Lin Chia-Chi, Lee Yu, Chiu Nien-Mu, Lin Pao-Yen, Huang Yu-Chi, Hung Chi-Fa, Wang Liang-Jen
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, No. 123, Dapi Road, Niaosung District, Kaohsiung City, Taiwan.
Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Kaohsiung City, Taiwan.
Int J Bipolar Disord. 2025 Apr 11;13(1):15. doi: 10.1186/s40345-025-00383-w.
Despite significant research on bipolar disorder, the interplay between depression, suicide risk, and stigma in patients with bipolar disorder and their caregivers remains underexplored. This study aimed to examine how stigma and suicide risk affect the severity of depression in both patients with bipolar disorder and their caregivers.
We recruited 76 patients with bipolar disorder and their 76 caregivers from a general hospital between August 2023 and July 2024. Assessments included a psychiatric diagnostic interview using the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, the Family APGAR Index, the Stigma Subscale of the Explanatory Model Interview Catalogue, and the Suicide Assessment Scale. Structural equation modeling (SEM) was employed to explore the mechanisms underlying depression in caregivers. Additionally, a stepwise forward logistic regression model identified key factors associated with depressive disorders in caregivers.
Among caregivers, depressive disorders were the most common psychiatric diagnosis (27.6%), followed by anxiety disorders (17.1%) and insomnia disorders (11.8%). SEM analysis revealed that suicidal ideation in patients (β = 0.72, p < 0.001) was significantly associated with depression severity in patients with bipolar disorder. Caregivers' stigma (β = 0.41, p < 0.001) and suicide risk (β = 0.39, p < 0.001) were positively associated with their own depression severity. Interestingly, caregivers' suicide risk (β = -0.20, p < 0.01) was inversely related to patients' depression severity. Unemployment, anxiety severity, suicide risk, and family support were also significant predictors of depression in caregivers.
Suicidal ideation in patients with bipolar disorder is strongly linked to the severity of their depressive symptoms. Among caregivers, higher levels of stigma and suicide risk are associated with greater depressive symptom severity, while caregivers' suicide risk appears to have a protective effect on patients' depression severity. Early identification and targeted interventions for individuals at high risk of suicide and stigma may help alleviate depression in both patients and their caregivers.
尽管对双相情感障碍进行了大量研究，但双相情感障碍患者及其照顾者中抑郁、自杀风险和耻辱感之间的相互作用仍未得到充分探索。本研究旨在探讨耻辱感和自杀风险如何影响双相情感障碍患者及其照顾者的抑郁严重程度。
2023年8月至2024年7月，我们从一家综合医院招募了76名双相情感障碍患者及其76名照顾者。评估包括使用迷你国际神经精神访谈进行的精神科诊断访谈、医院焦虑抑郁量表、家庭APGAR指数、解释模型访谈目录的耻辱感分量表和自杀评估量表。采用结构方程模型（SEM）探讨照顾者抑郁的潜在机制。此外，逐步向前逻辑回归模型确定了与照顾者抑郁障碍相关的关键因素。
在照顾者中，抑郁障碍是最常见的精神科诊断（27.6%），其次是焦虑障碍（17.1%）和失眠障碍（11.8%）。结构方程模型分析显示，患者的自杀意念（β = 0.72，p < 0.001）与双相情感障碍患者的抑郁严重程度显著相关。照顾者的耻辱感（β = 0.41，p < 0.001）和自杀风险（β = 0.39，p < 0.001）与他们自己的抑郁严重程度呈正相关。有趣的是，照顾者的自杀风险（β = -0.20，p < 0.01）与患者的抑郁严重程度呈负相关。失业、焦虑严重程度、自杀风险和家庭支持也是照顾者抑郁的重要预测因素。
双相情感障碍患者的自杀意念与他们的抑郁症状严重程度密切相关。在照顾者中，较高水平的耻辱感和自杀风险与更严重的抑郁症状相关，而照顾者的自杀风险似乎对患者的抑郁严重程度有保护作用。对自杀和耻辱感高风险个体进行早期识别和有针对性的干预可能有助于减轻患者及其照顾者的抑郁。
