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The Relationship between Bipolar Disorder and Financial Difficulties: A Qualitative Exploration of Client's Views


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This paper uses a qualitative methodology to explore how those with a diagnosis of Bipolar Disorder view their mental health as related to their finances. Themes identified were guilt around impulse spending, comfort spending and avoidant coping with finances.
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This is a pre-publication version of the following article: Richardson, T., Jansen, M., Turton,
W. & Bell, L. The Relationship Between Bipolar Disorder and Financial Difficulties: A
Qualitative Examination of Patient‟s Views. Clinical Psychology Forum, In Press.
The Relationship between Bipolar Disorder and Financial Difficulties:
A Qualitative Exploration of Client’s Views
Thomas Richardson, Principal Clinical Psychologist (Research Lead) a,b*
Megan Jansen Assistant Research Psychologist a,b
Wendy Turton, Professional Lead Waiting List Initiative c
Lorraine Bell, Consultant Clinical Psychologist a,b
a Mental Health Recovery Team North, Solent NHS Trust, St. Mary‟s Community Health
Campus, Milton Road, Portsmouth, PO3 6AD, U.K.
b School of Psychology, University of Southampton, Southampton, SO17 1BJ, U.K.
c Psychology and Psychological Therapy, Devon Partnership NHS Trust, Exeter, EX2 5FY
* Corresponding Author: Dr Thomas Richardson, Email, phone
004478767461662, fax: 023 9268 0267
This paper uses a qualitative methodology to explore how those with a diagnosis of Bipolar
Disorder view their mental health as related to their finances. Themes identified were guilt
around impulse spending, comfort spending and avoidant coping with finances.
A diagnosis of Bipolar Affective Disorder (BAD) is characterised by episodes of
depression and elevated mood (or mania) and is applied to 2-3% of the population
(Merikangas et al., 2011). Impulsive spending is also listed as a possible symptom in the
diagnostic criteria for a manic episode (American Psychiatric Association, 2013). During a
manic phase individuals have been shown to be at „high risk‟ for behaving impulsively with
increased risk of disruptive behaviours such as unrestrained spending, sexual indiscretions
and embarking on grand schemes (Muhtadie et al , 2014). Jones et al. (2015) found that
approximately 1 in 10 of those with BAD were at risk of developing a gambling problem.
Cheema, MacQueen, and Hassel (2015) found that those with BAD are poorer at managing
their finances, possibly related to increased impulsivity.
Richardson, Elliott, and Roberts (2013) conducted a systematic review and meta-analysis
and found that those with depression were more than twice as likely to be in debt. When
examined qualitatively (Barnes et al., 2016) found that economic hardships in combination
with other vulnerabilities “acted as the final straw to trigger self-harm”. A number of studies
have also identified that financial difficulties in particular overspending are a significant
source of stress for caregivers of those with a diagnosis of BAD (Beentjes, Goossens &
Poslawsky, 2012). However there are no previous studies on the impact of debt on mental
health in clients with BAD specifically (Richardson et al., 2013).
The present study therefore aimed to conduct a preliminary exploration of the relationship
between financial difficulties and mental health in those living with BAD using a qualitative
This qualitative study formed part of a larger quantitative study examining correlates
of debt in BAD. Participants with a diagnosis of BAD within a National Health Service
(NHS) secondary care mental health service were invited to take part by their clinician.
Participants were asked the following „Yes/No‟ questions: “In your opinion, have
your mental health problems made your debt or financial difficulties worse?” (84.3% n=59
responded „Yes‟) and In your opinion, have your debt or financial difficulties made your
mental health problems worse?” (71.4% n=50 responded „Yes‟). Forty four participants who
commented further on these questions were included in the qualitative analysis.
Six participants from this larger study were selected and invited to take part in a focus
group. Participants were selected at random; however twenty participants refused to take part
due to childcare difficulties, feeling uncomfortable in a group setting and work commitments.
The following questions were posed: Do you think debt and financial difficulties have an
impact on your mental health personally?, Do you think your mental health problems can
make your debt and financial difficulties worse? and Why do you think this might be?” The
discussion lasted 75 minutes.
