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Impact of Psychoeducation Applied to The Spouses of Bipolar Patients on Their Emotional Expression, Stigmatization, and Loneliness Levels

Year 2024, Volume: 10 Issue: 3, 239 - 254, 31.08.2024
https://doi.org/10.19127/mbsjohs.1514532

Abstract

Objective: Bipolar disorder (BD) is a serious burden for patients and family members due to recurrent mood episodes, hospitalizations, and loss of productivity. The goal of this study is to examine how psychoeducation affected the caregivers of bipolar patients' levels of emotional expression, stigmatization, loneliness, and mood symptoms.
Method: This research is a quasi-experimental intervention study applied as a pretest-posttest design with a control group. The study included 20 patients with bipolar diagnosis and 20 caregiver spouses who were followed up in our outpatient clinic. Participants were divided into 2 groups as study and control group. The spouses in the control group were interviewed only to evaluate their situation. The study group received a 6-session (15 hours) psychoeducation intervention. We administered the Emotion Expression Scale (EES), Self-Stigma Inventory for Families(SSI-F), UCLA Loneliness Scale (UCLA-LS), and DASS-21 Scale to the spouses of bipolar patients in the study and control groups before and after the psychoeducation program
Results: The mean age of the spouses in the study group was 43.4±7.04 years, the mean age of the spouses in the control group was 39±8.29 years and all of them were female. There was no significant difference between the mean scores of the SSI-F, DASS-21 and EES scales of the spouses in the study and control groups before the training (p>0.05). After the psychoeducation program was applied to the spouses in the intervention group, a significant decrease was observed in the SSI-F, EES, and DASS-21 scores (p<0.001, p<0.001, p=002, p=001, respectively). Although there was a decrease in UCLA-AS scores, it was not significant (p=.061)
Conclusion: Our study observed a significant decrease in the stigmatization, emotional expression, depression, and anxiety scores of the patients' spouses who participated in the intervention. Based on this result, it may be recommended to continue psychoeducation systematically in clinical practice.
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References

