Double Burden of Financial Constraints and Stigma with Isolation of Families of Bipolar Mood Disorder Patients: A Constructivist Grounded Theory Analysis from Tamil Nadu, India

Abstract

Background:

The family members of the bipolar patients are subjected to stigma and mental and physical abuse by the bipolar patient. This can reflect as expressed emotion and ultimately affect the financial and physical well-being of the patient and family members.

Objective:

The aim of this study was to understand various challenges faced by caregivers of bipolar disorder patients and their families, including emotional well-being, and financial challenges, as well as community and health system support.

Methods:

A constructivist grounded theory approach is used to understand the issue and develop themes.

Results:

Caregiving for individuals with bipolar disorder often presents gender-related differences, as women experiencing greater emotional burden and stress compared to men, who may focus more on financial and emotional support. These responsibilities are further complicated by financial constraints related to treatment, as the high costs of medication, therapy, and hospitalizations can be overwhelming, especially for families with limited resources or inadequate insurance coverage. Additionally, stigma and isolation significantly impact both patients and caregivers, as societal misconceptions, workplace discrimination, and excessive concern from the community can lead to withdrawal and reluctance to seek help, worsening mental health outcomes.

Conclusions:

Gender-based disparity in the well-being of caregivers of mental disorders is a neglected issue, which needs further research and support. Also, health system strengthening and community education are essential to improve the well-being of family members and caregivers of bipolar disorder patients.

Key Messages

• Caregiving challenges exhibit gender differences, with women experiencing greater emotional and financial burdens.

• Financial constraints, including the high cost of treatment and inadequate insurance, further strain families. Stigma and isolation, fueled by societal misconceptions and workplace discrimination, contribute to withdrawal and reduced access to care. Additionally, systemic gaps in mental healthcare, such as a shortage of professionals and long wait times, hinder effective support.

• Addressing gender-based caregiving disparities, strengthening healthcare systems, and promoting community awareness are crucial for improving the well-being of caregivers and families affected by bipolar disorder.

Globally, approximately 46 million individuals are affected by bipolar disorder. According to the Global Burden of Disease Study, bipolar disorder has a prevalence rate of 0.6% among the Indian population, affecting both males and females. The presence of this mental illness is associated with various psychosocial challenges, including a decline in the well-being and overall quality of life of family members.^1,2 Furthermore, relatives of individuals diagnosed with bipolar disorder often experience mental and physical abuse by the patient, in addition to facing social stigma and isolation from the community. Given these challenges, social and psychological support plays a crucial role in enhancing the well-being of family members caring for individuals with psychiatric disorders. ²

The scarcity of mental healthcare centers in rural areas is a significant factor contributing to treatment noncompliance.^3,4 However, this issue is not confined to rural regions alone; the unavailability of treatment facilities and a lack of awareness regarding existing services contribute to treatment noncompliance across various Indian states. According to Section 18 of the Mental Healthcare Act of 2017, every individual has the right to access mental health services through the state healthcare system, including treatment and financial support for healthcare services.^5,6 Furthermore, the Act mandates acute mental healthcare services, such as outpatient and inpatient care, within accessible localities.^2,7

Despite these provisions, multiple studies indicate that patients often need to travel considerable distances to receive mental health treatment, which contradicts the directives outlined in Section 18(d) of the Act. Additionally, the Act emphasizes that the government must ensure the delivery of mental health services of a standard comparable to general healthcare services. ⁶ The availability of essential psychiatric medications remains another area requiring improvement, as research has highlighted that the high cost of treatment and medication adversely affects the quality of care for individuals with mental disorders. Moreover, several factors, including socioeconomic status, gender, geographical location, and cultural and religious influences, play a crucial role in determining the well-being of caregivers of individuals with mental illnesses.^7,8

The objective of this study was to examine the various challenges encountered by caregivers of individuals with bipolar disorder and their families, with a particular focus on emotional well-being, financial burdens, and the support received from both the community and the healthcare system. This study is distinctive in its in-depth exploration of the experiences of caregivers and family members of individuals with mental disorders, emphasizing gender-related differences in caregivers’ well-being and quality of life, as well as the inclusivity of communities in the contemporary context.

The findings of this research would provide valuable insights for policymakers and mental healthcare professionals, facilitating the development of targeted interventions in health education and family education related to mental health disorders. The study employs a qualitative research design, utilizing in-depth interviews and analysis within the framework of a constructivist grounded theory (CGT) approach.

