{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:11:09Z","timestamp":1790885469796,"version":"4.1.0"},"reference-count":71,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,22]],"date-time":"2023-01-22T00:00:00Z","timestamp":1674345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>(1) Background: Spouses of individuals with bipolar disorder (BD) experience significant burdens, and the perception of the burden may affect dyadic adjustment. We aimed to investigate the sexual functions, alexithymic traits, marital satisfaction, and burden in patients with BD and their spouses. We also aimed to assess the mediating role of sexual functions and alexithymia in the relationship between burden and dyadic adjustment. (2) Methods: We included 81 patients with BD type 1 (40.69 \u00b1 8.55 years, 65.4% female, and 34.6% male) and their healthy spouses (40.95 \u00b1 7.30 years, 34.6% female, and 65.4% male) and 78 healthy controls (38.90 \u00b1 5.88, 48.7% female, and 51.3% male). The participants were evaluated using the Golombok\u2013Rust Inventory of Sexual Satisfaction (GRISS), Dyadic Adjustment Scale (DAS), Hamilton Depression Rating Scale (HDRS), Toronto Alexithymia Scale-20 (TAS-20), and Burden Assessment Scale (BAS). (3) Results: The GRISS scores of the control group were significantly lower than the spouses and BD groups. The DAS total score of the control group was significantly higher than that of the spouses and BD groups. Regression analyses revealed that TAS, GRISS, and HDRS scores were associated with DAS scores in the BD group. In the spouse group, TAS and BAS scores were associated with DAS scores. The GRISS scores partially mediated the relationship between dyadic adjustment and burden in the spouses of patients with BD. (4) Conclusions: Mental health professionals should regularly scan caregivers\u2019 perceptions of burden. Appropriate psychosocial interventions could help spouses of patients with BD to cope better with the burden and improve dyadic adjustment.<\/jats:p>","DOI":"10.3390\/bs13020091","type":"journal-article","created":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T04:50:41Z","timestamp":1674449441000},"page":"91","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The Relationship among Dyadic Adjustment and Disease Burden in Patients with Bipolar Disorder and Their Spouses"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8954-5901","authenticated-orcid":false,"given":"Zeynep","family":"Naml\u0131","sequence":"first","affiliation":[{"name":"Medical School, Department of Psychiatry, \u00c7ukurova University, 01330 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lut","family":"Tamam","sequence":"additional","affiliation":[{"name":"Medical School, Department of Psychiatry, \u00c7ukurova University, 01330 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Emin","family":"Demirkol","sequence":"additional","affiliation":[{"name":"Medical School, Department of Psychiatry, \u00c7ukurova University, 01330 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmut Onur","family":"Karaytu\u011f","sequence":"additional","affiliation":[{"name":"Medical School, Department of Psychiatry, \u00c7ukurova University, 01330 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caner","family":"Ye\u015filo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Ahi Evran University, 40100 K\u0131r\u015fehir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3131-6564","authenticated-orcid":false,"given":"Kerim","family":"U\u011fur","sequence":"additional","affiliation":[{"name":"Medical School, Department of Psychiatry, Turgut \u00d6zal University, 44900 Malatya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s11920-020-1130-0","article-title":"Bipolar disorder and suicide: A review","volume":"22","author":"Miller","year":"2020","journal-title":"Curr. Psychiatr. Rep."},{"key":"ref_2","first-page":"78","article-title":"Families of chronic psychiatric patients: A systematic review","volume":"5","author":"Duman","year":"2013","journal-title":"Curr. Approaches Psychiatr."},{"key":"ref_3","first-page":"165","article-title":"Caregiver burden in chronic mental illness: A systematic review","volume":"8","year":"2017","journal-title":"J. Psychiatr. Nurs."