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Liu F, Deng H, Hu N, Huang W, Wang H, Liu L, Chai J, Li Y. The relationship between self-stigma and quality of life in long-term hospitalized patients with schizophrenia: a cross-sectional study. Front Psychiatry 2024; 15:1366030. [PMID: 38903644 PMCID: PMC11188392 DOI: 10.3389/fpsyt.2024.1366030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/01/2024] [Indexed: 06/22/2024] Open
Abstract
Objective To investigate self-stigma's influence on schizophrenia patients' quality of life and its mediated impact by various factors. Methods This study adopted a cross-sectional design and randomly selected 170 hospitalized patients with schizophrenia for evaluation. The assessment tools included the Positive and Negative Syndrome Scale (PANSS), Internalized Stigma of Mental Illness Scale (ISMI), Schizophrenia Quality of Life Scale (SQLS), and Coping Questionnaire for Schizophrenia Patients (CQSP), among others. Correlation analysis, regression analysis, and mediation analysis were used to test the correlation and mediation effects. Results Self-stigma had a significant impact on quality of life (T = 8.13, p = 0.00). When self-stigma is used as a mediator, the problem-solving factor in coping strategies has an indirect effect on quality of life, which is significant (AB = -0.16, P = 0.02), while the avoidance factor in coping strategies has a direct effect on quality of life, which is significant (C' = 0.54, p < 0.001), and an indirect effect, which is also significant (AB = 0.25, p < 0.001). Conclusion The study highlights the significant impact of self-stigma on the quality of life of schizophrenia patients, emphasizing the crucial roles of self-esteem and coping strategies. These findings suggest clinical interventions to improve quality of life should focus on reducing self-stigma, especially enhancing self-esteem and promoting adaptive coping strategies. By addressing these factors, we can better support the mental health and well-being of those with schizophrenia, offering an effective approach to rehabilitation.
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Affiliation(s)
- Fuquan Liu
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Hu Deng
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Na Hu
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Wenqian Huang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Hong Wang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Lin Liu
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Jiabao Chai
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Ying Li
- Department of Psychosomatic Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
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Özer G, Işık İ, Escartín J. Is There Somebody Looking out for Me? A Qualitative Analysis of Bullying Experiences of Individuals Diagnosed with Bipolar Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:137. [PMID: 38397628 PMCID: PMC10887664 DOI: 10.3390/ijerph21020137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
According to the World Health Organisation, there are globally 40 million individuals with bipolar disorder (BD), and they experience stigma and discrimination, as many people with mental illness do. Work bullying (WB) is a common organisational problem, deteriorating the well-being and performance of employees and organisations. Although WB experiences have been researched for over three decades, we do not know much about the experiences of this group and what they need to extend their work-life. The current research aims to understand the workplace bullying experiences of individuals with BD and factors that may foster or hinder their participation in the labour force. The research methodology was based on in-depth interviews with 19 employees diagnosed with BD. Bullying experiences were mapped onto the Negative Acts Questionnaire. The data were analysed using the deductive qualitative content analysis on MAXQDA. Results showed that individuals with BD were exposed to bullying in work settings. Perceived reasons for the negative behaviours were mainly the undesirable individual characteristics of the bully, prejudices toward bipolar disorder, and already-existing toxic behaviours within the organisation. To reduce bullying, participants suggested that, among others, top management include equal and fair treatment of disadvantaged employees as performance criteria for supervisors and that organisations provide training against bullying, investigate complaints, apply sanctions, and establish an inclusive environment. If organisations set a stable and enduring vision, enhance a common identity for all employees, work on team building, and emphasise team efforts and goals, the organisational environment would be more inclusive, and individuals with BD would have longer work lives.
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Affiliation(s)
- Gülüm Özer
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK;
| | - İdil Işık
- Department of Psychology, Faculty of Economics, Administrative and Social Sciences, Bahcesehir University, Istanbul 34353, Türkiye;
| | - Jordi Escartín
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK;
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, 08035 Barcelona, Spain
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Brandeis BO, Siegle GJ, Franzen P, Soehner A, Hasler B, McMakin D, Young K, Buysse DJ. Subjective and neural reactivity during savoring and rumination. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:1568-1580. [PMID: 37726588 PMCID: PMC10684651 DOI: 10.3758/s13415-023-01123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 09/21/2023]
Abstract
Repetitive thinking about negative emotions or events is strongly associated with worse mental health, whereas repetitive positive thought is generally believed to be beneficial. This observation is at odds with the idea that all forms of repetitive thinking share underlying neural mechanisms. To resolve this apparent discrepancy, the present study examined relationships between subjective affect and neural mechanisms during periods of sustained processing of positive (savoring) and negative (rumination) emotion. We also examined potential common moderators of savoring and rumination including memory specificity and sleep quality. Results indicated that individuals who experience high positive affect during savoring also are likely to experience more intense negative affect during rumination. fMRI-derived brain activity revealed common mechanisms of rumination and savoring. Memory specificity had common effects on neural correlates of rumination and savoring; sleep quality was not associated with mechanisms of savoring or rumination. These results suggest that repetitive engagement with positive and negative affect is similar both subjectively and mechanistically. Clinical interventions for rumination may benefit from capitalizing on preserved capacity for savoring.
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Affiliation(s)
| | - Greg J Siegle
- University of Pittsburgh, School of Medicine, WPH, 3811 O'Hara St., Pittsburgh, PA, 15213, USA.
| | - Peter Franzen
- University of Pittsburgh, School of Medicine, WPH, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Adriane Soehner
- University of Pittsburgh, School of Medicine, WPH, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Brant Hasler
- University of Pittsburgh, School of Medicine, WPH, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Dana McMakin
- Florida International University, Miami, FL, USA
| | - Kym Young
- University of Pittsburgh, School of Medicine, WPH, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Daniel J Buysse
- University of Pittsburgh, School of Medicine, WPH, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
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4
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Mackali Z, Çetinkaya S, Ay N. The mediating role of self-compassion in the relationship between internalized stigma and psychological resilience in bipolar disorder. Psychol Psychother 2023; 96:952-966. [PMID: 37522719 DOI: 10.1111/papt.12488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/24/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Internalized stigma is known to be high in bipolar disorder (BD). Concepts such as self-compassion and psychological resilience have recently begun to be studied as protective factors for BD. The aim of the current study was to examine the relationships between internalized stigma, self-compassion and resilience among individuals with BD. METHOD One hundred and thirty-two male and female (18-65 years of age) participants with a DSM 5 diagnosis of BD (BD- I & BD- II) were included. The remission criteria (YMRS< 5 and HDRS< 7) was evaluated using clinician-administered measures and all participants were found to be remitted. Correlation and mediation analyses were performed. Participants completed the Internalized Stigma in Mental Illness Scale (ISMI), the Self-Compassion Scale (SCS) and the Resilience Scale for Adults (RSA). RESULTS Significant correlations were found between internalized stigma, sub-dimensions of self-compassion (self-kindness, self-judgement, common humanity, isolation, mindfulness, and over-identification), and resilience in the expected directions like negative correlations between internalized stigma and positive dimensions of self-compassion (self-kindness, common humanity and mindfulness). Self-judgement and self-kindness mediated the relationship between internalized stigma and psychological resilience. CONCLUSIONS The findings of the study shed light on which dimensions of self-compassion might be more beneficial to work with in order to increase resilience when working with internalized stigma in BD. This strengths-based investigation would be valuable to enrich psycho-social interventions for the prevention of relapse in BD.
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Affiliation(s)
- Zeynep Mackali
- Psychology Department, Istanbul Bilgi University, Istanbul, Turkey
| | - Saadet Çetinkaya
- University of Health Sciences, Bakırköy Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey
| | - Nur Ay
- Istanbul Arel University Psychological Counseling, Guidance, Application and Research Center, Istanbul, Turkey
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Hawke LD, Bennett R, Sheikhan NY, Yanos P. Lived experience adaptation of a psychosocial intervention for young adults with bipolar spectrum disorders: Process description and adaptation outcomes. Early Interv Psychiatry 2023; 17:1125-1130. [PMID: 37650493 DOI: 10.1111/eip.13461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
AIM Lived experience adaptation of mental health interventions can help ensure that the intervention is appropriate for the target population. This paper describes a youth-led adaptation of a self-stigma reduction intervention for young adults with bipolar spectrum disorders, that is, Narrative Enhancement and Cognitive Therapy. METHODS Standard guidelines for youth engagement were followed. A youth lived experience adaptation lead and a five-member youth lived experience advisory panel reviewed the intervention and made a number of adaptations to increase its relevance for young people with bipolar disorders. A brief evaluation of the engagement process was conducted. RESULTS The primary adaptations made to the intervention fell into five areas: (1) wording revisions for recovery-oriented language accessible to youth with a wide variety of language and literacy levels; (2) updating and tailoring to the diagnostic category, with the addition of new quotes describing the lived experience of stigma; (3) integration of a new, engaging graphic design; (4) development of a goal-setting module, as recommended by the research team; and (5) identification of the role of a peer co-facilitator. An evaluation of the engagement process showed that the engagement was extremely meaningful for the youth engaged. CONCLUSIONS Using a youth lived experience adaptation process, young people can make relevant, important changes to a psychosocial intervention. The resulting early intervention materials are research-ready and are hypothesized to meet the needs of young people with BD in a youth-friendly manner. Research on the acceptability, efficacy, and effectiveness of the newly adapted intervention will be required.
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Affiliation(s)
- Lisa D Hawke
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Natasha Y Sheikhan
- Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Philip Yanos
- Department of Psychology, John Jay College of Criminal Justice, New York, New York, USA
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Mejri I, Ouali U, Gronholm PC, Zgueb Y, Ouertani A, Nacef F. "To fast or not to fast?" Ramadan and religiosity through the eyes of people with bipolar disorder: an exploratory study. Front Psychiatry 2023; 14:1270000. [PMID: 37908594 PMCID: PMC10613667 DOI: 10.3389/fpsyt.2023.1270000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
Background The month of Ramadan, due to its changes in social rhythms, can seriously affect the course of bipolar disorder (BD). Therefore, psychiatrists sometimes find it necessary to discourage Ramadan practices, especially fasting, although taking part in this practice can give a sense of belonging and accomplishment to patients. Research on this subject is limited. Aim The aim of the present work was to explore: (i) religious practices with special attention to Ramadan before and after the onset of BD, (ii) the perceptions and behaviors related to not fasting during Ramadan in patients with BD and their families' attitudes, (iii) religiosity and self-stigmatization and their relationships with religious practices, and (iv) the doctor-patient relationship around fasting. Methods We conducted a retrospective, cross-sectional and descriptive study in clinically stabilized patients with BD in a public mental hospital and in a private psychiatric practice in Tunis, Tunisia. Socio-demographic and clinical data, as well as data related to general religious practices and Ramadan practices were collected using a self-established questionnaire. We assessed (i) religiosity of the patients with the Duke University Religion Index and (ii) self-stigma using the Internalized Stigma of Mental Illness scale. Results Our sample consisted of 118 patients of whom 65.3% were fasting regularly before BD onset. More than half had stopped this practice following BD onset. Of the patients who did not fast, 16% felt guilty about this and 4.9% reported receiving negative remarks from their surroundings. High self-stigma scores were observed in 11% of the patients. Self-stigma was associated significantly with negative perception of not fasting, negative remarks regarding not fasting and taking both meals at regular times during Ramadan. The decision whether to fast or not was taken without seeking medical advice in 71.2% of the sample, and 16.9% of the sample reported that their psychiatrist had spontaneously approached the issue of Ramadan fasting. Conclusion Religiosity and more specifically the practice of Ramadan remains an important point that should be considered when treating patients with psychiatric problems. It seems necessary that healthcare professionals should integrate the positive and the negative side of fasting into their reflections. Our results remain exploratory and encourage further work on the subject.
