The effects of psychoeducational family intervention on coping strategies of relatives of patients with bipolar I disorder: results from a controlled, real-world, multicentric study

Figures & data

Table 1 Sociodemographic and clinical characteristics of the sample

	Patients group				Relatives group
	Experimental group (n=60)	Treatment as usual group (n=67)	t/χ^2	p-value	Experimental group (n=72)	Treatment as usual group (n=67)	t/χ^2	p-value
Gender, F, % (n)	56.7 (34)	65.1 (41)	0.471	0.392	56.9 (41)	59.7 (40)	0.044	0.430
Age, M (SD)	50.0 (10.3)	48.6 (12.2)	0.975	0.458	50.9 (12.9)	52.7 (13.8)	0.734	0.780
Marital status, married, yes, % (n)	66.7 (40)	54.0 (34)	0.960	0.239	68.1 (49)	70.1 (47)	0.196	0.652
Level of education, high school, % (n)	46.7 (28)	41.3 (26)	1.969	0.121	36.9 (31)	40.0 (28)	1.594	0.486
Relationship with the patient, % (n)			NA				3.612	0.194
Parent	–	–			22.5 (16)	32.8 (22)
Spouse/partner	–	–			54.9 (39)	43.3 (29)
Son/daughter	–	–			9.9 (7)	16.4 (11)
Sibling	–	–			11.3 (8)	4.5 (3)
Other relative	–	–			1.4 (1)	3.0 (2)
Employed, yes, % (n)	43.3 (26)	31.7 (20)	1.050	0.327	55.7 (39)	49.2 (31)	1.317	0.633
Number of family members, M (SD)	3.4 (1.0)	3.2 (1.1)	-0.732	0.761	–	–	NA
Daily hours spent with the patient in the last 2 months, M (SD)	–	–	NA		6.6 (3.4)	6.7 (3.4)	1.245	0.455
Years of cohabiting with the patient, M (SD)	–	–	NA		24.6 (12.2)	27.9 (11.5)	1.586	0.760
Duration of illness, years, M (SD)	14.1 (10.0)	16.0 (6.7)	1.099	0.598	–	–	NA
Months in charge at the MHC, M (SD)	73.2 (69.0)	103.5 (75.3)	2.326	0.032	–	–	NA
No. of voluntary admissions lifetime, M (SD)	2.7 (4.1)	3.0 (3.4)	0.430	0.743	–	–	NA
No. of involuntary admissions lifetime, M (SD)	0.7 (2.0)	1.5 (4.2)	1.345	0.299	–	–	NA
Suicide attempts, yes, % (n)	23.7 (14)	23.8 (15)	0.008	0.983	–	–	NA
BPRS, manic/hostility symptoms, M (SD)	1.3 (0.5)	1.3 (0.5)	0.584	0.348	–	–	NA
BPRS, depression/anxiety symptoms, M (SD)	2.0 (0.7)	2.1 (0.8)	0.516	0.176	–	–	NA
DAS global score, M (SD)	2.9 (1.0)	2.8 (1.0)	0.425	0.371	–	–	NA
Antipsychotics, yes, % (n)	61.7 (37)	57.1 (36)	0.001	0.267	–	–	NA
Mood stabilizers, yes, % (n)	86.7 (52)	85.7 (54)	0.143	0.588	–	–	NA
Antidepressants, yes, % (n)	41.7 (25)	34.9 (22)	2.049	0.741	–	–	NA
FCQ – positive communication, M (SD)	–	–	NA		3.1 (0.6)	3.1 (0.6)	0.787	0.722
FCQ – patient’s involvement in social activities, M (SD)	–	–	NA		3.0 (0.7)	3.0 (0.7)	0.490	0.395
FCQ – relatives’ maintenance of social interests, M (SD)	–	–	NA		2.7 (1.0)	2.5 (0.8)	0.074	0.210
FCQ – seeking for information, M (SD)	–	–	NA		2.4 (1.0)	2.3 (0.9)	0.771	0.349
FCQ – collusion, M (SD)	–	–	NA		2.1 (0.3)	2.1 (0.4)	0.520	0.501
FCQ – spiritual help, M (SD)	–	–	NA		2.1 (1.1)	2.0 (1.2)	0.714	0.129
FCQ – talking with friends about patient’s condition, M (SD)	–	–	NA		2.1 (1.0)	1.9 (1.0)	0.271	0.379
FCQ – resignation, M (SD)	–	–	NA		2.0 (0.9)	2.0 (0.9)	0.783	0.901
FCQ – coercion, M (SD)	–	–	NA		2.0 (0.5)	2.0 (0.6)	0.481	0.559
FCQ – avoidance, M (SD)	–	–	NA		1.4 (0.7)	1.3 (0.6)	0.676	0.495
FCQ – use of alcohol and drugs, M (SD)	–	–	NA		1.1 (0.3)	1.2 (0.6)	0.075	0.741