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/j.1399-5618.2005.00191.x","article-title":"The burden on informal caregivers of people with bipolar disorder","volume":"7","author":"Ogilvie","year":"2005","journal-title":"Bipolar. Disord."},{"key":"ref_5","first-page":"196","article-title":"\u0130ki u\u00e7lu miza\u00e7 bozuklu\u011fu olgular\u0131nda aile y\u00fcklenmesi \u00fczerine kar\u015f\u0131la\u015ft\u0131rmal\u0131 bir \u00e7al\u0131\u015fma","volume":"15","author":"Yener","year":"2002","journal-title":"Dusunen. Adam."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5498\/wjp.v4.i1.1","article-title":"Impact of living with bipolar patients: Making sense of caregivers\u2019 burden","volume":"4","author":"Pompili","year":"2014","journal-title":"World J. Psychiatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1111\/j.1399-5618.2007.00365.x","article-title":"Prevalence and correlates of burden among caregivers of patients with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder","volume":"9","author":"Perlick","year":"2007","journal-title":"Bipolar. Disord."},{"key":"ref_8","first-page":"38","article-title":"A reliability and validity study on the Zarit caregiver burden scale","volume":"46","author":"Ozlu","year":"2009","journal-title":"Noro. Psikiyatr. Ars."},{"key":"ref_9","unstructured":"Worl Health Organization (1999). WHO Monographs on Selected Medicinal Plants, World Health Organization. [2nd ed.]."},{"key":"ref_10","first-page":"276","article-title":"Reliability and validity of the Turkish version of the burden assessment scale","volume":"49","author":"Aydemir","year":"2012","journal-title":"Noro. Psikiyatr. Ars."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1177\/0020764010390442","article-title":"A follow-up study of family burden in patients with bipolar affective disorder","volume":"58","author":"Maji","year":"2012","journal-title":"Int. J. Soc. Psychiatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1192\/bjp.175.1.56","article-title":"Burden experienced by care-givers of persons with bipolar affective disorder","volume":"175","author":"Perlick","year":"1999","journal-title":"Br. J. Psychiatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1023\/A:1020305226067","article-title":"Marital satisfaction and an information-processing measure of partner-schemas","volume":"26","author":"Whisman","year":"2002","journal-title":"Cognit. Ther. Res."},{"key":"ref_14","unstructured":"Goodwin, F.K., and Jamison, K.R. (1990). Manic-Depressive Illness:Bipolar Disorders and Recurrent Depression, Oxford University Press. [2nd ed.]."},{"key":"ref_15","first-page":"48","article-title":"People with bipolar disorders and their families","volume":"4","year":"2018","journal-title":"Turk. Klin. J. Psychiatr. Nurs-Spec. Top."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1111\/j.1399-5618.2005.00240.x","article-title":"Burden and marital and sexual satisfaction in the partners of bipolar patients","volume":"7","author":"Lam","year":"2005","journal-title":"Bipolar Disord."},{"key":"ref_17","first-page":"72","article-title":"Cinsellik ve \u00e7ift uyumu aras\u0131ndaki ili\u015fki: \u00dc\u00e7 grup evli \u00e7iftte kar\u015f\u0131la\u015ft\u0131rmal\u0131 bir \u00e7al\u0131\u015fma","volume":"18","author":"Erbek","year":"2005","journal-title":"Dusunen. Adam."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/j.1742-1241.2007.01506.x","article-title":"The influence of caregiver burden on sexual intimacy and marital satisfaction in couples with an Alzheimer spouse","volume":"62","author":"Simonelli","year":"2008","journal-title":"Int. J. Clin. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3063","DOI":"10.1111\/j.1743-6109.2009.01455.x","article-title":"Sexual dysfunctions and suicidality in patients with bipolar disorder and unipolar depression","volume":"6","author":"Carmassi","year":"2009","journal-title":"J. Sex Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1192\/bjp.bp.113.135335","article-title":"Associations between common mental disorders and sexual dissatisfaction in the general population","volume":"205","author":"Vanwesenbeeck","year":"2014","journal-title":"Br. J. Psychiatr."},{"key":"ref_21","first-page":"773","article-title":"Spousal burden in partners of patients with major depressive disorder and bipolar disorder","volume":"48","author":"Dudek","year":"2014","journal-title":"Psychiatr. Pol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.psychres.2019.01.033","article-title":"Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder","volume":"273","author":"Ospina","year":"2019","journal-title":"Psychiatry Res."