Why the caregivers of bipolar patients need to be in constant touch with a physician: A qualitative study of text messages from patient caregivers to a physician
More details
Hide details
M.D. Assistant professor of psychiatry, Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
MA. Clinical psychology, Rajaee hospital, Tehran, Iran
MA. Clinical psychology, Islamic Azad University, Science and Research Branch, Tehran, Iran
Publication date: 2018-11-18
Electron J Gen Med 2018;15(6):em88
The variety of caregiver’s needs of bipolar patients signifies the importance of performing dedicated interventions to help this group of caregivers based on the cultural conditions of the country in which they live; the present study therefore seeks to address this issue through a different method.

The families of 28 patients with bipolar disorder type 1 who were treated for at least two months by a single psychiatrist gradually entered the study over a six-month period. They received the phone number of the psychiatrist in attendance as soon as the patient was in remission according to the same psychiatrist’s interview. A total of 1908 texts were sent and received and each family sent an average of 68.14 text messages during the three years, with the minimum being 40 and the maximum 83. All the text messages were transcribed verbatim and were evaluated by three faculty members through the qualitative content analysis method.

In this study we found three themes and there were some codes in each theme. 1. The first theme was “Training” which the caregivers requested advice about symptoms and tests, the course of the disease, assurance, medication side-effects and their management, how to stop smoking, how to control high-risk behaviors and double checking appointments with the physician, making for a total of 1079 text messages received. 2. The second theme was “Reporting” which contained a description of emergency symptoms and requesting advice, reporting response or no response to the medications, reporting medication adherence and dosage taken. 3. The third theme: “The expression of feelings” including the expression of gratitude, saying congratulations on national and other celebrations and expressing anger and hatred.

Overall, the caregivers of patients with bipolar disorder have many needs; meeting these needs affects the patients’ outcome and the caregivers, but requires a greater attention by the healthcare team and it is necessary for these needs to be evaluated in the context of each distinct country.

