Stigma in bipolar disorder: A current review of the literature

A Social Media Study of Portrayals of Bipolar Disorders on YouTube: Content and Thematic Analyses

BACKGROUND

Individuals with mental disorders frequently use YouTube to express themselves, reach an audience, or as a means of understanding their condition. Testimonies posted on YouTube provide longer and richer perspectives than the short posts found on other social media platforms. Research focusing on the depiction of mental disorders on YouTube is blossoming. Bipolar disorders (BDs) are disabling mood disorders. The diagnosis of any mental disorder, and more so BD, is often a life-changing event. However, no published study has investigated the portrayal of diagnoses of BD on YouTube.

OBJECTIVE

This study aims to investigate the portrayals of BDs on YouTube, focusing on the diagnosis narratives and their accompanying narrative context, in particular, reports of personal experiences and reactions.

METHODS

We performed a manual content analysis of 39 testimonies (women: n=24, 62%) depicting BDs and their diagnosis by individuals with BD. We also performed a thematic analysis of the corpus relying upon a deductive and inductive approach.

RESULTS

Our manual content analysis revealed that portrayals included the disclosure of diagnoses of BD-I (as per both coders' agreement: 10 testimonies) and BD-II (11 testimonies) to a similar extent. The reactions to the diagnosis were mostly negative (8 testimonies), followed by positive (5 testimonies), while fewer portrayals indicated a denial of the condition (4 testimonies). Several portrayals made mention of issues in the areas of money and accommodation (15 testimonies), profession and education (13 testimonies), and relationships (20 testimonies). Medication (31 testimonies) and psychotherapy (23 testimonies) were often mentioned as part of treatment for BD, most generally in positive terms. The 8 themes emerging from the thematic analysis were: "reactions on diagnosis, treatment, and health care professionals' expertise," "trial and error in medication," "positive effects of BD," "disability, stigma, and shame," "loss," "family planning and genetics," "identity change (psychological and physical)," and "human social relationships."

CONCLUSIONS

Overall, our results underline the complexity and richness of the depiction of the diagnosis of BD and its narrative context, and highlight the importance of the moment of the diagnosis, medication, and psychotherapy. Our study emphasizes the need for further exploration of the impact of social media on mental health awareness.

The interrelationship of depression, stigma, and suicide risk among patients with bipolar disorder and their caregivers: a six-month follow-up study

BACKGROUND

Despite significant research on bipolar disorder, the interplay between depression, suicide risk, and stigma in patients with bipolar disorder and their caregivers remains underexplored. This study aimed to examine how stigma and suicide risk affect the severity of depression in both patients with bipolar disorder and their caregivers.

METHODS

We recruited 76 patients with bipolar disorder and their 76 caregivers from a general hospital between August 2023 and July 2024. Assessments included a psychiatric diagnostic interview using the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, the Family APGAR Index, the Stigma Subscale of the Explanatory Model Interview Catalogue, and the Suicide Assessment Scale. Structural equation modeling (SEM) was employed to explore the mechanisms underlying depression in caregivers. Additionally, a stepwise forward logistic regression model identified key factors associated with depressive disorders in caregivers.

RESULTS

Among caregivers, depressive disorders were the most common psychiatric diagnosis (27.6%), followed by anxiety disorders (17.1%) and insomnia disorders (11.8%). SEM analysis revealed that suicidal ideation in patients (β = 0.72, p < 0.001) was significantly associated with depression severity in patients with bipolar disorder. Caregivers' stigma (β = 0.41, p < 0.001) and suicide risk (β = 0.39, p < 0.001) were positively associated with their own depression severity. Interestingly, caregivers' suicide risk (β = -0.20, p < 0.01) was inversely related to patients' depression severity. Unemployment, anxiety severity, suicide risk, and family support were also significant predictors of depression in caregivers.

