Although the distress of a patient is the primary concern of all clinicians, I feel that it is also important to understand the psychological experiences of carers, as they have significant responsibility in supporting someone who is mentally ill. I am therefore extremely satisfied to see the recent study by Ranieri et al ^{Reference Ranieri, Madigan, Roche, McGuinness, Bainbridge and Feeney1} which has investigated the link between patient admission and caregiver stress.

Overall, the article presents a strong finding which could assist in identifying the types of support needed by carers to ensure that their own mental health is protected.

However, one limitation of the study that was not identified by the authors is the use of self-report measures. Although the questionnaire instruments used have been found to be reliable measures, participants are not always honest in their responses due to possible embarrassment, or the social desirability bias. ^{Reference Furnham2} This means that a true reflection of an individual's psychological state is not always captured accurately.

Furthermore, I feel that ‘suicidality’ should have been included as an additional variable due to the close link with psychological distress. ^{Reference Sokero, Melartin, Rytsala, Leskela, Lestela-Mielonen and Isometsa3} If a significant relationship was found, it might inform thinking around the types of support provided to carers.