Department of Psychiatry, Addis Ababa University, Ethiopia; School of Nursing and Midwifery, College of Health and medical Sciences, Haramaya University, Ethiopia.
Department of Psychiatry, Addis Ababa University, Ethiopia; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research, King's College London, UK.
Soc Sci Med. 2021 Feb;270:113625. doi: 10.1016/j.socscimed.2020.113625. Epub 2020 Dec 17.
Little is known about the specific experience people living with bipolar disorder in rural, low resource settings, where conditions that disrupt normal social interactions are often highly stigmatized and evidence-based treatments are rare.
To explore illness experience, coping strategies, help-seeking practices, and consequences of illness among people with bipolar disorder (PBD) and their family members in rural Ethiopia as an initial step for developing psychosocial intervention grounded by the experiences of PBD.
A qualitative methods using in-depth interviews were carried out with 27 individuals (15 PBD and 12 caregivers). The participants were identified on the basis of previous community-based research among people with severe mental illness. Interviews were carried out in Amharic, audio-recorded, transcribed, and translated into English. Data were analyzed using thematic analysis. Our approach was informed by phenomenological theory.
Three major themes emerged: expressions and experiences of illness, managing self and living with otherness, and the costs of affliction. PBD and caregivers were concerned by different forewarnings of illness. Stigma and social exclusion were entwined in a vicious cycle that shaped both illness experience and the economic health and social life of the household. Nonetheless, PBD and caregivers learned from their experiences, developed coping strategies, and sought relief from trusted relationships, spirituality, and medication.
Our findings suggest that psychosocial intervention could be used to strengthen existing resources, in order to improve the lives of PBD and their family members. However, pervasive stigma may be a barrier to group and peer support approaches.
对于生活在农村、资源匮乏环境中的双相情感障碍患者的具体经历，人们知之甚少，在这些环境中，扰乱正常社交互动的情况通常受到高度污名化，且很少有基于证据的治疗方法。
探索埃塞俄比亚农村地区双相情感障碍患者（PBD）及其家庭成员的疾病体验、应对策略、寻求帮助的行为以及疾病后果，作为开发基于 PBD 经验的心理社会干预措施的初步步骤。
采用定性方法，对 27 名个体（15 名 PBD 和 12 名照顾者）进行深入访谈。根据之前在严重精神疾病患者中进行的基于社区的研究，确定了这些参与者。访谈使用阿姆哈拉语进行，录音、转录并翻译成英文。使用主题分析进行数据分析。我们的方法受到现象学理论的启发。
出现了三个主要主题：疾病的表达和体验、自我管理和与他者共存、以及痛苦的代价。PBD 和照顾者对不同的疾病前兆感到担忧。污名化和社会排斥相互交织，形成了一个恶性循环，既影响了疾病体验，也影响了家庭的经济健康和社会生活。尽管如此，PBD 和照顾者从他们的经验中学习，发展应对策略，并从可信赖的关系、灵性和药物中寻求缓解。
我们的研究结果表明，心理社会干预可以用于加强现有资源，以改善 PBD 及其家庭成员的生活。然而，普遍存在的污名化可能是群体和同伴支持方法的障碍。