Methods

A CGT approach, as proposed by Charmaz, was employed in this study to gain a deeper understanding of the complexities of participants’ experiences by exploring how they construct and interpret their lived realities. CGT was selected due to its interactive nature, which facilitates the acquisition of in-depth subjective knowledge while incorporating the researchers’ interpretations.

In this methodological framework, researchers play a pivotal role in both data collection and analysis and in the interpretative processes. The research team comprised professionals from diverse disciplines, including psychology, psychiatry, and social medicine. Consequently, the process of meaning-making and researcher interpretation constitutes a crucial aspect of this study. Among the six researchers were one psychiatrist, one psychologist, and three public health experts. Three experts were qualified with a doctoral degree, and two were master’s degree holders. Three were females, and two were males. Two (first and second) authors were involved in data collection, and all five were involved in data analysis and writing. All five researchers were actively involved in various research projects, and two are experts in qualitative research techniques.

Qualitative data were collected from individuals with lived experience, specifically caregivers of individuals diagnosed with bipolar disorder. The study exclusively focused on this population to ensure a comprehensive exploration of their experiences. The research adhered to the guidelines outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist developed by Tong et al., ensuring methodological rigor and transparency in the study design and reporting.

The independent ethics committee of the university approved the study design and protocol.

Theoretical Framework

The study utilized the Theory of Expressed Emotion (EE) as its theoretical framework. EE is a psychological construct that examines the emotional expressions of caregivers of individuals with mental disorders. Various factors contribute to EE among caregivers, including the nature of the patient’s condition, societal stigma, and challenges related to treatment, such as financial burdens and accessibility to care.

EE is a multifaceted phenomenon, and this study seeks to explore the diverse factors that compromise the well-being of caregivers of individuals with mental illnesses. Elevated levels of EE among caregivers or relatives can negatively impact treatment adherence and the overall quality of care provided to the patient. Furthermore, heightened EE is associated with adverse effects on caregivers’ psychological well-being and overall quality of life.

Recruitment of the Participants

By the principles of CGT, purposive sampling was employed to recruit individuals with lived experiences as caregivers of individuals diagnosed with bipolar disorder. Participants were selected from the psychiatry and psychology departments of a tertiary care medical center where the researchers practice. Rapport building was ensured before starting with data collection. However, none of the participants had any personal contact or relationship with any of the researchers.

Inclusion Criteria

The study participants were family members who served as primary caregivers for individuals with bipolar disorder and were 18 years or older. Additionally, caregivers were eligible for inclusion if the patient had been undergoing continuous treatment for a minimum of two years and if they had cohabited with the patient for at least two consecutive years.

Exclusion Criteria

Caregivers who reported a diagnosed mental or chronic physical illness were excluded from the study. Additionally, individuals who provided care for any other physically or mentally ill person, apart from those diagnosed with bipolar disorder, were not included in the study.

Interview Process

The study was conducted in Chengalpattu, Tamil Nadu, India. A total of 38 participants were initially recruited, of whom 34 met the inclusion criteria and were selected for participation. Amongst the participants, 16 were females, and 12 were males; all aged between 24 and 59. Data were collected through open-ended interviews, guided by a structured interview protocol comprising ten pre-developed questions and an elaborate interview guide. All interviews were conducted face-to-face inside the research center. Only the interviewer and participant were inside the room during all interviews. The interviews focused on various aspects of caregiving, including daily routines, family dynamics, social interactions, treatment adherence and associated challenges, access to healthcare services, financial aspects of mental health care, and elements of EE. Data collection was concluded with saturation achievement, which was confirmed by two data collectors and a third researcher. A repeated interview was conducted with a female participant due to time constraints during the first session. Data were recorded in audio format, and the researcher wrote a field note during all interviews to guide data analysis. All interviews lasted between 40 and 120 minutes, of which 20 were between 60 and 90 minutes, and others exceeded 90 minutes. Three participants verified the transcript and developed sub-themes from it.

Reflexivity

The primary interviewer, the first author, engaged in continuous reflexive practices following each interview to assess potential biases that may have influenced the data collection process. While complete neutrality is not entirely achievable, researchers inevitably bring aspects of their own experiences into qualitative research, so efforts were made to mitigate these biases, as Charmaz suggested. Additionally, two other researchers with expertise in mental health were actively involved throughout all stages of the study to minimize the influence of subjectivity further.

Data Analysis

The interview recordings were transcribed and systematically imported into NVivo, a qualitative data management software, for coding and analysis. The CGT approach guided the analytical process, providing a methodological framework for coding while emphasizing adaptability, creativity, and reflexivity concerning potential biases and pre-existing theoretical knowledge.