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Affiliation(s)
- Imen Mejri
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Uta Ouali
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Petra C. Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Yosra Zgueb
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | | | - Fethi Nacef
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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7
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Favre S, Richard-Lepouriel H. Self-stigma and bipolar disorder: A systematic review and best-evidence synthesis. J Affect Disord 2023; 335:273-288. [PMID: 37207946 DOI: 10.1016/j.jad.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Bipolar disorder is a severe and chronic mental illness characterized by recurrent major depressive episodes and mania or hypomania. In addition to the burden of the disease and its consequences, self-stigma can impact people with bipolar disorder. This review investigates the current state of research in self-stigma in bipolar disorder. METHODS An electronic search was carried out until February 2022. Three academic databases were systematically searched, and best-evidence synthesis was made. RESULTS Sixty-six articles were related to self-stigma in bipolar disorder. Seven key themes were extracted from these studies: 1/ Comparison of self-stigma in bipolar disorder and other mental illnesses, 2/ Sociocultural context and self-stigma, 3/ Correlates and predictors of self-stigma, 4/ Consequences of self-stigma, 5/ Treatments and self-stigma, 6/ Management of self-stigma, and 7/ Self-stigma and recovery in bipolar disorder. LIMITATIONS Firstly, a meta-analysis could not be performed due to the heterogeneity of the studies. Secondly, limiting the search to self-stigma has excluded other forms of stigma that also have an impact. Thirdly, the under-reporting of negative or nonsignificant results due to publication bias and unpublished studies might have limited the accuracy of this reviews' synthesis. CONCLUSION Research on self-stigma in persons with bipolar disorder has been the focused on different aspects, and interventions to reduce self-stigmatization have been developed, but evidence of their effectiveness is still sparse. Clinicians need to be attentive to self-stigma, its assessment, and its empowerment in their daily clinical practice. Future work is required to establish valid strategies to fight self-stigma.
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Affiliation(s)
- Sophie Favre
- Mood disorder unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Mood disorder unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland.
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8
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Siegel-Ramsay JE, Sharp SJ, Ulack CJ, Chiang KS, Lanza di Scalea T, O'Hara S, Carberry K, Strakowski SM, Suarez J, Teisberg E, Wallace S, Almeida JRC. Experiences that matter in bipolar disorder: a qualitative study using the capability, comfort and calm framework. Int J Bipolar Disord 2023; 11:13. [PMID: 37079153 PMCID: PMC10119352 DOI: 10.1186/s40345-023-00293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 03/22/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND When assessing the value of an intervention in bipolar disorder, researchers and clinicians often focus on metrics that quantify improvements to core diagnostic symptoms (e.g., mania). Providers often overlook or misunderstand the impact of treatment on life quality and function. We wanted to better characterize the shared experiences and obstacles of bipolar disorder within the United States from the patient's perspective. METHODS We recruited 24 individuals diagnosed with bipolar disorder and six caretakers supporting someone with the condition. Participants were involved in treatment or support services for bipolar disorder in central Texas. As part of this qualitative study, participants discussed their everyday successes and obstacles related to living with bipolar disorder during personalized, open-ended interviews. Audio files were transcribed, and Nvivo software processed an initial thematic analysis. We then categorized themes into bipolar disorder-related obstacles that limit the patient's capability (i.e., function), comfort (i.e., relief from suffering) and calm (i.e., life disruption) (Liu et al., FebClin Orthop 475:315-317, 2017; Teisberg et al., MayAcad Med 95:682-685, 2020). We then discuss themes and suggest practical strategies that might improve the value of care for patients and their families. RESULTS Issues regarding capability included the struggle to maintain identity, disruptions to meaningful employment, relationship loss and the unpredictable nature of bipolar disorder. Comfort related themes included the personal perception of diagnosis, social stigma and medication issues. Calm themes included managing dismissive doctors, finding the right psychotherapist and navigating financial burdens. CONCLUSIONS Qualitative data from patients with bipolar disorder helps identify gaps in care or practical limitations to treatment. When we listen to these individuals, it is clear that treatments must also address the unmet psychosocial impacts of the condition to improve patient care, capability and calm.
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Affiliation(s)
- J E Siegel-Ramsay
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - S J Sharp
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - C J Ulack
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - K S Chiang
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - T Lanza di Scalea
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - S O'Hara
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - K Carberry
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - S M Strakowski
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - J Suarez
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- The City University of New York School of Labor and Urban Studies, New York, NY, USA
| | - E Teisberg
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School and McCombs School of Business at the University of Texas, Austin, TX, USA
| | - S Wallace
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School and McCombs School of Business at the University of Texas, Austin, TX, USA
| | - J R C Almeida
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
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Marion-Paris E, Beetlestone E, Paris R, Bouhadfane M, Villa A, Lehucher-Michel MP. Job retention for people with bipolar disorder: A qualitative analysis. Scand J Psychol 2023; 64:171-178. [PMID: 36307913 DOI: 10.1111/sjop.12876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/28/2022] [Accepted: 09/19/2022] [Indexed: 11/28/2022]
Abstract
At least half of people with bipolar disorder, whose global prevalence is greater than 1% of the general population, do not have a stable occupation. The objective of this study is to identify the factors perceived by bipolar people as having an impact on retention in employment. Semi-directed individual interviews were offered to subjects with bipolar disorder, of working age, who had been seen by three different hospital departments in the south of France. These people had to be medically stable and have at least one occupational experience. Each interview was recorded and transcribed manually and then analyzed according to a thematic classification of verbatims. Nineteen people participated in the interviews. Three major themes identified were classified into intrinsic (working routine and working environment) and extrinsic (external aids) factors for the bipolar person. The majority believe that working regular hours is a balancing factor. For everyone, night work and stress factors can lead to relapses. All stressed the need to destigmatize the disease. Most believe that it is necessary to develop employment support organizations specific to mental illnesses. This research helps to inform people with bipolar disorder about the occupational factors that help balance their condition. Personalized multidisciplinary care pathways involving occupational medicine must be developed in order to promote the balance of the disease and job retention.
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Affiliation(s)
- Elise Marion-Paris
- Assistance Publique des hôpitaux de Marseille-Service de Médecine et Santé au Travail-264 rue Saint Pierre, Marseille, France
| | - Emma Beetlestone
- Assistance Publique des hôpitaux de Marseille-Service de Psychiatrie-270 boulevard Sainte Marguerite, Marseille, France
| | - Raphaël Paris
- HIA Laveran-Service de réanimation-34 boulevard Laveran-13013 Marseille, Marseille, France
| | - Mouloud Bouhadfane
- Assistance Publique des hôpitaux de Marseille-Service de Médecine et Santé au Travail-264 rue Saint Pierre, Marseille, France
| | - Antoine Villa
- Assistance Publique des hôpitaux de Marseille-Service de Médecine et Santé au Travail-264 rue Saint Pierre, Marseille, France
- Aix-Marseille Univ, EA 3279, CEReSS (Centre d'études et de recherche sur les services de santé et la qualité de vie), Marseille, France
| | - Marie-Pascale Lehucher-Michel
- Assistance Publique des hôpitaux de Marseille-Service de Médecine et Santé au Travail-264 rue Saint Pierre, Marseille, France
- Aix-Marseille Univ, EA 3279, CEReSS (Centre d'études et de recherche sur les services de santé et la qualité de vie), Marseille, France
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10
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Andreou D, Steen NE, Jørgensen KN, Smelror RE, Wedervang-Resell K, Nerland S, Westlye LT, Nærland T, Myhre AM, Joa I, Reitan SMK, Vaaler A, Morken G, Bøen E, Elvsåshagen T, Boye B, Malt UF, Aukrust P, Skrede S, Kroken RA, Johnsen E, Djurovic S, Andreassen OA, Ueland T, Agartz I. Lower circulating neuron-specific enolase concentrations in adults and adolescents with severe mental illness. Psychol Med 2023; 53:1479-1488. [PMID: 35387700 PMCID: PMC10009386 DOI: 10.1017/s0033291721003056] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/05/2021] [Accepted: 07/13/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Both neurodegenerative and neurodevelopmental abnormalities have been suggested to be part of the etiopathology of severe mental illness (SMI). Neuron-specific enolase (NSE), mainly located in the neuronal cytoplasm, may indicate the process as it is upregulated after neuronal injury while a switch from non-neuronal enolase to NSE occurs during neuronal maturation. METHODS We included 1132 adult patients with SMI [schizophrenia (SZ) or bipolar spectrum disorders], 903 adult healthy controls (HC), 32 adolescent patients with SMI and 67 adolescent HC. Plasma NSE concentrations were measured by enzyme immunoassay. For 842 adults and 85 adolescents, we used total grey matter volume (TGMV) based on T1-weighted magnetic resonance images processed in FreeSurfer v6.0. We explored NSE case-control differences in adults and adolescents separately. To investigate whether putative case-control differences in NSE were TGMV-dependent we controlled for TGMV. RESULTS We found significantly lower NSE concentrations in both adult (p < 0.001) and adolescent patients with SMI (p = 0.007) compared to HC. The results remained significant after controlling for TGMV. Among adults, both patients with SZ spectrum (p < 0.001) and bipolar spectrum disorders (p = 0.005) had lower NSE than HC. In both patient subgroups, lower NSE levels were associated with increased symptom severity. Among adults (p < 0.001) and adolescents (p = 0.040), females had lower NSE concentrations than males. CONCLUSION We found lower NSE concentrations in adult and adolescent patients with SMI compared to HC. The results suggest the lack of progressive neuronal injury, and may reflect abnormal neuronal maturation. This provides further support of a neurodevelopmental rather than a neurodegenerative mechanism in SMI.
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Affiliation(s)
- Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Nils Eiel Steen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Runar Elle Smelror
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten Wedervang-Resell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Child and Adolescent Mental Health Research Unit, Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Stener Nerland
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Lars T. Westlye
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Terje Nærland
- K.G. Jebsen Center for Neurodevelopmental Disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Anne Margrethe Myhre
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Inge Joa
- TIPS – Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Solveig Merete Klæbo Reitan
- Faculty of Medicine and Health Sciences, Department of Mental Health, NTNU, Trondheim, Norway
- St Olavs Hospital, Department of Mental Health, Trondheim, Norway
| | - Arne Vaaler
- Faculty of Medicine and Health Sciences, Department of Mental Health, NTNU, Trondheim, Norway
- St Olavs Hospital, Department of Mental Health, Trondheim, Norway
| | - Gunnar Morken
- Faculty of Medicine and Health Sciences, Department of Mental Health, NTNU, Trondheim, Norway
- St Olavs Hospital, Department of Mental Health, Trondheim, Norway
| | - Erlend Bøen
- Psychosomatic and C-L Psychiatry, Adult, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Elvsåshagen
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Birgitte Boye
- Psychosomatic and C-L Psychiatry, Adult, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Behavioural Medicine, University of Oslo, Oslo, Norway
| | - Ulrik Fredrik Malt
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Silje Skrede
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Rune Andreas Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Bergen, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- Department of Clinical Science, Norwegian Centre for Mental Disorders Research (NORMENT), University of Bergen, Bergen, Norway
| | - Ole A. Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
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11
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Favre S, Aubry JM, Richard-Lepouriel H. Perceived public stigma and perceived public exposure by persons living with bipolar disorder: A qualitative study. Int J Soc Psychiatry 2023; 69:378-387. [PMID: 35506642 PMCID: PMC9983048 DOI: 10.1177/00207640221093495] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stigma impact the lives of persons living with bipolar disorder. AIM The aim of this study was to explore how perceived public stigma is described by people living with bipolar disorder and examine the links between perceived public stigma and perceived public exposure. METHOD Face-to-face in-depth interviews were conducted in a purposive sample of euthymic people living with bipolar disorder recruited in a mood disorder ambulatory unit. RESULTS Thematic analysis of the transcript yielded five independent themes that were related to perceived public stigma. Perceived public stigma of bipolar disorder was modeled as comprising the three elements of public stigmas (stereotype, prejudice, and discrimination), with the addition of public exposure as a core component. CONCLUSION The representation of bipolar disorder in society via newspapers, films/TV series, conferences, and celebrity self-disclosures is considered to have multiple impacts. People living with bipolar disorder have also reported a perceived public stigma of bipolar disorder that has both specific features and characteristics of general mental illness.