Notes: Mean score of each subscale is reported; score ranges from 1 (never) to 4 (always) with higher score indicating higher endorsement of each strategy. Significant p-values have been highlighted in bold characters.

Abbreviations: BPRS, Brief Psychiatric Rating Scale; DAS, Disability Assessment Schedule; FCQ, Family Coping Questionnaire; M, mean score; SD, standard deviation; MHC, mental health center; NA, not applicable.

Table 2 Correlation analyses

	Relatives’ sociodemographic characteristics								Patients’ sociodemographic characteristics
	Age		Years of education		Daily hours spent with the patient		Years spent with the patient in the same household		Age		Years of education		Months in charge at the MHC		Duration of illness (years)		BPRS depressive symptoms		BPRS manic symptoms		DAS global score
	ρ	p-value	ρ	p-value	ρ	p-value	ρ	p-value	ρ	p-value	ρ	p-value	ρ	p-value	ρ	p-value	ρ	p-value	ρ	p-value	ρ	p-value
FCQ – coercion	−0.044	0.611	−0.056	0.514	0.087	0.311	−0.062	0.470	−0.115	0.203	0.050	0.531	−0.001	0.824	−0.031	0.910	0.184	0.016	0.256	0.003	0.181	0.035
FCQ – collusion	0.328	0.000	−0.172	0.042	−0.002	0.980	0.171	0.045	−0.122	0.084	0.141	0.181	−0.153	0.280	−0.131	0.230	0.014	0.708	−0.030	0.775	0.136	0.609
FCQ – avoidance	−0.054	0.530	0.028	0.746	0.029	0.650	−0.046	0.589	−0.117	0.507	0.132	0.324	−0.035	0.096	−0.198	0.873	0.184	0.033	0.162	0.050	0.294	0.001
FCQ – resignation	0.132	0.124	−0.148	0.083	0.208	0.014	0.176	0.333	−0.094	0.268	0.077	0.140	0.074	0.296	−0.097	0.463	0.437	0.000	0.179	0.206	0.625	0.000
FCQ – spiritual help	0.173	0.043	−0.265	0.002	0.196	0.021	0.183	0.031	−0.092	0.357	−0.067	0.002	0.115	0.549	0.047	0.536	0.170	0.115	0.016	0.794	0.180	0.012
FCQ – use of alcohol and drugs	0.001	0.992	0.070	0.416	−0.021	0.808	−0.062	0.466	−0.063	0.687	0.153	0.299	−0.005	0.796	0.007	0.898	−0.034	0.796	0.080	0.112	−0.016	0.874
FCQ – patient’s involvement in social activities	−0.135	0.116	0.183	0.031	0.107	0.208	0.021	0.804	0.172	0.075	0.028	0.136	0.106	0.907	−0.035	0.272	0.364	0.000	0.014	0.624	−0.359	0.000
FCQ – positive communication	−0.107	0.212	0.114	0.183	0.040	0.640	−0.059	0.493	−0.043	0.891	−0.001	0.799	0.234	0.912	−0.009	0.023	0.186	0.056	−0.035	0.779	0.150	0.177
FCQ – relatives’ maintenance of social interests	−0.148	0.084	0.297	0.000	−0.471	0.000	−0.056	0.513	0.004	0.942	0.132	0.239	0.034	0.811	−0.004	0.642	−0.187	0.021	−0.119	0.193	−0.358	0.000
FCQ – seeking for information	0.021	0.805	0.004	0.959	0.048	0.572	0.028	0.747	−0.066	0.593	0.075	0.727	0.043	0.856	−0.149	0.887	0.288	0.000	−0.041	0.868	0.479	0.000
FCQ – talking with friends about patient’s condition	−0.077	0.367	−0.022	0.795	−0.066	0.441	0.058	0.495	−0.033	0.811	−0.028	0.460	0.012	0.545	−0.059	0.758	0.139	0.167	0.083	0.278	−0.253	0.000

Notes: Mean score of each subscale is reported; score ranges from 1 (never) to 4 (always), with higher score indicating higher endorsement of each strategy. Significant p-values have been highlighted in bold characters.

