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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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Teh WL, Samari E, Cetty L, Kumarasan R, Devi F, Shahwan S, Chandwani N, Subramaniam M. A reduced state of being: The role of culture in illness perceptions of young adults diagnosed with depressive disorders in Singapore. PLoS One 2021; 16:e0252913. [PMID: 34106985 PMCID: PMC8189483 DOI: 10.1371/journal.pone.0252913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/26/2021] [Indexed: 11/27/2022] Open
Abstract
Illness perceptions form a key part of common-sense models which are used widely to explain variations in patient behaviours in healthcare. Despite the pervasiveness of depressive disorders worldwide and in young adults, illness perceptions of depressive disorders have not yet been well understood. Moreover, while a high proportion of cases of depressive disorders reside in South-east Asia, few have explored illness perceptions that are culturally relevant to this region. To address these limitations, this study aimed to understand illness perceptions of young adults diagnosed with depressive disorders. Face-to-face semi-structured interviews were conducted among Chinese, Malay, and Indian young adults aged 20 to 35 years old, who were seeking treatment at a psychiatric hospital. Data reached saturation after 33 interviews (10 to 12 interviews per ethnic group) and five themes emerged from the thematic analysis: 1) A reduced state of being experienced at a point of goal disengagement, 2) the accumulation of chronic stressors in a system that demands success and discourages the pursuit of personally meaningful goals, 3) a wide range of symptoms that are uncontrollable and disabling, 4) poor decision making resulting in wasted opportunities, with some positive takeaways, and 5) accepting the chronicity of depression. Young adults typically experienced depression as a reduced state of being and it was thought of cognitively as an entity that may be a part of or separate from the self. Over and beyond these aspects of cognitive representations was the emergence of themes depicting conflicts and dilemmas between the self and the social environment that threatened self-identity and autonomy. Addressing these conflicts in therapy would therefore be of utmost relevance for young adults recovering from depressive disorders in the local setting.
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Affiliation(s)
- Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Fiona Devi
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Nisha Chandwani
- Department of Mood and Anxiety, Institute of Mental Health, Singapore, Singapore
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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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Perceptions of ADHD Among Diagnosed Children and Their Parents: A Systematic Review Using the Common-Sense Model of Illness Representations. Clin Child Fam Psychol Rev 2019; 21:57-93. [PMID: 29079900 DOI: 10.1007/s10567-017-0245-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Research on children and parents' experiences of ADHD has grown in recent years, attracting attention to their subjective perception of ADHD as a disorder. Theoretical accounts of illness perception suggest that it is multi-dimensional, consisting of at least five core constructs (see the common-sense model of illness representations or CSM: Leventhal et al., in: Rachman (ed) Medical psychology, Pergamon, New York, vol 2, pp 7-30, 1980, in: Baum, Taylor, Singer (eds) Handbook of psychology and health: social psychological aspects of health, Earlbaum, Hillsdale, vol 4, pp 219-252, 1984). We suggest that the application of CSM in children/adolescents with ADHD and their parents may play an important role in understanding their coping behavior, treatment adherence, and emotional well-being. A systematic search identified 101 eligible studies that investigated the perception of ADHD among diagnosed children/adolescents and their parents. In general, these studies support the existence of the multiple facets of illness representations proposed by the CSM in both diagnosed youngsters and parents indicating substantial variability among both parents and youngsters on each of these facets. The comprehensive assessment of the representations of ADHD indicates imbalance attention to the different representations of ADHD in the literature; disproportional research attention has been paid to the perceived effectiveness of treatment (i.e., treatment control dimension) compared to other illness representations (e.g., timeline, consequence, and coherence), despite research showing their relevance to treatment adherence among other implications. The review identifies the limitation of existing relevant research, needed foci for future studies, specific testable hypotheses, and potential clinical implications of the multifaceted representations of ADHD among youngsters and carers alike.