Ethical approach was granted by the University Of Southampton School Of
Psychology Ethics Committee as well as the local NHS research ethics committee. Informed
written consent was obtained from all participants.
Participant Characteristics
Participants were 68.2% (n=30) female, ages ranged from 25 to 69 with mean of 49.
Ethnicity was 77.3% (n=34) white British and,36.4% (n=16) i were employed. Co-morbid
psychiatric diagnoses were present in 34.1% (n=15) vof participants.
Qualitative analysis
Thematic Analysis (Braun & Clarke, 2006) was conducted. The focus group
recording and responses from the written questions were analysed together. Two reviewers
did an initial thematic analysis separately with no prior assumption of themes. Themes were
identified if quotes fitted from five or more participants. Reviewers then met to compare
initial themes and finalise themes.
Seven main themes were identified, with a further three subthemes. Illustrative quotes and the
number of participants whose responses fitted into these themes are described below.
1. Over-spending
Over-spending when hypo(manic) emerged as a broad theme with impulsive shopping and
excessive generosity as sub-themes.
1a. Impulse Shopping (n=44)
“Impulsive purchases… will spend all that I have when I am manic or hypo-manic.
Will spend on grand schemes.
When I am manic, I am extremely impulsive, and I can spend hours (mostly during
the night when I can’t sleep) shopping online.”
Participants reported that they exhibit spontaneous and impulsive spending habits
during (hypo)manic episodes, for example bulk buying and spending money on unnecessary
items. Participants reported „maxing out‟ credit cards and overdrafts and pawning jewellery
in order to have more dispensable income to then spend impulsively. This resulted in
“spending thousands of pounds on items,” and building up large debts of up to£12,000.
1b. Excessive Generosity (n=6)
I became high and gave away all my savings to charity 4 years ago.
When my mood is elevated, I feel the need to shower my wife and kids with gifts,
irrespective of finances.
Participants described during a (hypo)manic episode, being over-generous towards
others, with some giving all their savings to a charity, or buying gifts excessively for their
family and friends.
2. Anxiety/Depression (n=29)
The constant stress of financial pressure worsens my anxiety”
The realisation of debt can trigger a depressive bout.
Participants reported that debt and financial difficulties exacerbated depression and
anxiety. Participants reported stress about being able to pay off debt and meet living
expenses. Others criticised themselves for „economic inactivity‟ and linked this to depression.
Some participants reported having extreme anxieties surrounding possible bankruptcy and
home repossession. Participants linked these to feeling hopeless and unable to deal with their
financial situation.
2a. Suicidality (n=7)
The very reason I tried to commit suicide 3 years ago.
Increased spend, anxiety which leads to suicidal attempts/ideation to resolve it all.
Participants described having suicidal ideation resulting from what they saw as a
hopeless financial situation. At the extreme end, participants have felt so hopeless financially
that they have made attempts to end their life or ended up in hospital.
3. Regret/Guilt (n=10)
“When I am on a low that’s when it hits me how much I've spent on a high you don't
think about it
Then to lows, I would be concerned and worried about financial situation 'What
have I done!?'
Participants described feelings of guilt and regret upon releasing the extent to which they had
overspent when (hypo)manic, and this appeared to be linked to feeling low in mood.
4. Poor Planning/Avoidant Coping (n=27)
When I am depressed, I don’t open my mail and bills and get left unpaid. I avoid any
social contact at this time so telephone banking and going into a branch is out of the
When I get letters for debt, I don’t always open them or ignore them until the situation
gets worse
Participants reported leaving post and bills unopened to avoid dealing with their
financial situation, especially when low. Some also spoke about not being able to think
rationally or remember their purchases when depressed and subsequently making poor
financial decisions.
5. Vicious Cycle (n=8)
Catch 22. Stressed about money. You buy more and it goes round in circles.”
“It’s a vicious cycle. I realise I’m spending and putting my family in financial stress
and leads to larger depression. This is then leads to comfort spending again.”