CONCLUSIONS

Suicidal ideation in patients with bipolar disorder is strongly linked to the severity of their depressive symptoms. Among caregivers, higher levels of stigma and suicide risk are associated with greater depressive symptom severity, while caregivers' suicide risk appears to have a protective effect on patients' depression severity. Early identification and targeted interventions for individuals at high risk of suicide and stigma may help alleviate depression in both patients and their caregivers.

Correlation between disability, internalized stigma and mental recovery in patients with bipolar disorder

Background

This study aimed to examine the correlation between disability, internalized stigma and mental recovery in patients with bipolar disorder. It further examined the impact of internalized stigma and disability on mental recovery.

Methods

The study was conducted with 103 patients diagnosed with bipolar disorder in remission who had been referred to a Community Mental Health Center. Data were collected using the Short Disability Assessment Schedule, Internalized Stigma of Mental Illness Scale and Recovery Process Inventory. Data were analyzed using an independent t-test, a one-way analysis of variance, and a multiple linear regression analysis.

Results

No disability was diagnosed in 33.0% of the participants, while 25.2% had mild disability, 30.1% had moderate disability and 11.7% had severe disability. DAS-S scores indicated differences between the recovery process and internalized stigma scores (p < 0.05). While disability levels, alienation and perceived discrimination were not found to be effective on recovery, endorsement of stereotypes, social withdrawal, and resistance to stigma were found to be effective (F:43.343, p < 0.001, R2: 0.787).

Conclusion

The prevalence of disability in patients with bipolar disorder increases the likelihood that these individuals will need more help from others. The mental recovery is positively affected by the endorsement of stereotypes, social withdrawal, and resistance to stigma.

Disclosure costs: The impact of bipolar diagnosis and social desirability on stigma

BACKGROUND

The previous literature concerned with understanding stigma affecting patients with bipolar disorder relies predominantly on qualitative and survey approaches, and rarely contends with the potential role of social desirability on disclosure. The current project employs a 2 × 2 experimental approach to establish the presence of stigmatizing attitudes in a context with real social consequences (i.e., college housing decisions).

METHOD

Participants believed they were participating in a collaborative study with campus residential life. The project was designed to establish the presence of stigmatizing attitudes affecting patients with bipolar disorder compared to an unaffected control, as well as testing whether employing pressure to respond honestly (via bogus pipeline) affects stigma disclosure.

RESULTS

Study 1 results revealed that after reviewing a peer's housing application, stigma consequences were observable when a student disclosed a bipolar diagnosis at a large, public southeastern university (N = 182) across all outcomes (increased desire for social distance and perceived dangerousness, decreased relatability). In this sample social desirability did not appear to influence responding. In Study 2, at a small, private northeastern college (N = 168), stigma was observable on the dangerousness and relatability outcomes, but only demonstrable in terms of social distance under the conditions of the bogus pipeline.

DISCUSSION

Together, these findings contribute persuasive experimental evidence affirming the scope and impact of stigma in the lives of patients with bipolar disorder, and underscores the capacity for social desirability to mask the presence of stigma, which has significant implications for the interpretation of past stigma research.

Experiences of Functioning in Mood Disorders: Systematic Review and Qualitative Meta-Synthesis

INTRODUCTION

A key responsibility of mental health nursing practice is enhancing recovery from mood disorders, including facilitating improvements in daily functioning. However, in mood disorders, current definitions and measurements of functioning are led by researchers and clinicians.

AIM/QUESTION

We aimed to gain a comprehensive qualitative understanding of patients' experiences of functioning in mood disorders (major depressive disorder [MDD] and bipolar disorder [BD]).

METHOD

Databases were systematically searched for qualitative articles examining experiences of functioning in mood disorders. Findings were analysed and synthesised using inductive thematic synthesis.

RESULTS

Thirty-eight studies (n = 679, 43.5% BD, 61% female) from seventeen countries were included. While most studies were high quality, some (n = 4) had moderate to serious methodological issues. Four meta-themes were identified: sense of self; connection; mood management; and stigma. The contribution of stigma predominantly related to studies of BD rather than MDD.