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'What people diagnosed with bipolar disorder experience as distressing': A meta-synthesis of qualitative research. J Affect Disord 2019; 248:108-130. [PMID: 30731279 DOI: 10.1016/j.jad.2019.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is considered to have a significantly negative impact on functioning and prognosis is considered poor. Current treatments are modestly effective and predominantly focus on reducing extreme mood fluctuations and symptoms, yet less is known about what patients themselves describe as distressing. Therefore we aimed to assess this through a systematic review. METHODS A comprehensive literature search was conducted in four major bibliographic databases in August 2017, updated in July 2018. Qualitative studies exploring BD were included if they contained themes related to distress. First person accounts from people with BD discussing what they experience as distressing were extracted and synthesised using thematic synthesis. Author interpretations were also extracted to support the synthesis. RESULTS Twenty-four studies were included. Five main analytical themes were developed: 1) diagnosis, 2) loss, 3) uncertainty, 4) threat and 5) relationships. Two further crosscutting themes were identified as 1) stigma and 2) fear of relapse. Implications for interventions to focus on these causes of distress also emerged. LIMITATIONS The included studies did not adequately examine the authors' potential own biases and influences within their interpretations of the data. One author predominantly undertook data extraction and coding for the current review, although research team discussions led to an agreed consensus on themes. CONCLUSIONS This was the first qualitative study to specifically explore distress in BD. The meta-synthesis highlights important areas that people with BD experience as distressing. Adaptations to current interventions, to focus on what people find distressing could seek to improve treatment outcomes.
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Chakrabarti S. Treatment alliance and adherence in bipolar disorder. World J Psychiatry 2018; 8:114-124. [PMID: 30425942 PMCID: PMC6230924 DOI: 10.5498/wjp.v8.i5.114] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/07/2018] [Accepted: 10/23/2018] [Indexed: 02/05/2023] Open
Abstract
The clinician patient relationship lies at the core of psychiatric practice and delivery of mental health care services. The concept of treatment alliance in psychiatry has its origins in psychotherapy, but has also been influenced by several other constructs such as patient-centred care (PCC) and shared decision-making (SDM). Similarly, there has been a shift in conceptualization of treatment-adherence in psychiatric disorders including bipolar disorder (BD) from illness-centred and clinician-centred approaches to patient-centred ones. Moreover, the traditional compliance based models are being replaced by those based on concordance between clinicians and patients. Newer theories of adherence in BD place considerable emphasis on patient related factors and the clinician patient alliance is considered to be one of the principal determinants of treatment-adherence in BD. Likewise, current notions of treatment alliance in BD also stress the importance of equal and collaborative relationships, sensitivity to patients' viewpoints, sharing of knowledge, and mutual responsibility and agreement regarding decisions related to treatment. Accumulated evidence from quantitative research, descriptive accounts, qualitative studies and trials of psychosocial interventions indicates that efficacious treatment alliances have a positive influence on adherence in BD. Then again, research on the alliance-adherence link in BD lags behind the existing literature on the subject in other medical and psychiatric conditions in terms of the size and quality of the evidence, the consistency of its findings and clarity about underlying processes mediating this link. Nevertheless, the elements of an effective alliance which could have a positive impact on adherence in BD are reasonably clear and include PCC, collaborative relationships, SDM, open communication, trust, support, and stability and continuity of the relationship. Therefore, clinicians involved in the care of BD would do well to follow these principles and improve their interpersonal and communication skills in order to build productive alliances with their patients. This could go a long way in confronting the ubiquitous problem of non-adherence in BD. The role of future research in firmly establishing the alliance-adherence connection and uncovering the processes underlying this association will also be vital in devising effective ways to manage non-adherence in BD.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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Garcia Mantilla JS, Vasquez Rojas RA. The Visible and Less Visible in the Suffering of a Conversion Disorder in Children and Adolescents. A Qualitative Study of Illness Explanatory Models Presented to Caregivers of Children and Adolescents with Conversion Disorder. ACTA ACUST UNITED AC 2018; 47:155-164. [PMID: 30017038 DOI: 10.1016/j.rcp.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/05/2017] [Accepted: 02/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conversion disorder is a challenge for clinicians due to the conceptual gaps as regards its pathogenesis, the way in which it converges with other psychiatric disorders, and the lack of approaches to the experiences of both patients and family members with the disease. OBJECTIVE To describe Explanatory Models (EM) offered to caregivers of paediatric patients with conversion disorder who attended the Hospital de la Misericordia. METHODS A qualitative study was conducted with a convenience sample of 10 patients who attended the Hospital de La Misericordia, ¿Bogota? between May 2014 and April 2015. The tool used was an in-depth interview applied to parents and/or caregivers. RESULTS Caregivers have different beliefs about the origin of the symptoms, especially considering sickness, magical-mystical factors, and psychosocial factors. The symptoms are explained in each case in various ways and there is no direct relationship between these beliefs, the pattern of symptoms, and help-seeking behaviours. Symptomatic presentation is polymorphous and mainly interferes in the patient's school activities. The medical care is perceived as relevant, and psychiatric care as insufficient. Among the therapeutic routes, consultations with various agents are described, including medical care, alternative medicine, and magical-religious approaches. CONCLUSIONS EMs in conversion disorder are varied, but often include magical-religious elements and psychosocial factors. The underlying beliefs are not directly related to help-seeking behaviours or other variables.