Abbreviations: ρ, rho coefficient; FCQ, Family Coping Questionnaire.

Table 3 Differences in coping strategies adopted by relatives allocated to the experimental and TAU groups (N=139)

	Group	T0					T1					Paired samples
		Mean (SD)	Independent t-test	Mean diff	95% CI bootstrap	Bootstrap p-value	Mean (SD)	t-test	Mean diff	95% CI bootstrap	Bootstrap p-value	t-test	Mean diff^Citation2	95% CI bootstrap	Bootstrap p-value
Collusion	Exp	2.1 (0.3)	0.64	0.04	−0.08 to 0.17	0.520	1.2 (0.4)	3.32	−0.16	−0.06 to −0.25	0.001	3.91	−0.19	0.09–0.29	0.000
	TAU	2.1 (0.4)					2.1 (0.4)					1.23	0.07	−0.04 to 0.19	0.201
Patient’s involvement in social activities	Exp	2.9 (0.7)	0.69	0.08	−0.17 to 0.32	0.490	3.1 (0.7)	−2.26	−0.20	−0.38 to −0.04	0.032	1.49	0.14	−0.04 to 0.32	0.142
	TAU	3 (0.7)					2.9 (0.8)					−1.62	−0.14	−0.29 to 0.02	0.110
Resignation	Exp	2.0 (0.9)	−0.28	−0.04	−0.33 to 0.23	0.783	1.7 (0.8)	3.55	−0.41	0.18–0.63	0.001	−3.48	−0.32	−0.50 to −0.13	0.001
	TAU	1.9 (0.9)					2.1 (1)					1.51	0.13	−0.03 to 0.32	0.135
Avoidance	Exp	1.4 (0.7)	−0.42	−0.05	−0.24 to 0.17	0.676	1.2 (0.5)	2.08	−0.15	0.01–0.29	0.035	−2.98	−0.17	−0.27 to −0.06	0.004
	TAU	1.3 (0.6)					1.4 (0.6)					0.37	0.03	−0.13 to 0.22	0.711
Coercion	Exp	1.9 (0.5)	0.71	0.07	−0.12 to 0.24	0.481	1.9 (0.4)	4.62	−0.29	0.17–0.41	0.001	−0.913	−0.05	−0.16 to 0.04	0.364
	TAU	2.0 (0.5)					2.2 (0.5)					2.84	0.18	0.05–0.31	0.006
Relatives’ maintenance of social interests	Exp	2.7 (0.7)	−1.80	−0.24	−0.52 to 0.03	0.074	2.8 (0.7)	−2.53	−0.25	−0.47 to −0.05	0.020	1.4	0.09	−0.04 to 0.23	0.173
	TAU	2.5 (0.8)					2.5 (0.9)					0.72	0.05	−0.08 to 0.21	0.474
Positive communication	Exp	3.1 (0.5)	−0.27	−0.03	−0.23 to 0.16	0.797	3.3 (0.4)	−5.82	−0.35	−0.47 to −0.24	0.001	2.84	0.19	0.07–0.33	0.006
	TAU	3.1 (0.6)					2.9 (0.5)					−1.79	−0.13	−0.28 to 0.03	0.077
Seek for information	Exp	2.4 (1.0)	−0.30	−0.05	−0.36 to 0.24	0.771	2.6 (0.9)	−3.63	−0.42	−0.66 to −0.18	0.001	2.24	0.27	0.05–0.49	0.028
	TAU	2.3 (0.9)					2.2 (0.9)					−1.10	−0.13	−0.35 to 0.10	0.275
Use of alcohol and drugs	Exp	1.1 (0.3)	1.80	0.14	0.01–0.31	0.083	1.0 (0.2)		−0.16	0.08–0.25	0.899	−1.00	−0.03	−0.07 to 0.02	0.321
	TAU	1.2 (0.6)					1.2 (0.5)					−0.241	−0.01	−0.13 to 0.09	0.810
Talking with friends about patient’s condition	Exp	2.1 (0.9)	−1.11	−0.19	−0.52 to 0.14	0.271	1.9 (0.9)		−0.01	−0.22 to 0.22	0.961	−1.67	−0.19	−0.43 to 0.03	0.099
	TAU	1.9 (1)					1.9 (0.9)					0.24	0.03	−0.21 to 0.25	0.810
Spiritual help	Exp	2.0 (1.1)	−0.37	−0.07	−0.43 to 0.31	0.714	1.9 (1.1)		0.03	−0.24 to 0.32	0.832	−1.01	−0.12	−0.31 to 0.12	0.317
	TAU	1.9 (1.2)					1.9 (1.1)					0.08	0.01	−0.23 to 0.23	0.935

