Difficulties in emotional regulation mediates the impact of burden on quality of life and mental health in a sample of family members of people diagnosed with Borderline Personality Disorder

Background Although it has been suggested that family members of persons suffering from Borderline Personality Disorder (BPD) endure high levels of burden, however, the process and the impact of this burden in their lives, and specifically the relation between the burden and emotional regulation has not been broadly investigated among this population. The main objective of this study is to examine the impact of burden on quality of life and depression, anxiety and stress, as mediated by difficulties in emotional regulation in family members of persons diagnosed with BPD. Method Participants were 167 family members of persons diagnosed with BPD. The Burden Assessment Scale, Difficulties in Emotion Regulation Scale, Multicultural Quality of Life Index, and Depression Anxiety Stress Scale-21 were filled out. Mediation analysis was conducted using the Maximum Likelihood estimator, bootstrap method and listwise deletion for missing data. Results Burden showed a significant, negative effect on quality of life and positive on depression, anxiety and stress. Difficulties in emotion regulation significantly mediated these relations. After accounting for the mediating role of difficulties in emotion regulation, burden still had an impact on quality of life, depression, anxiety and stress. Women showed a higher level in both burden and stress than men. The caregivers with secondary and higher studies showed higher levels in burden than those with no studies. Not significant differences in burden, emotion regulation, depression, anxiety and stress were found related to marital status. Conclusion Difficulties in emotion regulation mediate the relations between burden and quality of life, depression, anxiety, and stress. Family members could engage in group interventions designed specifically for family members of people with BPD, oriented toward understanding the disorder or learning skills.

[1]  S. Fonseca-Baeza,et al.  Spanish adaptation of the Burden Assessment Scale in family caregivers of people diagnosed with borderline personality disorder , 2023, Borderline Personality Disorder and Emotion Dysregulation.

[2]  R. Baños,et al.  Multicultural Quality of Life Index in Relatives of People With Borderline Personality Disorder , 2022, Frontiers in Psychiatry.

[3]  Azita Fathnezhad-kazemi,et al.  Nurses’ job stress and its impact on quality of life and caring behaviors: a cross-sectional study , 2022, BMC Nursing.

[4]  J. Lima-Rodríguez,et al.  Factors Associated with Quality of Life in Relatives of Adults with Serious Mental Illness: A Systematic Review , 2022, Community Mental Health Journal.

[5]  P. Fabbietti,et al.  Association between care burden, depression and personality traits in Alzheimer’s caregiver: A pilot study , 2021, PloS one.

[6]  R. Baños,et al.  Un programa de entrenamiento para familiares de pacientes con trastorno límite de la personalidad basado en la terapia dialéctica comportamental , 2021, Behavioral Psychology/Psicología Conductual.

[7]  N. Stocks,et al.  Social isolation, social support and loneliness as independent concepts, and their relationship with health-related quality of life among older women , 2021, Aging & mental health.

[8]  S. Woods,et al.  Examining the Association between Emotional Dysregulation and Treatment Burden , 2021, Western journal of nursing research.

[9]  B. Amoo,et al.  Psychological distress and burden of care among family caregivers of patients with mental illness in a neuropsychiatric outpatient clinic in Nigeria , 2021, PloS one.

[10]  T. Fergus,et al.  Individual differences in emotion regulation prospectively predict early COVID-19 related acute stress , 2021, Journal of Anxiety Disorders.

[11]  M. Blanca,et al.  Life satisfaction and the mediating role of character strengths and gains in informal caregivers. , 2021, Journal of psychiatric and mental health nursing.

[12]  A. Cano-Vindel,et al.  Worry about COVID-19 contagion and general anxiety: Moderation and mediation effects of cognitive emotion regulation , 2021, Journal of Psychiatric Research.

[13]  V. Orgeta,et al.  Subjective caregiver burden and anxiety in informal caregivers: A systematic review and meta-analysis , 2021, PloS one.

[14]  Baiyang Zhang,et al.  Social support and quality of life among rural family caregivers of persons with severe mental illness in Sichuan Province, China: mediating roles of care burden and loneliness , 2021, Quality of Life Research.

[15]  Laura Bermejo Toro,et al.  Trait Mindfulness, Rumination, and Well-being in Family Caregivers of People with Acquired Brain Injury , 2021 .

[16]  I. Riccardi,et al.  Emotion Regulation, Physical Diseases, and Borderline Personality Disorders: Conceptual and Clinical Considerations , 2021, Frontiers in Psychology.

[17]  B. Karlsson,et al.  Social support and recovery from mental health problems: a scoping review , 2021, Nordic Social Work Research.

