The objective of the study was to find correlation of factors associated with resilience among caretakers of patients suffering with bipolar affective disorder (BPAD).

Materials & Methods

The present study was observation and cross-sectional, involved caretakers of patients suffering from bipolar affective disorder who were receiving services at outpatient department of Government Psychiatric Diseases Hospital Jammu which serves to whole Jammu province and was conducted over a period of 2 months. A total of 130 caretakers were selected and then assessed by using 25 Item Resilience Scale.

Results

Being educated and parent by relation were the factors which had significant positive whereas being female and unemployed were the factors which had significant negative correlation with resilience among caretakers of patients suffering from bipolar affective disorders. Factors such as age of the caretaker, male gender, being uneducated and employed had no correlation with resilience.

Conclusion

From present study, it has been concluded that there is significant positive correlation of resilience among caretakers who were educated and parent by relation whereas there is negative correlation between resilience and caretakers who were females and unemployed. Hence it is suggested that there is strong need for developing counseling intervention and stress coping techniques for promoting resilience among caretakers of BPAD patients. Resilience is defined as the capacity of human beings to survive and thrive in the face of adversity. It helps an individual to overcome difficult circumstances and go on to lead healthy, successful lives.[1] It is psychological process that provides relative resistance to an individual against the psychosocial risk experiences[2] and helps to maintain positive adaptation within the context of the significant adversity.[3]

The process of resilience involves various mechanisms of coping with, change, opportunity, adversity or stressful situation in such a manner that results in the, fortification, enrichment and sometimes identification of protective factors or resilient qualities.[4] Resilience includes the strengths possessed by individuals or families that enable them to overcome adversity.[1]

Bipolar affective disorder is a chronic disorder characterized by recurring and remitting episode of mania and depression associated with interepisodic period of remission.[5] Caring of a family member with severe mental illness is a stressful life events[6] and the caretaker may feel caretaking as burdensome,[7,8] report greater feelings of strain and there is greater disruption in family functioning.[9] associated with financial difficulties, patients dependence on caretaker, stigma etc.[10]

Resilience in caretakers not only helps to survive the day-to-day burden of caring for a family member who is mentally ill, but also to thrive that is to grow into a more flexible, healthier and stronger individual.[11] Since in our setup no study has been done to evaluate resilience among caretakers of bipolar patients, hence we conducted a study to find factors associated with resilience in caretakers of patients suffering from bipolar affective disorder.

Caring for a person with bipolar disorder poses both emotional burdens such as grief, worry, tension etc and objective burdens such as increased expenditure of money and time. It is also associated with decreased quality of life, impaired mental and physical health.[13] Resilience in a family members/caretakers of persons with mental illness can help to overcome the burden and stress of caretaking that may otherwise compromise their health and quality of life.[1]

In the present study mean resilience score of caretakers above 40 years was 121.51 (±25.5) whereas that of caretakers below 40 years was 113.81 (±17.94) and the difference between the two group was 7.7 which was statistically highly significant (p-value = 0.001). Our finding shows that the resilience was high in older as compared to younger caretakers of BPAD patients. This could be explained by the fact that the old caretakers may had gained more experience in handling the stressful life situations and meanwhile had developed more coping strategies and resources especially financial ones which helps them to reduce their psychological distress and increase their resilience.[14] Manhas RS et al had also observed that resilience was higher in old caretakers as compared to younger one’s.[15]

Moreover the pearson’s correlation value between resilience and caregivers above 40 years of age was 0.068 (p-value=0.768) and between resilience and caregivers below 40 years of age was 0.047 (p-value=0.279), both being non significant which shows that there is no significant association between resilience and age of the caretakers of bipolar patients. Our finding is consistent with Manhas RS et al who found no association of resilience with the age of the caretaker.[15] Similarly Herbert HS et al had also observed no statistical significant association between resilience and age of caretaker of mentally ill patient.[16]

The mean resilience score of male caretakers was 120.10 (±25.97) whereas that of female caretakers was 118.77 (±21.83). The difference between these two scores was 1.33 which was statistically significant (p-value=0.016). Thus the finding in this study shows that the resilience in male caretakers was significantly higher that of female caretakers. In developing countries like India, the families are often dominated by male members who keeps suppressing women resulting in more frustration and burden among women while caring for the mentally ill patients[14] which in turn leads to development of low coping levels resulting in low resilience among women caretakers.[17] Our finding is consistent with Manhas RS et al who observed that resilience was high in male as compared to female caretakers.[15]