The initial coding phase formed the foundation for developing subcategories and broader conceptual categories. Through the iterative application of CGT techniques, categories were identified, encapsulating the central phenomenon emerging from the data. Any discrepancies in coding were systematically examined and resolved through rigorous discussion, ensuring consistency before the finalization of thematic structures. A consensus-based approach, combined with continuous comparative analysis, facilitated the refinement of these categories.

New codes, subcategories, and categories were iteratively applied across the dataset to assess their coherence within the study’s broader conceptual framework. Given that coding within the CGT paradigm are an ongoing process, preliminary findings, and subcategories were continually refined through member checking. This involved presenting a synthesized summary of emerging insights to subsequent participants, thereby enhancing the credibility and coherence of the analytical framework. The final patterns and themes were established through consensus among all authors, ensuring methodological rigor and interpretative depth.

Results

Analysis and theme building formed four themes, which were: (a) Gender-Related Difference in Bipolar Disorder Caregiving; (b) Financial Constraints Related to Treatment; (c) Stigma and isolation, including Overconcern for the Community, Workplace issues; and (d) Gaps in the Mental Healthcare System.

Theme 1: Gender-Related Differences in Bipolar Disorder Caregiving

Significant differences exist in the perspectives and concerns of male caregivers providing care for female patients and female caregivers providing care for male patients. Male caregivers expressed concerns regarding the dependency of female patients, as well as the additional burden associated with performing household chores and managing familial responsibilities. Furthermore, male caregivers reported apprehensions about the long-term financial implications of the illness and its broader impact on other family members, particularly in the context of mental health conditions.

One male caregiver explained, My mother’s illness created many issues in the family, including my marriage was delayed; I do not know when she will be cured and how long we need to continue caring for her illness. Another caregiver commented, My wife was ill for 6 months continuously; it affected our family a lot, and my food and children’s studies are not going well.

However, female caregivers expressed greater concern regarding the long-term financial burden of care and the limited support available from society and the state. Compared to their male counterparts, female caregivers demonstrated a more positive and motivated attitude toward caregiving, exhibiting a greater acceptance of the male patient’s illness. Their primary focus was on various aspects of treatment accessibility and the timeline for recovery rather than the burden imposed by the patient or household management responsibilities. Female caregivers also conveyed a strong willingness to provide care regardless of the duration of the illness while simultaneously highlighting concerns related to societal stigma and the lack of external support. As one female caregiver stated, My husband needs medications and mental support; I am trying my best to manage the situation, but no one is helping us financially or otherwise.

Most female caregivers reported being dependent on external support and expressed concerns regarding the discontinuation of assistance. Additionally, many experienced feelings of guilt when seeking help from others. Notably, this concern was more frequently articulated by female caregivers, with half of the female participants highlighting the challenges associated with their caregiving role, particularly the societal stigma that limits their ability to seek assistance or establish social connections. Despite these limitations, their willingness to request help and frustration over the lack of available support were evident throughout the interviews.

A prevalent theme among female caregivers was a sense of isolation, which they reported as having a significant impact on their lifestyle and mental well-being. Interestingly, male caregivers who provided care for male relatives, such as a father caring for a son, expressed fewer concerns regarding the long-term burden of caregiving, societal stigma, or household responsibilities. Instead, their primary focus was on ensuring the treatment and recovery of the patient, regardless of the financial or temporal demands. In contrast, female caregivers caring for female patients, such as a mother caring for a daughter, reported similar concerns to those expressed by other female caregivers, particularly about stigma and the limited availability of external support.

Theme 2: Financial Constraints Related to Treatment

One of the primary concerns expressed by caregivers was the financial burden associated with the treatment of bipolar disorder. This burden includes direct and indirect costs, such as physician consultation fees, travel expenses to healthcare facilities, and medication costs. In addition to these direct costs, caregivers frequently reported experiencing a loss of working hours and, consequently, a direct loss of income. As one caregiver noted, I am always willing to accompany my husband for frequent hospital visits; however, my concern is that I am unable to work on those days, and my already limited monthly income is now barely sufficient to cover our food expenses.

Caregivers also raised concerns regarding the increasing treatment costs and other associated expenses. Medications that are difficult to obtain tend to be more expensive, forcing caregivers to purchase them at any cost. Many caregivers reported instances where financial constraints led to the discontinuation of medication, resulting in symptom relapse. One caregiver shared, She had several episodes of severe emotional outbursts last month. I know they were due to irregular medication intake, but I had no financial assistance to purchase her medicines. I even had to cut down on food purchases to manage expenses.

