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Pereira CS, Padoan CS, Silva MM, Magalhães PVS. A grounded theory on acceptance of diagnosis as a pathway to recovery in bipolar disorder. Sci Rep 2024; 14:13434. [PMID: 38862539 PMCID: PMC11166999 DOI: 10.1038/s41598-024-61923-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
The recovery process in bipolar disorder is a subjective and multidimensional experience that seeks to develop new meanings and purposes for living a satisfying life despite the limitations imposed by the disorder. Thus, this qualitative study aimed to explore the perceptions of recovery and the meanings attributed by individuals undergoing treatment for bipolar disorder to the elements considered relevant in this process. Semi-structured interviews with open-ended questions were conducted to explore the experiences and perspectives of recovery in individuals undergoing treatment for bipolar disorder. Grounded Theory was used as the method for qualitative analysis. The study included 26 participants aged between 18 and 65 years. Based on the analysis of participant reports, we identified two main themes: living with the illness and what it means to be in recovery. The perception of recovery is an individual process and can differ from the medical model. Participants suggest that accepting the diagnosis of bipolar disorder and finding meaning in life are essential to their recovery. They also describe how mental health professionals can facilitate or hinder this process. Understanding patients' perceptions can facilitate access to healthcare services and treatment adherence.
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Affiliation(s)
- Caroline Silveira Pereira
- Graduate Program in Psychiatry and Behavioral Sciences, Faculty of Medicine, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Stopinski Padoan
- Graduate Program in Psychiatry and Behavioral Sciences, Faculty of Medicine, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marielle Moro Silva
- Graduate Program in Psychiatry and Behavioral Sciences, Faculty of Medicine, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pedro V S Magalhães
- Graduate Program in Psychiatry and Behavioral Sciences, Faculty of Medicine, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Lucas JJ, Bouchoucha SL, Afrouz R, Reed K, Brennan-Olsen SL. LGBTQ+ Loss and Grief in a Cis-Heteronormative Pandemic: A Qualitative Evidence Synthesis of the COVID-19 Literature. QUALITATIVE HEALTH RESEARCH 2022; 32:2102-2117. [PMID: 36342414 PMCID: PMC9643120 DOI: 10.1177/10497323221138027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
LGBTQ+ people are no stranger to loss and grief, particularly during times of pandemic such as the 1980s-90s HIV/AIDS pandemic and now, the COVID-19 pandemic. Current COVID-19 loss and grief research remains relatively silent on LGBTQ+ peoples' loss and grief experiences. The aim of this research was to conduct a qualitative evidence synthesis of LGBTQ+ people's COVID-19 loss and grief experiences reported in the literature. A systematic search and inclusion strategy identified 22 relevant articles for review. Inductive thematic synthesis resulted in five loss-focused themes across the articles: (1) loss of work and livelihood, (2) loss of social and kinship connection, (3) loss of LGBTQ+ community connection, (4) loss of physical and mental health supports and (5) loss of LGBTQ+ identity authenticity, affirmation and visibility. Discussion of these themes highlights the many layered and often disenfranchised nature of LGBTQ+ people's loss during the COVID-19 pandemic.
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Affiliation(s)
- James J. Lucas
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
- James J. Lucas, School of Health and Social Development, Deakin University; Postal Address: Locked Bag 20001, Geelong, VIC 3220, Australia.