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Forgione FA. Diagnostic Dissent: Experiences of Perceived Misdiagnosis and Stigma in Persons Diagnosed With Schizophrenia. JOURNAL OF HUMANISTIC PSYCHOLOGY 2018. [DOI: 10.1177/0022167818777151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is not uncommon for individuals to disagree with their psychiatric diagnosis. The experience of perceived misdiagnosis can be challenging for service users, as mainstream psychiatric theory often views this disagreement as an indication of “poor insight” into their putative illness. Some researchers have suggested that labeling a service user as lacking insight can be detrimental to the service user’s recovery. Regardless of whether a person agrees with his or her diagnosis, persons labeled with “mental illness” sometimes internalize the discrimination and stigma that they encounter. However, few studies have examined the lived experience of disagreeing with a diagnosis. The present study investigated the first-person experiences of three individuals who believed that they were misdiagnosed with a psychotic disorder. As part of a larger study, participants completed in-depth interviews about their life history and experiences in psychiatric hospitals. Data were analyzed using phenomenological methods. Participants felt that their clinicians assigned an erroneous and stigmatizing label that did not match their self-experience. Diagnostic dissent, a form of perceived misdiagnosis, was a way for individuals to assert their self-experience against perceived invalidation and stigmatizing labels.
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Illness perceptions and adherence in bipolar disorder: An exploratory study. Compr Psychiatry 2018; 80:109-115. [PMID: 29091776 DOI: 10.1016/j.comppsych.2017.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/13/2017] [Accepted: 10/07/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND According to the Self-Regulation Model, illness perceptions influence an individual's coping (such as the taking of treatment) and emotional response to their illness. Emerging research suggests that this model could be used to explore illness perceptions in mental health. The aim of this exploratory study is, firstly, to measure and describe illness perception in French patients with a bipolar diagnosis and, secondly, to explore associations between illness perceptions and adherence in this population. METHOD Thirty-eight French patients with bipolar disorder completed the Illness Perception Questionnaire for Schizophrenia (except the identity dimension). We measured medication adherence with the Medication Adherence Rating Scale. RESULTS Our results showed that patients with high perceptions concerning treatment control, low perceptions of negative emotions of their mental illness, low perception of consequences and high comprehension of their disorder had a better adherence. CONCLUSIONS Illness perceptions can provide a framework for understanding adherence in bipolar disorder, and the findings could have important clinical and research implications.