Additionally, caregivers highlighted the price elasticity of medications, noting that mental health treatments are often prioritized over other essential expenses, such as food, travel, and household costs. One caregiver explained, I always set aside money for emergency hospital visits and medications for my mother. However, unexpected expenses, such as a high electricity bill or unavoidable local events, sometimes force me to use that money for other purposes. Such financial constraints were identified as a significant predictor of nonadherence to prescribed medication regimens.

Medication nonadherence was particularly prevalent among individuals from lower socioeconomic backgrounds, especially daily wage laborers. Many caregivers reported being unable to afford more than a few days’ worth of medication at a time, resulting in inconsistent medication intake. A caregiver working as a driver described, There are times when I do not earn enough daily income to purchase medications, or I am forced to allocate that money for vehicle maintenance expenses.

Despite an awareness of the importance of medication adherence and the consequences of irregular intake, many low- and middle-income caregivers expressed concern over their inability to meet basic daily needs, such as food expenses. One caregiver stated, I know my husband experiences relapses due to medication nonadherence, but I had no choice. Our son was ill, and we had to spend money on his treatment.

Furthermore, gender disparities in the financial burden of mental healthcare remain an overlooked issue. The costs associated with treatment and the risk of relapse due to financial constraints appear to impact female patients and caregivers disproportionately. Addressing these economic barriers is essential for improving treatment adherence and overall mental healthcare outcomes.

Theme 3: Stigma and Isolation, Including Overconcern from the Community and Workplace Issues

Stigma, both direct and indirect, significantly affects the quality of care for individuals with bipolar disorder, as well as the overall well-being of their caregivers. Caregivers who are continually exposed to societal stigma and isolation frequently report concerns related to exclusion from the community, job insecurity, strained familial and social relationships, and emotional distress. The lack of inclusivity within families and communities often exacerbates financial difficulties, feelings of helplessness, and other challenges, including treatment noncompliance and experiences of violence. As one caregiver explained, Constant pressure and discrimination from my co-workers, combined with my wife’s illness, have led to several emotional outbursts in recent times.

Stigma and social isolation also contribute to poor nutrition and inadequate living conditions for caregivers and their families. Some caregivers perceive stigma as avoidance or rejection and as excessive and unwarranted expressions of sympathy from others, which they find distressing and uncomfortable. Many caregivers reported that while they appreciate support and inclusion, excessive expressions of empathy can be overwhelming. One caregiver shared, I avoid meeting my relatives because they constantly express sympathy and discuss my husband’s illness, even though I reassure them that he is stable with treatment. This persistent expression of concern often discourages caregivers from engaging in social activities, leading to further isolation.

The issue is further complicated by the exclusion of caregivers from social and family events. Many caregivers reported experiences of being deliberately excluded from family gatherings despite having no prior conflicts with their relatives. One caregiver recounted, I was shocked to find out that I had been excluded from a relative’s wedding, even though I had never had any disagreements with them in the past. Such exclusion not only results in emotional distress but also contributes to financial isolation, as caregivers may hesitate to seek financial or emotional support from their communities.

Stigma and discrimination in the workplace are also prevalent, particularly against caregivers of individuals with bipolar disorder. Workplace exclusion, lack of support, and perceived stigma often result in job loss. Some caregivers reported resigning from their jobs due to the neglect and discrimination they experienced from colleagues. As one caregiver explained, I quit my job because my colleagues stopped interacting with me, and they even refused to share meals with me. I know it was because my mother has a mental disorder.

Addressing stigma and promoting greater inclusivity in both social and professional settings is crucial for improving the well-being of caregivers and ensuring better support systems for individuals with bipolar disorder.

Theme 4: Gaps in the Mental Healthcare System

Mental health services in India remain inadequate in addressing the complex needs of individuals with mental illnesses and their caregivers. The challenges extend beyond a lack of quality care, infrastructure, and trained professionals; systemic neglect of mental health patients and their families is a recurring concern. As highlighted in previous themes, financial barriers, including the inability to cover treatment costs and the absence of flexible healthcare expenditure, significantly impact access to care. One caregiver shared, I had no money to secure an appointment and eventually had to seek treatment at a private facility. Despite being below the poverty line, we had to pay the full consultation fee and purchase medications without discount.