Mohammadi M-R, Davidian H, Noorbala AA, Malekafzali H, Naghavi HR, Pouretemad HR, et al. An epidemiological survey of psychiatric disorders in Iran. Clinical practice and epidemiology in mental health. 2005;1(1):16. https://doi.org/10.1186/1745-0... PMid:16185355 PMCid:PMC1253522.
Yousefi-Nooraie R, Farhoudian A, Amini H, Mohammadi M-R, Mesgarpour B, Mansouri N, et al. Prevalence of mental disorders among high-school students in Iran: a systematic review. Iranian Journal of Psychiatry. 2009;4(1):1-6.
Vandad Sharifi M, Hajebi A, Radgoodarzi R. Twelve-month prevalence and correlates of psychiatric disorders in Iran: The Iranian Mental Health Survey, 2011. Archives of Iranian medicine. 2015;18(2):76. PMid:25644794.
Fountoulakis KN. Disability and Overall Burden Related with Bipolar Disorder. Bipolar Disorder: Springer;2015:361-88.
Guilera G, Gómez-Benito J, Pino Ó, Rojo E, Vieta E, Cuesta MJ, et al. Disability in bipolar I disorder: the 36-item world health organization disability assessment schedule 2.0. Journal of affective disorders. 2015;174:353-60. https://doi.org/10.1016/j.jad.... PMid:25553398.
Perlick D, Clarkin JF, Sirey J, Raue P, Greenfield S, Struening E, et al. Burden experienced by care-givers of persons with bipolar affective disorder. The British Journal of Psychiatry. 1999;175(1):56-62. https://doi.org/10.1192/bjp.17... PMid:10621769.
Perlick DA, Berk L, Kaczynski R, Gonzalez J, Link B, Dixon L, et al. Caregiver burden as a predictor of depression among family and friends who provide care for persons with bipolar disorder. Bipolar Disorders. 2016;18(2):183-91. https://doi.org/10.1111/bdi.12... PMid:27004622.
Perlick DA, Rosenheck RA, Miklowitz DJ, Chessick C, Wolff N, Kaczynski R, et al. Prevalence and correlates of burden among caregivers of patients with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder. Bipolar Disorders. 2007;9(3):262-73. https://doi.org/10.1111/j.1399... PMid:17430301.
Steele A, Maruyama N, Galynker I. Psychiatric symptoms in caregivers of patients with bipolar disorder: a review. Journal of affective disorders. 2010;121(1):10-21. https://doi.org/10.1016/j.jad.... PMid:19443040.
von Kardorff E, Soltaninejad A, Kamali M, Eslami Shahrbabaki M. Family caregiver burden in mental illnesses: The case of affective disorders and schizophrenia–a qualitative exploratory study. Nordic journal of psychiatry. 2015:1-7.
Van der Voort T, Goossens P, Van Der Bijl J. Burden, coping and needs for support of caregivers for patients with a bipolar disorder: a systematic review. Journal of Psychiatric and Mental Health Nursing. 2007;14(7):679-87. https://doi.org/10.1111/j.1365... PMid:17880662.
Reinares M, Vieta E, Colom F, Martinez-Aran A, Torrent C, Comes M, et al. What really matters to bipolar patients’ caregivers: sources of family burden. Journal of affective disorders. 2006;94(1):157-63. https://doi.org/10.1016/j.jad.... PMid:16737741.
Jönsson PD, Skärsäter I, Wijk H, Danielson E. Experience of living with a family member with bipolar disorder. International Journal of Mental Health Nursing. 2011;20(1):29-37. https://doi.org/10.1111/j.1447... PMid:21199242.
Weimand BM, Hall‐Lord ML, Sällström C, Hedelin B. Life‐sharing experiences of relatives of persons with severe mental illness–a phenomenographic study. Scandinavian journal of caring sciences. 2013;27(1):99-107. https://doi.org/10.1111/j.1471... PMid:22583154.
Rusner M, Carlsson G, Brunt D, Nyström M. Towards a more liveable life for close relatives of individuals diagnosed with bipolar disorder. International journal of mental health nursing. 2013;22(2):162-9. https://doi.org/10.1111/j.1447... PMid:22712875.
Cummings SM, Kropf NP. Predictors of depression among caregivers of older adults with severe mental illness. Journal of gerontological social work. 2015;58(3):253-71. https://doi.org/10.1080/016343... PMid:25357014.
Reinares M, Colom F, Sánchez‐Moreno J, Torrent C, Martínez‐Arán A, Comes M, et al. Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial. Bipolar disorders. 2008;10(4):511-9. https://doi.org/10.1111/j.1399... PMid:18452447.
Reinares M, Bonnín C, Hidalgo-Mazzei D, Sánchez-Moreno J, Colom F, Vieta E. The role of family interventions in bipolar disorder: A systematic review. Clinical psychology review. 2016;43:47-57. https://doi.org/10.1016/j.cpr.... PMid:26691629.
Honig A, Hofman A, Rozendaal N, Dingemans P. Psycho-education in bipolar disorder: effect on expressed emotion. Psychiatry research. 1997;72(1):17-22. https://doi.org/10.1016/S0165-....
Moradi-Lakeh M, Vosoogh-Moghaddam A. Health Sector Evolution Plan in Iran; equity and sustainability concerns. International journal of health policy and management. 2015;4(10):637. https://doi.org/10.15171/ijhpm... PMid:26673172 PMCid:PMC4594102.
Aarabi A, Cheraghi MA, Ghiyasvandian S. Factors effecting on involvement of nurse leaders in policy making for nursing in Iran: a qualitative study. International Journal of Advanced Nursing Studies. 2014;3(1):53.
Irajpour A, Alavi M, Abdoli S, Saberizafarghandi MB. Challenges of interprofessional collaboration in Iranian mental health services: A qualitative investigation. Iranian journal of nursing and midwifery research. 2012;17(2).
Mahdizadeh M, Heydari A, Moonaghi HK. A Review of the Clinical Interdisciplinary Collaboration among Nurses and Physicians. Open Journal of Nursing. 2015;5(07):654. https://doi.org/10.4236/ojn.20....
Malakouti Sk, Nojomi M, Mirabzadeh A, Mottaghipour Y, Zahiroddin A, Kangrani HM. A Comparative Study of Nurses as Case Manager and Telephone Follow-up on Clinical Outcomes of Patients with Severe Mental Illness. Iranian journal of medical sciences. 2016;41(1):19. PMid:26722141.
Sharifi V, Tehranidoost M, Yunesian M, Amini H, Mohammadi M, Roudsari MJ. Effectiveness of a low-intensity home-based aftercare for patients with severe mental disorders: A 12-month randomized controlled study. Community mental health journal. 2012;48(6):766-70. https://doi.org/10.1007/s10597... PMid:22772746.
Yesufu-Udechuku A, Harrison B, Mayo-Wilson E, Young N, Woodhams P, Shiers D, et al. Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. The British Journal of Psychiatry. 2015;206(4):268-74. https://doi.org/10.1192/bjp.bp... PMid:25833867.
Valentini J, Ruppert D, Magez J, Stegbauer C, Bramesfeld A, Goetz K. Integrated care in German mental health services as benefit for relatives–a qualitative study. BMC psychiatry. 2016;16(1):1. https://doi.org/10.1186/s12888... PMid:26921216 PMCid:PMC4769565.
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). https://doi.org/10.17795/ijpbs....
Aldhwaihi KAA. Types and Contributing Factors of Dispensing Errors in Hospital Pharmacies. 2016.
Salmasi S, Khan TM, Hong YH, Ming LC, Wong TW. Medication errors in the Southeast Asian countries: A systematic review. PloS one. 2015;10(9):e0136545. https://doi.org/10.1371/journa... PMid:26340679 PMCid:PMC4560405.
Nath SB, Marcus SC. Medical errors in psychiatry. Harvard review of psychiatry. 2006;14(4):204-11. https://doi.org/10.1080/106732... PMid:16912006.
Javidan M, Dastmalchian A. Culture and leadership in Iran: The land of individual achievers, strong family ties, and powerful elite. The Academy of Management Executive. 2003;17(4):127-42. https://doi.org/10.5465/ame.20....
Journals System - logo
Scroll to top