  • Angst J. Bipolar disorders in DSM-5: strengths, problems and perspectives. Int J Bipolar Disord. 2013;1(1):1–3.
  • Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA, et al. The long-term natural history of the weekly symptomatic status of bipo lar I disorder. Arch Gen Psychiatry. 2002;59(6):530–7.
  • Samalin L, de Chazeron I, Vieta E, Bellivier F, Llorca PM. Residual symptoms and specifc functional impairments in euthymic patients with bipolar disorder. Bipolar Disord marts. 2016;18(2):164–73
  • MacDonald K, Ferrari M, Fainman-Adelman N, Iyer SN. Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review. Soc Psychiatry Psychiatr Epidemiol. 2021;56(3):339–61
  • González-Pinto A, Balanzá-Martínez V, Hernández AB, Gutiérrez-Rojas L, Montes JM, de Dios Perrino,et al. Expert consensus on information sheet proposals for patients under treatment with lithium. Revista de Psiquiatría y Salud Mental (English Edition). 2021;14(1): 27-39.
  • McIntyre RS, Alda M, Baldessarini RJ, Bauer M, Berk M, Correll CU, et al. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry. 2022;21(3): 364–87.
  • Patton GC, Raniti M, Reavley N. Rediscovering the mental health of populations. World Psychiatry. 2021;20(2):151–2.
  • Boye HB, Bentsen TH, Notland OG, Munkvold OG, Lersbryggen AB, Oskarsson KH, et al. What predicts the course of expressed emotion in relatives of patients with schizophrenia or related psychoses? Soc Psychiatry Psychiatr Epidemiol 1999;34:35-43.
  • Hooley, J.M. Expressed emotion and relapse of psychopathology. Annual Review of Clinical Psychology, 2007;3(1), 329–352.
  • Corrigan PW, Penn DL. Lessons from social psychol-ogy on discrediting psychiatric stigma. Am Psychol. 1999;54(9):765–776.
  • 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):542–549.
  • Corrigan PW, Larson JE, Rusch N. Self-stigma and the“‘why try”’ effect: impact on life goals and evidence-based practices. World Psychiatry. 2009;8(2):75–81.
  • Yin M, Li Z, Zhou C. Experience of stigma among family members of people with severe mental illness: a qualitative systematic review. International Journal of Mental Health Nursing. 2020;29(2):141–160.
  • Zhang Y, Subramaniam M, Lee SP, Abdin E, Sagayadevan V, Jeyagurunathan A, et al. Affiliate stigma and its association with quality of life among caregivers of relatives with mental illness in Singapore. Psychiatry Research. 2018;265:55–61.
  • Navidian A, Kermansaravi F, Rigi SN. The effectiveness of a group psycho-educational program on family caregiver burden of patients with mental disorders. BMC Research Notes 2012;5:399.
  • Cole JD, Kazarian SS. The level of expressed emotion scale: a new measure of expressed emotion. Journal of Clinical Psychology 1988;44: 392–397.
  • Berksun OE. Şizofrenide aile faktörü: expressed emotion (EE): ölçek geliştirme ve uyarlama denemesi. Ankara Üniversitesi. Yayınlanmamış uzmanlık tezi.1992.
  • Yıldız M, İncedere A, Kiras F, Abut FB, Kircali A, İpci K. Development of Self-Stigma Inventory for Families of the patients with schizophrenia (SSI-F): validity and reliability study. Psychiatr Clin Psychopharmacol. 2019;29:463–471.
  • Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology. 1980;39(3): 472–480.
  • Demir A. UCLA Yalnızlık Ölçeği'nin geçerlik ve güvenirliği. Psikoloji Dergisi. 1989 ;7(23):14-18.
  • Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy. 1995;33:335–343.
  • Sarıçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. Journal of Cognitive-Behavioral Psychotherapy and Research. 2018;7(1):19-30.
  • Özerdem A, Tunca Z, Kaya N. The relatively good prognosis of bipolar disorders in a turkish bipolar clinic. J Affect Disord 2001;64(1):27-34.
  • Lam D, Donaldson C, Brown Y, Malliaris Y. Burden and marital and sexual satisfaction in the partners of bipolar patients. Bipolar Disord 2005;7(5):431-40.
  • Soo SA, Zhang ZW, Khong SJ, Low JEW, Thambyrajah VS, Alhabsyi SHBT, et al. Randomized controlled trials of psychoeducation modalities in the management of bipolar disorder: a systematic review. J Clin Psychiatry. 2018;79:17r11750.
  • Barbeito S, Vega P, Ruiz de Azúa S, González-Ortega I, Alberich S, González-Pinto A. Two-year evaluation of a multifamily psychoeducational program (PROTEC) in the family burden and prognosis of bipolar patients. Revista de Psiquiatría y Salud Mental. 2023;16(4): 225-234.
  • Colom F, Vieta E, Sánchez-Moreno J, Palomino-Otiniano R, Reinares M, Goikolea JM, et al. Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. Br J Psychiatry. 2009;194:260-265.
  • Zyto S, Jabben N, Schulte PFJ, Regeer EJ, Goossens PJJ, Kupka RW, et al. A multi-center naturalistic study of a newly designed 12-sessions group psychoeducation program for patients with bipolar disorder and their caregivers. Int J Bipolar Disord. 2020;8:26.
  • Baruch E, Pistrang N, Barker C. Psychological interventions for caregivers of people with bipolar disorder: a systematic review and meta-analysis. J Affect Disord. 2018;236:187–98.
  • Luciano M, Sampogna G. Medium and long-term efficacy of psychoeducational family intervention for bipolar I disorder: Results from a real-world, multicentric study. Bipolar Disord. 2022;24:647–657.
  • Lobban F, Akers N, Appelbe D, Chapman L, Collinge L, Dodd S, et al. Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar (REACT): online, observer-blind, randomised controlled superiority trial. BMC Psychiatry
  • Wrzus C, Hänel M, Wagner J, Neyer F. J. Social network changes and life events across the life span: A meta-analysis. Psychological Bulletin. 2013;139(1):53–80.
  • Tabatabaee M, Yousefi Nooraie R, Mohammad Aghaei A, Rostam-Abadi Y, Ansari M, Sharifi S, et al. Loneliness in the presence of others: A mixed-method study of social networks of caregivers of patients with severe mental disorders. International Journal of Social Psychiatry. 2023;69(1):190-199.
  • Sarıçam, H. Genç yetişkinler ile yaşlıların otantiklik, yaşamda anlam, mutluluk, affedicilik ve yalnızlık düzeylerinin karşılaştırılması. Doktora tezi. Gazi Üniversitesi, 2021. Ankara
  • Statista. (2021). How often do you feel lonely? Avaliable at: https://www.statista.com/statistics/1222815/loneliness-among-adults-by-country/
  • Perlick DA, Miklowitz DJ, Lopez N, Chou J, Kalvin C, Adzhiashvili V, et al. Family-focused treatment for caregivers of patients with bipolar disorder. Bipolar Disord. 2010;12:627-637.
  • Hubbard AA, McEvoy PM, Smith L, Kane RT. Brief group psychoeducation for caregivers of individuals with bipolar disorder: a randomized controlled trial. J Affect Disord. 2016;200:31–6.
  • Kolostoumpis D, Bergiannaki JD, Peppou LE, Louki E, Fousketaki S, Patelakis A, et al. Effectiveness of relatives’ psychoeducation on family outcomes in bipolar disorder. Int J Ment Health. 2015;44(4):290–302.

