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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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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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Pedersen AM, Straarup KN, Thomsen DK. "My life disappeared in illness": bipolar disorder and themes in narrative identity. Memory 2022; 30:857-868. [PMID: 35297312 DOI: 10.1080/09658211.2022.2051555] [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: 10/18/2022]
Abstract
Bipolar Disorder (BD) has substantial consequences for the course of life and the formation of self and identity. In the present study, we extended the existing literature by examining narrative identity. Fifteen female outpatients with remitted BD and fifteen non-clinical control participants described past and future chapters in their life stories. The chapters were coded for agency, communion, redemption and contamination. Patients diagnosed with BD described their past chapters with lower agency, lower communion and more contamination compared to the control group. Contrary to our expectations, the future chapters described by the BD patients did not differ significantly from the control group. A focus on narrative identity may contribute to understanding the disorder and inspire interventions targeting personal recovery.
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Affiliation(s)
- Anne Mai Pedersen
- Department of Psychology, Aarhus University, Aarhus, Denmark.,Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus, Denmark
| | | | - Dorthe Kirkegaard Thomsen
- Department of Psychology, Aarhus University, Aarhus, Denmark.,Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus, Denmark
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Weiner L, Li Chen Che M, Bertschy G, Weibel S. Patients' Perspective of the Impacts of Group Psychoeducation for Bipolar Disorder: A Qualitative Study. J Nerv Ment Dis 2022; 210:71-76. [PMID: 34982753 DOI: 10.1097/nmd.0000000000001414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Little is known regarding the mechanisms involved in the clinical improvement of patients with bipolar disorder (BD) after group psychoeducation. We aimed at investigating these mechanisms by focusing on their subjective experience. Thirteen patients with BD aged 35.54 (SD, 12.06) were recruited. Interviews were analyzed using thematic analysis. Four high-order themes were identified: a) relationship among patients, b) effect of the facilitation style, c) program-related factors, and d) subjective impacts. "Relationships among patients" included a lower-ordered theme evoked by all participants, that is, "shared experiences." Shared experiences included acknowledging that BD has a neurobiological substrate and that its manifestations are similar in BD; the social support and empowering message of those who have managed to exert control over the illness were also highlighted. Our results shed some light on the mechanisms underlying the effectiveness of group psychoeducation. The shared experience of patients seems to play an important role, probably through destigmatization.
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AY R, KILINÇEL O. Hekimlerin Bipolar Afektif Bozukluğa Karşı Damgalayıcı Tutumların Değerlendirilmesi. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2021. [DOI: 10.33631/duzcesbed.830836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Predictors of 1-year rehospitalization in inpatients with bipolar I disorder treated with atypical antipsychotics. Int Clin Psychopharmacol 2020; 35:263-269. [PMID: 32459726 DOI: 10.1097/yic.0000000000000318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bipolar disorder (BPD) is debilitating disorder, and patients can experience multiple relapses and subsequent hospitalizations. Since pharmacotherapy is the mainstay of treatment for patients with BPD, investigations on the effects of atypical antipsychotics (AAP) on reducing rehospitalization risk are crucial. The objective of study is to explore predictors of 1-year rehospitalization in patients with bipolar I disorder treated with AAP. A retrospective chart review on inpatients with bipolar I disorder was conducted. All participants were followed up for 1 year, and they were subdivided into three AAP treatment groups (olanzapine, risperidone, and quetiapine group). Kaplan-Meier survival analysis was implemented to detect time to rehospitalization due to any mood episodes within 1 year after discharge. Cox proportional regression model was adopted to find predictors of 1-year hospitalization in patients who experienced rehospitalization. One hundred thirty-eight participants were included in the study, and a 1-year rehospitalization rate was 18.1%. Time to rehospitalization did not differ between three AAP treatment groups. Predictors of rehospitalization due to any episode within 1 year were family history of depression and number of previous admission. Our findings can be conducive to understanding prognosis, and predicting rehospitalization risk in patients with BPD on AAP.
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Validation of a brief scale for the assessment of distress associated to bipolar disorder. THE EUROPEAN JOURNAL OF PSYCHIATRY 2019. [DOI: 10.1016/j.ejpsy.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The impact of a CBT-based bipolar disorder psychoeducation group on views about diagnosis, perceived recovery, self-esteem and stigma. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPrevious research has shown that psychoeducation for bipolar disorder (BD) improves symptoms and reduces relapse risk, but there is little research on how this impacts stigma, perceived recovery and views about diagnosis. The aim of this study was to explore whether a cognitive behaviour therapy (CBT)-based 12-week BD psychoeducation group conducted in a community mental health team for adults impacted perceived stigma, diagnosis-related self-esteem, recovery and views about diagnosis. The case series pre- and post-group had 23 participants across three groups. The Brief Illness Perception Questionnaire, views on Manic Depression Questionnaire, Bipolar Recovery Questionnaire and author-constructed questions were completed pre and post. Twenty participants completed the group. An intent-to-treat repeated measures multiple analysis of variance showed significantly improved perceived recovery and improvements in sense of control and understanding around their diagnosis. Other specific questions such as understanding of triggers and impact of thinking patterns also improved. However, there was no change in the perceived stigma or self-esteem associated with living with BD. CBT-based psychoeducation groups may help improve perceived recovery and factors such as sense of control in BD. However, there appears to be no impact on stigma and self-esteem, and the role of non-specific factors needs to be examined further.Key learning aims
(1)To raise awareness of the impact of stigma and self-esteem in bipolar disorder.(2)To understand the content and structure of CBT-based psychoeducation groups.(3)To consider the potential benefits of CBT-based psychoeducation groups beyond symptoms and relapse reduction on factors such as perceived recovery.