| | - Stéphane L. Bouchoucha
- Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
| | - Rojan Afrouz
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Kirk Reed
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Sharon L. Brennan-Olsen
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
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Burman CJ, Dempsey RC, Priest HM. Exploring men’s experiences and sense-making of bipolar disorder diagnoses and mood management: a photo-elicitation investigation. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2021.2018572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Craig J. Burman
- School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Robert C. Dempsey
- Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Helena M. Priest
- School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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Sims R, Michaleff ZA, Glasziou P, Thomas R. Consequences of a Diagnostic Label: A Systematic Scoping Review and Thematic Framework. Front Public Health 2022; 9:725877. [PMID: 35004561 PMCID: PMC8727520 DOI: 10.3389/fpubh.2021.725877] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: To develop a thematic framework for the range of consequences arising from a diagnostic label from an individual, family/caregiver, healthcare professional, and community perspective. Design: Systematic scoping review of qualitative studies. Search Strategy: We searched PubMed, Embase, PsycINFO, Cochrane, and CINAHL for primary studies and syntheses of primary studies that explore the consequences of labelling non-cancer diagnoses. Reference lists of included studies were screened, and forward citation searches undertaken. Study Selection: We included peer reviewed publications describing the perceived consequences for individuals labelled with a non-cancer diagnostic label from four perspectives: that of the individual, their family/caregiver, healthcare professional and/or community members. We excluded studies using hypothetical scenarios. Data Extraction and Synthesis: Data extraction used a three-staged process: one third was used to develop a preliminary framework, the next third for framework validation, and the final third coded if thematic saturation was not achieved. Author themes and supporting quotes were extracted, and analysed from the perspective of individual, family/caregiver, healthcare professional, or community member. Results: After deduplication, searches identified 7,379 unique articles. Following screening, 146 articles, consisting of 128 primary studies and 18 reviews, were included. The developed framework consisted of five overarching themes relevant to the four perspectives: psychosocial impact (e.g., positive/negative psychological impact, social- and self-identity, stigma), support (e.g., increased, decreased, relationship changes, professional interactions), future planning (e.g., action and uncertainty), behaviour (e.g., beneficial or detrimental modifications), and treatment expectations (e.g., positive/negative experiences). Perspectives of individuals were most frequently reported. Conclusions: This review developed and validated a framework of five domains of consequences following diagnostic labelling. Further research is required to test the external validity and acceptability of the framework for individuals and their family/caregiver, healthcare professionals, and community.
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Affiliation(s)
- Rebecca Sims
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Zoe A Michaleff
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
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Personal recovery in bipolar disorder: Systematic review and "best fit" framework synthesis of qualitative evidence - a POETIC adaptation of CHIME. J Affect Disord 2021; 292:375-385. [PMID: 34139411 DOI: 10.1016/j.jad.2021.05.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Personal recovery, living a satisfying, hopeful life alongside symptoms, has become an increasingly valued aim across mental health care agendas internationally. However, there is little understanding of how people experience personal recovery alongside the mood challenges characteristic of a bipolar disorder diagnosis. Personal recovery frameworks have been developed for populations with mixed psychiatric diagnoses, predominantly psychotic disorders. METHODS This systematic review of qualitative data used the widely adopted personal recovery processes Connectedness, Hope and optimism, Identity, Meaning and purpose, Empowerment (CHIME) in a "best fit" framework synthesis to understand personal recovery experiences in bipolar disorder. Included studies were coded with deductive framework analysis based on the CHIME processes and inductive thematic analysis for aspects beyond the a priori framework. RESULTS A comprehensive search of six literature databases led to inclusion of twelve articles published 2010-2020. Deductive coding supported the fit with the CHIME framework but revealed difficulties, losses, and tensions within and across recovery processes. The proposed framework for personal recovery in bipolar disorder, Purpose and meaning, Optimism and hope, Empowerment, Tensions, Identity, Connectedness (POETIC), organises all CHIME processes around these tensions. LIMITATIONS Diversity among study participants was limited with majority middle-aged, female, Western participants. CONCLUSIONS The compact POETIC personal recovery framework tailored for bipolar disorder is directly applicable to clinical practice with personal recovery objectives. It highlights the need for professionals to introduce personal recovery in a realistic and balanced way to address recent criticism by service user organisations of personal recovery as overly optimistic.
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Wright L, Lari L, Iazzetta S, Saettoni M, Gragnani A. Differential diagnosis of borderline personality disorder and bipolar disorder: Self-concept, identity and self-esteem. Clin Psychol Psychother 2021; 29:26-61. [PMID: 33811707 DOI: 10.1002/cpp.2591] [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: 05/27/2020] [Revised: 11/28/2020] [Accepted: 03/26/2021] [Indexed: 01/04/2023]
Abstract
Symptoms of borderline personality disorder (BPD) and bipolar disorder (BD) often overlap. In some cases, it is difficult to conduct a differential diagnosis based only on current diagnostic criteria Therefore, it is important to find clinical factors with high discriminatory specificity that, used together with structured or semi-structured interviews, could help improve diagnostic practice. We propose that a clinical analysis of identity, self-concept and self-esteem may help distinguish the two disorders, when they are not co-morbid. Our review of the studies that analyse these constructs in BD and BPD, separately, points in the direction of qualitative differences between the two disorders. In BPD, there is a well-documented identity diffusion, and the self-concept appears predominantly negative; shifts in self-concept and self-esteem are often tied to interpersonal triggers. In BD, patients struggle with their identity, but narrative identity might be less compromised compared with BPD; the shifts in self-concept and self-esteem appear more linked to internal (i.e. mood and motivational) factors. We end the paper by discussing the implications for clinicians and ideas for future comparative research.