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Affiliation(s)
- Sophie Favre
- Mood Disorder Unit, Psychiatric Specialties Service, Geneva University Hospital, Switzerland
| | | | - Hélène Richard-Lepouriel
- Mood Disorder Unit, Psychiatric Specialties Service, Geneva University Hospital, Switzerland.,Department of Psychiatry, University of Geneva, Switzerland
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12
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Latifian M, Abdi K, Raheb G, Islam SMS, Alikhani R. Stigma in people living with bipolar disorder and their families: a systematic review. Int J Bipolar Disord 2023; 11:9. [PMID: 36805368 PMCID: PMC9941403 DOI: 10.1186/s40345-023-00290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/04/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Stigma affects different life aspects in people living with bipolar disorder and their families. This study aimed to examining the experience of stigma and evaluating predictors, consequences and strategies to combat stigma in people with bipolar disorder and their families. METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) in 2022. We extensively reviewed six online databases (PubMed, Scopus, Medline, EMBASE, Web of Science and Google Scholar). Articles published in the English language about stigma in people living with bipolar disorders and their families were included. RESULTS A total of 42,763 articles were retrieved, of which 40 articles from 14 countries were included in this study (n = 7417 participants). Of the 40 articles, 29 adopted quantitative methods (72.5%), two used mixed-methods (5%), eight used qualitative (20%) methods, and one was a case series (2.5%). The results of the studies were categorized into four themes: 1. Stigma experienced by people living with bipolar disorders and their families, 2. Predictors of stigma in people living with bipolar disorders and their families, 3. Consequences of stigma in people living with bipolar disorders and their families, 4. Effective interventions and strategies to reduce stigma in people living with bipolar disorders and their families. CONCLUSION The results of this study might be useful to design psychiatric cognitive interventions to reduce stigma in people living with bipolar disorders and their families and designing community-based interventions to normalize bipolar disorder at the community level.
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Affiliation(s)
- Maryam Latifian
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Kianoush Abdi
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Ghoncheh Raheb
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sheikh Mohammed Shariful Islam
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Rosa Alikhani
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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13
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Ellouze S, Jenhani R, Bougacha D, Turki M, Aloulou J, Ghachem R. [Self-stigma and functioning in patients with bipolar disorder]. L'ENCEPHALE 2023; 49:34-40. [PMID: 36253184 DOI: 10.1016/j.encep.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 01/19/2023]
Abstract
Self-stigma of people with bipolar disorder is an underestimated problem, with serious consequences in terms of clinical severity and social and professional functioning. OBJECTIVES This study aimed to evaluate self-stigma in patients with bipolar disorder, to identify socio-demographic and clinical factors associated with it and to analyze the links between self-stigma and functioning in this population. METHODS We conducted a cross-sectional, descriptive and analytic study including 61 patients with bipolar disorder meeting criteria of remission. We used the internalized stigma of mental illness (ISMI) to investigate self-stigma, and the functioning assessment short test (FAST) to assess functioning. RESULTS The mean age of patients was 43.4 years. The sex ratio was 2.4. Half of the patients were single or divorced (50 %). They had secondary or university education in 69 % of cases and were professionally inactive in 59 % of cases. The socioeconomic level was low or medium in 92 % of cases. A personal judicial record was found in 16 % of patients, a suicide attempt in 41 % of cases. Most patients in our series had bipolar I disorder (92 %). The mean age at onset of the disease was 23.5 years, with a mean duration of disease progression of 20 years. Patients were hospitalized an average of 5.9 times. Most patients (90 %) exhibited psychotic features during their mood relapses. The mean duration of the last remission was 27.9 months. Patients had regular follow-ups at our consultations in 87 % of cases. Among the patients included in the study, 8 % were on long-acting neuroleptics. The mean score on the internalized stigma of mental illness was 2.36±0.56. More than half of our patients (59 %) were self-stigmatized. Discrimination and alienation were found in 51 % of cases, followed by resistance to stigmatization (43 %) and assimilation of stereotypes (41 %). Regarding functioning, a global impairment was noted in more than two thirds of patients (71 %). An alteration in professional functioning was found in 82 % of cases and in cognitive functioning in 69 % of cases. Disruption of the financial sphere concerned 43 % of the patients, and the relational sphere 41 % of them. Autonomy was altered in 41 % of patients. Analysis of the relationships between self-stigma and characteristics of the study population revealed statistically significant associations between higher self-stigma scores and single or divorced status, low socio-economic level and judicial record. In terms of clinical parameters, the mean self-stigma score was significantly associated with a higher total number of thymic episodes and hospitalizations, a longer cumulative duration of hospitalizations and a shorter duration of the last remission. In addition, the mean self-stigma score was associated with significantly more impaired functioning. CONCLUSIONS Our study underlines the need to work towards the implementation of management modalities aimed at combating the self-stigmatization of patients with bipolar disorder and mitigating its negative consequences during the course of the disease.
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Affiliation(s)
- S Ellouze
- Service de psychiatrie B, CHU de Hèdi Chaker de Sfax, Sfax 3000, Tunisie.
| | - R Jenhani
- Service de psychiatrie B, hôpital Razi, La Mannouba, Tunisie
| | - D Bougacha
- Service de psychiatrie B, hôpital Razi, La Mannouba, Tunisie
| | - M Turki
- Service de psychiatrie B, CHU de Hèdi Chaker de Sfax, Sfax 3000, Tunisie
| | - J Aloulou
- Service de psychiatrie B, CHU de Hèdi Chaker de Sfax, Sfax 3000, Tunisie
| | - R Ghachem
- Service de psychiatrie B, hôpital Razi, La Mannouba, Tunisie
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14
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Abraham AE, Busch CA, Brownell SE, Cooper KM. Should I write about mental health on my med school app? Examining medical school admissions committee members' biases regarding mental health conditions. ADVANCES IN PHYSIOLOGY EDUCATION 2022; 46:526-539. [PMID: 35900355 DOI: 10.1152/advan.00094.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
Mental health conditions can impact college students' academic achievements and experiences. As such, students may choose to disclose mental illnesses on medical school applications. Yet, no recent studies have investigated to what extent disclosure of a mental health condition may impact whether an applicant is accepted to medical school. We conducted an audit study to address this gap and surveyed 99 potential medical school admissions committee members from over 40 M.D.-granting schools in the United States. Participants rated a fictitious portion of a single medical school application on acceptability, competence, and likeability. They were randomly assigned to a condition: an application that explained a low semester grade-point average due to 1) a mental health condition, 2) a physical health condition, or 3) offered no explanation. After rating their respective application, all committee members were asked about when revealing a mental health condition would be beneficial and when it would be detrimental. Using ANOVAs, multinomial regression, and open coding, we found that medical school admissions committee members do not rate applications lower when a mental health condition is revealed. Committee members highlighted that revealing a mental health condition to demonstrate resiliency could be beneficial, but if the reference is vague or the condition is not being managed, it could be detrimental to a student's application. This work indicates that medical school admissions committee members do not exhibit a bias against mental health conditions and provides recommendations on how to discuss mental illness on medical school applications.
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Affiliation(s)
- Anna E Abraham
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, Arizona
| | - Carly A Busch
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, Arizona
| | - Sara E Brownell
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, Arizona
| | - Katelyn M Cooper
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, Arizona
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15
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Thornicroft G, Sunkel C, Alikhon Aliev A, Baker S, Brohan E, El Chammay R, Davies K, Demissie M, Duncan J, Fekadu W, Gronholm PC, Guerrero Z, Gurung D, Habtamu K, Hanlon C, Heim E, Henderson C, Hijazi Z, Hoffman C, Hosny N, Huang FX, Kline S, Kohrt BA, Lempp H, Li J, London E, Ma N, Mak WWS, Makhmud A, Maulik PK, Milenova M, Morales Cano G, Ouali U, Parry S, Rangaswamy T, Rüsch N, Sabri T, Sartorius N, Schulze M, Stuart H, Taylor Salisbury T, Vera San Juan N, Votruba N, Winkler P. The Lancet Commission on ending stigma and discrimination in mental health. Lancet 2022; 400:1438-1480. [PMID: 36223799 DOI: 10.1016/s0140-6736(22)01470-2] [Citation(s) in RCA: 122] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK.
| | | | - Akmal Alikhon Aliev
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Sue Baker
- Mind international, London, UK; Changing Minds Globally, London, UK
| | - Elaine Brohan
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | - Kelly Davies
- Centre for Implementation Science, King's College London, London UK
| | - Mekdes Demissie
- College of Health Sciences and Medicine, School of Nursing and Midwifery, Haramaya University, Ethiopia; Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | | | - Wubalem Fekadu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Petra C Gronholm
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Zoe Guerrero
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Dristy Gurung
- Centre for Implementation Science, King's College London, London UK; Transcultural Psychosocial Organization (TPO), Kathmandu Nepal
| | - Kassahun Habtamu
- Addis Ababa University, School of Psychology, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; WHO Collaborating Centre for Mental Health Research and Training, King's College London, London UK; Department of Psychiatry, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Heim
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | - Claire Henderson
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | | | - Nadine Hosny
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | | | | | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, Washington DC, USA
| | - Heidi Lempp
- Institute of Psychiatry, Psychology and Neuroscience, and Academic Department of Rheumatology, King's College London, London UK
| | - Jie Li
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Ning Ma
- Institute of Mental Health, Peking University, Beijing, China
| | - Winnie W S Mak
- Department of Psychology, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India; University of New South Wales, Sydney, NSW, Australia
| | - Maria Milenova
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | | | - Uta Ouali
- Razi Hospital and El Manar Medical School, University of Tunis, La Manouba, Tunisia
| | - Sarah Parry
- South London and the Maudsley NHS Foundation Trust, London, UK
| | | | - Nicolas Rüsch
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany; Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Taha Sabri
- Taskeen Health Initiative, Karachi, Pakistan
| | - Norman Sartorius
- Association for the Improvement of Mental health Programs, Geneva, Switzerland
| | | | | | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | - Norha Vera San Juan
- Health Service and Population Research Department, King's College London, London UK
| | - Nicole Votruba
- and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Petr Winkler
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
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16
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McIntyre RS, Alda M, Baldessarini RJ, Bauer M, Berk M, Correll CU, Fagiolini A, Fountoulakis K, Frye MA, Grunze H, Kessing LV, Miklowitz DJ, Parker G, Post RM, Swann AC, Suppes T, Vieta E, Young A, Maj M. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry 2022; 21:364-387. [PMID: 36073706 PMCID: PMC9453915 DOI: 10.1002/wps.20997] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.
