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Quality of Life Research

, Volume 27, Issue 6, pp 1493–1500 | Cite as

The ‘new normal’: relativity of quality of life judgments in individuals with bipolar disorder—a qualitative study

  • Emma Morton
  • Erin Michalak
  • Rachelle Hole
  • Simone Buzwell
  • Greg Murray
Article

Abstract

Purpose

Quality of life (QoL) is increasingly a target of interventions for bipolar disorders (BD). While the subjective experience of consumers is often elevated as central to the construct of QoL in BD, limited investigation in this area means subjective QoL remains poorly understood. The present qualitative study seeks to address this by investigating how people with BD appraise the quality of their lives in the context of a QoL self-management intervention.

Methods

Semi-structured interviews were conducted with 43 individuals who had participated in a self-management intervention for improving QoL in BD. Individuals were questioned about experiences of the intervention and perceptions of their QoL. Thematic analysis was used to explore participants’ appraisal of their QoL.

Results

An overarching theme concerned the intrinsic relativity of subjective QoL: individuals located QoL as relative to self, others and possible futures. Incorporating illness-related reference points for QoL (‘given my circumstances…’) was associated with perceptions of improved QoL. Deliberately modifying reference points for QoL was perceived as self-compassionate.

Conclusion

The present study generates novel hypotheses about how individuals with BD make sense of their QoL. Data suggest that individuals located their QoL relative to a variety of reference points, use of which was flexible. In accord with gap theories of QoL, individuals experienced acceptance of illness impacts as improving subjective sense of QoL. Rather than ‘settling for’ a lower standard of QoL, individuals experienced these changes as adaptive and positive. Findings are discussed in relation to the measurement and amelioration of QoL in BD.

Keywords

Bipolar disorder Psychiatric Recovery model Response shift Quality of life Qualitative 