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Affiliation(s)
- Livia Wright
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy
| | - Lisa Lari
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy
| | | | - Marco Saettoni
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy.,Unità Funzionale Salute Mentale Adulti, ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy
| | - Andrea Gragnani
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy.,Unità Funzionale Salute Mentale Adulti, ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy.,Scuola di Psicoterapia Cognitiva SRL, Rome, Italy
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Wehrman EC. "I was their worst nightmare": The identity challenges of military widows. DEATH STUDIES 2019; 45:583-593. [PMID: 31580208 DOI: 10.1080/07481187.2019.1671540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bereaved spouses reconstruct their identities to make sense of changes in how they understand themselves after loss. For military spouses, identity reconstruction might be particularly challenging since they must also manage changes in their military status. This study included interviews with bereaved U.S. military spouses (N = 9) about their experiences managing identity. Results indicate that participants experienced shifting identities. Individuals managed (a) multiple, conflicting identities and (b) the loss of identities. Findings suggest that participants' military status added a layer of identity reconstruction, making grief more complex. These results offer insight into how military survivors reconstruct identity following loss.
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Affiliation(s)
- Erin C Wehrman
- Department of Communication, Missouri State University, Springfield, MO, USA
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Williams E, Dingle GA, Calligeros R, Sharman L, Jetten J. Enhancing mental health recovery by joining arts-based groups: a role for the social cure approach. Arts Health 2019; 12:169-181. [PMID: 31146628 DOI: 10.1080/17533015.2019.1624584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND . Even though emerging evidence suggests that participation in arts-based group programs are helpful in supporting mental health, the field lacks an established theorical framework. This study explored the extent to which participants' experiences of singing or creative writing groups aligned with theorising proposed by the social cure approach. METHODS . Semi-structured interviews were conducted with 25 choir members, and 23 creative writing group members with chronic mental health conditions at two time points. Transcripts of the interviews were examined by four coders using thematic analysis. RESULTS . Consistent with social cure theorising, participation in the choir and creative writing group facilitated meeting participants' needs for belonging, support, self-efficacy, purpose, and positive emotions. CONCLUSIONS . This study demonstrated the psychosocial mechanisms by which participation in arts-based groups can enhance mental health. We conclude that engagement with the social cure framework may be useful to structure practice in this field.
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Affiliation(s)
- Elyse Williams
- School of Psychology, University of Queensland , St Lucia, Queensland, Australia
| | - Genevieve A Dingle
- School of Psychology, University of Queensland , St Lucia, Queensland, Australia
| | - Renee Calligeros
- School of Psychology, University of Queensland , St Lucia, Queensland, Australia
| | - Leah Sharman
- School of Psychology, University of Queensland , St Lucia, Queensland, Australia
| | - Jolanda Jetten
- School of Psychology, University of Queensland , St Lucia, Queensland, Australia
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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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Warwick H, Tai S, Mansell W. Living the life you want following a diagnosis of bipolar disorder: A grounded theory approach. Clin Psychol Psychother 2019; 26:362-377. [DOI: 10.1002/cpp.2358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Helen Warwick
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science CentreThe University of Manchester Manchester UK
| | - Sara Tai
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science CentreThe University of Manchester Manchester UK
| | - Warren Mansell
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science CentreThe University of Manchester Manchester UK
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Ironside ML, Johnson SL, Carver CS. Identity in bipolar disorder: Self-worth and achievement. J Pers 2019; 88:45-58. [PMID: 30714166 DOI: 10.1111/jopy.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/10/2018] [Accepted: 01/27/2019] [Indexed: 12/17/2022]
Abstract
This article considers self and self-concept in bipolar disorder. Bipolar disorder, defined on the basis of manic symptoms, is a highly debilitating psychopathology. It is heavily grounded in biology but symptom course is still very responsive to psychological and social forces in the lives of persons who have the disorder. This review assumes an overall view of the self that is typical of personality psychology: self as traits, self as goals and aspirations, and ongoing efforts to attain those goals. In this review, we will discuss two different facets of self and identity in bipolar disorder. First, we review a body of goal pursuit literature suggesting that persons with bipolar disorder endorse heightened ambitions for attaining goals and recognition from others. Second, we will review multiple findings which suggest that among persons with bipolar disorder, self-worth depends on measurable success in an extreme way. We will consider how the intersection of these two themes may lead to unique identity challenges for people with bipolar disorder, drawing from self-report, behavioral, and neuroscience findings to critically examine this viewpoint.
