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Brazilian Journal of Psychiatry

Print version ISSN 1516-4446On-line version ISSN 1809-452X

Rev. Bras. Psiquiatr. vol.31 no.4 São Paulo Dec. 2009 



The impact of marital status in hospitalized patients with bipolar disorder


O impacto da situação conjugal em pacientes internados com transtorno do humor bipolar



Dear Editor,

Many studies show that bipolar disorder (BD) causes ever-increasing distress to caregivers, which leaves many with a feeling of being overburdened. When caregivers believe that they are capable of controlling the patient's disease this feeling is reduced. This belief has been associated with good coping strategies, or coping style, which can in turn reduce rates of hospitalization.1 In a recent study with BD patients, the authors demonstrated that when patients were substance abusers, and were also separated from their partner, they had a 100% risk of hospitalization. The presence of a partner reduced this risk on 52%, and the lowest risk of hospitalization was associated with the presence of a partner and absence of drug involvement.2 It is also known that almost 40% of hospitalizations longer than 30 days are due to social and administrative factors beyond the psychiatrist's control, compared to 50% that are medically justified.3 In addition, hospitalization is considered an important indicator of greater severity and poorer outcomes for manic and mixed states in our country and in other regions of the world.4

Therefore, we conducted a retrospective case-control chart review study of patients that were hospitalized from January 1st 2004 to December 31st 2008, at the Psychiatric Unit of Santa Maria's University Hospital (a community public hospital). Of the 294 charts reviewed, we included 178 that fulfilled the inclusion criteria: 1) DSM-IV-TR diagnostic of BD, most recent episode manic with psychotic features; detailed descriptions about: 2) marital status, 3) length of disease, 4) number of mood episodes, 5) number of hospitalizations due to BD and 6) time of hospitalization due to BD. Subjects were divided into two groups: with (n = 43) or without spouse (n = 135). Results were analyzed using ANCOVA. Ethics committee approval was given.

The presence of a spouse was related to a lower total time of hospitalization, in days, in the patient's lifetime. Similarly, there were fewer hospitalizations in those patients that lived with a spouse. Curiously, disease related variables like total number of mood episodes and number of mood episodes per year of disease were not related to the presence of a spouse (Table 1). Confounding factors, such as adherence to treatment, were not evaluated, being limitations of the study.



We can conclude, then, that for this particular type of BD patient, the presence of a spouse can reduce hospitalization rates, though does not reduce the number of episodes of the disease. Future studies should investigate whether brief hospitalizations are associated with the pattern of coping skills of caregivers.


Pedro Domingues Goi
Laboratório de Pesquisa em Psiquiatria (LaPP), Hospital
Universitário de Santa Maria (HUSM), Santa Maria (RS), Brazil

Bruno Paz Mosqueiro
School of Medicine, Universidade Federal de Santa Maria
(UFSM), Santa Maria (RS), Brazil

Angelo Batista da Cunha
Psychiatric Unit, Laboratório de Pesquisa em Psiquiatria (LaPP),
Hospital Universitário de Santa Maria (HUSM), Universidade
Federal de Santa Maria (UFSM), Santa Maria (RS), Brazil




1. Goossens PJ, Van Wijngaarden B, Knoppert-van Der Klein EA, Van Achterberg T. Family caregiving in bipolar disorder: caregiver consequences, caregiver coping styles, and caregiver distress. Int J Soc Psychiatry. 2008;54(4):303-16.         [ Links ]

2. Hoblyn JC, Balt SL, Woodard SA, Brooks JO 3rd. Substance use disorders as risk factors for psychiatric hospitalization in bipolar disorder. Psychiatr Serv. 2009;60(1):50-5.         [ Links ]

3. Hallak JE, Crippa JA, Vansan G, Zuardi AW. Diagnostic profile of inpatients as a determinant of length of stay in a general hospital psychiatric unit. Braz J Med Biol Res. 2003;36(9):1233-40.         [ Links ]

4. Schwartzmann AM, Amaral JA, Issler C, Caetano SC, Tamada RS, Almeida KM, Soares MB, Dias RS, Rocca CC, Lafer B. A clinical study comparing manic and mixed episodes in patients with bipolar disorders. Rev Bras Psiquiatr. 2007;29(2):130-3.         [ Links ]

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