Michalak Erin E, Suto Melinda J, Barnes Steven J, Hou Sharon, Lapsley Sara, Scott Mike W, Murray Greg, Austin Jehannine, Elliott Nusha Balram, Berk Lesley
Department of Psychiatry, University of British Columbia, Canada.
Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada.
J Affect Disord. 2016 Dec;206:77-86. doi: 10.1016/j.jad.2016.06.057. Epub 2016 Jul 11.
Self-management represents an important complement to psychosocial treatments for bipolar disorder (BD), but research is limited. Specifically, little is known about self-management approaches for elevated mood states; this study investigated self-management strategies for: (1) maintaining balance in mood, and (2) stopping progression into hypomania/mania.
To identify the common components of BD self-management, Delphi Consensus Consultation methods were combined with a Community-Based Participatory Research (CBPR) approach across five study phases: (1) Qualitative dataset content analysis; (2) Academic/grey literature reviews; (3) Content analysis; (4) Two Delphi rounds (rating strategies on a 5-point Likert scale, Very Unhelpful-Very Helpful), and; (5) Quantitative analysis and interpretation. Participants were people with BD and healthcare providers.
Phases 1 and 2 identified 262 and 3940 candidate strategies, respectively; 3709 were discarded as duplicates/unintelligible. The remaining 493 were assessed via Delphi methods in Phase 4: 101 people with BD and 52 healthcare providers participated in Round 1; 83 of the BD panel (82%) and 43 of the healthcare provider panel (83%) participated in Round 2-exploratory factor analysis (EFA) was conducted on Round 2 results.
EFA was underpowered and sample was not ethnically diverse, limiting generalizability.
High concordance was observed in ratings of strategy effectiveness between the two panels. Future research could usefully investigate the provisional discovery here of underlying factors which link individual strategies. For example, 'maintaining hope' underpinned strategies for maintaining balance, and 'decreasing use of stimulants' underpinned strategies to interrupt hypo/manic ascent. There is merit in combining CBPR and Delphi methods.
自我管理是双相情感障碍（BD）心理社会治疗的重要补充，但相关研究有限。具体而言，对于情绪高涨状态的自我管理方法知之甚少；本研究调查了以下自我管理策略：（1）保持情绪平衡，以及（2）阻止病情发展为轻躁狂/躁狂。
为确定双相情感障碍自我管理的共同要素，将德尔菲共识咨询方法与基于社区的参与性研究（CBPR）方法相结合，分为五个研究阶段：（1）定性数据集内容分析；（2）学术文献/灰色文献综述；（3）内容分析；（4）两轮德尔菲法（使用5点李克特量表对策略进行评分，从非常无用到非常有用），以及；（5）定量分析与解读。参与者为双相情感障碍患者和医疗服务提供者。
第1阶段和第2阶段分别确定了262个和3940个候选策略；3709个因重复/难以理解而被剔除。其余493个在第4阶段通过德尔菲法进行评估：101名双相情感障碍患者和52名医疗服务提供者参与了第1轮；双相情感障碍小组的83人（占82%）和医疗服务提供者小组的43人（占83%）参与了第2轮——对第2轮结果进行了探索性因素分析（EFA）。
探索性因素分析的效能不足，且样本缺乏种族多样性，限制了研究结果的普遍性。
两个小组在策略有效性评分上观察到高度一致性。未来的研究可以有益地调查此处临时发现的将各个策略联系起来的潜在因素。例如，“保持希望”是保持平衡策略的基础，“减少使用兴奋剂”是中断轻躁狂/躁狂发作上升策略的基础。将基于社区的参与性研究方法和德尔菲法相结合是有价值的。