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Affiliation(s)
- Roger S. McIntyre
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada,Department of PharmacologyUniversity of TorontoTorontoONCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Ross J. Baldessarini
- Harvard Medical SchoolBostonMAUSA,International Consortium for Bipolar & Psychotic Disorders ResearchMcLean HospitalBelmontMAUSA,Mailman Research CenterMcLean HospitalBelmontMAUSA
| | - Michael Bauer
- University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Michael Berk
- IMPACT Strategic Research Centre, School of MedicineDeakin UniversityGeelongVICAustralia,Orygen, National Centre of Excellence in Youth Mental HealthCentre for Youth Mental Health, University of MelbourneMelbourneVICAustralia
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside Hospital, Northwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Department of Child and Adolescent PsychiatryCharité Universitätsmedizin BerlinBerlinGermany
| | | | - Kostas Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Mark A. Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA
| | - Heinz Grunze
- Allgemeinpsychiatrie OstKlinikum am WeissenhofWeinsbergGermany,Paracelsus Medical Private University NurembergNurembergGermany
| | - Lars V. Kessing
- Copenhagen Affective Disorder Research CenterPsychiatric Center CopenhagenCopenhagenDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - David J. Miklowitz
- Department of Psychiatry and Biobehavioral SciencesUniversity of California Los Angeles (UCLA) Semel InstituteLos AngelesCAUSA
| | - Gordon Parker
- School of PsychiatryUniversity of New South WalesSydneyNSWAustralia
| | - Robert M. Post
- School of Medicine & Health SciencesGeorge Washington UniversityWashingtonDCUSA,Bipolar Collaborative NetworkBethesdaMDUSA
| | - Alan C. Swann
- Department of PsychiatryBaylor College of MedicineHoustonTXUSA
| | - Trisha Suppes
- Department of Psychiatry and Behavioural SciencesStanford School of Medicine and VA Palo Alto Health Care SystemPalo AltoCAUSA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital ClinicUniversity of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS Foundation TrustBethlem Royal HospitalBeckenhamUK
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
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17
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Abstract
Stigma has been found to have an impact on those living with bipolar disorder, with many experiencing negative consequences of stereotypes, prejudice and discrimination as a result of their condition. The aim of this review was to assess the current literature in bipolar disorder to determine the impact of stigma on people living with this condition and caregivers. Public stigma was associated with greater functional impairment, anxiety and poorer work-related outcomes, while self-stigma was also found to be associated with lower levels of functioning across a range of domains and greater depressive and anxiety symptoms. For those with bipolar disorder, public stigma was reported at similar rates to those with schizophrenia and depression in some studies, with other studies noting mixed results. Qualitative studies noted that public stigma and discrimination were experienced from family, friends and healthcare providers. Self-stigma was found to be higher for those who were younger in several studies and associated with worse medication adherence. It was generally found to be higher in bipolar disorder participants than in those with anxiety disorders and lower than those with personality disorders. Limitations of the current research include the following: few studies have used a longitudinal design, few have assessed the impact of stigma on medication adherence and few have explored these issues in younger populations. More research is needed to explore the experiences of self-stigma for those in the younger age group specifically, given the relationship between younger age and greater self-stigma noted in several studies and the relationship between this and lower treatment adherence.
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Affiliation(s)
- Tania Perich
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Philip B Mitchell
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bojana Vilus
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Psychology, Western Sydney University, Penrith, NSW, Australia
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18
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He S, Ke XJ, Wu Y, Kong XY, Wang Y, Sun HQ, Xia DZ, Chen GH. The stigma of patients with chronic insomnia: a clinical study. BMC Psychiatry 2022; 22:449. [PMID: 35790932 PMCID: PMC9254637 DOI: 10.1186/s12888-022-04091-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/24/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The objective of this study was to explore the stigma and related influencing factors in individuals with chronic insomnia disorder (CID). METHODS A total of 70 CID patients and 70 healthy controls (CON) were enrolled in the study. All subjects completed the assessments of sleep, emotion, and cognition. Their stigma and life quality were measured using the Chronic Stigma Scale and the 36-Item Short-Form Health Survey (SF-36). RESULTS The ratio of individuals with stigma was significantly different between CID and CON groups (C2 = 35.6, p < 0.001). Compared with the CON group, the CID group had higher scores for total stigma (U = 662.0, p < 0.001), internalized stigma (U = 593.0, p < 0.001), enacted stigma (U = 1568.0, p < 0.001), PSQI (U = 2485.0, p < 0.001) and HAMD-17 (U = 69.5, p < 0.001) as well as lower scores for MoCA-C (U = 3997.5, p < 0.001) and most items of SF-36. Partial correlation analysis showed that different items of the Chronic Stigma Scale were positively correlated with illness duration, PSQI and HAMD-17 scores, while negatively correlated with one or more items of the SF-36. Multivariate regression analysis showed that illness duration and the Mental Health domain of the SF-36 were independent risk factors for one or more items of stigma in CID patients. CONCLUSION Patients with CID have an increased risk of stigma. Moreover, illness duration and Mental Health may be primary factors related to stigma.
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Affiliation(s)
- Shuo He
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Xue-Jia Ke
- grid.477985.00000 0004 1757 6137Department of Geriatrics, Hefei First People’s Hospital, Hefei, 230092 China
| | - Yan Wu
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Xiao-Yi Kong
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Yun Wang
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Hui-Qin Sun
- Department of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
| | - Deng-Zhi Xia
- Department of Outpatient, The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
| | - Gui-Hai Chen
- Department of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
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Docksey AE, Gray NS, Davies HB, Simkiss N, Snowden RJ. The Stigma and Self-Stigma Scales for attitudes to mental health problems: Psychometric properties and its relationship to mental health problems and absenteeism. Health Psychol Res 2022. [DOI: 10.52965/001c.35630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Stigma and Self-Stigma scales (SASS) measure multiple aspects of stigmatic beliefs about mental health problems, including cognitive aspects of stigma towards others (Stigma to Others) and emotional stigma toward others (Social Distance), anticipated stigma by others, self-stigma, avoidant coping strategies, and help-seeking intentions, alongside an index of social desirability. The properties of the SASS were investigated by employees of a large UK government organization. With minor exceptions, each of the SASS scales had strong psychometric properties, good internal reliability, and test-retest reliability. Social Distance, Anticipated Stigma, Self-Stigma, and Avoidant Coping were all strongly associated with a lack of help-seeking for mental health problems. Similarly, Stigma to Others, Self-Stigma, and Avoidant Coping were all associated with current mental health problems. Finally, absenteeism from the workplace was found to be negatively related to Stigma to Others, and positively related to Avoidant Coping and Anticipated Stigma. In conclusion, the SASS was able to measure several different forms of stigma about mental health simultaneously in people both with and without a history of mental health problems. The SASS can be used to monitor changes in mental health attitudes outcomes following intervention programs to investigate stigmatic attitudes to mental health problems across different samples.
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de Filippis R, Menculini G, D'Angelo M, Carbone EA, Tortorella A, De Fazio P, Steardo L. Internalized-stigma and dissociative experiences in bipolar disorder. Front Psychiatry 2022; 13:953621. [PMID: 35966460 PMCID: PMC9372275 DOI: 10.3389/fpsyt.2022.953621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Dissociative symptoms have been recently related to bipolar disorder (BD) symptomatology. Moreover, the disease burden carries on a share of perceived self-stigma that amplifies the BD impairment. Internalized stigma and dissociative symptoms often seem overlapping, leading toward common outcomes, with reduced treatment seeking and poor adherence. We hypothesize a potential relationship between dissociation and self-stigma in patients suffering from BD. MATERIALS AND METHODS In this cross-sectional study we enrolled a total of 120 adult clinically stable BD outpatients. All participants completed the Internalized Stigma of Mental Illness (ISMI), Dissociative Experiences Scale-II (DES-II), and Manchester Short Assessment of Quality of Life (MANSA). RESULTS Average age and age at BD (BD-I n = 66, 55%; BD-II n = 54, 45%) onset were 46.14 (±4.23), and 27.45 (±10.35) years, with mean disease duration of 18.56 (±13.08) years. Most participants were female (n = 71; 59.2%) and 40 (33%) of them experienced lifetime abuse, with an average of 1.05 (±0.78) suicide attempts. DES scores (mean 31.8, ±21.6) correlated with ISMI total-score, with significant association with spikes in Alienation (13.1, SD±3.1) (p < 0.001) and Stereotype (13.8, SD±3.9) (p < 0.001). Linear regression analysis has shown a significant association between DES total score and alienation (p < 0.001), stereotype (p < 0.001) and MANSA total-score (p < 0.001). DISCUSSION For the first time, our data suggests that self-stigma is associated to dissociative symptoms, reducing overall quality of life in BD. The early identification of at-risk patients with previous lifetime abuse and high perceived stigma could lead the way for an ever more precise tailoring of treatment management.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Martina D'Angelo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elvira Anna Carbone
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Unpacking stigma: Meta-analyses of correlates and moderators of personal stigma in psychosis. Clin Psychol Rev 2021; 89:102077. [PMID: 34563943 DOI: 10.1016/j.cpr.2021.102077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 06/18/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022]
Abstract
Personal stigma entails perceived, experienced and internalised stigmatisation. Mental Health stigma has been widely researched across a range of countries and a meta-analysis of their associations and moderators in psychosis is timely. Meta-analyses were conducted examining the correlates and moderators of personal stigma in terms of: (1) demographic variables (2) illness related variables (3) symptoms/negative outcomes, and (4) aspects of wellbeing. Associations were obtained from a total of 216 records. Several demographic factors including age, economic status, employment, and rural residence had small associations with aspects of personal stigma (r's = 0.12 to -0.13). Personal stigma aspects were inversely related to medication adherence (r's = -0.20, -0.21), and positively associated with insight and number of hospitalisations (r's = 0.09-0.19). Most symptoms were positively associated with personal stigma (r's = 0.10-0.43), whereas inverse relations with wellbeing variables were identified (r's = -0.13 to -0.54). Moderator effects emerged including that of cultural setting and sex, age and education level, highlighting the role of cultural and demographic factors in shaping personal stigma aspects in psychosis. The present study also highlights the importance of recognizing the negative effect of actual stigma and discrimination experiences; particularly its detrimental impact on self-image and its complex role in shaping the internalisation of societal stigma.
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Dubreucq J, Plasse J, Franck N. Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences. Schizophr Bull 2021; 47:1261-1287. [PMID: 33459793 PMCID: PMC8563656 DOI: 10.1093/schbul/sbaa181] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Self-stigma is associated with poor clinical and functional outcomes in Serious Mental Illness (SMI). There has been no review of self-stigma frequency and correlates in different cultural and geographic areas and SMI. The objectives of the present study were: (1) to review the frequency, correlates, and consequences of self-stigma in individuals with SMI; (2) to compare self-stigma in different geographical areas and to review its potential association with cultural factors; (3) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed, Web of Science, PsycINFO, Scopus, and Ovid SP Cumulative Index to Nursing and Allied Health Literature [CINAHL]) following PRISMA guidelines, was conducted on the frequency, correlates, and consequences of self-stigma in SMI. Out of 272 articles, 80 (29.4%) reported on the frequency of self-stigma (n = 25 458), 241 (88.6%) on cross-sectional correlates of self-stigma and 41 (15.0%) on the longitudinal correlates and consequences of self-stigma. On average, 31.3% of SMI patients reported high self-stigma. The highest frequency was in South-East Asia (39.7%) and the Middle East (39%). Sociodemographic and illness-related predictors yielded mixed results. Perceived and experienced stigma-including from mental health providers-predicted self-stigma, which supports the need to develop anti-stigma campaigns and recovery-oriented practices. Increased transition to psychosis and poor clinical and functional outcomes are both associated with self-stigma. Psychiatric rehabilitation and recovery-oriented early interventions could reduce self-stigma and should be better integrated into public policy.