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Hussain S, Imran N, Hotiana UA, Mazhar N, Asif A. Illness Perceptions in Patients of Schizophrenia: A Preliminary Investigation from Lahore, Pakistan. Pak J Med Sci 2017; 33:829-834. [PMID: 29067048 PMCID: PMC5648947 DOI: 10.12669/pjms.334.13128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Objective: Patient’s perception of their illness influences their healthcare decisions. The objectives of this study were to explore patient’s own beliefs about their illness (Schizophrenia) and perceived social support, and its impact on their attitudes toward pharmacological treatment in Lahore, Pakistan. Methods: This study was conducted at Mayo Hospital Lahore from March to September 2016. Hundred individuals suffering from Schizophrenia completed four questionnaires; a socio-demographic questionnaire, the Illness Perception Questionnaire for Schizophrenia(IPQ-S), Drug attitude Inventory-10 (DAI) and Multidimensional Scale of Perceived Social Support (PSS). Results: Stress, family problems, lack of friends & financial worries were endorsed strongly by patients as cause of their mental illness. Ambiguity regarding their mental illness duration and personal control was observed. Patients’ perceived significant negative consequences, negative emotional response, as well as had poor understanding of their mental illness and treatment effectiveness. Statistically significant gender differences in treatment control and illness coherence subscales of IPQS were observed. Drug attitude inventory was positively correlated with Treatment control subscale (p < .01) and negatively correlated with Illness coherence subscale of IPQS (p < .05). The negative consequences subscale and perceived social support was negatively correlated (p < .01). Conclusion: Patient’s perception about their own illness is predictor of their drug taking attitude and perceived social support. Study results should help to develop new interventions to correct inaccurate beliefs in patients with schizophrenia to improve illness outcome.
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Affiliation(s)
- Sadia Hussain
- Ms. Sadia Hussain, MSc Psychology. Intern Psychologist, Academic Department of Psychiatry & Behavioural Sciences King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Nazish Imran
- Dr. Nazish Imran, MBBS; FRCPsych; MRCPsych (London). Associate Professor, Child & Family Psychiatry Department. King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Usman Amin Hotiana
- Dr. Usman Amin Hotiana, MBBS; FCPS (Psy). Assistant Professor, King Edward Medical University/Mayo Hospital, Lahore, Pakistan Academic Department of Psychiatry & Behavioral Sciences
| | - Nauman Mazhar
- Dr. Nauman Mazhar, MBBS; MD(Psy); FCPS(Psy)Senior Registrar, Department of Psychiatry Services Hospital, Lahore, Pakistan
| | - Aftab Asif
- Prof. Aftab Asif, MBBS; MRCPsych Professor of Psychiatry, Academic Department of Psychiatry & Behavioural Sciences, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
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Kaite CP, Karanikola M, Merkouris A, Papathanassoglou EDE. "An ongoing struggle with the self and illness": α meta-synthesis of the studies of the lived experience of severe mental illness. Arch Psychiatr Nurs 2015; 29:458-73. [PMID: 26577563 DOI: 10.1016/j.apnu.2015.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/16/2015] [Accepted: 06/26/2015] [Indexed: 12/30/2022]
Abstract
The diverse experiences of severely mentally ill persons, most of the times, have not been taken into account, or integrated to the treatment procedures. This meta-synthesis aimed to examine what is like to live with severe mental illness narratives by employing a meta-ethnographic synthesis of seventeen published peer reviewed qualitative studies. Third order analysis revealed as core theme "An ongoing struggle for reconciliation with the self and the illness". Other themes included amongst others: loss of identity, pain of having had one's life stolen, being an outcast. The identification of the importance of the alterations of self-identity throughout the continuum of the severe mental disorder may be the focus of targeted psychosocial interventions.
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Affiliation(s)
- Charis P Kaite
- Cyprus University of Technology Department of Nursing, School of Health Sciences, Vragadinou, 3041-Limassol, Cyprus.
| | - Maria Karanikola
- Cyprus University of Technology Department of Nursing, School of Health Sciences, Vragadinou, 3041-Limassol, Cyprus.
| | - Anastasios Merkouris
- Cyprus University of Technology Department of Nursing, School of Health Sciences, Vragadinou, 3041-Limassol, Cyprus.