Similarly Mahmoud S had also found low resilience among female caretakers.[18] Moreover in the pearson’s correlation value between resilience and female gender of the caretaker was -0.25 with a p value of 0.046 which suggests that there is a significant negative correlation between resilience and female gender of the caregivers. Our finding is in accordance with Manhas RS et al who observed negative correlation of resilience with caretakers being females[15] whereas Herbert HS et al had found no statistical significant association between resilience and gender of caregivers of schizophrenia patients.[16]

In the present study mean resilience score of educated caretakers i.e. 120.86 (±28.46) was higher than that of uneducated caretakers who had mean resilience score of 116.73 (±21.45) which suggests that resilience was higher in educated caretakers with a difference of 4.13 from that of uneducated caretakers which was statistically highly significant (p-value=0.001). Being illiterate negatively influence the coping process and has decreases the quality of the caretaking.[19] Being educated creates more employment opportunities resulting in more money from salary which in turn decreases financial problems which occurs while caring of ill family member. Moreover knowledge gained from higher levels of education helps an individual to deal with stressful life events in a better way.[20]

The finding of ours is in accordance with Manhas RS et al who also observed that resilience was high in literate caretakers as compared to illiterate ones.[15] Our study also shows that there is significant positive correlation between resilience and educated caregivers with pearson’s correlation value of 0.295 and p-value of 0.026 Manhas RS et al had also observed that resilience and education of the caretakers are perfectly positively correlated[15] whereas no significant correlation between resilience and educational status of the caretaker was observed by Herbert HS et al.[16]

The mean resilience score of employed caretakers in the present study was 123.94 (±29.07) which was higher than that of unemployed caretakers with mean resilience score of 114.58 (±21.53) which suggests that resilience was higher in employed caretakers compared to unemployed caretakers. The mean difference between the two groups was 9.36 which was statistically highly significant (p-value=0.001). Whenever caretakers are employed, they had a regular source of income which helps them to deal with financial difficulties, increases self confidence and develop better coping mechanism while providing care to their mentally ill patients.[20] Our study is in accordance with Manhas RS et al who observed that employed caretakers had a higher resilience compared to unemployed ones.[15] Moreover the pearson’s correlation value between resilience and unemployed caretakers was -0.120 with p-value of 0.017 which shows that there is statistically significant negative correlation between resilience and unemployed caretakers. The results of our study are consistent with Manhas RS et al who observed statistically significant negative correlation between resilience and unemployment status of the caretakers.[15] However as per Herbert HS et al there was no statistical significant association between resilience and occupation of caretakers of mentally sick patients.[16]

In the present study the mean resilience score of parent caretakers i.e. 123.17 (±30.31) was higher than that of other caretakers who had mean resilience score of 119.13 (±22.03) whereas the mean difference between the two groups was 2.79 which was highly statistically significant (p-value=0.001). Our finding shows that the resilience in caretakers who were parents was significantly higher than the caretakers other than parent by relation. Multiple coping strategies like participating in religious practices, developing faith in God, hope for a better future, acceptance of illness, positive emotions, helping others with a similar problem, etc. are used by the caretakers who were parents and these coping strategies helps the caretakers to increases their resilience and reduce their caretaking burden.[21] Manhas RS et al had also observed resilience was high among caretakers who were parents of their patients. Moreover, in our study the pearson’s correlation value between resilience and parent caregivers was 0.359 with p-value of 0.023 which shows that there is statistically significant positive correlation between resilience and caregivers who were parents.

Our finding is in accordance with Manhas RS et al who also observed similar results[15] whereas Herbert HS et al had found no statistical significant association between resilience and relation of caretakers of mentally ill patient.[16] From present study it has been concluded that the resilience was more in caretakers who were above 40 years of age, males, educated, employed and were parents by relation to the patient. Also there is significant positive correlation of resilience among caretakers who were educated and parent by relation whereas there is negative correlation between resilience and caretakers who were females and unemployed. Hence it is suggested that there is strong need for developing counseling intervention and stress coping techniques for promoting resilience among caretakers of BPAD patients.