Bipolar hastaların eşlerine uygulanan psikoeğitimin eşlerin duygu dışavurum, damgalanma ve yalnızlık düzeylerine etkisi

Year 2024, Volume: 10 Issue: 3, 239 - 254, 31.08.2024
https://doi.org/10.19127/mbsjohs.1514532

Abstract

Amaç: Bipolar bozukluk (BB), tekrarlayan ruh hali atakları, hastane yatışları ve üretkenlik kaybı nedeniyle hastalar ve aile üyeleri için ciddi düzeyde yüktür. Bu çalışmada, bipolar hastalara bakım verenlere uygulanan psikoeğitimin duygu dışavurum, damgalanma, yalnızlık ve duygudurum belirtileri düzeylerine etkisinin incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Araştırmamız kontrol gruplu ön test-son test tasarım olarak yapılmış yarı-deneysel tipte bir müdahale çalışmasıdır. Araştırmaya polikliniğimizde takipleri yapılan 20 bipolar tanılı hasta ve 20 bakım veren eş dahil edildi. Katılımcılar çalışma ve kontrol grubu olmak üzere 2 gruba ayrıldı. Kontrol grubunda yer alan eşler ile sadece durumlarını değerlendirmeye yönelik görüşmeler yapıldı. Çalışma grubuna ise 6 oturumluk (15 saat) psikoeğitim müdahalesi uygulandı. Araştırmamızın çalışma ve kontrol grubunda yer alan bipolar hastaların eşlerine psikoeğitim programı öncesi ve sonrası olmak üzere Duygu Dışavurum Ölçeği (DDÖ), Kendini Damgalama Ölçeği-Aile (KDÖ-A), UCLA Yalnızlık Ölçeği (UCLA-YÖ ve DASS-21 Ölçeği uygulandı.
Bulgular: Araştırmamızın çalışma grubunda yer alan eşlerin yaş ortalaması 43.4±7.04 yıl, kontrol grubunda yer alan eşlerin yaş ortalaması 39±8.29 yıl ve tamamı kadın idi. Çalışma ve kontrol gruplarındaki eşlerin eğitim öncesi SSI-F, EES ve DASS-21 ölçeği puan ortalamaları arasında anlamlı bir fark yoktu (p>0.05). Müdahale grubunda yer alan eşlere uygulana psikoeğitim programı sonrası SSI-F, EES, DASS-21 ölçek puanlarında anlamlı düşme görülmüştür (p<0.001, p<0.001, p=002, p=001, sırasıyla). Ancak, UCLA-YÖ puanlarında düşme olmakla birlikte anlamlı değildir (p=.061).
Sonuç: çalışma grubu bakım vericilerinin uygulanan psikoeğitim sonrası damgalanma, duygu dışavurumu, depresyon ve anksiyete puanlarında anlamlı bir düşüş olduğu görülmüştür. Ancak, yalnızlık duygusu puanında düşme olsa da anlamlı olmadığı görülmüştür. Bu sonuca göre klinik uygulamalarda sistemli olarak psikoeğitimlerin sürdürülmesi önerilebilir.

