Oedegaard Christine H, Berk Lesley, Berk Michael, Youngstrom Eric A, Dilsaver Steven C, Belmaker Robert H, Oedegaard Ketil J, Fasmer Ole B, Engebretsen Ingunn M
Global Mental Health Research Group (GMHRG), Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Norway.
IMPACT Strategic Research Centre, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.
Aust N Z J Psychiatry. 2016 Nov;50(11):1096-1103. doi: 10.1177/0004867416668790. Epub 2016 Oct 14.
Clinical management of bipolar disorder patients might be affected by culture and is further dependent on the context of healthcare delivery. There is a need to understand how healthcare best can be delivered in various systems and cultures. The objective of this qualitative study was to gain knowledge about culture-specific values, beliefs and practices in the medical care provided to patients with bipolar disorders from a provider perspective in various areas of the world.
The International Society for Bipolar Disorders (ISBD) network provided the framework for this qualitative study. An electronic interview with open-ended questions was administered to 19 international experts on bipolar spectrum disorder representing the International Society for Bipolar Disorders chapter network in 16 countries and six continents. In addition, there were two in-depth interviews with bipolar spectrum disorder experts done prior to the survey. The data were analysed using content analysis, and the information was structured using the software NVivo by QSR International Pty Ltd.
All participants described sociocultural factors as important in healthcare delivery to bipolar patients in their part of the world, both in accessing healthcare and in providing culturally appropriate care. Factors that affected the provider's ability to supply good clinical management of patients were access to treatment options and long-term follow-up, as well as general strategies to combat stigma. In some societies, the patients' use of alternative treatments, gender issues and religion were also important factors. Understanding the impact of such culturally specific factors was overall regarded as essential for proper treatment interventions.
Sociocultural factors clearly affect the nature and quality of medical services delivered to bipolar patients. Financial, social and cultural factors affect patients' health-seeking behaviour, and this highlights the need for knowledge about such factors in order to adequately identify and treat bipolar patients globally. Culturally adapted training and psychoeducation programmes are particularly warranted.
双相情感障碍患者的临床管理可能会受到文化的影响，并且进一步取决于医疗服务的背景。有必要了解在各种系统和文化中如何最好地提供医疗服务。这项定性研究的目的是从世界不同地区提供者的角度，了解在为双相情感障碍患者提供的医疗服务中特定文化的价值观、信仰和实践。
国际双相情感障碍协会（ISBD）网络为这项定性研究提供了框架。对代表国际双相情感障碍协会在16个国家和六大洲的分会网络的19位双相谱障碍国际专家进行了开放式电子访谈。此外，在调查之前对双相谱障碍专家进行了两次深入访谈。使用内容分析法对数据进行分析，并使用QSR国际私人有限公司的NVivo软件对信息进行整理。
所有参与者都将社会文化因素描述为在其所在地区为双相情感障碍患者提供医疗服务时的重要因素，无论是在获得医疗服务还是提供符合文化背景适宜的护理方面。影响提供者对患者进行良好临床管理能力的因素包括获得治疗选择和长期随访，以及消除污名的总体策略。在一些社会中，患者使用替代疗法、性别问题和宗教也是重要因素。总体而言，了解这些特定文化因素的影响被认为是进行适当治疗干预的关键。
社会文化因素显然会影响为双相情感障碍患者提供的医疗服务的性质和质量。经济、社会和文化因素会影响患者的求医行为，这凸显了了解这些因素的必要性，以便在全球范围内充分识别和治疗双相情感障碍患者。特别需要开展适应文化的培训和心理教育项目。
