Understanding and measuring resilience in patients with Bipolar Disorder: examining its role as a predictor of recovery, quality of life and psychosocial functioning
Year: 2016
Type: dissertation
Study design: Observational Study
Abstract: Background: Bipolar Disorder (BD) is a complex, severe, and recurrent mental illness, characterized by cyclical and extreme mood swings ranging from episodes of mania or hypomania to depression, interspersed with periods of euthymia. The worldwide aggregate lifetime prevalence rate is 2.4% for Bipolar Spectrum Disorders (BSD), including BD-I (0.6%), BD-II (0.4%), and subthreshold BD (1.4%). BD is often unrecognized and frequently runs with other mental disorder comorbidities, and therefore it is underdiagnosed or misdiagnosed until the right diagnosis is given after an average delay of eight years since the first affective episode. BD impacts negatively in psychosocial and work functioning and quality of life of people who suffer the disorder. The chronicity across the life span and the early onset of this severe mental illness is responsible for the sixth leading cause of disability-adjusted life years worldwide; therefore, BD results in a high socioeconomic and health burden. Resilience is understood as the dynamic process in which psychological, social, environmental, and biological factors interact to enable an individual at any stage of life to develop, maintain, or regain their mental health despite exposure to adversity. Research is rapidly growing in the field of psychological resilience. In the area of BD, even if some studies have demonstrated that people with BD can live a positive, fulfilling, and contributing life, the available scientific literature about resilience in BD is very scarce. Aims: The present doctoral thesis aims (1) to review the literature on resilience and recovery in order to understand their meanings and roles in the mental health area (Study 1), (2) to understand the resilience experience and its qualities in BD from the perspectives of BD patients and clinicians, so as to build a synthetic theoretical model of resilience in BD (Study 2), (3) to develop a psychometrically reliable and valid questionnaire of resilience specific to BD (Study 3), and (4) to analyze the cross-sectional and prospective associations between resilience and mental health adjustment indicators in BD (Study 4). Methods: The design of this doctoral thesis is based on a mixed methodology that includes a theoretical review (Study 1), qualitative methodology (Study 2), and quantitative approach, involving the development and validation of a questionnaire (Study 3) and path analyses (Study 4). For the Study 1, a total of 84 documents on resilience and recovery were reviewed, and differences, similitudes, and convergences between both constructs were analyzed. For Study 2, 15 patients in remission from BD and six clinicians who were experts in the treatment of BD took part in semi-structured interviews or in different focus groups. For Study 3, a new BD-specific resilience measure, the Resilience Questionnaire for Bipolar Disorder (RBD), was developed based on results from the previous qualitative study and on the literature review on resilience. A clinical sample of 125 patients diagnosed with BD, and a comparison sample of 107 people from the general population completed the RBD along with a self-reported battery of questionnaires at baseline [sociodemographic and clinical questions, the Resilience Scale (RS-25), the Brief Quality of Life in Bipolar Disorder (Brief-QoL.BD), the Internal States Scale (ISS), the Bipolar Recovery Questionnaire (BRQ)], and were followed up 6 months later, analyzing the psychometric properties of the RBD (reliability, construct validity, concurrent validity, known-groups validity, and responsiveness). Exploratory and confirmatory factorial analyses were undertaken, together with reliability and ANOVA analyses. The same BD patients from Study 3 took part in Study 4. In Study 4, participants (n = 125) who participated in Study 3 received follow-ups between 6-12 months. For Study 4, participants at follow-up completed the following measures: sociodemographic and clinical questions, the RBD, the Brief-QoL.BD, the ISS, the BRQ, and the Work and Social Adjustment Scale (WSAS). Cross-sectional and prospective analyses included bivariate correlations and path analyses to explore associations between resilience and mental health adjustment indicators of personal recovery, well-being, bipolar symptomatology, psychosocial functioning deficit, and quality of life. Results: Results from the Study 1 indicate that while there is a substantial overlap between aspects of resilience and recovery in the context of mental health, differences between both constructs enable understanding of the roles of each one and the relationship between them. As a result, it is suggested that resilience plays a moderating role in the impact of stressors on the process of personal recovery. Results from the qualitative study provide the first understanding of the process and qualities of resilience as experienced in BD. As a result, we obtained a resilience model for