Notes: T0= baseline assessment; T1= 6 months assessment. Bootstrap p-value based on 1,000 bootstrap replications. Mean difference = TAU mean – experimental mean. Mean difference² = experimental mean T1 – experimental mean T0 or TAU mean T1–TAU mean T0. Mean score at each subscale is reported; score ranges from 1 (never) to 4 (always), with higher score indicating higher endorsement of each strategy. Significant p-values have been highlighted in bold characters.

Abbreviations: Exp, experimental group; FCQ, Family Coping Questionnaire; TAU, Treatment As Usual group; T0, baseline assessment; T1, end of the intervention assessment; diff, difference.

Table 4 Impact of the experimental intervention on the problem-oriented coping strategies

	Patients’ social involvement		Relatives’ maintenance of social interests		Positive communication		Searching for information		Talking with friends
	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Experimental treatment	0.157 (−0.08 to 0.40)	0.199	0.309 (0.04–0.57)	0.023	0.295 (0.13–0.46)	0.001	0.443 (0.12–0.76)	0.007	−0.011 (−0.35 to 0.32)	0.948
Patient’s gender, male	−0.123 (−0.43 to 0.18)	0.426	0.147 (−0.19 to 0.48)	0.386	−0.117 (−0.33 to 0.10)	0.281	−0.141 (−0.55 to 0.27)	0.493	0.254 (−0.17 to 0.68)	0.240
Relative’s gender, male	−0.145 (−0.45 to 0.16)	0.344	0.126 (−0.21 to 0.46)	0.453	−0.115 (−0.33 to 0.09)	0.280	−0.151 (−0.55 to 0.25)	0.457	0.099 (−0.52 to 0.32)	0.642
Relationship with patients, ref. cat.: other
Parent	057 (−1.02 to 1.14)	0.917	−0.451 (−10.64 to 0.73)	0.452	0.655 (−0.10 to 10.41)	0.088	−0.193 (−10.63 to 10.24)	0.791	−0.661 (−20.17 to 0.84)	0.386
Partner	0.310 (−0.55 to 10.16)	0.475	−0.767 (−10.70 to 0.17)	0.108	0.605 (0.01–10.20)	0.047	−0.196 (−10.33 to 0.94)	0.734	−0.376 (−10.57 to 0.81)	0.533
Son	0.157 (−0.78 to 10.10)	0.742	−0.139 (−10.17 to 0.89)	0.791	0.321 (−0.34–0.98)	0.335	−0.307 (−10.56 to 0.95)	0.629	0.007 (−10.30 to 10.32)	0.992
Sibling	0.333 (−0.64 to 10.31)	0.501	−0.123 (−10.19 to 0.95)	0.820	0.619 (−0.06 to 10.30)	0.075	−0.062 (−10.40 to 10.20)	0.925	−0.030 (−10.39 to 10.33)	0.965
Duration of the illness	−0.004 (−0.02 to 0.01)	0.632	0.006 (−0.01 to 0.02)	0.491	−0.002 (−0.01 to 0.01)	0.655	−0.009 (−0.03 to 0.01)	0.367	0.005 (−0.01 to 0.02)	0.633
Months in charge	−0.000 (−0.01 to 0.01)	0.673	0.000 (−0.01 to 0.01)	0.778	−0.000 (−0.01 to 0.01)	0.484	0.000 (−0.01 to 0.01)	0.760	0.000 (−0.01 to 0.01)	0.835
Daily hours with the patient	0.020 (−0.01 to 0.06)	0.290	−0.052 (−0.09 to −0.01)	0.015	0.024 (0.00–0.05)	0.071	−0.039 (−0.09 to 0.01)	0.130	−0.034 (−0.01 to 0.02)	0.207
Patient’s age	0.002 (−0.02 to 0.02)	0.821	0.001 (−0.02 to 0.02)	0.955	0.000 (−0.01 to 0.01)	0.944	0.006 (−0.02 to 0.03)	0.643	−0.018 (−0.05 to 0.01)	0.205
Relative’s age	−0.008 (−0.02 to 0.01)	0.409	−0.002 (−0.02 to 0.01)	0.823	−0.017 (−0.03 to −0.01)	0.008	0.000 (−0.02 to 0.02)	0.993	0.009 (−0.01 to 0.03)	0.500
Relative’s years of schooling	0.074 (0.04–0.39)	0.105	0.207 (−0.02 to 0.44)	0.080	0.048 (−0.10 to 0.19)	0.522	−0.075 (−0.36 to 0.21)	0.601	0.066 (−0.23 to 0.36)	0.660
Years spent in the same household	−0.005 (−0.02 to 0.01)	0.451	0.001 (−0.01 to 0.01)	0.910	−0.001 (−0.01 to 0.01)	0.887	0.004 (−0.01 to 0.02)	0.622	0.012 (−0.01 to 0.03)	0.210
BPRS, depressive symptoms, baseline	0.231 (0.02–0.44)	0.028	−0.029 (−0.25 to 0.20)	0.798	0.050 (−0.09 to 0.19)	0.491	0.001 (−0.27 to 0.27)	0.994	0.109 (−0.18 to 0.39)	0.455
BPRS, manic symptoms, baseline	0.048 (−0.21 to 0.31)	0.716	0.101 (−0.18 to 0.39)	0.483	−0.102 (−0.28 to 0.08)	0.267	−0.165 (−0.51 to 0.18)	0.349	0.134 (−0.23 to 0.50)	0.466
DAS, global score	0.049 (−0.11 to 0.21)	0.544	−0.134 (−0.31 to 0.04)	0.131	0.049 (−0.06 to 0.16)	0.386	0.382 (0.17–0.59)	0.001	0.171 (−0.05 to 0.39)	0.129