DISCUSSION

This study highlights the potential breadth of functioning experiences described by people with mood disorders, ranging from general understandings of functioning (work, relationships) to broader aspects like sense of self and stigma.

IMPLICATIONS FOR PRACTICE

Mental health nurses have an important role in addressing stigma and can offer strategies to improve mood management, connection, and sense of self, which will improve functioning and promote recovery for people with mood disorders.

Understanding Relapse in Bipolar Disorder at a Tertiary Mental Health Facility in Uganda

Background

Bipolar disorder (BD) is a chronic psychiatric condition characterized by recurrent episodes of mania, hypomania, and depression, affecting approximately 1 in 150 adults globally. BD contributes significantly to disability and years of life lost, with a notable prevalence in Africa. The high relapse rates in BD, exacerbated by limited mental health resources and underdiagnosis, highlight the need for targeted interventions. This study explores the factors contributing to relapse among BD patients at Butabika National Referral Mental Hospital, Uganda, a crucial mental health facility in the region.

Methods

This cross-sectional qualitative study was conducted at Butabika National Referral Mental Hospital. Adult patients aged 18-65, diagnosed with BD and experiencing relapse after treatment, were included. Data were collected through purposive sampling, focusing on obtaining detailed personal accounts from approximately 15 participants until data saturation was achieved. Thematic analysis identified key themes and subthemes related to relapse factors.

Results

Five major themes emerged: treatment adherence, psychosocial factors, cultural beliefs, economic challenges, and coping mechanisms. Non-adherence to medication, driven by side effects, forgetfulness, and financial constraints, was a significant relapse factor. Psychosocial stressors, such as life events and social isolation, alongside stigma and cultural beliefs in traditional healing, further complicated relapse patterns. Economic hardships affected medication access and treatment consistency. Supportive social networks and psychoeducation emerged as crucial for effective management and relapse prevention.

Conclusion

Addressing medication adherence, psychosocial stressors, cultural beliefs, and economic barriers through a holistic approach integrating medical treatment with psychoeducation and support systems is essential for improving patient outcomes and reducing relapse rates in this setting. Therefore, the effective management of bipolar disorder at Butabika National Referral Mental Hospital requires a complex interplay between biological, psychological, and social factors.

Narrative enhancement and cognitive therapy for self-stigma among youth with bipolar disorder or multiple mental health conditions: protocol for a pilot randomised basket trial

INTRODUCTION

Self-stigma occurs when individuals internalise negative stereotypes about their mental health conditions. Self-stigma is common among those with serious mental illnesses, including youth, and is considered a major barrier to recovery through its impact on hope, self-esteem and self-identity. This patient-oriented protocol aims to assess the feasibility of conducting a future full-scale randomised controlled trial (RCT) of a youth-oriented adaptation of narrative enhancement and cognitive therapy for self-stigma among youth (NECT-Y).

METHODS AND ANALYSIS

This is a two-site, two-arm pilot basket RCT with 1:1 randomisation to NECT-Y or treatment as usual (TAU). Participants are youth, ages 16-29 diagnosed with bipolar disorder, any subtype (Basket 1) or with any two or more mental health conditions (Basket 2). After informed consent, we will conduct baseline assessments and randomisation, then either a 14-week NECT-Y group intervention or TAU. Diagnostic interviews will be used to confirm diagnosis at baseline. A range of self-report questionnaires will be administered at baseline, post-treatment and 3 month follow-up. The primary outcome is feasibility as indicated by the achievement of recruitment goals, retention and adherence, intervention fidelity and the absence of serious adverse events. Secondary outcomes include acceptability and the intervention's impact on self-stigma, wellness, symptomatology, treatment-seeking attitudes and other related constructs. A youth advisory group is informing all stages of the study process.

