Effective self-management strategies for bipolar disorder: A community-engaged Delphi Consensus Consultation study

Michalak, Erin E.; Suto, Melinda; Barnes, Steven J.; Hou, Sharon; Lapsley, Sara; Murray, Greg; Austin, Jehannine; Elliott, Nusha Balram; Berk, Lesley; CREST.BD,

doi:10.1016/j.jad.2016.06.057

Cited by 31 publications

(41 citation statements)

References 49 publications

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“…This included strategies relating to sleep, abstaining from drugs and alcohol, medical care, and healthy eating. These findings are consistent with recommendations from both experts with lived experience and health-care professionals, which support the use of lifestyle strategies in the management of the condition (Depp et al, 2009;Malhi et al, 2015;Michalak et al, 2016;Russell & Browne, 2005;Suto et al, 2010). The importance of sleep has been reported in prior studies (Russell & Browne, 2005;Suto et al, 2010;Villaggi et al, 2015) and may have particular importance in the management of bipolar disorder, given that instability in circadian rhythms may be associated with the onset of episodes (Murray et al, 2011).…”

Section: Discussionsupporting

confidence: 86%

Use of self‐care strategies in the management of bipolar disorder and their relationship to symptoms, illness intrusiveness, and quality of life

Wynter

Perich

2019

Clinical Psychologist

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Background:The benefits of self-care have been reported in other chronic illnesses, but bipolar disorder research has focused primarily on medication management. This study explored the use of self-care strategies by people living with bipolar disorder and the relationships between the use of self-care strategies and symptoms, illness intrusiveness, and quality of life.Methods: Eighty participants with bipolar disorder were recruited to participate in an online survey. Participants provided clinical backgrounds and selfreported current symptoms of depression, mania, anxiety, stress, perceived illness intrusiveness and the frequency of use, and perceived helpfulness of 69 self-care strategies. Results:A range of self-care strategies were endorsed, including "spend time with your pet or other animal," as well as creative pursuits. "Abstain from recreational drugs" was the strategy most commonly endorsed as being used frequently, while "get enough sleep" was most commonly rated as being the most helpful. Greater frequency of use of self-care strategies was significantly associated with improved quality of life, reduced illness intrusiveness, and reduced depression, anxiety, and stress scores, but not self-reported mania scores.Conclusions: This study provides support for strategies relating to sleep, and drug and alcohol abstinence, and for several strategies yet to be explored such as spending time with pets. Future studies should explore the use of these strategies longitudinally and how depression symptoms may mediate the relationship between the use of self-care strategies, quality of life, and illness intrusiveness. Key Points1 Greater frequency of use of self-care strategies was associated with improved quality of life, reduced illness intrusiveness, and reduced depression, anxiety, and stress scores. 2 Mania was not associated with the use of self-care strategies.

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Section: Discussionsupporting

confidence: 86%

Use of self‐care strategies in the management of bipolar disorder and their relationship to symptoms, illness intrusiveness, and quality of life

Wynter

Perich

2019

Clinical Psychologist

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“…For instance, proper nutrition, good sleep hygiene, and regular exercise and socialization are common self‐management strategies that persons with BD use to better control their moods, behaviours and overall wellness (Michalak et al . ; Murray et al . ).…”

Section: Introductionmentioning

confidence: 99%

“…Planning in advance for fluctuating mood states has also been identified as an important tactic (Michalak et al . ; Murray et al . ).…”

Section: Introductionmentioning

confidence: 99%

“…Control is, however, integral to wellness with BD. For instance, proper nutrition, good sleep hygiene, and regular exercise and socialization are common self-management strategies that persons with BD use to better control their moods, behaviours and overall wellness (Michalak et al 2016;Murray et al 2011). Planning in advance for fluctuating mood states has also been identified as an important tactic (Michalak et al 2016;Murray et al 2011).…”

Section: Introductionmentioning

confidence: 99%

“…For instance, proper nutrition, good sleep hygiene, and regular exercise and socialization are common self-management strategies that persons with BD use to better control their moods, behaviours and overall wellness (Michalak et al 2016;Murray et al 2011). Planning in advance for fluctuating mood states has also been identified as an important tactic (Michalak et al 2016;Murray et al 2011). Here, we present findings that offer insight into some of the ways in which persons with BD use alcohol and other substances in an attempt to control their BD symptoms, how substance use provides a sense of being in control, methods of controlled substance use, and feeling not in control (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Aspects of control and substance use among middle‐aged and older adults with bipolar disorder