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Affiliation(s)
- Julien Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
- Fondation FondaMental, Créteil, France
| | - Julien Plasse
- Réseau Handicap Psychique, Grenoble, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation cognitive, Centre Hospitalier Le Vinatier, Bron, France
| | - Nicolas Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation cognitive, Centre Hospitalier Le Vinatier, Bron, France
- Pôle Centre Rive Gauche, Centre Hospitalier Le Vinatier, Bron, France
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Stigma and Endometriosis: A Brief Overview and Recommendations to Improve Psychosocial Well-Being and Diagnostic Delay. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158210. [PMID: 34360501 PMCID: PMC8346066 DOI: 10.3390/ijerph18158210] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
Endometriosis is a chronic gynecological disease that affects approximately 1 in 10 women of reproductive age. Symptoms of severe pelvic pain, infertility, fatigue, and abnormal menstruation can cause significant negative effects on an individual’s physical and mental health, including interactions with their family, friends, and health care providers. Stigma associated with endometriosis has been under-studied and is rarely discussed in current literature. Herein, this paper aims to provide a brief overview of published literature to explore and establish the plausibility of stigma as a driver of suboptimal psychosocial well-being and diagnostic delay among individuals living with endometriosis. We present the clinical characteristics and physical and mental health consequences associated with endometriosis, highlight several theoretical constructs of stigma, and review the limited studies documenting women’s lived experiences of endometriosis-related stigma. To mitigate harmful effects of this phenomenon, we recommend increasing efforts to assess the prevalence of and to characterize endometriosis-related stigma, implementing awareness campaigns, and developing interventions that combat the multidimensional negative effects of stigma on timely care, treatment, and quality of life for individuals living with endometriosis.
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Azorin JM, Lefrere A, Belzeaux R. The Impact of Bipolar Disorder on Couple Functioning: Implications for Care and Treatment. A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57080771. [PMID: 34440977 PMCID: PMC8400362 DOI: 10.3390/medicina57080771] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023]
Abstract
If there is an abundant literature on the impact of bipolar illness on the family and/or caregivers of patients, few studies have addressed its impact on marital relationship and couple functioning. Uncovering information relating specifically to this topic may be particularly relevant due to the unusually high divorce rate among individuals with bipolar disorder. We therefore conducted a systematic literature search to evaluate the existing data on bipolar disorder and marital issues, with a special focus on the help and support that can be provided by mental health professionals in this regard. We identified quantitative studies with pre-defined outcomes as well as qualitative investigations trying to understand the experiences of partners. A total of 27 articles were included in the review. The literature was found to capture the impact of bipolar disorder on partners as well as on the marital relationship itself or the children. Bipolar illness has a negative impact on the lives of partners including self-sacrifice, caregiver burden, emotional impact, and health problems. This negative impact can be aggravated by a lack of care and a lack of information from health personnel. The negative impact on the relationship includes volatility in the relationship, stigmatization, dissatisfaction with sexual life, and lower rates of childbearing. Negative impacts are likely to favor disease relapses for the patient. Children may also be negatively impacted. However, the illness may sometimes have positive impacts such as personal evolution, strengthening relationship, or new hope and perspectives. Based on these findings, the interventions of mental health professionals should be aimed at minimizing the negative impacts while favoring the positive ones.
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25
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Pal A, Saxena V, Avinash P. Stigma in Bipolar Affective Disorder: A Systematic Quantitative Literature Review of Indian Studies. Indian J Psychol Med 2021; 43:187-194. [PMID: 34345093 PMCID: PMC8287384 DOI: 10.1177/0253717621996618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Bipolar affective disorder (BPAD) is one of the most common severe mental illnesses that cause morbidity. Stigma can negatively influence the disease experience in patients with BPAD. Significant differences are observed in the attributes of stigma across the various sociocultural milieus. The current review was thus conducted to compile the evidence regarding the burden and correlates of various forms of stigma in BPAD in India. METHODS An exhaustive literature review was conducted in PubMed, MedIND, and Google Scholar to identify Indian studies conducted on stigma in BPAD. The broad themes in various forms of stigma were identified (qualitative analysis). Quantitative analysis of measures of stigma was done, calculating the effect size in BPAD and comparator groups (schizophrenia and anxiety disorders) using standardized mean difference. RESULTS Overall, 12 studies could be identified for qualitative analysis, and 5 were used for quantitative analysis. Overall, the current evidence points out that the stigma in BPAD is less than that in schizophrenia but more than that in anxiety disorders. Internalized stigma in BPAD is correlated with poor self-esteem, reduced community participation, and low quality of life. Caregivers of patients with BPAD also experience significant stigma. CONCLUSIONS The review shows that stigma in BPAD is substantial. It also draws attention to the fact that the research regarding stigma in BPAD is lagging behind. This review also provides a platform to develop an intervention in the Indian scenario, where further research should be carried out.
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Affiliation(s)
- Arghya Pal
- Dept. of Psychiatry, All India
Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Vrinda Saxena
- Dept. of Psychiatry, Himalayan
Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun,
Uttarakhand, India
| | - Priyaranjan Avinash
- Dept. of Psychiatry, Himalayan
Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun,
Uttarakhand, India
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26
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Madden JM, Araujo-Lane C, Foxworth P, Lu CY, Wharam JF, Busch AB, Soumerai SB, Ross-Degnan D. Experiences of health care costs among people with employer-sponsored insurance and bipolar disorder. J Affect Disord 2021; 281:41-50. [PMID: 33290926 DOI: 10.1016/j.jad.2020.10.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/02/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cost-sharing disproportionately affects people with chronic illnesses needing more care. Our qualitative study examined lived experiences navigating insurance benefits and treatment for bipolar disorder, which requires ongoing access to behavioral specialists and psychotropic medications. METHODS Forty semi-structured telephone interviews with individuals with bipolar disorder and employer-sponsored health insurance, or their family caregivers, explored health care needs, coverage details, out-of-pocket (OOP) costs, and perspectives on value. An iterative analytic approach identified salient themes. RESULTS Most individuals in our sample faced an annual insurance deductible, from $350-$10,000. OOP costs for specialist visits ranged from $0-$450 and for monthly psychotropic medications from $0-$1650. Acute episodes and care for comorbidities, including medication side effects, added to cost burdens. Medication nonadherence due to OOP costs was rare; respondents frequently pointed to the necessity of medications: "whatever it takes to get those"; "it's a life or death situation." Respondents also prioritized visits to psychiatrist prescribers, though visits were maximally spaced because of cost. Psychotherapy was often deemed unaffordable and forgone, despite perceived need. Interviewees cited limited networks and high out-of-network costs as barriers to specialists. Cost-sharing sometimes led to debt, skimping on nonbehavioral care or other necessities, exacerbated or prolonged mood symptoms, and stress at home. LIMITATIONS Volunteer respondents may not fully represent the target population. CONCLUSIONS Many people with bipolar disorder in US employer-sponsored plans experience undertreatment, hardship, and adverse health consequences due to high cost-sharing. More nuanced insurance benefit designs should accommodate the needs of individuals with complex conditions.
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Affiliation(s)
- Jeanne M Madden
- Northeastern University School of Pharmacy, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA.
| | - Carina Araujo-Lane
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | | | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | - J Frank Wharam
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | - Alisa B Busch
- McLean Hospital and Department of Health Care Policy, Harvard Medical School, USA
| | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
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27
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Kim HC. Friends support as a mediator in the association between depressive symptoms and self-stigma among university students in South Korea. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1781425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hee Chul Kim
- Institute of Social Welfare Research, Hallym University, Chuncheon, Republic of Korea
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Chakrabarti S. Treatment Attitudes and Adherence Among Patients with Bipolar Disorder: A Systematic Review of Quantitative and Qualitative Studies. Harv Rev Psychiatry 2020; 27:290-302. [PMID: 31385812 DOI: 10.1097/hrp.0000000000000228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Systematic reviews about treatment attitudes of patients influencing adherence in bipolar disorder (BD) are rare. METHODS A systematic review was conducted according to the PRISMA guidelines and principles of thematic synthesis. Selectively identified quantitative and qualitative studies were used to examine the attitude-adherence relationship in BD, the types and correlates of treatment attitudes, and the impact of psychosocial interventions on attitudes. RESULTS The final list of 163 articles included 114 observational reports (incorporating 21 psychosocial intervention trials), 45 qualitative/descriptive studies, and 4 patient surveys. A positive association between treatment attitudes and adherence was found in most quantitative and qualitative studies, though the strength of the relationship was unclear. Thematic analysis of qualitative studies suggested that patient attitudes influencing adherence were based on perceived advantages and disadvantages of treatment. The principal correlates of patients' attitudes were family attitudes, the clinician-patient alliance, social support, and patients' knowledge of BD. Though negative attitudes such as denial, concerns about adverse treatment consequences, and stigmatizing effects of treatment were common, many patients believed treatment to be beneficial and necessary. The limited data on the effect of psychosocial interventions indicated that treatments selectively targeting attitudes enhanced adherence. LIMITATIONS The studies were heterogeneous in design; the quality was uneven (fair to poor); and the risk of bias moderate to high. CONCLUSIONS Despite these flaws, awareness of the existing evidence on the attitude-adherence association and other aspects of treatment attitudes in BD can help in efforts to address nonadherence in BD.
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Affiliation(s)
- Subho Chakrabarti
- From the Department of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh (India)
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Crusey A, Schuller KA, Trace J. Access to care barriers for patients with Bipolar disorder in the United States. J Healthc Qual Res 2020; 35:167-172. [PMID: 32305373 DOI: 10.1016/j.jhqr.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/17/2020] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The five major comorbidities associated with Bipolar Disorder (BPD) include anxiety disorder, substance abuse, attention deficit hyperactivity disorder, personality disorder, and other medical conditions. These conditions are extremely prevalent among patients with BPD. Additionally, the medications used to treat this disorder can cause severe weight gain, which leads to cardiovascular disease, type 2 diabetes, and other endocrine disorders. PURPOSE The purpose of this paper is to inform the medical community and health policymakers of the causes and comorbidities associated with BPD; stigma, acceptance of insurance, shortage of providers and costs as barriers to access care; and the collaborative care model and policy-based solutions to improve the access to high quality care and the quality of life of people living with bipolar disorder. RESULTS Recent policy developments that address mental health in the United States, such as, the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Helping Families in Mental Health Crisis Act are opportunities to improve access to care. Though not specifically targeting BPD, collaborative programs and mental health policies can start monitoring the comorbidities associated with BPD. By focusing on prevention and collaborative care, providers can slow the acceleration of symptoms and allow for quicker channels of treatment for comorbidities.
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Affiliation(s)
- A Crusey
- Department of Social & Public Health Ohio University, Athens, OH, United States
| | - K A Schuller
- Department of Social & Public Health Ohio University, Athens, OH, United States.
| | - J Trace
- Department of Social & Public Health Ohio University, Athens, OH, United States
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Pallesen K, Brown J, Rose D, Lawrence V. An interpretative phenomenological analysis of the experience of receiving a diagnosis of bi-polar disorder. J Ment Health 2020; 29:358-363. [PMID: 32326856 DOI: 10.1080/09638237.2020.1755020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Research has shown that receiving a psychiatric diagnosis can have both positive and negative consequences for people. The way in which diagnoses are imparted is an under-researched area and may play an important role in reducing stigma and aiding recovery.Aims: The aim of the present study was to get an in-depth understanding of service users' experience of receiving a diagnosis of bipolar disorder.Methods: Nine service users recently diagnosed with bipolar disorder were interviewed using a semi-structured interview schedule designed to elicit information regarding the positive and negative aspects of receiving their diagnosis. All transcripts were analysed using Interpretative Phenomenological Analysis (IPA).Findings: The findings can be described in terms of three master themes: 1. "Perceived fit between diagnosis and lived experience", 2. "Evaluating the utility of carrying the diagnostic label" and 3. "The role of diagnosis in searching for solutions to one's difficulties".Conclusion: This study draws attention to the importance of evaluating the fit between diagnosis and personal experiences and to the relevance of perceived stigma. The findings also highlight the significance of the client-clinician relationship in establishing fit and instilling hope, which has implications for the acceptance of the diagnosis and engagement with services.
