Support for personal recovery concept in bipolar disorder

By Lucy Piper, Senior medwireNews Reporter

Researchers have found that “respect, hope, and self-empowerment” (RHSE) is a key psychosocial factor in the personal recovery of adults with bipolar disorder.

The concept of personal recovery, as opposed to clinical recovery, has received little attention in bipolar disorder, but researchers Samson Tse (University of Hong Kong, China) and colleagues believe it “may be useful if it facilitates service development and is incorporated into mental health policy and planning.”

It is based on four key stages of recovery, measured in the current study using the Stage of Recovery scale: overwhelmed by the disability (Stage 1); struggling with the disability (Stage 2); living with the disability (Stage 3); and living beyond the disability (Stage 4).

The team recruited 75 patients, aged an average of 45 years, with bipolar disorder in remission, of whom two (2.7%) were in Stage 1 of recovery, 12 (16.0%) were in Stage 2, 38 (50.7%) were in Stage 3, and 23 (30.7%) were in Stage 4.

RHSE, as measured on the Recovery Elements Assessment Questionnaire (REAQ), was the strongest factor on decision tree analyses to distinguish between the early and late stages of recovery. Specifically, patients with a score of 2.33 or above out of a possible 5 on the RHSE subscale were significantly more likely to be in Stage 1 of recovery, whereas those scoring below 2.33 were more likely to be in Stages 3 or 4.

This finding supports the need for healthcare professionals to support patients’ rights, interests, and culture and provide them with the opportunity to make informed choices to help them progress toward the later stages of recovery, say the researchers.

Being older was also a key factor, with participants aged 45 years or older more likely to be in Stage 3 of recovery, whereas younger patients were more likely to be in Stage 2.

Also, among the younger patients, those diagnosed before 22 years of age were significantly more likely to be in Stage 3, while those diagnosed at an older age were almost all in Stage 2.

Tse and colleagues note in Bipolar Disorders that none of the clinical variables, such as Hamilton Depression Rating Scale or Young Mania Rating Scale scores, predicted stage of recovery.

“This reinforces our proposition that the changes involved in personal recovery may differ from the factors related to clinical recovery,” they write.

The researchers believe that personal recovery could be improved by targeting certain interventions at the different stages. For instance, greater emphasis on emotional support and empathetic understanding may benefit patients in the early stages, whereas evidence-based information about optimal self-management strategies may help more during the later stages.

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