Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders

Abstract

Caregivers of psychiatrically impaired children experience considerable parenting stress. However, no research has evaluated parenting stress within the context of pediatric bipolar spectrum disorders (BPSD). Thus, the aim of this investigation was to identify predictors and moderators of stress among caregivers in the Longitudinal Assessment of Manic Symptoms study. Participants included 640 children and their caregivers in the Longitudinal Assessment of Manic Symptoms cohort. Children had a mean age of 9.4 ± 1.9 years (68% male, 23% BPSD); parents had a mean age of 36.5 ± 8.3 years (84% mothers). Children with BPSD had more service utilization, psychiatric diagnoses, mood and anxiety symptoms, and functional impairment but fewer disruptive behavior disorders. Caregivers of children with BPSD were more likely than caregivers of children without BPSD to have a partner, elevated depressive symptoms, antisocial tendencies, and parenting stress (Cohen’s d = .49). For the whole sample, higher child IQ, mania, anxiety, disruptive behavior, and caregiver depression predicted increased parenting stress; maternal conduct disorder predicted lower stress. Child anxiety and disruptive behavior were associated with elevated caregiver stress only for non-BPSD children. Caregivers of children with BPSD experience significant burden and thus require specialized, family-focused interventions. As stress was also elevated, to a lesser degree, among depressed caregivers of children with higher IQ, mania, anxiety, and disruptive behavior, these families may need additional supports as well. Although parents with conduct/antisocial problems evidenced lower stress, these difficulties should be monitored. Thus, parenting stress should be evaluated and addressed in the treatment of childhood mental health problems, especially BPSD.

FUNDING

Support for this article was provided by the National Institute of Mental Health: R01 MH073801, R01-MH073967, R01-MH073953, and R01-MH073816.

POTENTIAL CONFLICTS OF INTEREST

Dr. Youngstrom has consulted about psychological assessment with Otsuka, Lundbeck, Janssen, Western Psychological Services, and Pearson. Dr. Arnold has received research funding from Curemark, Forest, Lilly, Neuropharm, Novartis, Noven, Shire, Supernus, and Young Living (as well as National Institutes of Health [NIH] and Autism Speaks) and has consulted with or been on advisory boards for Arbor, Gowlings, Ironshore, Neuropharm, Novartis, Noven, Organon, Otsuka, Pfizer, Roche, Seaside Therapeutics, Sigma Tau, Shire, Tris Pharma, and Waypoint; he also received travel support from Noven. Dr. Frazier has received federal funding or research support from, acted as a consultant to, received travel support from, and/or received a speaker’s honorarium from the Cole Family Research Fund, Simons Foundation, Ingalls Foundation, Forest Laboratories, Ecoeos, IntegraGen, Kugona LLC, Shire Development, Bristol-Myers Squibb, NIH, and the Brain and Behavior Research Foundation. Dr. Birmaher receives royalties from American Psychiatric Publishing, Random House, UpToDate, and Lippincott Williams & Wilkins. Dr. Findling receives or has received research support, acted as a consultant, and/or served on a speaker’s bureau for Alcobra, American Academy of Child & Adolescent Psychiatry, American Physician Institute, American Psychiatric Press, Bracket, CogCubed, Cognition Group, Coronado Biosciences, Dana Foundation, Elsevier, Forest, Guilford Press, Ironshore, Johns Hopkins University Press, Jubilant Clinsys, KemPharm, Lundbeck, Merck, NIH, Neurim, Novartis, Otsuka, Oxford University Press, Pfizer, Physicians Postgraduate Press, Purdue, Rhodes Pharmaceuticals, Roche, Sage, Shire, Sunovion, Supernus Pharmaceuticals, Teva, Transcept Pharmaceuticals, Tris, Validus, and WebMD. Dr. Fristad receives royalties from American Psychiatric Press, Guilford Press and Child & Family Psychological Services, as well as honoraria from Physicians’ Post-Graduate Press. Drs. Algorta, MacPherson, Taylor, and Horwitz and Ms. Belt have no conflicts to report.

Additional information

Funding

Support for this article was provided by the National Institute of Mental Health: R01 MH073801, R01-MH073967, R01-MH073953, and R01-MH073816.