Correlates of subjective and objective burden among caregivers of patients with bipolar disorder Ostacher MJ, Nierenberg AA, Iosifescu DV, Eidelman P, Lund HG, Ametrano RM, Kaczynski R, Calabrese J, Miklowitz DJ, Sachs GS, Perlick DA, the STEP-BD Family Experience Collaborative Study Group. Correlates of subjective and objective burden among caregivers of patients with bipolar disorder. Objective: We examined the relationship between mood symptoms and episodes in patients with bipolar disorder and burden reported by their primary caregivers. Method: Data on subjective and objective burden reported by 500 primary caregivers for 500 patients with bipolar disorder participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were collected using semistructured interviews. Patient data were collected prospectively over 1 year. The relationship between patient course and subsequent caregiver burden was examined. Results: Episodes of patient depression, but not mood elevation, were associated with greater objective and subjective caregiver burden. Burden was associated with fewer patient days well over the previous year. Patient depression was associated with caregiver burden even after controlling for days well. Conclusion: Patient depression, after accounting for chronicity of symptoms, independently predicts caregiver burden. This study underscores the important impact of bipolar depression on those most closely involved with those whom it affects. M. J. Ostacher 1,6 , A. A. Nierenberg 1,6 , D. V. Iosifescu 1 , P. Eidelman 1 , H. G. Lund 1 , R. M. Ametrano 1 , R. Kaczynski 2 , J. Calabrese 3 , D. J. Miklowitz 4 , G. S. Sachs 1,6 , D. A. Perlick 5 , the STEP-BD Family Experience Collaborative Study Group* 1 Massachusetts General Hospital, Bipolar Clinic and Research Program, Boston, MA, 2 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 3 Department of Psychiatry, Case Western Reserve University, Cleveland, OH, 4 Department of Psychology, University of Colorado, Boulder, CO, 5 Department of Psychiatry, Mount Sinai School of Medicine, New York, NY and 6 Department of Psychiatry, Harvard Medical School, Boston, MA, USA Key words: bipolar disorder; depression; interpersonal relations; social environment Michael J Ostacher, MD, MPH, Massachusetts General Hospital, Bipolar Clinic and Research Program, 50 Staniford Street, Suite 580, Boston, MA 02114, USA. E-mail: mostacher@partners.org *Charles Bowden, MD; Jodi Gonzalez, PhD (University of Texas); Jenifer Culver, PhD; Terence Ketter, MD (Stanford University); Mark Fosse, MD (University of Oklahoma College of Medicine); Lauren Marangell, MD (Baylor College of Medicine); Jayendra Patel, MD (University of Massachusetts), Cheryl Chessick, MD (University of Colorado) Accepted for publication April 2, 2008 Significant outcomes • Family members of caregivers of patients with bipolar disorder have significant burden. • Burden is acutely related to depression in the patient. • Mood elevation is not significantly related to increased burden compared with the burden experienced by caregivers of euthymic patients. Limitations • The study included only caregivers who were willing to participate. • The cohort is predominantly Caucasian. • Subjects were recruited primarily from academic medical centers. Acta Psychiatr Scand 2008: 118: 49–56 All rights reserved DOI: 10.1111/j.1600-0447.2008.01201.x Copyright Ó 2008 The Authors Journal Compilation Ó 2008 Blackwell Munksgaard ACTA PSYCHIATRICA SCANDINAVICA 49