Note: Significant p-values have been highlighted in bold characters.

Abbreviations: BPRS, Brief Psychiatric Rating Scale; DAS, Disability Assessment Schedule; OR, odds ratio; CI, confidence intervals; ref. cat., reference category.

Table 5 Impact of the experimental intervention on the emotion-focused coping strategies

	Collusion		Resignation		Avoidance		Coercion		Use of alcohol and drugs		Seeking for spiritual help
	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Experimental treatment	−0.116 (−0.25 to 0.02)	0.086	−0.380 (−0.68 to −0.08)	0.014	−0.185 (−0.39 to 0.01)	0.070	−0.268 (−0.46 to −0.08)	0.002	−0.182 (−0.33 to −0.04)	0.014	−0.002 (−0.38 to 0.38)	0.994
Patient’s gender, male	0.005 (−0.16 to 0.17)	0.956	−0.336 (−0.72 to 0.04)	0.083	−0.214 (−0.47 to 0.04)	0.098	−0.220 (−0.46 to 0.02)	0.071	−0.085 (−0.27 to 0.10)	0.355	−0.164 (−0.65 to 0.32)	0.505
Relative’s gender, male	0.048 (−0.12 to 0.21)	0.566	−0.317 (−0.69 to 0.06)	0.098	−0.151 (−0.40 to 0.10)	0.236	−0.201 (−0.44 to 0.03)	0.094	0.039 (−0.14 to 0.21)	0.667	−0.498 (−0.98 to −0.02)	0.042
Relationship with patients, ref. cat.: other
Parent	0.261 (−0.33 to 0.85)	0.386	−0.435 (−10.78 to 0.91)	0.523	0.335 (−10.23 to 0.56)	0.462	−0.173 (−10.02 to 0.67)	0.685	0.466 (−0.18 to 10.11)	0.154	0.110 (−10.61 to 10.83)	0.899
Partner	0.072 (−0.40 to 0.54)	0.761	−0.112 (−10.78 to 0.95)	0.835	−0.267 (−0.98 to 0.44)	0.457	0.015 (−0.65 to 0.68)	0.966	0.288 (−0.22 to 0.80)	0.265	0.210 (−10.15 to 10.57)	0.760
Son	0.112 (−0.41 to 0.63)	0.670	−0.208 (−10.38 to 0.96)	0.726	−0.727 (−10.51 to 0.05)	0.068	0.017 (−0.72 to 0.75)	0.963	−0.049 (−0.51 to 0.61)	0.864	−0.104 (−10.60 to 10.39)	0.891
Sibling	0.093 (−0.44 to 0.63)	0.732	−0.574 (−10.79 to 0.64)	0.352	−0.334 (−10.14 to 0.49)	0.417	−0.144 (−0.91 to 0.62)	0.710	0.298 (−0.28 to 0.88)	0.313	−0.156 (−10.70 to 10.40)	0.842
Duration of the illness	−0.005 (−0.01 to 0.00)	0.269	−0.002 (−0.02 to 0.01)	0.836	0.001 (−0.01 to 0.01)	0.901	0.003 (−0.01 to 0.01)	0.654	0.002 (−0.01 to 0.01)	0.702	0.018 (−0.01 to 0.04)	0.119
Months in charge	0.000 (−0.00 to 0.00)	0.705	0.001 (−0.01 to 0.01)	0.286	0.001 (−0.01 to 0.01)	0.247	0.000 (−0.01 to 0.01)	0.775	−0.001 (−0.01 to 0.01)	0.236	−0.001 (−0.01 to 0.01)	0.718