},{"key":"ref_23","first-page":"45","article-title":"Do emotion recognition and emotion regulation predict dyadic adjustment? The moderating role of relationship length","volume":"28","author":"Ursu","year":"2020","journal-title":"JPER"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Klietz, M., Schnur, T., Drexel, S.C., Lange, F., Paracka, L., Huber, M.K., Dressler, D., H\u00f6glinger, G.U., and Wegner, F. (2020). Alexithymia is associated with reduced quality of life and increased caregiver burden in parkinson\u2019s disease. Brain Sci., 10.","DOI":"10.3390\/brainsci10060401"},{"key":"ref_25","first-page":"513","article-title":"Caregiver burden in chronic diseases","volume":"3","author":"Balaban","year":"2011","journal-title":"Curr. Approaches Psychiatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jad.2007.08.007","article-title":"Subsyndromal depressive symptoms in patients with bipolar and unipolar disorder during clinical remission","volume":"107","author":"Vieta","year":"2008","journal-title":"J. Affect Disord."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1192\/bjp.133.5.429","article-title":"A rating scale for mania: Reliability, validity and sensitivity","volume":"133","author":"Young","year":"1978","journal-title":"Br. J. Psychiatr."},{"key":"ref_29","first-page":"107","article-title":"Young mani derecelendirme \u00f6l\u00e7e\u011finin T\u00fcrkiye\u2019de ge\u00e7erlik ve g\u00fcvenilirli\u011fi","volume":"13","author":"Oral","year":"2001","journal-title":"T\u00fcrk. Psikiyatr. Derg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1136\/jnnp.23.1.56","article-title":"A rating scale for depression","volume":"23","author":"Hamilton","year":"1960","journal-title":"J. Neurol. Neurosurg. Psychiatr."},{"key":"ref_31","first-page":"251","article-title":"Hamilton Depresyon Derecelendirme \u00d6l\u00e7e\u011fi (HDD\u00d6)\u2019nin ge\u00e7erli\u011fi, g\u00fcvenirli\u011fi ve klinikte kullan\u0131m\u0131","volume":"4","author":"Akdemir","year":"1996","journal-title":"Psikiyatr. Psikol. Psikofarmakol. Dergisi."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/BF01542223","article-title":"The GRISS: A psychometric instrument for the assessment of sexual dysfunction","volume":"15","author":"Rust","year":"1986","journal-title":"Arch. Sex Behav."},{"key":"ref_33","first-page":"83","article-title":"Golombok-Rust cinsel doyum \u00f6l\u00e7e\u011fi\u2019nin standardizasyon \u00e7al\u0131\u015fmas\u0131","volume":"4","year":"1993","journal-title":"T\u00fcrk. Psikiyatr. Derg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2307\/350547","article-title":"Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads","volume":"38","author":"Spanier","year":"1976","journal-title":"J. Marriage Fam."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1027\/\/1015-5759.16.3.214","article-title":"Applicability of the Dyadic Adjustment Scale for measurement of marital quality with Turkish couples","volume":"16","author":"Demir","year":"2000","journal-title":"Eur. J. Psychol. Assess"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/0022-3999(94)90005-1","article-title":"The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure","volume":"38","author":"Bagby","year":"1994","journal-title":"J. Psychosom. Res."},{"key":"ref_37","first-page":"214","article-title":"Reliability and factorial validity of the Turkish version of the 20-item Toronto alexithymia scale (TAS-20)","volume":"19","author":"Evren","year":"2009","journal-title":"Klin. Psikofarmakol. Bul."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/0149-7189(94)90004-3","article-title":"Burden assessment scale for families of the seriously mentally ill","volume":"17","author":"Reinhard","year":"1994","journal-title":"Eval. Program Plann."},{"key":"ref_39","unstructured":"Hayes, A.F. (2018). Introduction to Mediation, Moderation, and Conditional Processes Analysis: A Regression-Based Approach (Methdology in the Social Sciences), Guildford Publications. [2nd ed.]."