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Gatzoyia D, Kotsis K, Koullourou I, Goulia P, Carvalho AF, Soulis S, Hyphantis T. The association of illness perceptions with depressive symptoms and general psychological distress in parents of an offspring with autism spectrum disorder. Disabil Health J 2013; 7:173-80. [PMID: 24680046 DOI: 10.1016/j.dhjo.2013.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 09/28/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Raising a child with an autism spectrum disorder (ASD) is a severe stressor and parents often present high levels of depression. Depression is associated with illness perceptions but this association has not been studied in parents of ASD offspring. OBJECTIVE We aimed to assess the prevalence of psychological distress symptoms and their associations with illness perceptions in parents with an ASD offspring. METHODS In 111 parents of ASD offspring we assessed depressive symptoms (PHQ-9), illness perceptions (B-IPQ) and general psychological distress (GHQ-28). Multiple linear and logistic regressions were used to assess their independent associations. RESULTS The prevalence of parental clinically significant depressive symptoms was 34.2%, while 55% presented clinically significant levels of general psychological distress. Younger parents and those with lower financial resources had greater psychological distress and more severe depressive symptoms. Parents felt that the condition impacted their lives and believed it would be chronic. Their beliefs about the consequences and the chronicity of the disorder were significant independent correlates of their psychological distress and depressive symptoms severity. CONCLUSIONS These findings indicate that a remarkable proportion of parents with an ASD offspring present clinically significant depressive symptoms, which were associated with illness perceptions relevant to the consequences and the chronicity of the disorder. Our data encourage psychotherapeutic interventions aiming to support parents to deal with the consequences and chronicity of their offspring's disorder, in order to reduce parental psychological distress.
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Affiliation(s)
- Dimitra Gatzoyia
- Department of Primary Education, Special and Intercultural Education, University of Ioannina, Greece
| | - Konstantinos Kotsis
- Department of Psychiatry, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Iouliani Koullourou
- Department of Psychiatry, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Panagiota Goulia
- Department of Psychiatry, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - André F Carvalho
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Spyros Soulis
- Department of Primary Education, Special and Intercultural Education, University of Ioannina, Greece
| | - Thomas Hyphantis
- Department of Psychiatry, Medical School, University of Ioannina, 45110 Ioannina, Greece.
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Russell L, Moss D. A Meta-Study of Qualitative Research Into the Experience of ‘Symptoms’ and ‘Having a Diagnosis’ for People Who Have Been Given a Diagnosis of Bipolar Disorder. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i3.675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Russell L, Moss D. A Meta-Study of Qualitative Research Into the Experience of ‘Symptoms’ and ‘Having a Diagnosis’ for People Who Have Been Given a Diagnosis of Bipolar Disorder. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i2.560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Constructed as a barrier to treatment adherence, ambivalence is typically pathologized in qualitative research on “bipolar disorder”—seen as something to be feared and eradicated. Here, I critically review this position, arguing that it is constructed through a “lens of risk” that problematically presumes people have a chronic mental illness that requires lifelong pharmaceutical intervention. I then draw on the accounts of three young women who have been diagnosed with bipolar disorder to demonstrate how people’s concerns, questions, and dreams could instead be seen as a site of expertise about diagnostic and treatment practices; in turn using their ambivalence to stitch together an alternative analytic “lens of desire” through which to re-view accounts of bipolar disorder. Overall this article is thus both a commentary on mainstream research practices in psychology and an experiment with how we might look differently; believing that perhaps the real risk associated with people’s ambivalence is its ability to force us—psychologists and psychiatrists—to question the ways in which we do madness.
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Baines T, Wittkowski A. A Systematic Review of the Literature Exploring Illness Perceptions in Mental Health Utilising the Self-Regulation Model. J Clin Psychol Med Settings 2012; 20:263-74. [DOI: 10.1007/s10880-012-9337-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Patel S, Wittkowski A, Fox JRE, Wieck A. An exploration of illness beliefs in mothers with postnatal depression. Midwifery 2012; 29:682-9. [PMID: 22882968 DOI: 10.1016/j.midw.2012.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/31/2012] [Accepted: 06/10/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE to explore illness beliefs in women with postnatal depression and suggest an appropriate health belief model. About 10% of recently delivered mothers suffer from depression. Postnatal depression may differ from depression occurring at other times in an individual's life not only symptomatically but also experiences, perceptions and beliefs about the illness differ because of the individual's specific role as a carer for a newborn baby. Whilst illness beliefs have been extensively examined using models from physical health, recent studies have pointed out that physical health models may not provide an appropriate framework to explore mental health difficulties and require adapting. DESIGN qualitative study using face-to-face interviews for data collection. SETTING Greater Manchester, England. METHODS as illness beliefs have not yet been formally assessed using established questionnaires, the present study employed qualitative methodology to explore illness beliefs in mothers with postnatal depression (PND). Semi-structured interviews were conducted with 11 participants who were depressed following the birth of their child. Interview transcripts were analysed using grounded theory methodology. The point of theoretical sufficiency was reached with this sample size. FINDINGS the rich data allowed for a theory of illness beliefs in PND to be developed encompassing six core categories: 'unmet expectations', 'identifying stressors in their life context', 'conflict over label', 'antidepressants: the lesser of two evils', 'loss of time' and 'uncertain futures.' KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE participants made multiple appraisals of their PND in light of their initial difficulties, their improvements and consequences, the future and subsequent service involvement. Participants' narratives were conflicting and uncertain with internal struggles evident as mothers were torn between their desire to be good mothers and their perceptions that PND meant that they were not good enough mothers. Thus, the themes identified in this study did not match onto the key dimensions postulated by Leventhal's self-regulation model of illness beliefs.