Stalman

Canham

Mahmood

et al. 2017

Int J Mental Health Nurs

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High prevalence rates of alcohol and substance use disorders have been reported among persons with bipolar disorder (BD). In the present study, we explored the daily experiences of middle-aged and older adults living with BD who reported regular substance use and the ways in which participants expressed 'control' in relation to their use of alcohol and other substances. Semistructured, in-depth interviews were conducted with 12 participants (nine women and three men), aged 36-57 years of age (mean = 49 years). Thematic analyses identified emergent themes and patterns in participants' life histories. The theme of 'control' emerged as central to participants' reports, and was organized into four categories: (i) substance use to control BD symptoms; (ii) substance use provides a sense of being in control; (iii) methods of controlled substance use; and (iv) not having control: overreliance on substances. Implications of the present study include the need for nurses to openly discuss the use of alcohol and other drugs with persons with BD, provide health information and screening, and determine whether persons with BD feel they have control over their substance use. Several lines of research with persons who have BD and use substances are suggested.

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Effects of a Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder on Relapse, Symptom Burden, and Quality of Life

et al. 2023

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ImportanceBipolar disorder–specific psychotherapy combined with pharmacotherapy improves relapse risk, symptom burden, and quality of life, but psychotherapy is not easily accessible.ObjectiveTo determine if a smartphone-based self-management intervention (LiveWell) can assist individuals with bipolar disorder to maintain wellness.Design, Setting, and ParticipantsAn assessor-blind randomized clinical trial enrolled participants from March 20, 2017, to April 25, 2019, with 48-week follow-up ending on April 10, 2020. Participants were randomly assigned to usual care or usual care plus the smartphone intervention stratified by relapse risk based on initial clinical status (low risk: asymptomatic recovery; high risk: continued symptomatic, prodromal, recovering, symptomatic recovery). Participants with bipolar disorder I were recruited from clinics in the Chicago and Minneapolis-Saint Paul areas. Data were analyzed from June 19, 2020, to May 25, 2022.InterventionsThe smartphone-based self-management intervention consisted of an application (app), coach, and website. Over 16 weeks, participants had a coach visit followed by 6 phone calls, and they completed daily and weekly app check-ins. The app provided adaptive feedback and information for developing a personalized wellness plan, the coach provided support, and the website provided summary data and alerts.Main Outcomes and MeasuresThe primary outcome was time to relapse. Secondary outcomes were percentage-time symptomatic, symptom severity, and quality of life.ResultsOf the 205 randomized participants (mean [SD] age, 42 [12] years; 125 female individuals [61%]; 5 Asian [2%], 21 Black [10%], 13 Hispanic or Latino [6%], 7 multiracial [3%], 170 White [83%], 2 unknown race [1%]), 81 (40%) were randomly assigned to usual care, and 124 (60%) were randomly assigned to usual care plus the smartphone intervention. This clinical trial did not detect a reduction in relapse risk for the smartphone intervention (hazard ratio [HR], 0.65; 95% CI, 0.39-1.09; log-rank P = .08). However, decreased relapse was observed for low-risk individuals (HR, 0.32; 95% CI, 0.12-0.88; log-rank P = .02) but not high-risk individuals (HR, 0.86; 95% CI, 0.47-1.57; log-rank P = .62). Reduced manic symptom severity was observed for low-risk individuals (mean [SE] difference, −1.4 [0.4]; P = .001) but not for high-risk individuals (mean [SE] difference, 0 [0.3]; P = .95). The smartphone-based self-management intervention decreased depressive symptom severity (mean [SE] difference, −0.80 [0.34]; P = .02) and improved relational quality of life (mean [SE] difference, 1.03 [0.45]; P = .02) but did not decrease percentage-time symptomatic (mean [SE] difference, −5.6 [4.3]; P = .20).Conclusions and RelevanceThis randomized clinical trial of a smartphone-based self-management intervention did not detect a significant improvement in the primary outcome of time to relapse. However, a significant decrease in relapse risk was observed for individuals in asymptomatic recovery. In addition, the intervention decreased depressive symptom severity and improved relational quality of life. These findings warrant further work to optimize the smartphone intervention and confirm that the intervention decreases relapse risk for individuals in asymptomatic recovery.Trial RegistrationClinicalTrials.gov Identifier: NCT03088462

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Effective self-management strategies for bipolar disorder: A community-engaged Delphi Consensus Consultation study

Cited by 31 publications

References 49 publications

Use of self‐care strategies in the management of bipolar disorder and their relationship to symptoms, illness intrusiveness, and quality of life

Use of self‐care strategies in the management of bipolar disorder and their relationship to symptoms, illness intrusiveness, and quality of life

Aspects of control and substance use among middle‐aged and older adults with bipolar disorder

Effects of a Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder on Relapse, Symptom Burden, and Quality of Life

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