"What makes you well?" Supports of well-being in bipolar disorder. A qualitative study.

OBJECTIVE: Subjective experience of people living with bipolar disorder is gaining attention in the field of research. Improving well-being could be as important as symptom remission, but this constitutes a vague concept. This study aimed at exploring the boundaries and the determinants of the well-being of people living with bipolar disorder in a French context. METHODS: Individual semi-structured interviews were conducted with 16 patients by three professionals. Interviews were transcribed and analysed using the thematic analysis method. RESULTS: Various dimensions emerged as contributing to well-being: daily routines, connectedness, regaining a positive identity, and self-awareness for self-management. CONCLUSIONS: In addition to those common to the general population, this study highlighted specific determinants of well-being: the construction of a positive identity through acceptance of the diagnosis, the importance of self-awareness and self-management. They are highly intertwined with those of personal recovery and could help caregivers design interventions that directly target these goals. This study aimed to identify specific components of well-being for people living with bipolar disorder. Understanding the determinants of well-being enable caregivers to design tailored interventions that directly target quality of life and help improve bipolar disorder outcomes.

The experience of caregivers providing therapeutic patient education for people living with bipolar disorder: a qualitative study.

BACKGROUND: Therapeutic patient education (TPE) programs are psycho-educational treatments suggested for all chronic diseases. For several years, these programs have been developing for people living with bipolar disorder. However, to date, only few qualitative studies have explored the experience of caregivers. We wanted to explore the experience of caregivers working in psychiatry as facilitators of a therapeutic education program for people living with bipolar disorder. METHOD: A single-center qualitative study was carried out. We conducted an inductive exploration, examining the content of the discourse produced in a focus group of eight caregivers in therapeutic education. The corpus was transcribed manually and a thematic analysis was conducted by two authors in a blinded fashion before combining. RESULTS: Four dimensions and twenty themes were identified: i) facilitators' pleasant experiences of the TPE sessions with a secure climate and a sense of belonging to a group, ii) being a TPE facilitator with a new horizontal and collaborative posture valuing the experiential knowledge, iii) the role of the TPE sessions with knowledge provision, empowerment and destigmatization, and iv) perceived changes in patients with an appeasement, the awareness of a shared experience, openness to others, a phenomenon of identification to peers and a new commitment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The observations noted overlap with the elements of the personal recovery well known CHIME framework (Connectedness, Hope, positive Identity, Meaning in life and Empowerment). Therapeutic education is a developing form of psychosocial rehabilitation care: through the mobilization of a new attitude of caring, the facilitation of TPE programs could be a lever for changing the posture of caregivers in favor of supporting the personal recovery of people with bipolar disorder. These results would need to be confirmed by further studies.

Patients' perspectives of the effects of a group-based therapeutic patient education program for bipolar disorder: a qualitative analysis.

BACKGROUND: Few qualitative studies have explored the impact of group-based psychoeducation programs from the perspective of patients with bipolar disorder, and no studies to date have examined the effects of such programs on patients' personal recovery. The aim of this study was to explore the effects of a group therapeutic education program on the personal recovery of people with bipolar disorder and its determinants. METHODS: Three professionals conducted semistructured interviews with 16 patients who participated in 9 weekly sessions of four separate bipolar therapeutic education programs. The interviews were transcribed verbatim and analyzed inductively by two of the professionals using the thematic analysis method. RESULTS: Three main themes emerged from the interviews: the elements of therapeutic education, the experience of therapeutic education and the changes facilitated by therapeutic education. The changes reported by the participants included the evolution of the patient's relationship with the disorder, improvement in the patient's knowledge of the disorder, improvement in disorder management throughout daily life in general, and development of psycho-social skills and social relationships. CONCLUSIONS: This study provides support for the beneficial impact of group therapeutic education programs on the personal recovery of people with bipolar disorder. These programs improve all dimensions of recovery according to the CHIME model, with connectedness, hope and empowerment being the main dimensions impacted. Our results indicate that therapeutic group education programs can be beneficial for people with bipolar disorder at any point during their experience of the disorder, with the potential exception of periods of thymic decompensation.

Regards croisés sur le confinement : personnes vivant avec des troubles psychiques, aidants familiaux et soignants.

AIMS: The study examines the experience of people living with mental disorders and their family during the spring 2020 confinement in France, as well as the care they received during this period. It also focuses on the experiences of caregivers and how they reorganized themselves during this same period. METHOD: Using both qualitative and quantitative methods, three surveys were conducted during the confinement. Data was collected through two online questionnaires and semi-direct individual interviews with service users, families, and caregivers. RESULTS: The responses to our questionnaires from 173 family members, 68 service users and 40 caregivers show that people suffering from mental disorders adapted well to the confinement. Compared to the general population, there was no instance of psychiatric over-morbidity. However, the families suffered more from psychological difficulties. The deployment of remote consultations, responsiveness and availability of professionals were helpful for users. On the other hand, rapid adaptation that caregivers had to undergo made them experience a sense of loss of the actual meaning of their work. Families suffered from the lack of availability of caregivers. CONCLUSION: The mental health of people suffering from mental disorders involved in this study was not impacted by the confinement. They made use of the various protective resources. The habit of having a solitary life and the knowledge of available resources may have played a favorable role. Peer support has been particularly supportive. Further studies are needed to evaluate the hypothesis of a "second psychiatric wave" due to the global pandemic.