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Affiliation(s)
- Sonia Patel
- Division of Clinical Psychology, University of Manchester, Manchester, UK
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Inder M, Crowe M, Moor S, Carter J, Luty S, Joyce P. ‘It wouldn’t be me if I didn’t have bipolar disorder’: managing the shift in self-identity with bipolar disorder. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1752-9824.2011.01117.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jönsson PD, Skärsäter I, Wijk H, Danielson E. Experience of living with a family member with bipolar disorder. Int J Ment Health Nurs 2011; 20:29-37. [PMID: 21199242 DOI: 10.1111/j.1447-0349.2010.00704.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Bipolar disorder (BD) is a severe illness that has a serious impact on the lives of those affected and on their families. The aim of this study was to elucidate what it means for family members to live with an adult person who has BD, with reference to their views concerning the condition of the person affected and the future. During 2005, 17 family members of people with the disorder were interviewed, and the data obtained were subjected to a qualitative content analysis. The findings showed that family members felt alone with their experiences and struggled to make sense of and to maintain normality, as their life was encroached on by the condition. Bearing the burden of responsibility and control made it difficult for family members to focus on their own future. To build hope, they needed opportunities to share their experiences with others, increased understanding of the condition, and relief from the burden they bore. This study underlines the importance of strengthening support holistically for family members living with an adult person with BD. Support and interventions concerning these families' needs have to be developed and should be provided by all mental health-care services.
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Illness perceptions: are beliefs about mental health problems associated with self-perceptions of engagement in people with psychosis? Behav Cogn Psychother 2010; 39:151-63. [PMID: 21062529 DOI: 10.1017/s1352465810000627] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Self-Regulation Model (SRM) has been presented as a framework for assessing the perceptions people hold about their mental health problem. Currently no direct attempts have been made to assess the association between illness perceptions and engagement in psychosis. Engagement is an important issue for health professionals providing support to people with psychosis; therefore, research demonstrating a link between illness perceptions and engagement may enable targeted interventions to facilitate engagement and enhance outcome. AIM To assess whether beliefs about mental health are associated with self-perceptions of engagement in people with psychosis. METHOD Participants with psychosis completed two questionnaires; beliefs about mental health and self-perceptions of engagement with mental health services. RESULTS A belief that the mental health difficulty has fewer negative consequences, increased perceptions of personal ability to control the mental health difficulty, a belief that treatment is helpful in controlling symptoms and a more coherent understanding of the mental health difficulty were all associated with higher self-perception engagement scores. Multivariate analyses indicated that a more coherent understanding and a belief that treatment is helpful were the strongest and most consistent predictors of higher self-perception engagement scores. However, the direction of the associations cannot be established. CONCLUSIONS This study suggests that the SRM is a promising model for mental health problems and that beliefs about mental health are associated with self-perceptions of engagement in people with psychosis. The importance of further intervention-based research studies that examines causality is highlighted.