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Karambelas, G.J., Filia, K., Byrne, L.K., Allott, K.A., Jayasinghe, A., and Cotton, S.M. (2022). A systematic review comparing caregiver burden and psychological functioning in caregivers of individuals with schizophrenia spectrum disorders and bipolar disorders. BMC Psychiatr., 22.","DOI":"10.1186\/s12888-022-04069-w"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1177\/00207640211061984","article-title":"Evaluation of patient social support, caregiver burden, and their relationship with the course of the disease in patients with bipolar disorder","volume":"68","author":"Shokrgozar","year":"2022","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5455\/PBS.20210809071633","article-title":"The impact of caregiver burden on marital adjustment in spouses of patients with mental disorders","volume":"12","author":"Isler","year":"2022","journal-title":"Psychiatry Behav. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jad.2009.04.020","article-title":"Psychiatric symptoms in caregivers of patients with bipolar disorder: A review","volume":"121","author":"Steele","year":"2010","journal-title":"J. Affect Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1177\/070674378302800506","article-title":"Hypomania and marital conflict","volume":"28","author":"Lesser","year":"1983","journal-title":"Can. J. Psychiatr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1176\/ajp.138.6.764","article-title":"A comparison of nonpatient and bipolar patient\u2013well spouse couples","volume":"138","author":"Frank","year":"1981","journal-title":"Am. J. Psychiatr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1111\/bdi.13249","article-title":"Sexual dysfunction among males and females with bipolar disorder and healthy subjects: The burden of illness severity","volume":"24","author":"Mosconi","year":"2022","journal-title":"Bipolar. Disord."},{"key":"ref_47","first-page":"68","article-title":"Sexual functions in women with bipolar disorder and their healthy spouses","volume":"20","author":"Arslan","year":"2019","journal-title":"Anadolu Psikiyatr. Derg."},{"key":"ref_48","first-page":"245","article-title":"Sexual functions in male patients with bipolar disorder and their healthy Spouses","volume":"20","author":"Arslan","year":"2019","journal-title":"Anadolu Psikiyatr. Derg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1159\/000228249","article-title":"Functioning and disability in bipolar disorder: An extensive review","volume":"78","author":"Torrent","year":"2009","journal-title":"Psychother Psychosom."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.jad.2007.12.234","article-title":"Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up","volume":"109","author":"Rubio","year":"2008","journal-title":"J. Affect Disord."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1017\/S0033291715001993","article-title":"Meta-analysis of Theory of Mind (ToM) impairment in bipolar disorder","volume":"46","author":"Bora","year":"2016","journal-title":"Psychol. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1111\/j.1600-0447.2011.01808.x","article-title":"Social cognition in euthymic bipolar disorder: Systematic review and meta-analytic approach","volume":"125","author":"Martino","year":"2012","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1176\/appi.psy.50.1.59","article-title":"Alexithymia and health-related quality of life in a general population","volume":"50","author":"Mattila","year":"2009","journal-title":"Psychosomatics"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s10508-012-0006-8","article-title":"Alexithymia, negative emotions, and sexual behavior in heterosexual university students from Italy","volume":"42","author":"Scimeca","year":"2013","journal-title":"Arch. Sex Behav."},{"key":"ref_55","first-page":"717","article-title":"Alexithymia, a neuropsychological method of approach","volume":"37","author":"Bermond","year":"1995","journal-title":"J. Psychiatr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"20183","DOI":"10.4088\/JCP.v67n1009","article-title":"Subsyndromal depressive symptoms are associated with functional impairment in patients with bipolar disorder: Results of a large, multisite study","volume":"67","author":"Altshuler","year":"2006","journal-title":"J. Clin. Psychiatr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1037\/a0020352","article-title":"Predictors of relationship functioning for patients with bipolar disorder and their partners","volume":"24","author":"Sheets","year":"2010","journal-title":"J. Fam. Psychol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"239","DOI":"10.4103\/0019-5545.102423","article-title":"A comparative study of caregiver burden in psychiatric illness and chronic medical illness","volume":"54","author":"Ampalam","year":"2012","journal-title":"Indian J. Psychiatr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1080\/15487761003757009","article-title":"Caregiver burden and coping in schizophrenia and bipolar disorder: A qualitative study","volume":"13","author":"Ganguly","year":"2010","journal-title":"Am. J. Psychiatr. Rehabil."