Participants reported a bi-directional relationship whereby over-spending when
(hypo)manic led to depression when the extent of financial difficulties was realised. A way of
coping was then to comfort spend which then led to a vicious cycle or „downward spiral‟.
6. Impact on Employment (n=24)
I am dependent on benefits so I face constant pressure to economise.
After my last breakdown, I had to take a lot of time off work and lost my job. Mental
illness makes it difficult to earn money. Therefore meaning I am trapped.”
Participants described that having a diagnosis of BAD introduced difficulties in
maintaining employment. As a result, participants reported having to take on lesser role or a
part-time position with a reduced income or stop work altogether and rely on benefits which
introduced additional pressure to economise.
7. Comfort Spending (n=6)“If I am depressed I reward myself I can go out on food and
During down periods, I essentially comfort spend.
During low periods, participants reported that they were inclined to buy items to self-
soothe and comfort themselves. Some said they bought items with the aim to cheer
themselves up or try and make themselves feel better, with some even saying that when they
were low about financial difficulties they bought items to cheer themselves up, thus this also
linking to the vicious cycle theme described above This appears qualitatively different to the
impulsive spending experienced during a (hypo)manic episode as it served a different
The present study aimed to examine the relationship between financial difficulties and
mental health in those living with BAD using qualitative methods. This is the first time this
relationship has been examined in this population. The emerging themes support the
impulsive spending diagnostic criteria for bipolar disorder (APA, 2013). Overspending was
the strongest theme that emerged with all participants identifying with this. , which links with
previous literature that overspending is reported as a source of stress in caregivers of those
with BAD (Beentjes, Goossens & Poslawsky, 2012). Participants reported that shopping
impulsively and excessive financial generosity towards others were key behaviours when
elated followed by a feeling of guilt and regret upon realisation of the resulting financial
situation. Guilt is a common characteristic of depression (APA, 2013). Similarly, the theme
of avoidant coping and poor planning emerged, which has also been shown as an important
psychosocial concept in depression (Ottenbreit & Dobson, 2004).
Participants reported experiencing feelings of anxiety and depression as a
consequence of their poor financial management and/or situation, linking to previous research
demonstrating a relationship between debt and depression (Richardson et al., 2013). In
addition, participants reported suicidal thoughts, in line with Barnes et al. (2016) who found
that economic hardship contributes to self-harm. Participants reported that they comfort
spend to try and make themselves feel better when depressed. Interventions which try to
reduce depression and anxiety in BAD may therefore reduce comfort spending and improve
financial capability. The impact of employment theme links to previous research suggests
that the majority of those with BAD are unemployed (Bowden, 2005).
A vicious cycle with mental health impacting those financial difficulties and this then
looping back to affect their mental health also emerged from the Thematic Analysis. This is
outlined in Figure 1. Over-spending whilst (hypo)manic via impulsive shopping or excessive
generosity appears to lead to regret and guilt when mood begins to stabilise and individuals
contemplate their financial situation. This then fuels anxiety and depression, and poor
planning and avoidant coping around finances when depressed can worsen financial
difficulties potentially leading to suicidality. Many then end up comfort spending to try and
ease negative affect, however the positive impact of this is short-lived and there is a potential
vicious cycle back to depression when individuals start to regret or feel guilty about their
over-spending again.
***Insert Figure 1 here***
One of the limitations is the lack of ethnic diversity within the sample. There may
have been a selection bias in the focus group as many people refused to take part. In addition
the larger quantitative study was advertised as on „Mood and Money‟ so participants may be
more likely to see finances and mental health as related than those who declined to take part.
The findings highlight that financial difficulties may be a particular issue for those
with a diagnosis of BAD; further research to explore this relationship is needed. A number of
possible psychological mechanisms were identified; including impulsivity during high
moods, and self-critical thoughts and avoidant coping behaviours during low moods, and
suggestions are made as to how these might be related over time. Psychological interventions
could be utilised to help address these variables and thus possibly reduce the impact of poor
mental health on finances and vice versa in those with a diagnosis of BAD. These findings
have also highlighted the possibility of financial or social intervention to reduce impulsive
spending when manic, for example having a „guardian‟ to look after credit cards.