Daily hours spent with the patient	−0.003 (−0.02 to 0.02)	0.806	0.021 (−0.03 to 0.07)	0.374	0.002 (−0.03 to 0.03)	0.910	0.009 (−0.02 to 0.03)	0.538	0.002 (−0.02 to 0.02)	0.874	0.023 (−0.04 to 0.08)	0.453
Patient’s age	0.004 (−0.01 to 0.01)	0.448	−0.008 (−0.03 to 0.01)	0.515	0.001 (−0.01 to 0.01)	0.895	−0.008 (−0.02 to 0.01)	0.302	0.006 (−0.01 to 0.01)	0.301	−0.013 (−0.04 to 0.02)	0.419
Relative’s age	0.004 (−0.01 to 0.01)	0.410	−0.003 (−0.03 to 0.02)	0.772	−0.014 (−0.03 to 0.00)	0.063	0.005 (−0.01 to 0.01)	0.468	−0.010 (−0.02 to 0.00)	0.070	−0.010 (−0.04 to 0.02)	0.507
Relative’s years of schooling	0.085 (−0.03 to 0.20)	0.149	−0.232 (−0.49 to 0.03)	0.084	0.046 (−0.13 to 0.22)	0.607	−0.051 (−0.22 to 0.11)	0.544	−0.056 (−0.18 to 0.07)	0.381	−0.352 (−0.69 to −0.02)	0.040
Years spent in the same household	0.007 (−0.00 to 0.01)	0.068	0.006 (−0.01 to 0.02)	0.452	0.007 (−0.00 to 0.01)	0.210	−0.002 (−0.01 to 0.01)	0.764	−0.002 (−0.01 to 0.01)	0.657	0.016 (−0.00 to 0.04)	0.119
BPRS, depressive symptoms, baseline	−0.027 (−0.14 to 0.09)	0.632	0.137 (−0.12 to 0.39)	0.290	0.036 (−0.13 to 0.21)	0.679	0.040 (−0.12 to 0.20)	0.621	−0.065 (−0.19 to 0.06)	0.298	0.135 (−0.19 to 0.46)	0.413
BPRS, manic symptoms, baseline	0.031 (−0.11 to 0.17)	0.673	−0.212 (−0.54 to 0.11)	0.196	0.008 (−0.21 to 0.22)	0.942	−0.008 (−0.21 to 0.19)	0.934	0.047 (−0.11 to 0.20)	0.553	−0.151 (−0.56 to 0.26)	0.472
DAS, global score	0.073 (−0.01 to 0.16)	0.102	0.321 (0.12 to 0.52)	0.002	0.090 (−0.04 to 0.22)	0.178	0.009 (−0.11 to 0.13)	0.883	0.053 (−0.04 to 0.15)	0.269	0.078 (−0.17 to 0.33)	0.540

Notes: Mean score at each subscale is reported; score ranges from 1 (never) to 4 (always), with higher score indicating higher endorsement of each strategy. Significant p-values have been highlighted in bold characters.

Abbreviations: BPRS, Brief Psychiatric Rating Scale; DAS, Disability Assessment Schedule; OR, odds ratio.

MiklowitzDJGoldsteinMJBehavioral family treatment for patients with bipolar affective disorderBehav Modification199014457489

 PubMed Web of Science ®Google Scholar