References

  • Angst J. Bipolar disorders in DSM-5: strengths, problems and perspectives. Int J Bipolar Disord. 2013;1(1):1–3.
  • Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA, et al. The long-term natural history of the weekly symptomatic status of bipo lar I disorder. Arch Gen Psychiatry. 2002;59(6):530–7.
  • Samalin L, de Chazeron I, Vieta E, Bellivier F, Llorca PM. Residual symptoms and specifc functional impairments in euthymic patients with bipolar disorder. Bipolar Disord marts. 2016;18(2):164–73
  • MacDonald K, Ferrari M, Fainman-Adelman N, Iyer SN. Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review. Soc Psychiatry Psychiatr Epidemiol. 2021;56(3):339–61
  • González-Pinto A, Balanzá-Martínez V, Hernández AB, Gutiérrez-Rojas L, Montes JM, de Dios Perrino,et al. Expert consensus on information sheet proposals for patients under treatment with lithium. Revista de Psiquiatría y Salud Mental (English Edition). 2021;14(1): 27-39.
  • McIntyre RS, Alda M, Baldessarini RJ, Bauer M, Berk M, Correll CU, et al. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry. 2022;21(3): 364–87.
  • Patton GC, Raniti M, Reavley N. Rediscovering the mental health of populations. World Psychiatry. 2021;20(2):151–2.
  • Boye HB, Bentsen TH, Notland OG, Munkvold OG, Lersbryggen AB, Oskarsson KH, et al. What predicts the course of expressed emotion in relatives of patients with schizophrenia or related psychoses? Soc Psychiatry Psychiatr Epidemiol 1999;34:35-43.
  • Hooley, J.M. Expressed emotion and relapse of psychopathology. Annual Review of Clinical Psychology, 2007;3(1), 329–352.
  • Corrigan PW, Penn DL. Lessons from social psychol-ogy on discrediting psychiatric stigma. Am Psychol. 1999;54(9):765–776.
  • 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):542–549.
  • Corrigan PW, Larson JE, Rusch N. Self-stigma and the“‘why try”’ effect: impact on life goals and evidence-based practices. World Psychiatry. 2009;8(2):75–81.
  • Yin M, Li Z, Zhou C. Experience of stigma among family members of people with severe mental illness: a qualitative systematic review. International Journal of Mental Health Nursing. 2020;29(2):141–160.
  • Zhang Y, Subramaniam M, Lee SP, Abdin E, Sagayadevan V, Jeyagurunathan A, et al. Affiliate stigma and its association with quality of life among caregivers of relatives with mental illness in Singapore. Psychiatry Research. 2018;265:55–61.
  • Navidian A, Kermansaravi F, Rigi SN. The effectiveness of a group psycho-educational program on family caregiver burden of patients with mental disorders. BMC Research Notes 2012;5:399.
  • Cole JD, Kazarian SS. The level of expressed emotion scale: a new measure of expressed emotion. Journal of Clinical Psychology 1988;44: 392–397.
  • Berksun OE. Şizofrenide aile faktörü: expressed emotion (EE): ölçek geliştirme ve uyarlama denemesi. Ankara Üniversitesi. Yayınlanmamış uzmanlık tezi.1992.
  • Yıldız M, İncedere A, Kiras F, Abut FB, Kircali A, İpci K. Development of Self-Stigma Inventory for Families of the patients with schizophrenia (SSI-F): validity and reliability study. Psychiatr Clin Psychopharmacol. 2019;29:463–471.
  • Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology. 1980;39(3): 472–480.
  • Demir A. UCLA Yalnızlık Ölçeği'nin geçerlik ve güvenirliği. Psikoloji Dergisi. 1989 ;7(23):14-18.
  • Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy. 1995;33:335–343.
  • Sarıçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. Journal of Cognitive-Behavioral Psychotherapy and Research. 2018;7(1):19-30.
  • Özerdem A, Tunca Z, Kaya N. The relatively good prognosis of bipolar disorders in a turkish bipolar clinic. J Affect Disord 2001;64(1):27-34.