Thank you to the participants and staff who helped with recruitment. This research
was supported by a Research Capability Fund grant from the National Institute for Health
Research via Solent NHS Trust.
Word count
2,491 (including table)
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Figure 1: A diagrammatic timeline of the proposed themes in line with mood changes
... A recent longitudinal study also showed that debts increased the risk of developing a common mental health problem over the course of a year, but those with existing mental health problems were also more at risk of being unable to pay back debts over the course of the year (9). Qualitative research with those with Bipolar Disorder has similarly identified a theme of a "Vicious Cycle" between money and mental health problems (10). ...
... Research with Bipolar disorder has also shown the role of psychological factors, such as cognitions around achievement, dependency, and poorer mindfulness increasing compulsive spending over item (41). As well as our knowledge regarding the impact of financial difficulties on mental health, given the research suggesting a possible vicious cycle (6,7,9,10), the intervention also aimed to work on factors which might lead to poor mental health impacting finances such as addressing poor financial coping and avoidance around finances which have been reported by individuals with Bipolar Disorder (10). Space from Money Worries thus aimed to tackle financial difficulties and poor mental health in an integrative fashion. ...
... Research with Bipolar disorder has also shown the role of psychological factors, such as cognitions around achievement, dependency, and poorer mindfulness increasing compulsive spending over item (41). As well as our knowledge regarding the impact of financial difficulties on mental health, given the research suggesting a possible vicious cycle (6,7,9,10), the intervention also aimed to work on factors which might lead to poor mental health impacting finances such as addressing poor financial coping and avoidance around finances which have been reported by individuals with Bipolar Disorder (10). Space from Money Worries thus aimed to tackle financial difficulties and poor mental health in an integrative fashion. ...
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Background: Previous research has shown a strong relationship between financial difficulties and mental health problems. Psychological factors such as hope and worry about finances appear to be an important factor in this relationship. Objective: To develop an online based psychological intervention (Space from Money Worries) to tackle the psychological mechanisms underlying the relationship between poor mental health and financial difficulties, and to conduct an initial evaluation of the acceptability and preliminary efficacy of the intervention. Materials and Methods: 30 participants accessing Increasing Access to Psychological Therapies (IAPT) services completed GAD-7 to measure anxiety and PHQ-9 to measure depression upon signing up to the online intervention and again 4 to 8 weeks after this. Participants also completed a measure of perceived financial distress/wellbeing and a “Money and Mental Health Scale” constructed for the evaluation. Results: Overall, 77% (n = 23) completed the intervention and follow-up assessments. Intent to Treat Analysis showed that there were statistically significant improvements in symptoms of depression, anxiety, improved perceived financial wellbeing and reduced scores on the money and mental health scale. The vast majority of participants rated each module positively. Conclusions: Space from Money Worries appears to be acceptable and may lead to improvements in mental health, perceived financial wellbeing and a reduced relationship between financial difficulties and poor mental health. However, future research with a larger sample and a control group are needed to confirm that these changes are due to the intervention.
... For example, manic episodes in bipolar disorder (BD) are associated with impulsive spending and compulsive purchasing (4). The resultant relationship between financial instability and mental health is cyclical and bidirectional -financial instability can worsen mental health, which in turn, can cause further financial challenges, leading to a vicious cycle (5,6,7,8). ...
... Mental health issues can lead to problematic financial behaviors. For instance, those with bipolar disorder have reported often avoiding finances and finding it hard to plan especially when depressed (7). Depression has also been linked with cognitive impairments such as in attention, working memory and problem solving (11), all of which have the potential to impact financial capability. ...
... For many, it is the desired part of a dopamine loop and a distraction from negative feelings (17). While these purchasing habits may have temporary and fleeting positive outcomes for the individual, they can create increased feelings of regret, guilt, and even suicidality in the long-term (7). Not only can they affect personal finances, but can also become a stressor in relationships and other parts of their life. ...