However, financial constraints are not limited to direct treatment costs. Insurance and reimbursement policies frequently exclude mental health conditions, further limiting access to essential care. One caregiver reported, My husband had a severe relapse recently, and I wanted to admit him to the hospital. However, the insurance policy we purchased does not cover psychiatric admissions, so I had to manage his condition at home. Additionally, the unavailability of psychiatric medications in public pharmacies exacerbates the financial burden on families. One caregiver noted, I search for my mother’s medications every week. It is difficult to find them at pharmacies offering discounts, so I am forced to buy them at full price each time. This financial strain often leads to catastrophic economic consequences for families caring for individuals with mental illnesses.

Beyond financial barriers, there are significant gaps in awareness and accessibility of mental health services. Many patients and caregivers are either unaware of available mental health facilities or report the absence of such services in their vicinity. Consequently, individuals must travel long distances or seek appointments with private practitioners, further straining middle- and low-income families. In response to these challenges, some families, particularly those with financial constraints, opt for alternative treatments, including consultations with non-medical practitioners or spiritual healers.

Addressing these systemic gaps in mental healthcare is essential to ensuring equitable access to quality treatment and financial support for individuals with mental illnesses and their caregivers. Strengthening healthcare infrastructure, improving insurance coverage for psychiatric care, and enhancing the availability of subsidized medications are critical steps toward a more inclusive and effective mental healthcare system.

Discussion

Mental illness and its treatment remain significant challenges worldwide due to a multitude of factors, including the availability of treatment, willingness to seek care, societal acceptance, and stigma-related concerns (Figure 1).^2,4,5 Individuals diagnosed with mental illnesses often face considerable difficulties, but the burden extends beyond the patient to their families as well. The denial and exclusion from relatives, neighbors, or friends can be deeply traumatizing, not only for the individual but also for their caregivers and family members.^7,8

Figure 1. Themes, Subthemes and Conceptual Model Identified from the Results.

(Arrows show the direction of the relationship between sub-themes grouped under different themes)

One of the critical challenges in mental healthcare is educating communities about the nature of mental illnesses, the necessity of support, and the importance of integrating individuals with mental health conditions and their families into society. ⁷ However, limited awareness, sociocultural beliefs, persistent stigma, and inefficiencies in healthcare systems often hinder this effort. These factors contribute to heightened emotional distress among caregivers, which in turn negatively impacts the patient’s well-being. ⁹

The findings of this study diverge slightly from previous research, particularly in highlighting the role of gender as a significant theme influencing the emotional burden and overall quality of life of caregivers. Gender disparities emerged as a key determinant in caregivers’ experiences, particularly about emotional distress and caregiving responsibilities. Additionally, other critical factors, such as financial constraints in accessing healthcare, societal stigma and isolation, and inefficiencies within the mental healthcare system, were identified as major contributors to the diminished quality of life among caregivers. Addressing these issues requires a multidimensional approach, including policy interventions to improve mental healthcare accessibility, increased financial support, and community-based initiatives to reduce stigma and promote inclusion.

Gender plays a crucial role in determining the quality of care received by individuals with various illnesses, particularly in the context of mental health. ¹⁰ In India, gender-based disparities in work-life balance, rights, and exposure to abuse have been widely studied and discussed by social scientists. This study highlights significant differences in caregiving experiences based on gender, with male caregiver–female patient and female caregiver–male patient dynamics demonstrating distinct challenges. Female caregivers primarily expressed concerns related to financial struggles and societal stigma, while male caregivers were more concerned with long-term dependency and family-related issues. ¹¹

Research indicates that women with mental health conditions tend to have higher levels of dependency and face greater difficulties in establishing financial stability or securing community support. This study revealed that most female caregivers did not receive public assistance to cope with caregiving responsibilities. While previous research has primarily focused on the stigma and challenges faced by female psychiatric patients and their families, this study underscores that female caregivers also experience significant hardship.^10,11 Findings suggest that job loss, family disputes, discrimination, and community isolation disproportionately affect female caregivers compared to their male counterparts. ¹¹

India has actively pursued policies and programs to enhance the quality of life for individuals with mental illnesses and their caregivers. The Mental Healthcare Act of 2017 emphasizes integrated care, improvements in mental healthcare infrastructure, and enhanced training for healthcare providers. ⁹ Furthermore, the Indian government has sought to raise awareness regarding mental illnesses to facilitate the social reintegration of patients and their families. However, health financing remains a persistent challenge due to India’s vast population and uneven allocation of resources. ⁹ Mental health services often fall short in accessibility and quality due to funding constraints. Concerns regarding the neglect of mental healthcare—relative to other medical domains—have been voiced by mental health professionals and advocacy organizations. The financial burden associated with mental healthcare, particularly the high cost of medications, emerged as a central theme in this study. Many caregivers reported catastrophic healthcare expenditures, leading to compromised treatment adherence.

