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Financial Difficulties in Bipolar Disorder:
Results from the Mood and Money Study.
Dr. Thomas Richardson
Principal Clinical Psychologist, Solent NHS Trust
Thomas.Richardson@solent.nhs.uk
Acknowledgements
Co-Authors:
Megan Jansen
Chris Fitch
Dr. Lorraine Bell
Wendy Turton
Funded:
Research Capability Funding NIHR
Thanks to participants and all those who referred.
Solent Research department esp. Dr. Sarah Williams,
Dr. Katherine Newman-Taylor, Uni of Southampton.
ICD-10: Diagnostic Criteria
Mania:
“The individual may embark on extravagant and
impractical schemes, spend money recklessly…”
Hypomania:
Possible: “appearance of interests in quite new ventures
and activities, or mild over-spending.”
Psychology of Bipolar
●Feel need to be independent, when manic do not listen
to advice.
●Strong beliefs about:
●Goal attainment (e.g. If I try hard enough I should be
able to excel in anything I attempt’)
●Achievement (‘My life is wasted unless I’m a success).
●Life events both positive and negative linked to mood
episodes.
Psychology of Bipolar
●Catastrophic beliefs about failure.
●Mania: Overgeneralise from successes.
●Greater ambitions for fame and fortune: these
escalate manic symptoms.
Debt and Mental Health
Richardson et al. (2013) meta-analysis:
● Those with depression more than twice as likely to be
in debt.
Richardson et al. (2015, 2016):
● Vicious cycle between financial difficulties and eating
disorder risk, alcohol problems and anxiety in students.
Previous Research: Bipolar
●High risk for gambling (Jones et al., 2015).
● Fletcher et al. (2013) Impulse spending when
hypomanic in 70%
● Poor financial management associated with
impulsivity Cheema et al. (2015)
● Caregivers report financial difficulties and impulsive
spending a source of stress (Beentjes, et al. 2012)
● Nothing on debt or impact on mental health
Qualitative Analysis
●44 with Bipolar Disorder answered written questions
●Six took part in focus group
●Thematic analysis
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, 295, 2-6.
Themes
Themes Quotes
1. Overspending
a. Impulse Shopping
b. Excessive Generosity
• “Impulsive purchases… will spend all
that I have when I am manic or hypo-
manic.”
• “I became high and gave away all my
savings to charity 4 years ago.”
2. Anxiety/Depression
a. Suicidality
• “The realisation of debt can trigger a
depressive bout.”
• “The very reason I tried to commit
suicide 3 years ago.”
3. Regret/Guilt • “Regret about overspending – “What
made me buy these things!?”
Themes
Themes Quotes
4. Poor
Planning/Avoidant
Coping
• “Prone to burying head in the sand,
ignoring demands for payments.”
5. Vicious Cycle • “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.”
6. Poor Employment • “Affected work and the amount I earn.
Had to take an £8000 pay cut to
support positive mental health.”
7. Comfort Spending • “During down periods, I essentially
comfort spend.”
Themes: Timeline with Mood Changes
Method: Participants
●54 patients with Bipolar Disorder recruited from
Community Mental Health Teams in Portsmouth
●40 took part at a second time point 4 months later
Both papers submitted for publication.
Method: Measures
Finances:
●Finances: debt, problems paying bills, perceived financial
wellbeing
●Compulsive shopping scale “There are times when I
have a strong urge to buy.”
Mental Health:
●Centre Epidemiological Studies Depression Scale
●Altman Self-Rating Mania Scale
●Perceived Stress Scale
●GAD-7
Method: Measures
Psychological Variables
●Rosenberg Self-Esteem Scale: “I certainly feel useless
at times”.”
●Mindful Attention Awareness Scale: “It seems I am
“running on automatic” without much awareness of what
I’m doing”
●Dysfunctional Attitude Scale 24 item: “If I try hard
enough, I should be able to excel at anything I attempt”
● Barratt Impulsivity Scale 15 item: “I act on the spur of
the moment”
Method: Measures
Psychological Variables
●Brief Hypomanic Attitudes and Positive Predictions
Inventory: “When I feel good, I know that whatever I do, I
could do no wrong”
●9 item subjective thought over activation questionnaire:
“My thoughts never stop’”
Results Over Time
●Poorer perceived financial wellness increased anxiety
and stress over time (after controlling baseline
symptoms).
●How clients saw there finances more important than
objective measures such as number loans
Results Over Time
•Greater financial difficulties increased later thoughts
around achievement, goal focus and hypomanic
cognitions.
•Greater impulsivity- greater later financial difficulties
Note in above baseline scores not controlled for.
•Poorer perceived financial wellness lowered self-
esteem over time
Compulsive Spending: Partial
correlations over time
Greater
Compulsive
Spending
Lower Mindfulness Higher Dependency on
Others
Greater
Achievement Focus
Depression
Stress
Anxiety
r=-.46, p<.01
r=.48, p<.01
r=.42, p<.01
r=.28, p<.05
r=-.45 p<.01.
r=.34, p<.05
r=.41, p<.01
r=.28, p<.01
Financial
difficulties
Poor perceived
financial wellness
Anxiety
Avoid
finances Compulsive
spending
Regret Dependence
Generosity
Go without Low self-
esteem
Depression
Suicidality
Poor
mindfulness
Hypomanic
cognitions:
achievement, goal
focus
Plan to make
money
Hypomania and
impulsivity
increases
Desire for
comfort
Conclusions
●Finances affect mental health and vice versa in Bipolar:
Vicious cycle.
●Compulsive spending is key: might not be random:
goal-focused possibly to try and make money.
●Many psychological mechanisms.
●Role for psychological therapies: CBT, Mindfulness.
●Future research needed: Test model and develop
interventions.
Questions to consider
●Does this fit what you have seen with Bipolar clients?
●Is there anything missing?
●What does this mean in terms of intervention and
prevention?