[18]  E. Simonsen,et al.  Burden and Treatment Satisfaction among Caregivers of Adolescents with Borderline Personality Disorder. , 2020, Family process.

[19]  Sana Tauseef Sentiment and Stock Returns: A Case for Conventional and Islamic equities in Pakistan , 2020, Business & Economic Review.

[20]  M. Jovev,et al.  A study comparing the experiences of family and friends of young people with borderline personality disorder features with family and friends of young people with other serious illnesses and general population adults , 2020, Borderline Personality Disorder and Emotion Dysregulation.

[21]  D. Dorstyn,et al.  The Protective Role of Social Support Sources and Types Against Depression in Caregivers: A Meta-Analysis , 2020, Journal of Autism and Developmental Disorders.

[22]  Prosenjit Ghosh,et al.  Comparative study on caregiver burden and their quality of life in caring patients of Schizophrenia and bipolar affective disorder , 2020 .

[23]  R. Baños,et al.  Interventions for Family Members and Carers of Patients with Borderline Personality Disorder: A Systematic Review. , 2020, Family process.

[24]  H. Hanagasi,et al.  Caregiver Burden, Quality of Life and Related Factors in Family Caregivers of Dementia Patients in Turkey , 2020, Issues in mental health nursing.

[25]  Siyuan Tang,et al.  Mitigating distress and promoting positive aspects of caring in caregivers of children and adolescents with schizophrenia: Mediation effects of resilience, hope, and social support. , 2020, International journal of mental health nursing.

[26]  J. Baker,et al.  Support, interventions and outcomes for families/carers of people with borderline personality disorder: A systematic review. , 2019, Personality and mental health.

[27]  M. Blanchard,et al.  “It's very hard for me to say anything positive”: A qualitative investigation into borderline personality disorder treatment experiences in the Australian context , 2019 .

[28]  R. Perneczky,et al.  Determinants of self‐ and carer‐rated quality of life and caregiver burden in Alzheimer disease , 2019, International journal of geriatric psychiatry.

[29]  D. Mennin,et al.  A Randomized Controlled Trial of Emotion Regulation Therapy for Psychologically Distressed Caregivers of Cancer Patients , 2019, JNCI cancer spectrum.

[30]  Hanik Endang Nihayati,et al.  Relationship Between Caregivers’ Burden of Schizophrenia Patient with Their Quality of Life in Indonesia , 2019, Journal of Psychosocial Rehabilitation and Mental Health.

[31]  H. Meng,et al.  The Influence of Social Support and Care Burden on Depression among Caregivers of Patients with Severe Mental Illness in Rural Areas of Sichuan, China , 2019, International journal of environmental research and public health.

[32]  B. Grenyer,et al.  A Randomized Controlled Trial of Group Psychoeducation for Carers of Persons With Borderline Personality Disorder. , 2019, Journal of personality disorders.

[33]  Richard Bennett Acceptance and Commitment Therapy , 2019 .

[34]  R. Robles,et al.  Needs assessment of informal primary caregivers of patients with borderline personality disorder: psychometrics, characterization, and intervention proposal , 2019, Salud mental.

[35]  Laura Parra-Anguita,et al.  Perceived Needs of The Family Caregivers of People with Dementia in a Mediterranean Setting: A Qualitative Study , 2019, International journal of environmental research and public health.

[36]  N. Procter,et al.  Carer perspectives of people diagnosed with borderline personality disorder: A scoping review of emergency care responses. , 2019, Australasian emergency care.

[37]  G. Gan,et al.  Anxiety, depression and quality of life of medical students in Malaysia. , 2019, The Medical journal of Malaysia.

[38]  P. Fonagy,et al.  A Randomized Controlled Trial of a Mentalization-Based Intervention (MBT-FACTS) for Families of People With Borderline Personality Disorder , 2019, Personality disorders.

[39]  M. Poggenpoel,et al.  Experiences of family members who have a relative diagnosed with borderline personality disorder , 2018, Curationis.

[40]  S. Chong,et al.  Positive Caregiving Characteristics as a Mediator of Caregiving Burden and Satisfaction With Life in Caregivers of Older Adults , 2018, Journal of geriatric psychiatry and neurology.

[41]  J. Denollet,et al.  Type D Personality as a Risk Factor in Coronary Heart Disease: a Review of Current Evidence , 2018, Current Cardiology Reports.

[42]  G. Melvin,et al.  Perceived Invalidation in Adolescent Borderline Personality Disorder: An Investigation of Parallel Reports of Caregiver Responses to Negative Emotions , 2018, Child Psychiatry & Human Development.