Although financial constraints were a significant factor contributing to suboptimal care for bipolar disorder patients, this study highlights additional variables that exacerbate the issue. Mental healthcare differs from other medical fields because it necessitates long-term treatment, consistent medication use, and rehabilitative care. ⁷ The absence of mental health facilities within reasonable proximity causes inconvenience and delays in seeking treatment and increases financial burdens due to travel expenses and lost wages. Caregivers in this study expressed feeling overwhelmed by the lack of mental healthcare services, which contributed to heightened emotional distress and a diminished ability to provide quality care. Prior studies have emphasized supporting caregivers to enhance patient and caregiver well-being. ¹²

Medication management remains a significant concern among mental health professionals and caregivers. While previous studies have identified nonadherence due to medication refusal and adverse side effects, this study highlights the financial inaccessibility and unavailability of psychiatric medications as primary concerns. The price elasticity of medications is particularly low among low- and middle-income communities in India, leading to inconsistent medication use and frequent relapses. Although the Indian government has introduced initiatives to provide affordable medications through public pharmacies, awareness regarding these programs remains limited, and their effectiveness is often questioned. This underscores the need for comprehensive health education and awareness campaigns on disease management, treatment accessibility, insurance options, and medication procurement. Additionally, systemic issues such as staffing shortages, disparities in-service distribution, and concerns regarding the quality of mental healthcare facilities have been widely reported in previous research. ¹¹ Although participants in this study did not explicitly mention these issues, related concerns—such as prolonged travel distances and extended waiting times—were recurring themes.

Stigma, social exclusion, and discrimination continue to be pervasive issues for individuals with mental illnesses in India. While female caregivers in this study reported greater challenges, many of the concerns—such as community isolation, lack of inclusivity, and unemployment—were common across genders. This study highlights the urgent need to extend support to patients and their caregivers and family members. Strengthening the healthcare system to ensure adequate mental health services, improving financial support mechanisms, and promoting community education remain crucial priorities. Public education initiatives aimed at reducing stigma and fostering social inclusion are still essential in India to facilitate better integration of mental health patients into society.

Implications

Caregiver Support Initiatives—Implementing family counselling and health education programs tailored to the needs of caregivers.

Gender-Specific Interventions—Providing targeted support for female caregivers who face unique challenges in caregiving responsibilities and financial stability.

Community Awareness Programs—Promoting inclusive societal attitudes towards mental illnesses and advocating for the integration of affected individuals and their families.

Healthcare System Strengthening—Expanding access to affordable mental healthcare, ensuring the availability of essential medications, and implementing financial support mechanisms.

Limitations

Given the use of a CGT approach, this study’s findings are not generalizable. Instead, the focus is on generating a contextually situated and nuanced understanding of the phenomenon under investigation, grounded in the participant’s experiences and the specific research setting.

Future Directions

Future research should focus on evaluating gender-based disparities in caregiver well-being and burden. Additionally, studies exploring the effectiveness of various health education strategies in raising awareness about mental health disorders and available support services are warranted.

Conclusion

Financial constraints, societal stigma, and inadequate governmental support compound mental health disorders. The findings of this qualitative study indicate a significant gender-based disparity in caregiver well-being and EEs. Female caregivers face heightened challenges, including social isolation, stigma, excessive concern for the patient, and financial difficulties, often leading to helplessness and job loss. In contrast, male caregivers responsible for female patients primarily express concerns regarding the long-term nature of the illness and its impact on their family dynamics and daily lives.

Financial difficulties, exacerbated by loss of working hours, job insecurity due to stigma, and the overall economic burden of caregiving, were common across both genders. Additionally, structural inadequacies such as the inaccessibility of mental healthcare facilities, limited availability of essential psychiatric medications, and the high cost of treatment further contribute to the challenges faced by caregivers. A multipronged approach is essential to improve the mental healthcare system in India. This includes providing family counseling and targeted support for caregivers, implementing gender-sensitive interventions, and strengthening mental healthcare services to ensure accessibility, affordability, and continuity of care. Addressing these concerns will not only enhance the well-being of caregivers but also improve treatment outcomes for individuals with mental health disorders.