ETHICS AND DISSEMINATION

The Research Ethics Board for Centre for Addiction and Mental Health (#062/2024) has approved this study protocol. Ethics is also approved at London Health Sciences Centre (Western Health Sciences Research Ethics Board (HSREB) #125812). Results will be published in international peer-reviewed journals and presented at relevant conferences. Summaries will be provided to the funders of the study, as well as to lay audiences, including study participants.

TRIAL REGISTRATION NUMBER

NCT06672562.

Mood Disorder Public Stigma in Jewish Communities in the United States

This study employed an experimental vignette design in Jewish communities in the United States (n = 243) to investigate whether public stigma toward target individuals with major depressive disorder or bipolar disorder presenting with either mania or depression was associated with their gender and symptomatology. The Mental Illness Stigma Scale (Day et al., in J Appl Soc Psychol 37(10):2191-2219, 2007) was used to measure the following dimensions of public stigma: (a) anxiety; (b) relationship disruption; (c) hygiene; (d) visibility; (e) treatability; (f) professional efficacy; and (g) recovery. The influence of characteristics of survey respondents on public stigma was also examined. In Jewish communities in the United States, mood disorder symptomatology was associated with the stigma dimensions of recovery, relationship disruption, and hygiene. Among respondents, younger and middle-aged males reported increased treatment efficacy stigma. Research implications include designing stigma reduction interventions tailored to specific diagnostic (e.g., bipolar disorder) and demographic (e.g., younger males) groups within the Jewish community.

Enhancing work life through social cognition: the effect of SCIT in bipolar disorder

Objectives

This study aimed to investigate the effectiveness of social cognition and interaction therapy (SCIT) in improving occupational functioning in individuals diagnosed with bipolar disorder I (BD-I). The effects of SCIT intervention with standard treatment methods were investigated on social cognition and functioning effects, which are often negatively affected in patients with BD-I.

Methods

The research involved 28 participants, allocated into two groups: An experimental group (n = 12) receiving SCIT for 8 weeks alongside standard treatments (pharmacotherapy and psychiatric interviews), and a control group (n = 16) undergoing standard treatment without additional interventions. Outcome measures were assessed using a suite of tools, including the Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Eyes Test (ET), Metacognition Scale (MCI), Internalized Stigma of Mental Illnesses (ISMI), and Functioning Assessment Short Test (FAST). Given the small sample size, non-parametric tests were employed for data analysis. Analyses were conducted using the Mann-Whitney U test and Wilcoxon test for comparisons between the experimental and control groups and within groups. Also, the effects of the intervention on social cognition, occupational functioning and resistance to stigmatization were dealt.

Results

The findings revealed that participants in the experimental group showed significant improvements in social cognition and occupational functioning after SCIT compared to the control group. However, the levels of stigmatization experienced by individuals as a result of ISMI measurements were significantly lower in the SCIT group compared to the control group.

Conclusion

The study concludes that SCIT can be an effective intervention for enhancing certain psychosocial and cognitive functions in individuals with BD-I, thereby improving their occupational functioning. Nevertheless, the persistent levels of stigma indicate the need for additional strategies to address the broader challenges faced by individuals with BD-I in terms of societal perception and self-stigmatization.

Examining the relationships between self-stigma, loneliness, depressive symptoms, and suicidal ideation among people with bipolar disorder

People diagnosed with bipolar disorder (BD) commonly experience self-stigma, which negatively affects various health outcomes. The aim of the present study was to elucidate the mechanisms through which self-stigma may contribute to suicidality among bipolar patients by investigating the mediating roles of loneliness and depressive symptoms. A total of 140 patients with BD were cross-sectionally assessed with self-report scales measuring self-stigma, loneliness, depressive symptoms and suicidal ideation, and with a clinician-rated scale evaluating overall psychopathology. Path analysis was used to analyze the data. Self-stigma was directly related to more severe loneliness, depressive symptoms and suicidal thoughts. There were also significant direct effects of loneliness on depressive symptoms and depressive symptoms on suicidal ideation. The direct effect of loneliness on suicidality was non-significant. The following indirect effects on suicidal ideation were found: from self-stigma via depressive symptoms, from loneliness via depressive symptoms and a sequential effect from self-stigma through loneliness and depressive symptoms. Our findings clearly indicate that interventions aiming to reduce the risk of suicide among people with BD should be comprehensive and take into account not only psychiatric symptoms, but also social context and the psychological aspects of living with this diagnosis.