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Suto M, Murray G, Hale S, Amari E, Michalak EE. What works for people with bipolar disorder? Tips from the experts. J Affect Disord 2010; 124:76-84. [PMID: 19969370 DOI: 10.1016/j.jad.2009.11.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 11/10/2009] [Accepted: 11/10/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Little is known about how patients successfully manage their bipolar disorder (BD). This is a remarkable gap in the BD literature, given that current treatments are inadequate and information about beneficial self-management strategies could have clinical and theoretical implications. Here, we present results from a study of self-management strategies used by a sample of high-functioning individuals with BD. METHODS The objectively rated Multidimensional Scale of Independent Functioning (MSIF) was used to confirm high functioning status (score <3) amongst a sample of individuals self-described as functioning well with BD type I or II (N=32). Participants completed quantitative scales to assess psychiatric history, current symptoms, functioning and quality of life, and underwent either an individual interview or focus group to answer open questions about the self-management strategies they used to maintain or regain wellness. RESULTS Wellness strategies fell into the following themes: 1) Sleep, rest, exercise and diet; 2) Ongoing monitoring; 3) Enacting a plan; 4) Reflective and meditative practices; 5) Understanding BD and educating others; 6) Connecting with others. CONCLUSIONS The wellness strategies described by the current sample have substantial overlap with those identified in the sole comparable qualitative study. They are also broadly consistent with, and serve to elaborate on proposed mechanisms of therapeutic action in adjunctive psychosocial interventions for BD. The findings constitute hopeful stories for people affected by the disorder and suggest further research to confirm and refine mechanisms of beneficial effect in BD.
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Affiliation(s)
- Melinda Suto
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
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"I really don't know whether it is still there": ambivalent acceptance of a diagnosis of bipolar disorder. Psychiatr Q 2010; 81:157-65. [PMID: 20182915 DOI: 10.1007/s11126-010-9125-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Questioning a diagnosis of bipolar disorder is not surprising given the chronic and fluctuating nature of the illness. Qualitative research using thematic analysis was used to derive an understanding of the process patients used to make sense of their diagnosis of bipolar disorder. The findings suggested that receiving a diagnosis was an active process. Factors such as fluctuating moods, changing diagnoses or misdiagnosis, difficulties patients have differentiating self from illness, mistrust in mental health services, and experiences of negative side effects of medication can contribute to ambivalence about the diagnosis and lead to relapse. These findings highlight the need for clinicians to focus on patients' perceptions of bipolar disorder and work with the ambivalence in the process of facilitating greater acceptance. This has the potential for reducing relapses through increased adherence with treatment.
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Proudfoot JG, Parker GB, Benoit M, Manicavasagar V, Smith M, Gayed A. What happens after diagnosis? Understanding the experiences of patients with newly-diagnosed bipolar disorder. Health Expect 2009; 12:120-9. [PMID: 19538647 DOI: 10.1111/j.1369-7625.2009.00541.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED Bipolar disorder is chronic condition involving episodes of both depression and elevated mood, associated with significant disability and high relapse rates. Recent estimates suggest a lifetime prevalence of 5%. Little is known about the subjective experiences of patients after receiving a diagnosis of bipolar disorder, and the impact of these experiences on patients' willingness and ability to work with their health professionals to find the most effective combination of treatments and to set up self-management plans. OBJECTIVE This paper describes a qualitative study exploring the experiences and difficulties faced by patients after they have received a diagnosis of bipolar disorder, as expressed online to expert patients trained to provide informed support. DESIGN Qualitative study. SETTING Online communication within a public health service setting. PARTICIPANTS Twenty-six participants with recently-diagnosed bipolar disorder communicated online with 'Informed Supporters', people who had been managing their bipolar disorder effectively for 2 years or more, as part of an online psycho-education programme. RESULTS Participants cited unwanted side-effects of medication, coping with unpleasant symptoms, positive and negative reactions to the diagnosis, identifying early warning signs and triggers of the illness, the loss of a sense of self, uncertainty about their future and stigma as issues of major importance after diagnosis. CONCLUSIONS Personal concerns and difficulties following diagnosis can undermine effective treatment, thwart self-management efforts and interfere with effective functioning. Such data are important for clinicians to take into account when they work in partnership with their patients to fine-tune treatments and help them set up self-management plans.