  • Lam D, Donaldson C, Brown Y, Malliaris Y. Burden and marital and sexual satisfaction in the partners of bipolar patients. Bipolar Disord 2005;7(5):431-40.
  • Soo SA, Zhang ZW, Khong SJ, Low JEW, Thambyrajah VS, Alhabsyi SHBT, et al. Randomized controlled trials of psychoeducation modalities in the management of bipolar disorder: a systematic review. J Clin Psychiatry. 2018;79:17r11750.
  • Barbeito S, Vega P, Ruiz de Azúa S, González-Ortega I, Alberich S, González-Pinto A. Two-year evaluation of a multifamily psychoeducational program (PROTEC) in the family burden and prognosis of bipolar patients. Revista de Psiquiatría y Salud Mental. 2023;16(4): 225-234.
  • Colom F, Vieta E, Sánchez-Moreno J, Palomino-Otiniano R, Reinares M, Goikolea JM, et al. Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. Br J Psychiatry. 2009;194:260-265.
  • Zyto S, Jabben N, Schulte PFJ, Regeer EJ, Goossens PJJ, Kupka RW, et al. A multi-center naturalistic study of a newly designed 12-sessions group psychoeducation program for patients with bipolar disorder and their caregivers. Int J Bipolar Disord. 2020;8:26.
  • Baruch E, Pistrang N, Barker C. Psychological interventions for caregivers of people with bipolar disorder: a systematic review and meta-analysis. J Affect Disord. 2018;236:187–98.
  • Luciano M, Sampogna G. Medium and long-term efficacy of psychoeducational family intervention for bipolar I disorder: Results from a real-world, multicentric study. Bipolar Disord. 2022;24:647–657.
  • Lobban F, Akers N, Appelbe D, Chapman L, Collinge L, Dodd S, et al. Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar (REACT): online, observer-blind, randomised controlled superiority trial. BMC Psychiatry
  • Wrzus C, Hänel M, Wagner J, Neyer F. J. Social network changes and life events across the life span: A meta-analysis. Psychological Bulletin. 2013;139(1):53–80.
  • Tabatabaee M, Yousefi Nooraie R, Mohammad Aghaei A, Rostam-Abadi Y, Ansari M, Sharifi S, et al. Loneliness in the presence of others: A mixed-method study of social networks of caregivers of patients with severe mental disorders. International Journal of Social Psychiatry. 2023;69(1):190-199.
  • Sarıçam, H. Genç yetişkinler ile yaşlıların otantiklik, yaşamda anlam, mutluluk, affedicilik ve yalnızlık düzeylerinin karşılaştırılması. Doktora tezi. Gazi Üniversitesi, 2021. Ankara
  • Statista. (2021). How often do you feel lonely? Avaliable at: https://www.statista.com/statistics/1222815/loneliness-among-adults-by-country/
  • Perlick DA, Miklowitz DJ, Lopez N, Chou J, Kalvin C, Adzhiashvili V, et al. Family-focused treatment for caregivers of patients with bipolar disorder. Bipolar Disord. 2010;12:627-637.
  • Hubbard AA, McEvoy PM, Smith L, Kane RT. Brief group psychoeducation for caregivers of individuals with bipolar disorder: a randomized controlled trial. J Affect Disord. 2016;200:31–6.
  • Kolostoumpis D, Bergiannaki JD, Peppou LE, Louki E, Fousketaki S, Patelakis A, et al. Effectiveness of relatives’ psychoeducation on family outcomes in bipolar disorder. Int J Ment Health. 2015;44(4):290–302.
There are 38 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research articles
Authors

Hanife Kocakaya 0000-0002-5907-3808

Kübra Arslan 0000-0003-4916-8317

Publication Date August 31, 2024
Submission Date July 11, 2024
Acceptance Date August 15, 2024
Published in Issue Year 2024 Volume: 10 Issue: 3

Cite

Vancouver Kocakaya H, Arslan K. Impact of Psychoeducation Applied to The Spouses of Bipolar Patients on Their Emotional Expression, Stigmatization, and Loneliness Levels. Mid Blac Sea J Health Sci. 2024;10(3):239-54.

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