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In this paper, we present novel research methods for collecting and analyzing personal financial data alongside mental health factors, illustrated through a N=1 case study using data from one individual with bipolar disorder. While we have not found statistically significant trends nor our findings are generalizable beyond this case, our approach provides an insight into the challenges of accessing objective financial data. We outline what data is currently available, what can be done with it, and what factors to consider when working with financial data. More specifically, using these methods researchers might be able to identify symptomatic traces of mental ill health in personal financial data such as identifying early warning signs and thereby enable preemptive care for individuals with serious mental illnesses. Based on this work, we have also explored future directions for developing interventions to support financial wellbeing. Furthermore, we have described the technical, ethical, and equity challenges for financial data-driven assessments and intervention methods, as well as provided a broad research agenda to address these challenges. By leveraging objective, personalized financial data in a privacy-preserving and ethical manner help lead to a shift in mental health care.
... Individuals with bipolar disorder also appear to be more uniquely concerned about personal finances and unemployment than they are about the broader economy. In light of evidence that financial worries may represent a 'final straw' that triggers self-harm and suicidality (Barnes et al., 2016;Richardson et al., 2017), especially close attention to the mental health of individuals with bipolar disorder may be warranted. This is pertinent given the very severe levels of depression currently evident in males with the disorder, and the widespread economic hardships that are likely to be encountered as the pandemic continues to unfold. ...
Background Physical-distancing strategies during the coronavirus (COVID-19) pandemic may be particularly detrimental to the mental health of individuals with a pre-existing mood disorder. Data on the mental health status of these individuals during the current pandemic is sparse, and their current mental health needs unclear. Method We characterised COVID-19 related lifestyle changes, primary concerns and psychological distress in n=1292 respondents self-reporting a mood disorder (either bipolar disorder or depressive disorder) and n=3167 respondents without any reported mental disorder from the COLLATE (COvid-19 and you: mentaL heaLth in AusTralia now survEy) project; an Australian national survey launched on April 1st 2020. Results Psychological distress was heightened in the mood disorder group compared to the group with no mental disorder, with stress and depression further elevated in respondents with bipolar disorder compared to those with depressive disorder; and men with bipolar disorder having even higher levels of depression than women with bipolar disorder. Respondents with bipolar disorder were particularly concerned about financial issues associated with COVID-19 compared to those with depressive disorder and those with no mental disorder. Adverse changes to lifestyle behaviours were more prevalent in respondents with a mood disorder and linked to higher levels of distress. Limitations Mood disorder was self-reported and was not clinically verified. Conclusions Current psychological distress levels are elevated in individuals with mood disorder and are associated with maladaptive situational and lifestyle changes occurring in response to COVID-19.
... Qualitative research with the sample analyzed here identified themes in Bipolar Disorder of impulsive shopping and overspending, depression, anxiety and suicidality about debt and comfort spending to cope with low mood (Richardson, Jansen, Turton & Bell, 2017). However at present no studies have examined quantitative correlations between these variables. ...
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Background: There has been little research on whether finances affect mental health in bipolar disorder. Aims: This study aimed to examine the relationship between finances and mental health in bipolar disorder across two time points. Methods: Fifty-four participants with bipolar disorder in a National Health Service community mental health service completed questionnaires examining financial difficulties, compulsive buying and perceived financial well-being. Questionnaires also measured alcohol dependence, stress, depression, anxiety, past and current manic symptoms. Results: Partial correlations showed correlations over time: depression, anxiety and stress predicted later compulsive buying. Compulsive buying also predicted later anxiety. Lower perceived financial wellness increased anxiety and stress over time. Being on benefits was associated with higher depression and going without items such as clothes was linked to higher depression, stress, anxiety and past hypomanic symptoms. Conclusions: Financial difficulties are related to mental health in bipolar disorder. Poor mental health leads to compulsive buying, whereas worry about finances increases anxiety and stress, with a vicious cycle for anxiety.