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Petrie KJ, Broadbent E, Kydd R. Illness perceptions in mental health: Issues and potential applications. J Ment Health 2009. [DOI: 10.1080/09638230802523047] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jönsson PD, Wijk H, Skärsäter I, Danielson E. Persons living with bipolar disorder--their view of the illness and the future. Issues Ment Health Nurs 2008; 29:1217-36. [PMID: 18979326 DOI: 10.1080/01612840802370764] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study is to describe the meaning of living with bipolar disorder (BD) based on individuals' views of the illness and their future. Interviews were conducted with 18 participants who resided in Sweden and had been diagnosed with bipolar disorder. Qualitative content analysis was employed. The findings revealed that daily life of those with BD was characterized by insecurity and challenges of accepting, understanding, and managing the illness. Increased hope of being able to influence the condition and receiving support to achieve a stable structure in life facilitates the management of daily life. Further research is needed on the next of kins' experiences of living with persons with BD.
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Affiliation(s)
- Patrik Dahlqvist Jönsson
- The Sahlgrenska Academy, The Vårdal Institute at Göteborg University, Institute of Health and Caring Sciences, Göteborg, Sweden.
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Broadbent E, Kydd R, Sanders D, Vanderpyl J. Unmet needs and treatment seeking in high users of mental health services: role of illness perceptions. Aust N Z J Psychiatry 2008; 42:147-53. [PMID: 18197510 DOI: 10.1080/00048670701787503] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A small number of patients tend to use a disproportionately high amount of mental health services. Understanding the needs and behaviours of this group is important in order to improve patient management. Few studies have investigated the role that patients' perceptions about their mental illness play in guiding coping responses and treatment seeking. The aim of the present study was to investigate how illness perceptions in high users of mental health services were related to unmet needs and treatment-seeking behaviours. METHOD A total of 203 high users of mental health services were interviewed using the Brief Illness Perception Questionnaire, the Camberwell Assessment of Need and the Drug Attitude Inventory, and were also asked to report the number of visits they had made to the general practitioner in the past year. District Health Board clinical staff completed the Camberwell Assessment of Need and the Global Assessment of Functioning for each user. RESULTS More negative perceptions about mental illness were associated with higher ratings of unmet needs by both patients and staff. Negative perceptions were also related to poorer attitudes towards medication, and lower functioning. Perceptions about the personal ability to control the illness were consistently associated with better outcomes. Patients' causal attributions could be categorized as social, psychological, biological and behavioural. More frequent visits to the general practitioner were associated with perceptions of more severe symptoms, greater concern and higher emotional responses to the illness, and psychosocial causal attributions. CONCLUSION Illness perceptions provide a framework to assess patients' ideas about severe mental illness and a means by which to identify maladaptive beliefs. Interventions targeted at changing these beliefs may encourage better self-management.
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Affiliation(s)
- Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Clatworthy J, Bowskill R, Rank T, Parham R, Horne R. Adherence to medication in bipolar disorder: a qualitative study exploring the role of patients' beliefs about the condition and its treatment. Bipolar Disord 2007; 9:656-64. [PMID: 17845282 DOI: 10.1111/j.1399-5618.2007.00434.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Patients' perceptions of illness and treatment have been found to predict adherence to medication in many chronic conditions. This has not yet been fully explored in bipolar disorder (BD). The aim was to use a qualitative methodology to explore in depth the beliefs about BD and its treatment that are associated with adherence to medication prescribed for BD. METHODS Sixteen adults prescribed prophylactic treatment for BD completed semi-structured interviews about their perceptions of BD and its treatment and their adherence to medication. Interviews were recorded and transcribed verbatim. Two researchers identified perceptions associated with non-adherence in the transcripts. RESULTS Thirteen participants (81%) reported some degree of intentional or unintentional medication non-adherence. Intentional non-adherence was associated with patients' concerns about the prescribed medication, arising from the experience of side effects, but also from beliefs that regular use could lead to adverse effects in the future. Intentional non-adherence was also associated with doubts about the personal need for medication, which were related to perceptions of BD (e.g., not accepting diagnosis, believing the condition is not controllable, believing it is not a chronic condition). CONCLUSIONS This study has identified some of the salient beliefs about BD and its treatment that should be elicited and addressed in interventions to facilitate adherence to medication. Further quantitative work is justified to explore the utility of this approach in the development of interventions.
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Affiliation(s)
- Jane Clatworthy
- Centre for Behavioural Medicine, School of Pharmacy, University of London, London, UK
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