On being and having: a qualitative study of self-perceptions in bipolar disorder

Background

Bipolar disorder (BD) is a chronic and often severe mental illness. Yet despite the well-documented complexities in its diagnosis and treatment, little research has been dedicated to understanding the complex inner landscape experienced by those living with BD. Even as qualitative research has explored the lived experience of BD across a variety of perspectives, i.e., what BD looks like, there is a lack of research exploring what BD means to those living with the condition. We conducted individual, semi-structured interviews with 20 adults with clinically stable BD to explore their perceptions of the condition, their construction of meaning of their illness, and their view of BD in relation to their sense of self. We coded the transcripts according to the principles of thematic analysis and analyzed the data using an interpretative phenomenological analysis approach.

Results

We identified three overarching domains: (1) Benefit or burden: a dialectic through which participants weighed the valence of their illness over time; (2) Self or other: the internal or external locus through which they experienced BD; and (3) From ineffability to meaning making: the process of naming, understanding, and incorporating BD into their life's whole. Within each domain, themes and subthemes outline nuanced and often conflicting perspectives of participants' illness experiences.

Conclusions

Across the varied and nuanced perspectives uncovered, our work provides a framework of three domains central to the inner reality of lived bipolar experience. Thoughtful understanding of patients' experiences, perspectives, and desires within these three domains may aid clinicians and loved ones alike in more sensitively and effectively addressing the unique individual needs of those living with BD. It may also be informative for individuals living with BD themselves. By exploring patients' perspectives in each of the three domains we identified, those with or at risk for BD as well as those caring for people with BD may be better positioned to help identify the inner work and practical interventions (such as finding bipolar community, or pathways to occupational thriving) needed to achieve a rich, meaningful life with BD.

Factors that influence medication adherence in women with fibromyalgia: A path analysis

AIMS

To investigate the relationships between depression symptoms, perceived stigma, disease severity, patient-provider communication and medication adherence in fibromyalgia patients. The objectives were to explore how these factors influence treatment adherence and to develop a comprehensive model illustrating their interconnections.

BACKGROUND

Fibromyalgia is a chronic pain syndrome with fatigue, sleep issues and idiopathic pain. Medication adherence is limited by insufficient symptom relief, side effects and costs. Stigma further complicates fibromyalgia. Disease severity affects patient-provider communication. Associations between depression, stigma, severity, communication and adherence in fibromyalgia are unclear.

DESIGN

A cross-sectional, correlational study.

METHODS

The STROBE guidelines for cross-sectional studies were followed. Participants included Hebrew-speaking participants who were members of two Facebook groups: 'Shades of Purple' and 'Fibromyalgia- Get to Know!' Between February and April 2022. They undertook evaluations using The Patient Health Questionnaire-9 to gauge depression symptoms, assessed perceived stigma, utilised The Revised Fibromyalgia Impact Questionnaire to determine disease severity, employed The Patient Reaction Assessment questionnaire for patient-provider communication, and used the 8-item Morisky Medication Adherence Scale (MMAS-8). Associations between the variables were explored using Pearson's correlations and path analyses.