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Richa S, Chammay R, Dargél A, Henry C, Masson M. Ethical considerations in bipolar disorders. Encephale 2018; 44:286-287. [PMID: 29415803 DOI: 10.1016/j.encep.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
The implications of biomedical ethics principles extend to both medical care and biomedical research. They are particularly relevant for psychiatry in which pathologies are often chronic and disabling. Bipolar disorders impact the ability to make judgements and to take decisions during mood episodes and remain a stigmatised condition. Early interventions, even those in the prodromal phase, pose ethical questions for both clinicians and researchers. The degree of patients' autonomy in their clinical care must also now be considered from a biomedical ethics perspective.
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Affiliation(s)
- S Richa
- Department of psychiatry, faculty of medicine, Saint-Joseph university, Pobox 17-5208 Beirut, Lebanon.
| | - R Chammay
- Department of psychiatry, faculty of medicine, Saint-Joseph university, Pobox 17-5208 Beirut, Lebanon
| | - A Dargél
- Unité perception et mémoire, Institut Pasteur, 25-28, rue du Docteur Roux, 75015 Paris, France; Unité mixte de recherche, centre national de la recherche scientifique, UMRS-CNRS 3571, 3, rue Michel Ange, 75016 Paris, France; Nightingale hospitals Paris-Clinique Bellevue-Meudon, 8, avenue du 11-Novembre-1918, 92190 Meudon, France
| | - C Henry
- Unité perception et mémoire, Institut Pasteur, 25-28, rue du Docteur Roux, 75015 Paris, France; Université Paris-Est, UPEC, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Pôle de psychiatrie, hôpital H. Mondor-A. Chenevier, AP-HP, 31, rue du Parc, 94000 Créteil, France
| | - M Masson
- Service-hospitalo universitaire, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Nightingale hospitals Paris-Clinique du Château, 11, bis rue de la Porte-Jaune, 92380 Garches, France
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Pal A, Sharan P, Chadda RK. Internalized stigma and its impact in Indian outpatients with bipolar disorder. Psychiatry Res 2017; 258:158-165. [PMID: 29028582 DOI: 10.1016/j.psychres.2017.09.087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 09/30/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
Abstract
Patients with many psychiatric disorders have considerable internalized stigma. The current study intended to examine the level and impact of internalized stigma in patients with bipolar affective disorder (BPAD). 60 patients with BPAD, 33 patients with schizophrenia and 30 patients with anxiety disorders were compared on Internalized Stigma of Mental Illness scale and The Stigma Scale. The patients with BPAD were assessed using Rosenberg Self-Esteem Scale (RSES), Participation scale (PS) and World Health Organization Quality Of Life - Brief Version - Hindi (WHOQOL-bref). Significant differences were found in all domains of self-stigma measures among the three groups. Using appropriate covariates, it was found that the differences were significant and independent of the effect of the covariates. In patients of BPAD, stigma and its domains were significantly correlated with the measures on monthly income, education, socio-occupational functioning, RSES, PS and WHOQOL-bref. Patients with BPAD experience substantial stigma, which was intermediate between that experienced by patients with schizophrenia (higher) and that experienced by patients with anxiety disorder (lower). Internalized stigma has significant impact on self-esteem, socio-occupational participation and functioning, and quality of life in patients with BPAD. Small sample size, sample of convenience, and cross-sectional design, limit the generalizability of the results.
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Affiliation(s)
- Arghya Pal
- Department of Psychiatry, Medical College and Hospital, Kolkata, India.
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Rakesh Kumar Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
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Pedersen AM, Nielsen Straarup K, Thomsen DK. Narrative identity in female patients with remitted bipolar disorder: a negative past and a foreshortened future. Memory 2017; 26:219-228. [DOI: 10.1080/09658211.2017.1344250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Anne Mai Pedersen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
- Center on Autobiographical Memory Research, (CON AMORE), Aarhus University, Aarhus C, Denmark
| | | | - Dorthe Kirkegaard Thomsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
- Center on Autobiographical Memory Research, (CON AMORE), Aarhus University, Aarhus C, Denmark
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