From caregiver burden to psychological resilience and positive emotional outcomes: the effectiveness of innovative psychiatric nursing intervention among family caregivers of patients with bipolar disorder.

Abstract

Background: Family caregivers of people with bipolar disorder (BD) often experience substantial caregiver burden (CB), lower psychological resilience (PR), and fewer caregiving rewarding feelings (CRF), which generally affect caregiver well-being and patient care. In this study, we assessed the effectiveness of an innovative psychiatric nursing intervention in reducing CB, improving PR, and fostering CRF among family caregivers of patients with BD.

Methods: A two-arm randomized controlled pre- and post-test study was conducted with 70 family caregivers recruited from a psychiatric hospital in Egypt. Eligible family caregivers were recruited using convenience sampling and were subsequently randomized in a 1:1 ratio to either the intervention group (n = 35) or the control group (n = 35). The intervention ran for eight weeks and was a structured nurse-led psychiatric telenursing program that blended psychoeducation, stress control, coping ability training, mindfulness practices, communication skills, and resilience-building strategies. Outcomes were measured using validated tools for CB, PR, and CRF, both before and after the program. Data were analyzed using descriptive statistics, independent-samples t-tests, separate repeated-measures ANOVAs, separate ANCOVAs adjusted for baseline scores, Pearson's correlation analysis, and multiple linear regression.

Results: Participants in the intervention group demonstrated significantly lower CB and significantly higher PR and CRF than those in the control group (all p < 0.001). Separate repeated-measures ANOVAs demonstrated significant main effects of time and group, together with significant group × time interactions across all three outcome variables. Separate ANCOVAs further confirmed that these differences remained statistically significant after adjusting for baseline scores. In addition, PR and CRF were identified as significant independent predictors of CB in multiple linear regression analysis.

Conclusions: Overall, the findings suggest that structured nurse-led psychiatric telenursing interventions may be linked to decreased CB along with improved PR and CRF among family caregivers.

Recommendations: In practical terms, structured nurse-led psychoeducational sessions may function as an important part of family-centred psychiatric care. To confirm the durability of the benefits and determine their applicability in broader settings, further multicenter studies with longer follow-up periods are needed to assess the sustainability and generalizability of these effects.

Trial registration: ClinicalTrials.gov NCT07548359, registered on April 22, 2026. Retrospectively registered.