RESULTS

The study included 141 women with fibromyalgia, aged 22 to 76 years. Most reported having a stable partner (69.5%) and 75.2% had children. The treatment adherence levels were as follows: 53.2% (N = 75)-low, 33.3% (N = 47)-medium and 13.5% (N = 19)-high. Depression positively correlated with stigma. Stigma negatively correlated with patient-provider communication. Patient-provider communication positively correlated with treatment adherence. A significant negative indirect effect of depression on treatment adherence through stigma and patient-provider communication was found.

CONCLUSIONS

Perceived stigma and patient-provider communication played a mediating role in the relationships between depression and treatment adherence among women with fibromyalgia.

RELEVANCE TO CLINICAL PRACTICE

Addressing stigma related to fibromyalgia and effective patient-provider communication can positively influence treatment adherence.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Self-Stigma in Patients with Endogenous Mental Disorders: A Cross-Sectional Comparative Study

BACKGROUND

Self-stigma remains one of the most vexing issues in psychiatry. It complicates the treatment and social functioning of patients with endogenous psychiatric disorders. Identifying the specific features of self-stigma depending on the type and duration of the endogenous mental illness can help solve this problem.

AIM

The aim of this study was to establish the level and specific features of self-stigma in patients with various types of chronic endogenous psychiatric disorders at different disease stages and to establish the correlation between the level of self-stigma and the attitude of the patient to his/her disease and treatment.

METHODS

Clinical psychopathology assessment, psychometric scales and questionnaires: "Positive and Negative Syndrome Scale" (PANSS), "Questionnaire for Self-Stigma Assessment in Mentally Ill Patients", and Russian versions of the "Insight Scale for Psychosis" (ISP), and "Drug Attitude Inventory" (DAI-10). The cross-sectional study included 86 patients with endogenous mental illnesses (bipolar affective disorder and schizophrenia spectrum disorders.

RESULTS

The analysis of the results of the "Questionnaire for Self-Stigma Assessment in Mentally Ill Patients" showed that at the initial disease stages the highest level of self-stigma is observed in patients with bipolar affective disorder (M±σ=1.22±0.73; Me [Q1; Q3]=1.10 [0.83; 1.60]), while the lowest level was observed in patients with schizophrenia spectrum disorders (M±σ=0.86±0.53; Me [Q1; Q3]=0.77 [0.31; 1.25]). Patients with schizophrenia and schizoaffective disorder and a disease duration more than five years participating in a long-term comprehensive psychosocial rehabilitation program also demonstrated high rates of self-stigma (M±σ=1.20±0.57, Me [Q1; Q3]=1.26 [0.89; 1.47]). The study groups showed differences in terms of the structure of components of self-stigma and their severity; significant correlations were uncovered between the self-stigma parameters and the attitude of patients to their disease and therapy.

CONCLUSION

The results of this study contribute to a better understanding of the specific features of self-stigma in patients with various endogenous disorders at different stages of the disease. These data can be used as part of a comprehensive psychosocial treatment program for this patient cohort, as well as for future research.

Self-stigma and bipolar disorder: A systematic review and best-evidence synthesis

BACKGROUND

Bipolar disorder is a severe and chronic mental illness characterized by recurrent major depressive episodes and mania or hypomania. In addition to the burden of the disease and its consequences, self-stigma can impact people with bipolar disorder. This review investigates the current state of research in self-stigma in bipolar disorder.

METHODS

An electronic search was carried out until February 2022. Three academic databases were systematically searched, and best-evidence synthesis was made.

RESULTS

Sixty-six articles were related to self-stigma in bipolar disorder. Seven key themes were extracted from these studies: 1/ Comparison of self-stigma in bipolar disorder and other mental illnesses, 2/ Sociocultural context and self-stigma, 3/ Correlates and predictors of self-stigma, 4/ Consequences of self-stigma, 5/ Treatments and self-stigma, 6/ Management of self-stigma, and 7/ Self-stigma and recovery in bipolar disorder.

