Suicidal ideation and depressive symptoms among bipolar patients as predictors of the health and well-being of caregivers.

The longitudinal course of bipolar disorder is characterized by a high risk for attempted or completed suicides (1–3). On average, 30% to 40% of patients with bipolar disorder experience suicidal ideation (SI) and/or attempt suicide at some point in their lives (1–12). Suicidal thoughts and behaviors are closely linked with episodes of bipolar depression (5, 13). Patients may suffer for extended periods from episodes of depression; Judd et al. (13) found in a 12.8-year follow-up study that bipolar patients spent 32% of their time in states of depression, in contrast to 9% in mania. By extension, suicidal risk can be chronic and persistent (14). Suicidal thoughts and behaviors, therefore, are a significant health problem within the bipolar population (15). Caregivers of patients with bipolar disorder, similar to caregivers of patients with other major affective or chronic psychiatric disorders, report high levels of stress and poorer general health, increased visits to their primary care physicians, and higher numbers of symptoms of physiological and psychological conditions, including depressed mood, when compared to caregivers who report less stress (16–20). Cross-sectional studies report that caregivers feel especially distressed by patients’ depression and/or suicidal thoughts or behaviors (18, 21–24). A prospective study found that caregivers feel more strain secondary to patients’ depressive symptoms than to patients’ manic symptoms (24). Our own cross-sectional data indicated that caregivers of patients with current SI or a history of suicide attempts reported lower general health scores and higher levels of depressed mood than caregivers of patients without SI or an attempt history (25). However, these cross-sectional associations do not allow us to make inferences about directions of effects. The present study aimed to evaluate whether caregivers’ health and depression varied over time in relation to changes in patients’ SI and depressive symptoms. We hypothesized that caregivers associated with patients who endorsed more SI and depression at baseline and over one year would have a worse course of self-reported general health and more depressed mood compared to caregivers of patients with less SI and depression. We also hypothesized that caregivers of patients whose SI and depression increased over one year would report worse health and more depressed mood than caregivers of patients whose SI and depression stayed the same or decreased. A secondary objective of this study was to evaluate the unique contribution of SI to caregivers’ health and mood variables, above and beyond the effect of patients’ depressive symptoms. We hypothesized that SI would have a contribution to caregiver health independent of the effects of patients’ depression.