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Affiliation(s)
- Kasper Pallesen
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - June Brown
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - Diana Rose
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - Vanessa Lawrence
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
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Azorin JM, Simon N. Dopamine Receptor Partial Agonists for the Treatment of Bipolar Disorder. Drugs 2020; 79:1657-1677. [PMID: 31468317 DOI: 10.1007/s40265-019-01189-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Bipolar disorder is a chronic, disabling, and costly illness with frequent relapses and recurrences, high rates of co-morbid conditions, and poor adherence to treatment. Mood stabilizers and antipsychotics are the cornerstones of treatment. Dopamine receptor partial agonists are a novel class of antipsychotic agents with original pharmacodynamic properties. Among them, two have been approved by the US Food and Drug Administration for the treatment of bipolar disorder. Aripiprazole (oral formulation) has been approved as monotherapy for the treatment of manic/mixed episodes in adult and pediatric populations and for maintenance treatment in adults, and as adjunctive treatment to mood stabilizers, for the acute treatment of manic/mixed episodes and for maintenance in adults. An intramuscular formulation of aripiprazole has been approved for the treatment of agitation in mania and a long-acting injectable formulation has been approved as maintenance treatment. In the USA, cariprazine has been approved as monotherapy for the acute treatment of manic/mixed as well as bipolar depressive episodes. Brexpiprazole is not yet approved to treat bipolar disorder. The evidence supporting these indications is reviewed via an analysis of clinical registration trials as well as additional studies, on the basis of a systematic literature search. Further studies dealing with other aspects of bipolar illness are also presented. Aripiprazole and cariprazine are efficacious and generally well tolerated agents that have shown cost effectiveness, and may therefore enrich our therapeutic armamentarium for bipolar illness. Brexpiprazole, which displays an overall promising tolerability profile, deserves further efficacy studies.
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Affiliation(s)
- Jean-Michel Azorin
- Department of Psychiatry, Sainte Marguerite Hospital, 13009, Marseille, France.
| | - Nicolas Simon
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Hôpital Sainte Marguerite, Service de Pharmacologie Clinique, CAP, Marseille, France
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Dregan A, McNeill A, Gaughran F, Jones PB, Bazley A, Cross S, Lillywhite K, Armstrong D, Smith S, Osborn DPJ, Stewart R, Wykes T, Hotopf M. Potential gains in life expectancy from reducing amenable mortality among people diagnosed with serious mental illness in the United Kingdom. PLoS One 2020; 15:e0230674. [PMID: 32218598 PMCID: PMC7100972 DOI: 10.1371/journal.pone.0230674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/05/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To estimate the potential gain in life expectancy from addressing modifiable risk factors for all-cause mortality (excluding suicide and deaths from accidents or violence) across specific serious mental illness (SMI) subgroups, namely schizophrenia, schizoaffective disorders, and bipolar disorders in a Western population. METHODS We have used relative risks from recent meta-analyses to estimate the population attribution fraction (PAF) due to specific modifiable risk factors known to be associated with all-cause mortality within SMI. The potential gain in life expectancy at birth, age 50 and age 65 years were assessed by estimating the combined effect of modifiable risk factors from different contextual levels (behavioural, healthcare, social) and accounting for the effectiveness of existing interventions tackling these factors. Projections for annual gain in life expectancy at birth during a two-decade was estimated using the Annual Percentage Change (APC) formula. The predicted estimates were based on mortality rates for year 2014-2015. RESULTS Based on the effectiveness of existing interventions targeting these modifiable risk factors, we estimated potential gain in life expectancy at birth of four (bipolar disorders), six (schizoaffective disorders), or seven years (schizophrenia). The gain in life expectancy at age 50 years was three (bipolar disorders) or five (schizophrenia and schizoaffective disorders) years. The projected gain in life expectancy at age 65 years was three (bipolar disorders) or four (schizophrenia and schizoaffective disorders) years. CONCLUSIONS The implementation of existing interventions targeting modifiable risk factors could narrow the current mortality gap between the general and the SMI populations by 24% (men) to 28% (women). These projections represent ideal circumstances and without the limitation of overestimation which often comes with PAFs.
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Affiliation(s)
- Alex Dregan
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Anna Bazley
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Sean Cross
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Kate Lillywhite
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - David Armstrong
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Shubulade Smith
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
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Quenneville AF, Badoud D, Nicastro R, Jermann F, Favre S, Kung AL, Euler S, Perroud N, Richard-Lepouriel H. Internalized stigmatization in borderline personality disorder and attention deficit hyperactivity disorder in comparison to bipolar disorder. J Affect Disord 2020; 262:317-322. [PMID: 31733922 DOI: 10.1016/j.jad.2019.10.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/10/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Internalized stigma constitutes a major concern in mental health illness. It has numerous repercussions on patients, including poor self-esteem, higher illness severity, poor adherence to care and reduced global functioning. The goal of this study was to compare internalized stigma between three diagnoses frequently seen in psychiatric practice: Borderline personality disorder (BPD), Attention deficit-hyperactivity disorder (ADHD) and Bipolar disorder (BD). METHODS A total of 244 French-speaking patients were recruited in a specialized psychiatric center at University Hospitals of Geneva, Switzerland. 39 patients had a diagnosis of BPD, 136 had ADHD and 69 had BD. Every subjects completed the Internalized Stigma of Mental Illness (ISMI) scale, which is the most widely used scale employed to measure of internalized stigma. One way ANOVA analysis with adjustment on age and gender was done to compare the three groups (BPD, ADHD, BD). RESULTS Participants with BPD reported higher ISMI score than subjects with ADHD and BD. BD experienced more internalized-stigma than ADHD. Higher ISMI score was also associated with higher severity of the respective disorder, poorer quality of life and unemployment. LIMITATIONS Limitations of this research include the small sample, especially in BPD group. A disequilibrium between male and female subjects can also impact our results. Observational nature of our study mean that we can only make correlation between variables and not infer causality. Finally, other confounding factors not taken into account in this study may have had influence on stigma. CONCLUSIONS Our findings are coherent with recent literature on BPD reporting high level of distress and of stigmatization. This has serious consequences on provided care and need to be address by mental health professionals to assure the optimal service to this population.
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Affiliation(s)
- Andréanne Filion Quenneville
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Department of Psychiatry, University of Montreal, Montreal, Canada.
| | - Déborah Badoud
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rosetta Nicastro
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Françoise Jermann
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Favre
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Anne-Lise Kung
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Sebastian Euler
- University Hospital Zurich, Department of Consultation Psychiatry and Psychosomatics, Zurich, Switzerland
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Hélène Richard-Lepouriel
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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Sahota PKC, Sankar PL. Bipolar Disorder, Genetic Risk, and Reproductive Decision-Making: A Qualitative Study of Social Media Discussion Boards. QUALITATIVE HEALTH RESEARCH 2020; 30:293-302. [PMID: 31409193 DOI: 10.1177/1049732319867670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this study, we present views on bipolar disorder and reproductive decision-making through an analysis of posts on Reddit™, a major Internet discussion forum. Prior research has shown that the Internet is a useful source of data on sensitive topics. This study used qualitative textual analysis to analyze posts on Reddit™ bipolar discussion boards that dealt with genetics and related topics. All thread titles over 4 years were reviewed (N = 1,800). Genetic risk was often raised in the context of Redditors' discussions about whether or not to have children. Reproductive decision-making for Redditors with bipolar was complex and influenced by factors from their past, present, and imagined future. These factors coalesced under a summative theme: for adults with bipolar disorder, what was the manageability of parenting a child? Reproductive decisions for individuals with bipolar disorder are complex, and Reddit™ is a novel source of information on their perspectives.
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Affiliation(s)
- Puneet K C Sahota
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Clements C, Kapur N, Jones SH, Morriss R, Peters S. Qualitative investigation of relatives' and service users' experience of mental healthcare for suicidal behaviour in bipolar disorder. BMJ Open 2019; 9:e030335. [PMID: 31719074 PMCID: PMC6858148 DOI: 10.1136/bmjopen-2019-030335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE People with bipolar disorder are known to be at high risk of engaging in suicidal behaviours, and those who die by suicide have often been in recent contact with mental health services. The objective of this study was to explore suicidal behaviour in bipolar disorder and how this is monitored and managed by mental health services. AIMS To identify themes within relatives' and service users' accounts of mental healthcare, related to management and prevention of suicidal behaviour in bipolar disorder. DESIGN Thematic analysis of 22 semistructured interviews. PARTICIPANTS Participants were aged 18 years or over, fluent in written and spoken English, and either had bipolar disorder with a history of suicidal behaviour, or were relatives of people with bipolar disorder who had died by suicide. SETTING England, UK. PRIMARY OUTCOME Themes identified from participants' accounts of mental healthcare for suicidal behaviours in bipolar disorder. RESULTS Two main themes were identified. 'Access to care' was characterised by a series or cycle of potential barriers to care (eg, gate-keepers, lack of an accurate diagnosis) which had the potential to increase risk of suicidal behaviour if failure to access care continued over time. 'Problems with communication' captured the importance of maintaining open routes of communication between all parties involved in care to ensure successful monitoring and management of suicidal behaviours in bipolar disorder. CONCLUSIONS Mental health services need to be accessible and respond rapidly to people with suicidal behaviour in bipolar disorder. Open communication and inclusion of relatives in care, where appropriate, could help closer monitoring of changes in symptoms that indicate increased risk.
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Affiliation(s)
- Caroline Clements
- Centre for Mental Health and Safety, University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Steven H Jones
- Health Research, Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | | | - Sarah Peters
- Psychology and Mental Health, University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
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Au CH, Wong CSM, Law CW, Wong MC, Chung KF. Self-stigma, stigma coping and functioning in remitted bipolar disorder. Gen Hosp Psychiatry 2019; 57:7-12. [PMID: 30654294 DOI: 10.1016/j.genhosppsych.2018.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Stigma has a deleterious effect on functioning in individuals with bipolar disorder (BD). However, there has been no research investigating how stigma coping predicts self-stigma and functioning in BD. Furthermore, how different stages of self-stigma might affect functioning is unclear. The following hypotheses were examined: (1) Stigma coping by withdrawal and secrecy was associated with more self-stigma; (2) Stigma coping by withdrawal and secrecy was associated with worse social functioning; and (3) Later stages of self-stigma were associated with worse social functioning. METHODS A random sample of remitted BD in a regional psychiatric clinic was examined using a cross-sectional design (n = 115). Self-stigma was measured using the Chinese versions of Self-Stigma of Mental Illness Scale (C-SSMIS). Social functioning was assessed using the Functional Assessment Short Test (FAST). Stigma coping was evaluated using the Stigma Coping Orientation Scale (SCOS). RESULTS Multiple regression analysis revealed that coping by secrecy was associated with the stereotype agreement subscale of C-SSMIS, while coping by withdrawal was associated with the C-SSMIS self-concurrence and self-esteem decrement subscales. Another regression analysis showed that FAST total score was associated with the self-esteem decrement subscale of C-SSMIS and the severity of depressive and manic symptoms. CONCLUSION We showed that self-esteem decrement, the final stage of self-stigma, was the most crucial stage in determining psychosocial functioning. Our findings suggested that stigma-reduction intervention should be arranged during the early stage of BD and targeted at various dysfunctional stigma coping.
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Affiliation(s)
- Chi-Hung Au
- Department of Psychiatry, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Corine Sau-Man Wong
- Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region
| | - Chi-Wing Law
- Department of Psychiatry, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Ming-Cheuk Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Ka-Fai Chung
- Department of Psychiatry, Queen Mary Hospital, Hong Kong Special Administrative Region; Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, University of Hong Kong, Hong Kong Special Administrative Region.