LIMITATIONS

Firstly, a meta-analysis could not be performed due to the heterogeneity of the studies. Secondly, limiting the search to self-stigma has excluded other forms of stigma that also have an impact. Thirdly, the under-reporting of negative or nonsignificant results due to publication bias and unpublished studies might have limited the accuracy of this reviews' synthesis.

CONCLUSION

Research on self-stigma in persons with bipolar disorder has been the focused on different aspects, and interventions to reduce self-stigmatization have been developed, but evidence of their effectiveness is still sparse. Clinicians need to be attentive to self-stigma, its assessment, and its empowerment in their daily clinical practice. Future work is required to establish valid strategies to fight self-stigma.

The Big Five as Predictors of Cognitive Function in Individuals with Bipolar Disorder

The connection between cognitive function and the "Big Five" personality traits (openness, conscientiousness, extraversion, agreeableness, and neuroticism) in the general population is well known; however, studies researching bipolar disorder (BD) are scarce. Therefore, this study aimed to investigate the Big Five as predictors of executive function, verbal memory, attention, and processing speed in euthymic individuals with BD (cross-sectional: n = 129, including time point t1; longitudinal: n = 35, including t1 and t2). Participants completed the NEO Five-Factor Inventory, the Color and Word Interference Test, the Trail Making Test, the d2 Test of Attention Revised, and the California Verbal Learning Test. The results showed a significant negative correlation between executive function and neuroticism at t1. Changes in cognitive function between t1 and t2 did not correlate with and could not be predicted by the Big Five at t1. Additionally, worse executive function at t2 was predicted by higher neuroticism and lower conscientiousness at t1, and high neuroticism was a predictor of worse verbal memory at t2. The Big Five might not strongly impact cognitive function over short periods; however, they are significant predictors of cognitive function. Future studies should include a higher number of participants and more time in between points of measurement.

Morphine exposure during adolescence induces enduring social changes dependent on adolescent stage of exposure, sex, and social test

Drug exposure during adolescence, when the 'reward' circuitry of the brain is developing, can permanently impact reward-related behavior. Epidemiological studies show that opioid treatment during adolescence, such as pain management for a dental procedure or surgery, increases the incidence of psychiatric illness including substance use disorders. Moreover, the opioid epidemic currently in the United States is affecting younger individuals raising the impetus to understand the pathogenesis of the negative effects of opioids. One reward-related behavior that develops during adolescence is social behavior. We previously demonstrated that social development occurs in rats during sex-specific adolescent periods: early to mid-adolescence in males (postnatal day (P)30-40) and pre-early adolescence in females (P20-30). We thus hypothesized that morphine exposure during the female critical period would result in adult sociability deficits in females, but not males, and morphine administered during the male critical period would result in adult sociability deficits in males, but not females. We found that morphine exposure during the female critical period primarily resulted in deficits in sociability in females, while morphine exposure during the male critical period primarily resulted in deficits in sociability primarily in males. However, depending on the test performed and the social parameter measured, social alterations could be found in both sexes that received morphine exposure at either adolescent stage. These data indicate that when drug exposure occurs during adolescence, and how the endpoint data are measured, will play a large role in determining the effects of drug exposures on social development.

Stigma in people living with bipolar disorder and their families: a systematic review

BACKGROUND

Stigma affects different life aspects in people living with bipolar disorder and their families. This study aimed to examining the experience of stigma and evaluating predictors, consequences and strategies to combat stigma in people with bipolar disorder and their families.

METHODS

We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) in 2022. We extensively reviewed six online databases (PubMed, Scopus, Medline, EMBASE, Web of Science and Google Scholar). Articles published in the English language about stigma in people living with bipolar disorders and their families were included.

RESULTS

A total of 42,763 articles were retrieved, of which 40 articles from 14 countries were included in this study (n = 7417 participants). Of the 40 articles, 29 adopted quantitative methods (72.5%), two used mixed-methods (5%), eight used qualitative (20%) methods, and one was a case series (2.5%). The results of the studies were categorized into four themes: 1. Stigma experienced by people living with bipolar disorders and their families, 2. Predictors of stigma in people living with bipolar disorders and their families, 3. Consequences of stigma in people living with bipolar disorders and their families, 4. Effective interventions and strategies to reduce stigma in people living with bipolar disorders and their families.