BD including the following resilience topics in BD: antecedent conditions for resilience, turning point, self-awareness, self-management of BD, balanced self-style, positive personality qualities, and interpersonal support. Results from the Study 3 support the development of the new 23-item RBD, which includes five factors (‘self-management of BD’, ‘turning point’, ‘self-care’, ‘self-confidence’, and ‘interpersonal support’), that show satisfactory psychometric results with respect to construct validity, reliability, concurrent validity, known groups validity, and responsiveness (at follow-up) in people diagnosed with BD. Patients who were classified within the recovered group scored higher in resilience than either patients classified within the not recovered group or the comparison sample from the general population. In the last study, path analyses indicate that the resilience domains self-management of BD, self-care, and self-confidence, and turning point explain cross-sectionally the variance of the mental health-related outcome variables. Study 4 also shows that self-management of BD and turning point resilience domains prospectively explain the variance on personal recovery. The role of turning point is notable, since it is negatively associated with well-being, quality of life, and psychosocial functioning in the cross-sectional path analysis; turning point at baseline, however, is a predictor (positively associated) of personal recovery at follow-up. Conclusions: Findings from the different studies of this doctoral thesis point to the relevance of resilience in people diagnosed of BD as a construct that contributes to explain the process of personal recovery in these patients. Different domains of resilience explain cross-sectionally and predict prospectively the variance on a number of mental health indicators. This doctoral thesis supports the importance of resilience in the recovery process of people diagnosed with BD, providing a model of resilience in BD that explains in detail the main resilience qualities. This doctoral thesis also includes the development of a psychometrically sound measure of resilience specific for BD patients, the RBD (23 items). Next, this doctoral thesis identifies the domains of resilience that have statistical significance in the variability on mental health outcomes, both cross-sectionally and longitudinally. In the final section of this doctoral thesis, I provide a general discussion and conclusions from the four studies. This section also comprises main limitations, future directions, and practical implications of this research. Introducción: El Trastorno Bipolar (TB) es una enfermedad compleja, severa y recurrente, caracterizada por oscilaciones cíclicas y extremas del estado de ánimo, que fluctúan entre episodios de manía o hipomanía y depresión, alternados con períodos de eutimia. La tasa de prevalencia agregada durante la vida es de 2.4% para el espectro de trastornos bipolares, incluyendo TB-I (0.6%), TB-II (0.4%), y TB subumbrales (1.4%). El TB suele pasar desapercibido y frecuentemente se acompaña de comorbilidades con otros trastornos mentales, y por lo tanto el TB es subdiagnosticado o no se diagnostica correctamente hasta dar con el diagnóstico acertado tras un retraso medio de ocho años desde el primer episodio afectivo. El TB impacta negativamente en el funcionamiento psicosocial y laboral y sobre la calidad de vida de las personas que lo sufren. La cronicidad a lo largo de la vida y el comienzo temprano de esta enfermedad mental severa, explica por qué el TB ocupa el sexto lugar entre las causas de años de vida ajustados por discapacidad del mundo; De esta forma, el TB supone una alta carga socioeconómica y sanitaria. La resiliencia se entiende como el proceso dinámico en el que factores psicológicos, sociales, ambientales y biológicos interactúan para permitir que un individuo, en cualquier etapa de su vida, desarrolle, mantenga, o recobre su salud mental a pesar de la exposición a la adversidad. La investigación en el campo psicológico de la resiliencia es cada vez mayor. En el área del TB, a pesar de que algunos estudios han demostrado que las personas con TB pueden vivir una vida positiva, plena y contributiva, la literatura científica disponible sobre la resiliencia en el TB es muy escasa. Objetivos: La presente tesis doctoral tiene como objetivos (1) revisar la literatura en resiliencia y recuperación para entender sus significados y roles en el contexto de la salud mental (Estudio 1), (2) entender la experiencia y cualidades de la resiliencia en el TB desde las perspectivas de pacientes diagnosticados de TB y clínicos para construir un modelo teórico que sintetice la resiliencia en el TB (Estudio 2), (3) desarrollar un cuestionario de resiliencia específico para el TB que sea psicométricamente fiable y válido (Estudio 3), y (4) analizar las asociaciones transversales y prospectivas entre la resiliencia y los indicadores de salud mental en el TB (Estudio 4). Métodos: El diseño de esta t
Source: DeustoTeka
Author: Echezarraga Porto, Ainara
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G2505595414, G466295218
OpenAlex ID: W7080695710