Abbreviations

QoL

Quality of life

BD

Bipolar disorder

Notes

Funding

This study was funded by the Canadian Institute of Health Research Knowledge to Action Grant.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Murray, G., & Michalak, E. E. (2012). The quality of life construct in bipolar disorder research and practice: Past, present, and possible futures. Bipolar Disorders, 14(8), 793–796.CrossRefPubMedGoogle Scholar
  2. 2.
    Morton, E., Michalak, E. E., & Murray, G. (2017). What does quality of life refer to in bipolar disorders research? A systematic review of the construct’s definition, usage and measurement. Journal of Affective Disorders, 212, 128–137.CrossRefPubMedGoogle Scholar
  3. 3.
    Ware, J. E. (1995). The status of health assessment. Annual Review of Public Health, 16, 327–354.CrossRefPubMedGoogle Scholar
  4. 4.
    Gitlin, M. J., & Miklowitz, D. J. (2017). The difficult lives of individuals with bipolar disorder: A review of functional outcomes and their implications for treatment. Journal of Affective Disorders, 209, 147–154.CrossRefPubMedGoogle Scholar
  5. 5.
    Sachs, G. S., & Rush, A. J. (2003). Response, remission, and recovery in bipolar disorders: What are the realistic treatment goals? Journal of Clinical Psychiatry, 64(Suppl 6), 18–22.PubMedGoogle Scholar
  6. 6.
    McIntyre, R. S. (2009). Understanding needs, interactions, treatment, and expectations among individuals affected by bipolar disorder or schizophrenia: The UNITE global survey. Journal of Clinical Psychiatry, 70(Suppl 3), 5–11.CrossRefPubMedGoogle Scholar
  7. 7.
    Eiring, Ø, Nylenna, M., & Nytrøen, K. (2016). Patient-important outcomes in the long-term treatment of bipolar disorder: A mixed-methods approach investigating relative preferences and a proposed taxonomy. Patient, 9(2), 91–102.CrossRefPubMedGoogle Scholar
  8. 8.
    Haarig, F., Berndt, C., Kühnert, M., Fuchs, S., Bräunig, P., & Mühlig, S. (2016). What is important to patients? Determination of patient-centered therapeutic goals in the treatment of bipolar disorders. Zeitschrift fur Psychiatrie, Psychologie und Psychotherapie, 64(2), 111–120.CrossRefGoogle Scholar
  9. 9.
    Maczka, G., Siwek, M., Skalski, M., & Dudek, D. (2009). Patients’ and doctors’ attitudes towards bipolar disorder—Do we share our beliefs? Psychiatria Polska, 43(3), 301–312.PubMedGoogle Scholar
  10. 10.
    Sajatovic, M., Jenkins, J. H., Cassidy, K. A., & Muzina, D. J. (2009). Medication treatment perceptions, concerns and expectations among depressed individuals with type I bipolar disorder. Journal of Affective Disorders, 115(3), 360–366.CrossRefPubMedGoogle Scholar
  11. 11.
    Michalak, E. E., Hole, R., Livingston, J. D., Murray, G., Parikh, S. V., Lapsley, S., & McBride, S. (2012). Improving care and wellness in bipolar disorder: Origins, evolution and future directions of a collaborative knowledge exchange network. International Journal of Mental Health Systems.  https://doi.org/10.1186/1752-4458-6-16.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Murray, G., Leitan, N. D., Thomas, N., Michalak, E. E., Johnson, S. L., Jones, S., et al. (2017). Towards recovery-oriented psychosocial interventions for bipolar disorder: Quality of life outcomes, stage-sensitive treatments, and mindfulness mechanisms. Clinical Psychology Review, 52, 148–163.CrossRefPubMedGoogle Scholar
  13. 13.
    Michalak, E. E., Yatham, L. N., Kolesar, S., & Lam, R. W. (2006). Bipolar disorder and quality of life: A patient-centered perspective. Quality of Life Research, 15(1), 25–37.CrossRefPubMedGoogle Scholar
  14. 14.
    Michalak, E. E., & Murray, G. (2010). Development of the QoL.BD: A disorder-specific scale to assess quality of life in bipolar disorder. Bipolar Disorders, 12(7), 727–740.CrossRefPubMedGoogle Scholar
  15. 15.
    Michalak, E. E., Morton, E. M., Barnes, S. J., Hole, R., CREST.BD, & Murray, G. (2018). If you build it, will they come? A mixed-methods study of online knowledge translation strategies for bipolar disorder (in preparation)Google Scholar
  16. 16.
    Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing and Health Sciences, 15, 398–405.CrossRefPubMedGoogle Scholar
  17. 17.
    Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd edn.). Thousand Oaks, CA: SAGE.Google Scholar
  18. 18.
    Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.CrossRefGoogle Scholar
  19. 19.
    Calman, K. C. (1984). Quality of life in cancer patients—An hypothesis. Journal of Medical Ethics, 10(3), 124–127.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Michalos, A. C. (1985). Multiple discrepancies theory (MDT). Social Indicators Research, 16(4), 347–413.CrossRefGoogle Scholar
  21. 21.
    Rapkin, B. D., & Schwartz, C. E. (2004). Toward a theoretical model of quality-of-life appraisal: Implications of findings from studies of response shift. Health and Quality of Life Outcomes, 2(1), 14.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Evans, S., & Huxley, P. (2005). Adaptation, response-shift and quality of life ratings in mentally well and unwell groups. Quality of Life Research, 14(7), 1719–1732.CrossRefPubMedGoogle Scholar
  23. 23.
    Mechanic, D. (2006). Organisation of care and quality of life of persons with serious and persistent mental illness. In H. Katschnig, H. Freeman & N. Sartorius (Eds.), Quality of life in mental disorders (2nd edn., pp. 309–320). Chichester: Wiley.Google Scholar
  24. 24.
    Katschnig, H. (2006). How useful is the concept of quality of life in psychiatry? In H. Katschnig, H. Freeman & N. Sartorius (Eds.), Quality of life in mental disorders (2nd edn., pp. 3–17). Chichester: Wiley.Google Scholar
  25. 25.
    Fayers, P. M., & Machin, D. (2016). Quality of life: The assessment, analysis and reporting of patient-reported outcomes (3rd edn.). Chichester: Wiley.Google Scholar
  26. 26.
    Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.Google Scholar
  27. 27.
    Dowd, E. T., & Pace, T. M. (1989). The relativity of reality. In A. Freeman, K. M. Simon, L. E. Beutler & H. Arkowitz (Eds.), Comprehensive handbook of cognitive therapy (pp. 213–226). Boston: Springer.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of HealthArts and Design Swinburne UniversityMelbourneAustralia
  2. 2.Division of Mood Disorders, Department of PsychiatryUniversity of British ColumbiaVancouverCanada
  3. 3.School of Social WorkUniversity of British Columbia OkanaganKelownaCanada
  4. 4.Department of Psychological SciencesSwinburne University of TechnologyHawthornAustralia

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