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Ross AM, Morgan AJ, Jorm AF, Reavley NJ. A systematic review of the impact of media reports of severe mental illness on stigma and discrimination, and interventions that aim to mitigate any adverse impact. Soc Psychiatry Psychiatr Epidemiol 2019; 54:11-31. [PMID: 30349962 DOI: 10.1007/s00127-018-1608-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This review aims to summarise the evidence on the impact of news media and social media reports of severe mental illness (SMI) on stigma, and interventions that aim to mitigate any adverse impact. METHODS A systematic search of electronic databases was conducted in December 2017 to identify studies that report on the impact of media coverage or media interventions on stigma related to schizophrenia, psychosis, bipolar disorder, or mental illness in general. Data were synthesised narratively. RESULTS 12 studies met inclusion criteria; seven explored the impact of news media on stigma towards SMI or general mental illness, two explored the impact of social media, while three evaluated interventions that aimed to mitigate this impact. These studies showed that positive news reports and social media posts are likely to lead to reductions in stigmatizing attitudes and negative reports and social media posts are likely to increase stigmatizing attitudes. There were a limited number of interventions aiming to mitigate the negative impact of news reports of mental illness on stigma; however, these were ineffective. Interventions with media professionals appear to be successful at reducing their stigmatizing attitudes, but can also act to increase both positive and negative reports in the media. CONCLUSIONS Given the limited research evidence on the impact of news and social media on stigma towards SMI, and on the effectiveness of interventions aiming to mitigate this impact, further studies of higher quality are needed in this area. Due to mixed findings, interventions with media professionals are also an area of research priority.
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Affiliation(s)
- Anna M Ross
- Centre for Mental Health, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia.
| | - Amy J Morgan
- Centre for Mental Health, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
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Quality of life in stabilized outpatients with bipolar I disorder: Associations with resilience, internalized stigma, and residual symptoms. J Affect Disord 2018; 238:399-404. [PMID: 29909303 DOI: 10.1016/j.jad.2018.05.055] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/07/2018] [Accepted: 05/28/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Improving Quality of Life (QoL) is an important objective in the treatment of bipolar disorder. The aim of the current study was to examine to which extent resilience, internalized stigma, and psychopathology are correlated to QoL. METHODS We recruited 60 outpatients diagnosed with bipolar I disorder according to DSM-IV criteria and 77 healthy control subjects from the general community. In patients, symptoms were quantified by the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS) and internalized stigma by the Internalized Stigma of Mental Illness (ISMI) scale. In order to assess QoL and resilience, the Berliner Lebensqualitätsprofil (BELP) and the Resilience Scale (RS-25) were used in both patients and control subjects. RESULTS Despite presenting with a very mild symptom level and relatively low internalized stigma, patients with bipolar I disorder indicated significantly lower QoL and resilience as compared to healthy control subjects. In patients, QoL correlated significantly with resilience, internalized stigma, and residual symptoms of depression. No significant correlations were observed between QoL and residual manic symptoms. LIMITATIONS The cross-sectional design and the relatively small sample size limit the generalizability of our results. Furthermore, levels of resilience and internalized stigma may change over the course of the illness and have different impacts on the long-term outcome of patients with bipolar disorder. CONCLUSION Our results show that QoL of patients suffering from bipolar I disorder, even when only mildly ill, is strongly associated with the degree of resilience and internalized stigma, and that particularly residual depressive symptoms have a negative impact on QoL. In addition to drug treatment, psychotherapeutic approaches should be applied to strengthen resilience, to reduce internalized stigma, and, ultimately, to improve quality of life.
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Jackson-Best F, Edwards N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 2018; 18:919. [PMID: 30049270 PMCID: PMC6062983 DOI: 10.1186/s12889-018-5861-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/17/2018] [Indexed: 01/12/2023] Open
Abstract
Background Stigma across HIV/AIDS, mental illness, and physical disability can be co-occurring and may interact with other forms of stigma related to social identities like race, gender, and sexuality. Stigma is especially problematic for people living with these conditions because it can create barriers to accessing necessary social and structural supports, which can intensify their experiences with stigma. This review aims to contribute to the knowledge on stigma by advancing a cross-analysis of HIV/AIDS, mental illness, and physical disability stigma, and exploring whether and how intersectionality frameworks have been used in the systematic reviews of stigma. Methods A search of the literature was conducted to identify systematic reviews which investigated stigma for HIV/AIDS, mental illness and/or physical disability. The electronic databases MEDLINE, CINAHL, EMBASE, COCHRANE, and PsycINFO were searched for reviews published between 2005 and 2017. Data were extracted from eligible reviews on: type of systematic review and number of primary studies included in the review, study design study population(s), type(s) of stigma addressed, and destigmatizing interventions used. A keyword search was also done using the terms “intersectionality”, “intersectional”, and “intersection”; related definitions and descriptions were extracted. Matrices were used to compare the characteristics of reviews and their application of intersectional approaches across the three health conditions. Results Ninety-eight reviews met the inclusion criteria. The majority (99%) of reviews examined only one of the health conditions. Just three reviews focused on physical disability. Most reviews (94%) reported a predominance of behavioural rather than structural interventions targeting stigma in the primary studies. Only 17% of reviews used the concept and/or approach of intersectionality; all but one of these reviews examined HIV/AIDS. Conclusions The lack of systematic reviews comparing stigma across mental illness, HIV/AIDS, and physical disability indicates the need for more cross-comparative analyses among these conditions. The integration of intersectional approaches would deepen interrogations of co-occurring social identities and stigma.
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Affiliation(s)
| | - Nancy Edwards
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 1 Stewart Street, Room 205, Ottawa, ON, K1N 7M9, Canada
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Rim SJ, Jang H, Park S. Psychometric Properties of the Korean Translation of the Attention-Deficit/Hyperactivity Disorder Stigma Questionnaire. Soa Chongsonyon Chongsin Uihak 2018; 29:122-128. [PMID: 32595304 PMCID: PMC7289458 DOI: 10.5765/jkacap.170038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 12/30/2022] Open
Abstract
Objectives: This study evaluated the psychometric properties of the Korean version of the attention-deficit/hyperactivity disorder (ADHD) Stigma Questionnaire (ASQ) and the effect of the source of information about mental health on ADHD stigma. Methods: The Korean translation of the ASQ was prepared, and 673 participants, 20–64 years of age, completed the questionnaire using an online panel survey in South Korea. The participants also completed questionnaires detailing sociodemographic variables and the source of their mental health knowledge. Cronbach’s alpha coefficient was used to explore the internal consistency of the ASQ. Factor analysis using Varimax rotation was conducted to investigate the structure of the ASQ. Results: The 26-item ASQ demonstrated excellent internal consistency (Cronbach’s alpha=0.940). Factor analysis supported a threefactor structure, including Concerns with Public Attitudes, Negative Self-Image, and Disclosure Concerns. There were no significant differences in the total ASQ scores according to sociodemographic characteristics. Participants who reported the internet as their major source of information about mental health showed higher ASQ scores compared to those who used other sources for mental health information. Conclusion: The Korean translation of the ASQ has acceptable psychometric properties among Korean adults. Inaccurate information from the internet could increase the stigma toward ADHD.
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Affiliation(s)
- Soo Jung Rim
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Korea
| | - Hyesue Jang
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Korea
| | - Subin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Korea
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 930] [Impact Index Per Article: 155.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
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Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
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A study of the real-world effectiveness of group psychoeducation for bipolar disorders: Is change in illness perception a key mediator of benefit? J Affect Disord 2018; 227:713-720. [PMID: 29179141 DOI: 10.1016/j.jad.2017.11.072] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/25/2017] [Accepted: 11/12/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Findings from efficacy trials of group psychoeducation (PE) for bipolar disorders (BD) led to its inclusion in evidence-based guidelines as a first-line mandatory treatment. However, pragmatic trials and observational studies are needed to determine its real-world effectiveness, impact on outcomes deemed important to patients and to clarify potential mediators of any benefits. METHODS Individuals with BD were offered the opportunity to participate in 20h of PE and asked to complete pre- and post-intervention ratings of symptoms, knowledge about BD, medication adherence, and illness perception. A priori, two key patient outcomes were identified (social functioning and self-esteem); sample attrition due to dropout or relapse was recorded. RESULTS Of 156 individuals who completed the pre-PE assessments, 103 completed the program and post-PE assessments. Only 4 of 53 dropouts were associated with BD relapse. Post-intervention, the PE completers demonstrated a statistically significant improvement in social functioning (p = 0.003, Effect Size (ES) = 0.26) and a trend towards improved self-esteem (ES = 0.14). Whilst there were significant changes in medication adherence (p = 0.002, ES = 0.28), knowledge of BD (p < 0.001, ES = 1.20), and illness perception (p < 0.001, ES = -0.37), mediational analysis demonstrated that only change in illness perception was associated to change in functioning (p=0.03) with no contribution from changes in knowledge of BD or medication adherence. CONCLUSIONS In real-world settings, over 60% individuals completed 10-session course of PE. After controlling for demography and baseline clinical state, change in illness perception, rather than change in knowledge or medication adherence, emerged as a potential mediator of some benefits of PE.
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Cloutier M, Greene M, Guerin A, Touya M, Wu E. The economic burden of bipolar I disorder in the United States in 2015. J Affect Disord 2018; 226:45-51. [PMID: 28961441 DOI: 10.1016/j.jad.2017.09.011] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND The current societal costs of bipolar I disorder (BDI) have not been comprehensively characterized in the United States, as previous studies are based on data from two decades ago. METHODS The costs of BDI were estimated for 2015 and comprised direct healthcare costs, non-healthcare costs, and indirect costs, calculated based on a BDI prevalence of 1%. The excess costs of BDI were estimated as the difference between the costs incurred by individuals with BDI and those incurred by individuals without BD or individuals from the general population. Direct healthcare costs were assessed using three large US claims databases for insured individuals and the literature for uninsured individuals. Direct non-healthcare and indirect costs were based on the literature and governmental publications. RESULTS The total costs of BDI were estimated at $202.1 billion in 2015, corresponding to an average of $81,559 per individual, while the excess costs of BDI were estimated at $119.8 billion, corresponding to an average of $48,333 per individual. The largest contributors to excess costs were caregiving (36%), direct healthcare costs (21%), and unemployment (20%). In sensitivity analyses, excess costs ranged from $101.2 to $124.3 billion. LIMITATIONS Direct healthcare costs were calculated based on a BDI diagnosis, thus excluding undiagnosed patients. Direct non-healthcare and indirect costs were based on combined estimates from the literature. CONCLUSIONS Besides direct healthcare costs, BDI was associated with substantial direct non-healthcare and indirect costs. More effective treatments and practices are needed to optimize therapeutic strategies and contain direct and indirect costs.
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Affiliation(s)
| | - Mallik Greene
- Health Economics & Outcomes Research, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA.
| | | | - Maelys Touya
- Health Economics and Outcomes Research (HEOR)-US, Lundbeck, Deerfield, IL, USA
| | - Eric Wu
- Analysis Group, Inc., Boston, MA, USA
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44
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Stiles BM, Fish AF, Vandermause R, Malik AM. The Compelling and Persistent Problem of Bipolar Disorder Disguised as Major Depression Disorder: An Integrative Review [Formula: see text]. J Am Psychiatr Nurses Assoc 2018; 24:415-425. [PMID: 29952230 DOI: 10.1177/1078390318784360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder. OBJECTIVE The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening. DESIGN An integrative review was conducted using standard criteria for evaluating research articles. RESULTS Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed. CONCLUSIONS Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.
