Recovery beyond clinical improvement - Recovery outcomes measured for people with bipolar disorder between 1980 and 2020

Barbara Mezes; Fiona Lobban; Deborah Costain; Laura Hillier; Damien Longson; Filippo Varese; Steven H Jones

doi:10.1016/j.jad.2022.04.075

Recovery beyond clinical improvement - Recovery outcomes measured for people with bipolar disorder between 1980 and 2020

J Affect Disord. 2022 Jul 15:309:375-392. doi: 10.1016/j.jad.2022.04.075. Epub 2022 Apr 22.

Authors

Barbara Mezes¹, Fiona Lobban², Deborah Costain³, Laura Hillier², Damien Longson⁴, Filippo Varese⁵, Steven H Jones²

Affiliations

¹ Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK; Centre of Resilience for Social Justice, School of Sport and Health Sciences, University of Brighton, Brighton, UK. Electronic address: b.mezes@brighton.ac.uk.
² Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK.
³ Department of Mathematics and Statistics, Lancaster University, Lancaster, UK.
⁴ Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
⁵ Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, the University of Manchester, Manchester, UK.

PMID: 35469910
DOI: 10.1016/j.jad.2022.04.075

Abstract

Background: Outcome measurement in bipolar disorder (BD) traditionally focused on clinical improvement without considering other domains. Improvement trajectories in clinical and social-functional domains are different and can simultaneously appear in one while not in other domains. Measuring personal recovery (PR) has become a priority internationally. This review explored the shift in research investigating operational recovery definitions and underpinning factors of recovery in BD over the past four decades.

Methods: Studies defining recovery domains (other than clinical recovery) in BD were systematically reviewed; operational recovery definitions and factors assessed in association with recovery were thematically categorised and integrated in a narrative synthesis.

Results: Thirty-three studies, comprising 3638 participants from 19 countries were included. Identified operational recovery definition themes included i) PR ii) social-functional (SFR), and iii) occupational-residential (ORR) recovery. Examined factors were grouped as demographic, clinical and psychosocial factors. Predominantly demographic factors were linked to ORR and clinical factors to SFR. Depressive symptomatology was the only clinical factor associated with PR. Research investigating psychosocial factors in PR is emerging and has showed that resilience and appraisals of mood seem to be associated with PR.

Limitations: Studies not available in English or examining functioning without defining recovery were excluded.

Conclusions: Earlier operational recovery definitions of ORR and SFR were often arbitrary and inconsistent, and predominantly focused on clinical and demographic underpinning factors. While research attempts to follow the significant policy shifts towards personalised care by measuring what matters to individuals and exploring broader underpinning psychosocial factors, it is still lagging behind.

Keywords: Bipolar disorder; Functional recovery; Occupational recovery; Personal recovery; Social recovery.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Affect
Bipolar Disorder* / diagnosis
Bipolar Disorder* / psychology
Humans