CONCLUSION

The results of this study might be useful to design psychiatric cognitive interventions to reduce stigma in people living with bipolar disorders and their families and designing community-based interventions to normalize bipolar disorder at the community level.

The Current Quality of Web-Based Information on the Treatment of Bipolar Disorder: A Systematic Search

Background: An important aspect of managing chronic disorders like bipolar disorder is to have access to relevant health information. This study investigates and compares the quality of information on the treatments of bipolar disorder that is available on English websites, as an international language, and on Italian websites, as a popular local language. Methods: A systematic review search was obtained from four search engines. We excluded unrelated materials, scientific papers, and duplicates. We analyzed popularity with PageRank; technological quality with Nibbler; readability with the Flesh Reading Ease test and Gulpease index; quality of information with the DISCERN scale, the JAMA benchmark criteria, and on the extent of adherence to the HONCode. Results: 35 English and 31 Italian websites were included. The English websites were found to have a higher level of quality information and technological quality than the Italian ones. Overall, the websites were found to be difficult to read, requiring a high level of education. Conclusions: These results can be important to inform guidelines for the improvement of health information and help users to reach a higher level of evidence on the websites. Users should find the benefits of treatment, support for shared decision-making, the sources used, the medical editor’s supervision, and the risk of postponing treatment.

Psychiatric and Psychosocial Factors of Suicide Decedents and Survivor of Suicide Loss: Psychological Autopsy Study of Incheon City in South Korea

In South Korea, the suicide rate is more than double the OECD average, and precise identification of the cause is required for suicide prevention. Psychological autopsy is used to reveal factors related to suicidal behavior; however, such studies are lacking in Korea. This study investigated the factors related to suicide using psychological autopsies in Incheon, a major city in Korea. In total, 46 cases were investigated using the Korea-Psychological Autopsy Checklist (K-PAC), and data on mental health conditions and psychosocial factors of suicide decedents and their families were analyzed. It was estimated that 87% of individuals of suicides had a mental health condition before death, but only 15.2% continued treatment or counseling. Most individuals who died of suicide showed warning signs before death, but only 19.6% of survivors of suicide loss noticed them. Mental health concerns before and after the death of the individual were also identified in more than half of their families. To prevent suicide, intensive and continuous treatment for psychiatric conditions and prompt recognition of active response to suicide warning signs are required. Care for the mental health of family members is also important.

Facilitators and Barriers of Medication Adherence Based on Beliefs of Persons with Bipolar Disorder: A Qualitative Study

One of the big challenges in treating individuals with bipolar disorder (BD) is nonadherence to medication. This is the principal factor associated with a worse prognosis or outcome of the disease. This study aimed to explore and analyze the individual perceptions that people with BD have about the positive and negative aspects when taking medication. A descriptive and interpretative study was carried out using the qualitative research paradigm with the use of the analytical technique of discourse analysis, extracting the data through the completion of focus groups. Participants’ speech was digitally audio-recorded in digital format. In order to complete the codification of the participants’ speech content, we relied on the qualitative data analysis (using the QRS NVivo 10 computer software). Thirty-six participants diagnosed with bipolar disorder took part in our study. In the participants’ speech concerning the main barriers to pharmacological treatment, three key topics were identified. Perceived facilitators were summarized in four factors. The main facilitators regarding the use of pharmacological treatment in individuals with BD were the ones related with the perceived need for treatment in the acute phase, the recognition of the illness, the shared clinical decision, and the causal biological attribution in the chronic phase. In terms of perceived barriers, social control was identified in both phases, adverse effects in the acute phase, and the absence of effective treatment in the chronic state.