Effect of Psychoeducation on the Resilience of the Family Caregivers of Patients with Bipolar Disorder

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.

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.

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).

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 familychr('39')s attitude towards the client and the disease, and on the other hand, it also significantly affects the clientchr('39')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.