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"299","DOI":"10.4103\/ipj.ipj_28_21","article-title":"Evaluation of burden felt by caregivers of patients with schizophrenia and bipolar disorder","volume":"30","author":"Tanna","year":"2021","journal-title":"Ind. Psychiatry J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.cpr.2014.12.002","article-title":"Towards a better understanding of caregiver distress in early psychosis: A systematic review of the psychological factors involved","volume":"35","author":"Jansen","year":"2015","journal-title":"Clin. Psychol. Rev."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Berk, L., Berk, M., Dodd, S., Kelly, C., Cvetkovski, S., and Jorm, A.F. (2013). Evaluation of the acceptability and usefulness of an information website for caregivers of people with bipolar disorder. BMC Med., 11.","DOI":"10.1186\/1741-7015-11-162"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.12740\/PP\/OnlineFirst\/32177","article-title":"Caregiving burden and psychological distress among spouses of bipolar patients-comparative analysis of subtype I and II","volume":"49","author":"Arciszewska","year":"2015","journal-title":"Psychiatr. Pol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.jad.2019.03.035","article-title":"Understanding the role of m-Health to improve well-being in spouses of patients with bipolar disorder","volume":"250","author":"Casarez","year":"2019","journal-title":"J. Affect Disord."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/S0165-0327(01)00450-5","article-title":"Impact of bipolar affective disorder on family and partners","volume":"67","author":"Dore","year":"2001","journal-title":"J. Affect Disord."},{"key":"ref_66","first-page":"28","article-title":"Burden of care in key relatives of patients with bipolar disorder","volume":"23","author":"Nischal","year":"2020","journal-title":"Delhi Psychiatr. J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1111\/bdi.12370","article-title":"Living with bipolar disorder: The impact on patients, spouses, and their marital relationship","volume":"18","author":"Granek","year":"2016","journal-title":"Bipolar. Disord."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1111\/j.1399-5618.2008.00588.x","article-title":"Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: A randomized controlled trial","volume":"10","author":"Reinares","year":"2008","journal-title":"Bipolar. Disord."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jad.2018.04.077","article-title":"Psychological interventions for caregivers of people with bipolar disorder: A systematic review and meta-analysis","volume":"236","author":"Baruch","year":"2018","journal-title":"J. Affect Disord."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1177\/1039856218772249","article-title":"Comparative familial aggregation of bipolar disorder in patients with bipolar I and bipolar II disorders","volume":"26","author":"Parker","year":"2018","journal-title":"Australas Psychiatr."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Liu, X., Ma, X., Wang, W., Zhang, J., Sun, X., Luo, X., and Zhang, Y. (2021). The functional impairment of different subtypes and occupational states in euthymic patients with bipolar disorder. BMC Psychiatr., 21.","DOI":"10.1186\/s12888-021-03242-x"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/13\/2\/91\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:13:39Z","timestamp":1760120019000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/13\/2\/91"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,22]]},"references-count":71,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["bs13020091"],"URL":"https:\/\/doi.org\/10.3390\/bs13020091","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,22]]}}}