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Objective Self-harm and suicide increase in times of economic recession, but little is known about why people self-harm when in financial difficulty, and in what circumstances self-harm occurs. This study aimed to understand events and experiences leading to the episode of self-harm and to identify opportunities for prevention or mitigation of distress. Setting Participants’ homes or university rooms. Participants 19 people who had attended hospital following self-harm in two UK cities and who specifically cited job loss, economic hardship or the impact of austerity measures as a causal or contributory factor. Primary and secondary outcome measures Semistructured, in-depth interviews. Interviews were audio recorded, transcribed and analysed cross-sectionally and as case studies. Results Study participants described experiences of severe economic hardship; being unable to find employment or losing jobs, debt, housing problems and benefit sanctions. In many cases problems accumulated and felt unresolvable. For others an event, such as a call from a debt collector or benefit change triggered the self-harm. Participants also reported other current or past difficulties, including abuse, neglect, bullying, domestic violence, mental health problems, relationship difficulties, bereavements and low self-esteem. These contributed to their sense of despair and worthlessness and increased their vulnerability to self-harm. Participants struggled to gain the practical help they felt they needed for their economic difficulties or therapeutic support that might have helped with their other co-existing or historically damaging experiences. Conclusions Economic hardships resulting from the recession and austerity measures accumulated or acted as a ‘final straw’ to trigger self-harm, often in the context of co-existing or historically damaging life-experiences. Interventions to mitigate these effects should include providing practical advice about economic issues before difficulties become insurmountable and providing appropriate psychosocial support for vulnerable individuals.
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Introduction: Impulsivity and risk-taking behaviours are reported in bipolar disorder (BD). We examined whether financial management skills are related to impulsivity in patients with BD. Methods: We assessed financial management skills using the Executive Personal Finance Scale (EPFS), impulsivity using the Barratt Impulsiveness Scale (BIS) and response inhibition using an emotional go/no-go task in bipolar individuals (N = 21) and healthy controls (HC; N = 23). Results: Patients had fewer financial management skills and higher levels of impulsivity than HC. In patients and controls, increased impulsivity was associated with poorer personal financial management. Patients and HC performed equally on the emotional go/no-go task. Higher BIS scores were associated with faster reaction times in HC. In patients, however, higher BIS scores were associated with slower reaction times, possibly indicating compensatory cognitive strategies to counter increased impulsivity. Conclusions: Patients with BD may have reduced abilities to manage personal finances, when compared against healthy participants. Difficulty with personal finance management may arise in part as a result of increased levels of impulsivity. Patients may learn to compensate for increased impulsivity by modulating response times in our experimental situations although whether such compensatory strategies generalize to real-world situations is unknown.
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Background North American studies show bipolar disorder is associated with elevated rates of problem gambling; however, little is known about rates in the different presentations of bipolar illness.AimsTo determine the prevalence and distribution of problem gambling in people with bipolar disorder in the UK.Method The Problem Gambling Severity Index was used to measure gambling problems in 635 participants with bipolar disorder.ResultsModerate to severe gambling problems were four times higher in people with bipolar disorder than in the general population, and were associated with type 2 disorder (OR = 1.74, P = 0.036), history of suicidal ideation or attempt (OR = 3.44, P = 0.02) and rapid cycling (OR = 2.63, P = 0.008).Conclusions Approximately 1 in 10 patients with bipolar disorder may be at moderate to severe risk of problem gambling, possibly associated with suicidal behaviour and a rapid cycling course. Elevated rates of gambling problems in type 2 disorder highlight the probable significance of modest but unstable mood disturbance in the development and maintenance of such problems. © The Royal College of Psychiatrists 2015.
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This paper systematically reviews the relationship between personal unsecured debt and health. Psychinfo, Embase and Medline were searched and 52 papers were accepted. A hand and cited-by search produced an additional 13 references leading to 65 papers in total. Panel surveys, nationally representative epidemiological surveys and psychological autopsy studies have examined the relationship, as have studies on specific populations such as university students, debt management clients and older adults. Most studies examined relationships with mental health and depression in particular. Studies of physical health have also shown a relationship with self-rated health and outcomes such as obesity. There is also a strong relationship with suicide completion, and relationships with drug and alcohol abuse. The majority of studies found that more severe debt is related to worse health; however causality is hard to establish. A meta-analysis of pooled odds ratios showed a significant relationship between debt and mental disorder (OR=3.24), depression (OR=2.77), suicide completion (OR=7.9), suicide completion or attempt (OR=5.76), problem drinking (OR=2.68), drug dependence (OR=8.57), neurotic disorder (OR=3.21) and psychotic disorders (OR=4.03). There was no significant relationship with smoking (OR=1.35, p>.05). Future longitudinal research is needed to determine causality and establish potential mechanisms and mediators of the relationship.
