Perlick Deborah A, Rosenheck Robert A, Clarkin John F, Maciejewski Paul K, Sirey JoAnne, Struening Elmer, Link Bruce G
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
Psychiatr Serv. 2004 Sep;55(9):1029-35. doi: 10.1176/appi.ps.55.9.1029.
This study evaluated the direct and indirect effects of family burden and affective response on medication adherence and outcome among patients with bipolar disorder.
Data were examined for 126 patients who were consecutively admitted to the psychiatric service at a university-affiliated hospital and who met research diagnostic criteria for bipolar I or II disorder or for schizoaffective disorder, manic type, and their family caregivers. A total of 101 pairs of patients and family caregivers (80 percent) completed 15 months of study and were included in the analyses. Patients and their identified caregivers were assessed within two weeks of either discharge from the index inpatient admission or initiation of outpatient treatment (baseline assessment). Patients and caregivers were also assessed seven and 15 months after the baseline assessment. Structural equation modeling was used to evaluate caregivers' influences on patients' medication adherence seven months after baseline and on clinical outcome 15 months after baseline.
The indexes of overall fit for the path model confirmed the a priori measurement model. Significant paths were found from the caregiver's perceived burden at baseline to the caregiver's emotional overinvolvement at baseline, from the caregiver's emotional overinvolvement at baseline to the patient's medication adherence at the seven month follow-up, and from the patient's medication adherence at the seven-month follow-up to the patient's outcome at the 15-month follow-up. The paths from the caregiver's perceived burden at baseline to the patient's medication adherence seven months after baseline and the patient's outcome 15 months after baseline were not significant.
When caregivers of patients with bipolar illness experience a high burden, patient outcome is adversely affected. This relationship is mediated through families' affective response and patients' medication adherence.
本研究评估了家庭负担和情感反应对双相情感障碍患者药物依从性及治疗结果的直接和间接影响。
对126例连续入住大学附属医院精神科且符合双相I型或II型障碍或精神分裂症伴躁狂型研究诊断标准的患者及其家庭照顾者的数据进行了分析。共有101对患者和家庭照顾者（80%）完成了15个月的研究并纳入分析。在患者从首次住院出院或开始门诊治疗后的两周内（基线评估）对患者及其指定的照顾者进行评估。在基线评估后的7个月和15个月也对患者和照顾者进行了评估。采用结构方程模型来评估照顾者在基线后7个月对患者药物依从性以及基线后15个月对临床结局的影响。
路径模型的整体拟合指数证实了先验测量模型。发现了从基线时照顾者感知到的负担到基线时照顾者情感过度投入、从基线时照顾者情感过度投入到7个月随访时患者的药物依从性、以及从7个月随访时患者的药物依从性到15个月随访时患者结局的显著路径。从基线时照顾者感知到的负担到基线后7个月患者的药物依从性以及基线后15个月患者结局的路径不显著。
当双相情感障碍患者的照顾者负担较重时，患者的结局会受到不利影响。这种关系是通过家庭的情感反应和患者的药物依从性介导的。