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Affiliation(s)
- Manon L Ironside
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Sheri L Johnson
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Charles S Carver
- Department of Psychology, University of Miami, Coral Gables, Florida
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Acero ÁR, Cano-Prous A, Castellanos G, Martín-Lanas R, Canga-Armayor A. Family identity and severe mental illness: A thematic synthesis of qualitative studies. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2017. [DOI: 10.1002/ejsp.2240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ángela R. Acero
- University of Navarra; Navarra Spain
- Universidad de La Sabana y Clínica Universidad de La Sabana; Chía Colombia
- Clínica Universidad de Navarra; Navarra Spain
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Borda JP. Self over time: another difference between borderline personality disorder and bipolar disorder. J Eval Clin Pract 2016; 22:603-7. [PMID: 27144989 DOI: 10.1111/jep.12550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/30/2016] [Indexed: 01/17/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES The nature of the relationship between bipolar disorder and borderline personality disorder has been an intense field of debate in the last two decades. Current diagnostic classifications approach this complex phenomenon using syndromatic definitions based on presence or absence of a restricted set of signs or symptoms that have demonstrated low specificity. One of the several utilities of the phenomenological method in psychiatry is to complement the clinical panorama, helping in the process of identifying potential differences between two separated clinical syndromes. The main objective of this publication is to explore one particular clinical difference between these two conditions - that is, the experience of self-continuity and time perception. METHODS the argument explored in this paper is based on previous second-person or phenomenological accounts of sufferers of both conditions. RESULTS AND CONCLUSIONS Whereas borderline personality disorder patients tend to experience only the present moment, referring frequent difficulties of drawing experiences of the past in order to determine their own future, bipolar disorder patients are constantly worried about the contradictions in their past experiences and the latent risk of losing control of themselves in future episodes of their disease. This contrast should be, however, corroborated in future research comparing directly the two groups in terms of the continuity of the self and their temporal structures.
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Abstract
A hermeneutic phenomenological analysis reveals the complexity of bipolar disorder. Operating at biological, psychological, and social levels this phenomenon creates dilemmas and people must account for their choices in a moral order. Two participants suffer from the condition, whereas a third is employed to deliver mental health treatment. Three themes are identified showing that all the participants struggle to feel they are competent and consistent decision makers. They feel exposed, fearing that others will impose interpretations on their behavior. They resist the imposition of a medical model, wanting to believe that choices are personal and related to life experiences. This person-centered interpretation is favored because it offers the potential for learning, for achieving autonomy, and growth. By attending to the interpersonal aspects of emotion and subjectivity, this analysis challenges the idea that autonomy can be undermined by a disease process in a simple manner. It is suggested that mental health care systems need to deliver services in which the personal and interpersonal aspects of recovery are adequately managed.
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'You just lose the people you know': relationship loss and mental illness. Arch Psychiatr Nurs 2015; 29:96-101. [PMID: 25858201 DOI: 10.1016/j.apnu.2014.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/05/2014] [Accepted: 11/27/2014] [Indexed: 11/21/2022]
Abstract
The purpose of this qualitative study was to explore the nature, scope and consequences of losses resulting from mental illness. This paper presents findings from a key theme of this study-the loss of relationships. Thematic analysis revealed two categories: loss of intimate relationships, which included subcategories of (i) spouses/partners, (ii) children/parenthood, (iii) family, and (iv) friends; and (2) people within the community, such as people at church and support groups. Relationships are seen as one of the most crucial yet challenging elements to recovery and wellbeing for people affected by mental illness.
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