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Affiliation(s)
- Brandie M Stiles
- 1 Brandie M. Stiles, PhD, MSN, PMHNP-BC, University of Missouri-St. Louis, St. Louis, MO, USA; Centerpointe Hospital, St. Louis, MO, USA
| | - Anne F Fish
- 2 Anne F. Fish, PhD, RN, FAHA, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Roxanne Vandermause
- 3 Roxanne Vandermause, PhD, RN, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Azfar M Malik
- 4 Azfar M. Malik, MD, MBA, Centerpointe Hospital, St. Louis, MO, USA
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45
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Michalak EE, McBride S, Barnes SJ, Wood CS, Khatri N, Balram Elliott N, Parikh SV. Bipolar disorder research 2.0: Web technologies for research capacity and knowledge translation. J Eval Clin Pract 2017; 23:1144-1152. [PMID: 28471066 DOI: 10.1111/jep.12736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Current Web technologies offer bipolar disorder (BD) researchers many untapped opportunities for conducting research and for promoting knowledge exchange. In the present paper, we document our experiences with a variety of Web 2.0 technologies in the context of an international BD research network: The Collaborative RESearch Team to Study psychosocial issues in BD (CREST.BD). METHODS Three technologies were used as tools for enabling research within CREST.BD and for encouraging the dissemination of the results of our research: (1) the crestbd.ca website, (2) social networking tools (ie, Facebook, Twitter), and (3) several sorts of file sharing (ie YouTube, FileShare). For each Web technology, we collected quantitative assessments of their effectiveness (in reach, exposure, and engagement) over a 6-year timeframe (2010-2016). RESULTS In general, many of our strategies were deemed successful for promoting knowledge exchange and other network goals. We discuss how we applied our Web analytics to inform adaptations and refinements of our Web 2.0 platforms to maximise knowledge exchange with people with BD, their supporters, and health care providers. CONCLUSIONS We conclude with some general recommendations for other mental health researchers and research networks interested in pursuing Web 2.0 strategies.
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Affiliation(s)
- Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Collaborative Research Team to study psychosocial issues in Bipolar Disorder (CREST.BD), Vancouver, BC, Canada
| | - Sally McBride
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven J Barnes
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Collaborative Research Team to study psychosocial issues in Bipolar Disorder (CREST.BD), Vancouver, BC, Canada
| | - Chanel S Wood
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Collaborative Research Team to study psychosocial issues in Bipolar Disorder (CREST.BD), Vancouver, BC, Canada
| | - Nasreen Khatri
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada.,Collaborative Research Team to study psychosocial issues in Bipolar Disorder (CREST.BD), Vancouver, BC, Canada
| | - Nusha Balram Elliott
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Collaborative Research Team to study psychosocial issues in Bipolar Disorder (CREST.BD), Vancouver, BC, Canada
| | - Sagar V Parikh
- University of Michigan, Ann Arbor, Michigan, USA.,University of Toronto, Toronto, Ontario, Canada.,Collaborative Research Team to study psychosocial issues in Bipolar Disorder (CREST.BD), Vancouver, BC, Canada
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46
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O'Donnell L, Himle JA, Ryan K, Grogan-Kaylor A, McInnis MG, Weintraub J, Kelly M, Deldin P. Social Aspects of the Workplace Among Individuals With Bipolar Disorder. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2017; 8:379-398. [PMID: 29416591 PMCID: PMC5798466 DOI: 10.1086/693163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is characterized by recurrent mood episodes and profound impairments in psychosocial functioning. Occupational disability is one of the most problematic impairments for individuals with BD due to high rates of unemployment and work impairments. Current evidence indicates that social stressors at work-such as social isolation, conflict with others, and stigmas-are common experiences for employed individuals with BD. Yet, few studies have examined the relationship between social stressors at work and overall occupational functioning, instead focusing on individual clinical features of the disorder. METHOD This cross-sectional study employed logistic and linear regressions to determine which demographic variables, mood symptoms, and social aspects of the work environment (exclusion, conflict, social support, stigma) were associated with work status (working vs. not working) and work functioning for individuals with bipolar disorder I and II. RESULTS Greater stigma and exclusion at work (p < .05) are associated with unemployment among adult individuals with BD, and higher degrees of depression and conflict at work (p < .05) are associated with work impairments for employed individuals. CONCLUSIONS By examining two distinct measures of work outcomes (work status and work functioning) within the same group of participants, this study provides a unique insight, revealing that predictors of occupational functioning vary based on the specific measure of work outcomes used. This study also emphasizes the need for treatments that address the clinical features of BD and intervene in the work environment to improve functioning and prevent unemployment among individuals with BD.
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Affiliation(s)
- Lisa O'Donnell
- Postdoctoral fellow at the University of California Los Angeles
| | - Joseph A Himle
- Associate Dean for Research and a professor of social work and psychiatry at the University of Michigan
| | - Kelly Ryan
- Clinical assistant professor of psychiatry at the University of Michigan
| | | | - Melvin G McInnis
- Thomas B. and Nancy Upjohn Woodworth Professor of Bipolar Disorder and Depression and a professor of psychiatry at the University of Michigan
| | - Jenna Weintraub
- Research associate in social work at the University of Michigan
| | - Marisa Kelly
- Research associate in psychiatry at the University of Michigan
| | - Patricia Deldin
- Professor of psychology and psychiatry at the University of Michigan
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47
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Clemente AS, Santos WJD, Nicolato R, Firmo JOA. Stigma related to bipolar disorder in the perception of psychiatrists from Belo Horizonte, Minas Gerais State, Brazil. CAD SAUDE PUBLICA 2017; 33:e00050016. [PMID: 28724024 DOI: 10.1590/0102-311x00050016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 08/24/2016] [Indexed: 11/22/2022] Open
Abstract
This research sought to understand meanings and implications of the stigma related to bipolar disorder in relation to social processes and local cultural value systems. Seven semidirected individual interviews were performed with psychiatrists (from Belo Horizonte city, Minas Gerais State, Brazil) and analyzed with referential from the Medical Anthropology. Some potential stigmatizing views about bipolar disorder patients were endorsed by respondents related to biomedical model of bipolar disorder. They claimed about the extreme trivialization of this diagnosis nowadays and observed that, in spite of the mitigation of stigma related to bipolar disorder over time, it remains an important issue, especially at labor fields and as a cause of refusal of treatment.
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Affiliation(s)
| | | | - Rodrigo Nicolato
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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48
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Nicholas J, Fogarty AS, Boydell K, Christensen H. The Reviews Are in: A Qualitative Content Analysis of Consumer Perspectives on Apps for Bipolar Disorder. J Med Internet Res 2017; 19:e105. [PMID: 28389420 PMCID: PMC5400886 DOI: 10.2196/jmir.7273] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/02/2017] [Accepted: 03/04/2017] [Indexed: 02/06/2023] Open
Abstract
Background The delivery of mobile health (mHealth) services is acceptable to mental health consumers. However, despite the benefits of accessibility, cost-effectiveness, anonymity, and ability to tailor content to individual needs, consumer engagement remains a hurdle for uptake and continued use. This may be unsurprising as few studies have examined app content from the consumer perspective or assessed consumer preferences for the content of apps for mental health management. An opportunity to examine consumer perspectives exists in using naturally generated data that is publically available in the Google Play and Apple app stores. Whereas commercial developers routinely use this data, to date there has been no in-depth evaluation within scientific research. Objective The aim of our study was to explore what consumers consider useful content for mental health management apps, identify unmet needs, and understand user expectations of mental health apps within the context of apps for bipolar disorder. Methods Publically available English language consumer reviews of 48 apps for bipolar disorder were used as data, providing a total of 2173 reviews. Review text was coded and analyzed using a team approach to qualitative content analysis. Results were presented in 2 forms: (1) a quantitative summary of the 9 major and minor themes and (2) a qualitative synthesis of key thematic findings. Results The majority of reviews were for symptom monitoring apps (87.94%, 1911/2173). The qualitative content analysis revealed 5 main themes: (1) laudatory talk, comments regarding the app’s benefits including helpfulness and successful design features (74.00% of reviews, 1608/2173); (2) unfavorable feedback, negative reviews largely concerning unmet needs, privacy and technical issues, and potential dangers of app use (25.54%, 555/2173); (3) conceptions of community, referring to both communities of users with mental ill-health accessed via the app and a community created among app users and developers (24.25%, 527/2173); (4) wishlist features, app features requested by users (17.53%, 381/2173); and (5) apps and therapy, app use within clinical care (10.58%, 230/2173). Four minor themes were also identified: (1) app cost, (2) privacy and data security, (3) comparisons with traditional monitoring, and (4) evidence-based mHealth. Conclusions Although mostly positive, the proportion of reviews containing wishlist requests indicates consumer needs are not adequately addressed by currently available disorder management apps. Consumers value content that is helpful, supportive, and easy to use, and they are integrating apps into their health management and clinical care without necessarily considering the evidence-base or clinical effectiveness of the tool. User expectations regarding developer responsiveness to their needs has implications for community-based participatory research and integrated knowledge translation. However, this expectation is incompatible with current mHealth funding structures.
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Affiliation(s)
- Jennifer Nicholas
- Black Dog Institute, University of New South Wales, Sydney, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Andrea S Fogarty
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, Australia
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49
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Lim Q, McGill BC, Quinn VF, Tucker KM, Mizrahi D, Patenaude AF, Warby M, Cohn RJ, Wakefield CE. Parents' attitudes toward genetic testing of children for health conditions: A systematic review. Clin Genet 2017; 92:569-578. [PMID: 28170090 DOI: 10.1111/cge.12989] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 12/13/2022]
Abstract
This review assessed parents' attitudes toward childhood genetic testing for health conditions, with a focus on perceived advantages and disadvantages. We also evaluated the factors that influence parents' attitudes toward childhood genetic testing. We searched Medline, Medline In-Process, EMBASE, PsycINFO, Social Work Abstracts and CINAHL. We screened 945 abstracts and identified 21 studies representing the views of 3934 parents. Parents reported largely positive attitudes toward childhood genetic testing across different genetic tests with varying medical utility. Parents perceived a range of advantages and disadvantages of childhood genetic testing. Childhood genetic testing was viewed by most as beneficial. Parents' education level, genetic status, sex and sociodemographic status were associated with reported attitudes. This yielded some conflicting findings, indicating the need for further research. Genetic counseling remains essential to support this population in making well-informed decisions. Targeted interventions tailored to specific families with different sociodemographic characteristics may be useful. Further research on the long-term impact of childhood genetic testing on families is warranted.
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Affiliation(s)
- Q Lim
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - B C McGill
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - V F Quinn
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - K M Tucker
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - D Mizrahi
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - A F Patenaude
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - M Warby
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - R J Cohn
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - C E Wakefield
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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50
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Blanco C, Compton WM, Saha TD, Goldstein BI, Ruan WJ, Huang B, Grant BF. Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III. J Psychiatr Res 2017; 84:310-317. [PMID: 27814503 PMCID: PMC7416534 DOI: 10.1016/j.jpsychires.2016.10.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/07/2016] [Accepted: 10/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of this study was to present 12-month and lifetime prevalence, correlates, comorbidity, treatment and disability of DSM-5 bipolar I disorder. METHODS Nationally representative U.S. adult sample (N = 36,309), the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions - III. RESULTS Prevalences of 12-month and lifetime DSM-5 bipolar I disorder were 1.5% and 2.1% and did not differ between men (1.6% and 2.2%) and women (1.5% and 2.0%). Prevalences of bipolar I disorder were greater among Native Americans, and lower among Blacks, Hispanics and Asians/Pacific Islanders than whites. Rates were also lower among younger than older individuals, those previously married than currently married and with lower education and income relative to higher education and income. Bipolar I disorder was more strongly related to borderline and schizotypal personality disorders (adjusted odds ratios (AORS) = 2.2-4.7)), than to anxiety disorders (AORs = 1.3-2.9), and substance use disorders (AORs = 1.3-2.1) overall and among men and women. Quality of life was lower among individuals with bipolar I disorder relative to those without the disorder. Treatment rates among individuals with bipolar I disorder were low in the total sample (46%, SE = 2.63), among men (36.7%, SE = 3.82) and among women (55.8%, SE = 3.32). CONCLUSIONS Bipolar I disorder continues to be common disabling and highly comorbid disorder among men and women, contributing substantially to low quality of life and burden of disease in our society.
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Affiliation(s)
- Carlos Blanco
- Division of Epidemiology, Service and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., Rockville, MD, 20852, USA.
| | - Wilson M. Compton
- Division of Epidemiology, Service and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd. Rockville, MD 20852
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| | - Benjamin I. Goldstein
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room FG 53, Toronto, Canada, M4N 3M5
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD, 20852, USA.
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
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