Objective: Bipolar disorder has been associated with elevated impulsivity - a complex construct subsuming multiple facets. We aimed to compare specific facets of impulsivity in bipolar disorder, including those related to key psychological correlates of the illness: reward sensitivity and strong emotion. Method: Ninety-one individuals diagnosed with bipolar I disorder (inter-episode period) and 80 controls completed several well-validated impulsivity measures, including those relevant to reward (Fun-seeking subscale of the Behavioral Activation System scale) and emotion (Positive Urgency and Negative Urgency scales). Results: Bipolar participants reported higher impulsivity scores than did controls on all of the impulsivity measures, except the Fun-seeking subscale of the Behavioral Activation System scale. Positive Urgency - a measure assessing the tendency to act impulsively when experiencing strong positive emotion - yielded the largest group differences: F(1,170) = 78.69, P < 0.001, partial η(2) = 0.316. Positive Urgency was also associated with poorer psychosocial functioning in the bipolar group: ΔR(2) = 0.24, b = -0.45, P < 0.001. Conclusion: Individuals with bipolar I disorder appear to be at particular risk of behaving impulsively when experiencing strong positive emotions. Findings provide an important first step toward developing a more refined understanding of impulsivity in bipolar disorder with the potential to inform targeted interventions.
PURPOSE: Bipolar mania is characterized by marked impairment in social, occupational, or other important areas of functioning. One should expect to see an equally severe burden in informal caregivers. The literature was reviewed in order to provide a foundation upon which to build nursing interventions. CONCLUSIONS: Several characteristics of bipolar mania—patient aggressiveness, lack of insight, and financial problems—were identified as severe burdens to caregivers. Professionals might not have a total view of the extent of the burden in caregivers. This review could not link the patients' mania or hypomania to factors that were described in other literature on caregiver burden related to bipolar disorder, regardless of the type of episode. PRACTICE IMPLICATIONS: There is a need for further research in this area to make more explicit the burden on caregivers during times of mania or hypomania.
Previous research has demonstrated a relationship between avoidance and depression, although the nature of this relationship has been confused by inconsistent definitions of avoidance. Following a review of the construct of avoidance and an examination of past research, a new multidimensional measure of avoidance was developed and validated using an undergraduate student sample (245 females and 146 males). Four reliable factors reflecting combinations of cognitive/behavioral and social/nonsocial dimensions of avoidance were obtained from the factor analysis of the new scale, entitled the "Cognitive-Behavioral Avoidance Scale" (CBAS). The scale showed the predicted relationships with convergent and divergent measures used for construct validation. As predicted, subscales of the CBAS, as well as the overall scale score, were significantly related to the depression and anxiety criterion measures. The findings from this study suggest that avoidance may be an important construct in the psychosocial conceptualization of depression. In addition, this integrated measure of avoidance has potential utility for depression researchers. Suggestions for further scale development and research are provided.
Bipolar disorder affects many aspects of an individual's life and greatly interferes with a person's ability to find and maintain employment. The evidence indicates that a majority of patients with bipolar disorder are not employed and many others are employed only part time. Job-related difficulties are common, and patients with bipolar disorder tend to have higher rates of absenteeism from work compared with working individuals without bipolar disorder. A limited amount of data suggests that appropriate treatment may improve occupational status among patients with bipolar disorder. The ability to work is closely related to functional recovery, which tends to be incomplete in a majority of patients with bipolar disorder.
Diagnostic and statistical manual of mental disorders (DSM-5)
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5): American Psychiatric Association.