الفهرس 
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Abstract
Bipolar disorder (BD) is a mental health disorder characterized by extreme shifts in mood, high suicide rate, sleep problems, and dysfunction of psychological traits like self-esteem (feeling inferior when depressed and superior when manic) (Rantala et al, 2021). Ther are numerous adverse effects for caregivers of patients with biolar disorder, impairing quality of life, causing time lost from work, financial stresses, limiting time for leisure and socializing, as well as causing adverse health effects such as elevated stress and depression or feeling of stigmatization . (Papastavrou et al , 2021).
Stigma is defined as a pervasive social mechanism with negative ramifications for people who experience mental illness (Reupert et al , 2021). Stigma is conceptualized as a feeling of disgrace, shame, and self-blame that results in social exclusion, isolation, and embarrassment. (Schomerus et al , 2019).
Quality of life is a broad concept that encompasses an individual’s physical and psychological health, independence, social relationships, and personal belief environment (WHO, 2022).
The present study aimed to assess the relationship between stigma and quality of life among family caregivers of patients with bipolar disorder. It was conducted at outpatient clinics of the mental health at Fayoum university hospital. The subjects of the study consisted of 80 family care givers of patient with bipolar disorder who meet the inclusion criteria.
The following tools were used for data collection:
I- interviewing Questionar: It consist two parts:
a- Socio demographic data for caregivers of patients with bipolar disorder.
It was develop by the researcher and it was used to assess personal and social characteristics of family care givers of patient with bipolar disorder as sex, age, marital status, educational level, economic status, profession, place of residence , duration of illness , family history and relation to the patient.
b-Demographic data for patients with bipolar disorder.
It consisted of age, sex marital status, economic status, duration of illness, type of bipolar disorder and previous hospitalization.
Tool II: Modified consumer experience of stigma scale (MCESQ)
It was designed by Dickerson, Somerville, Origonu, Ringel and Parente (2002) and adopted to assess reaction experienced by relatives of mentally ill patient.This scale consist of twenty – one items on two subscales. Responses were rated on four –points Likert scale:
0 =strongly disagree, 1 =disagree, 2 = agree, 3 = strongly
Agree were grouped thematically a prior into two subscales: stigma experience and discrimination that assessed the degree to which an individual had perceived negative social action.
Tool II: Quality of life scale scale.
This scale consist of 100 items could be grouped into seven dimensionsnamely: physical, social, psychological, spiritual, positive feeling and satisfaction, work and general satisfaction for mentally ill patient’s family care givers , the first subscale is positive feeling and satisfaction that consists of 39 items,the second subscale is physical health and activities that consists of 13 items.
The third subscale is social relationship that consists of 33, the fourth subscale is psychological state that consists of 3 items,the fifth subscale is ability to work that consists of 4 items, the sixth subscale is spiritual beliefs that consists of 4 items, the seven subscale is general satisfaction that consists of 5 items.Responses were measured on five- point likert- type scale where: 1 = ,2 = rarely, 3 = sometimes,4 = usually, 5 = always,the higher the score the better the quality of life.
The current study was carried out through 3 months. Data collected were done through interviewing the caregivers in the hospital in an individual basis. Each interview lasted for 30-45 minutes “depending on the response of the caregivers.
The main findings of the current study revealed that:
• (53.8 %) of caregivers under study were females “while (46.3%) were males.
• Majority of the studied sample (56.3%) were aged between 30 to 40years old, 31.3% were more than 40 years old, and 12.5% at 20 years old.
• More than half of patients (56.3%) were average education (read and write), 35.0% were illiterate, and 8.8% were high education.
• 50.0% weren’t working, and 36.3 % were business and 13.8% were employed.
• (86.3%) of them were married, 10.0% were widowed, and 3.8% were divorced.
• (76.3%) of patients had duration of illness more than 3 years, 23.8 % had suffered from menta illness for 1-3years.
• (61.3%) had twice previous admission to psychiatric hospitals, 27.5% were admitted triple, and 11.3% were admitted once.
• Regarding patient family members suffered from mental disorder 61.3% of them suffered from mental disorder and 38.8% of them not suffered from any mental disorder.
• Regarding stigma it was observed that 82.5% among studied caregiver of patients with bipolar disorder are stigmatized and (17.5%) donot have stigma.
• Regarding quality of life it was observed that 53.8% among studied caregiver have low level of quality of life, 25.0% have moderate level of quality of life and 21.3% have high level of quality of life.
• There was a negative statistical significant relation between total level of stigma and total level of quality of life domain.
Conclusion
According to the results of this study, it can be cocluded that:
The majority of the caregivers of patients with bipolar disorder were stigmatized, more than half of them had low level of quality of life and one quarter of them had moderate level of quality of life, meanwhile, slightly more than quarter of them had high level of quality of life. Additionally, there is a negative statistical significant relation between total score of stigma and total score of quality of life among caregivers of patients with bipolar disorder under study.
Recommendations
Based on the current study finding the following recommendations were proposed:
For caregivers:
• An educational program of caregivers of patients with bipolar disorder on knowledge, attitude and practice about bipolar disorder to enhance their awareness about their patient’s illness.
• Developing nursing intervention program for family caregivers of patients with bipolar disorder on their coping strategies to help them to cope with stigma and to fit the stigma which consequently affect their quality of life.
• Counceling intervention program for caregivers of patients with bipolar disorder on their coping strategies and how to deal effectively with patients with bipolar disorder.
For Research:
• Future studies should focus on studying the social life of the caregiver and whether it may support BD patients, along with how far psychoeducation for the caregivers might affect the course of the disease.
For Nursing;
• An Educational and training program for nursing staff should be done emphasizing the area of communication and how to deal with patients with bipolar disorder.
• Psychiatric nurses should identify all needs of caregivers of patients with bipolar disorder to enable them to reduce their stress and burden and then enhance their quality of life.