[43]  Jacqueline N. Cohen,et al.  Partners of Individuals with Borderline Personality Disorder: A Systematic Review of the Literature Examining Their Experiences and the Supports Available to Them , 2018, Harvard review of psychiatry.

[44]  J. Kossowsky,et al.  The role of emotion regulation in chronic pain: A systematic literature review. , 2018, Journal of psychosomatic research.

[45]  M. Salamero,et al.  Quality of life in family caregivers of schizophrenia patients in Spain: caregiver characteristics, caregiving burden, family functioning, and social and professional support , 2018, International journal of psychiatry in clinical practice.

[46]  Hannah T. Boettcher,et al.  The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial , 2017, JAMA psychiatry.

[47]  Joaquín T. Limonero,et al.  The influence of psychological factors on the burden of caregivers of patients with advanced cancer: Resiliency and caregiver burden , 2017, Palliative and Supportive Care.

[48]  M. Jovev,et al.  Evaluation of a psychoeducational group intervention for family and friends of youth with borderline personality disorder , 2017, Borderline Personality Disorder and Emotion Dysregulation.

[49]  A. Arntz,et al.  Emotion Regulation in Schema Therapy and Dialectical Behavior Therapy , 2016, Front. Psychol..

[50]  L. Roemer,et al.  Mindfulness and emotion regulation , 2015 .

[51]  S. Lawn,et al.  Experiences of family carers of people diagnosed with borderline personality disorder. , 2015, Journal of psychiatric and mental health nursing.

[52]  B. Grenyer,et al.  The relationship between expressed emotion and wellbeing for families and carers of a relative with Borderline Personality Disorder. , 2015, Personality and mental health.

[53]  B. Grenyer,et al.  Supporting a person with personality disorder: a study of carer burden and well-being. , 2014, Journal of personality disorders.

[54]  Tian Chen,et al.  Introduction to mediation analysis with structural equation modeling , 2013, Shanghai archives of psychiatry.

[55]  B. Grenyer,et al.  Burden and Support Needs of Carers of Persons with Borderline Personality Disorder: A Systematic Review , 2013, Harvard review of psychiatry.

[56]  Tanja Schmidt,et al.  "Mad or bad?": burden on caregivers of patients with personality disorders. , 2012, Journal of personality disorders.

[57]  E. Idvall,et al.  A life tiptoeing: being a significant other to persons with borderline personality disorder. , 2011, Archives of psychiatric nursing.

[58]  Juan E Mezzich,et al.  The Multicultural Quality of Life Index: presentation and validation. , 2011, Journal of evaluation in clinical practice.

[59]  A. New,et al.  Parental burden associated with borderline personality disorder in female offspring. , 2011, Journal of personality disorders.

[60]  Janet E. Giffin Family Experience of Borderline Personality Disorder , 2008 .

[61]  Kenneth N. Levy,et al.  Transference focused psychotherapy: Overview and update , 2008, The International journal of psycho-analysis.

[62]  P. Hoffman,et al.  In Their Own Words , 2008 .

[63]  E. Struening,et al.  Family connections: a program for relatives of persons with borderline personality disorder. , 2005, Family process.

[64]  P. Fonagy,et al.  Psychotherapy for Borderline Personality Disorder: Mentalization Based Treatment , 2004 .

[65]  K. L. Gratz,et al.  Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale , 2004 .

[66]  D. Black,et al.  STEPPS: a cognitive-behavioral systems-based group treatment for outpatients with borderline personality disorder--a preliminary report. , 2002, Comprehensive psychiatry.

[67]  J. Hooley,et al.  Expressed emotion and clinical outcome in borderline personality disorder. , 1999, The American journal of psychiatry.

[68]  J. Gross The Emerging Field of Emotion Regulation: An Integrative Review , 1998 .

[69]  S. Minsky,et al.  Burden assessment scale for families of the seriously mentally ill , 1994 .

[70]  P. Lachenbruch Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[71]  Jacob Cohen Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[72]  G. Panayiotou,et al.  Coping with the invisible enemy: The role of emotion regulation and awareness in quality of life during the COVID-19 pandemic , 2020 .

[73]  Papastavrou Evridiki GENDER ISSUES IN CARING FOR DEMENTED RELATIVES , 2009 .

[74]  P. Lovibond,et al.  Manual for the Depression Anxiety Stress Scales. 2 , 1995 .

[75]  Marsha M. Linehan,et al.  Skills Training Manual for Treating Borderline Personality Disorder , 1993 .

[76]  K. Bollen,et al.  DIRECT AND INDIRECT EFFECTS: CLASSICAL AND BOOTSTRAP ESTIMATES OF VARIABILITY , 1990 .