双相情感障碍中的重要经历：一项运用能力、舒适和平静框架的定性研究
Experiences that matter in bipolar disorder: a qualitative study using the capability, comfort and calm framework.
作者信息
Siegel-Ramsay J E, Sharp S J, Ulack C J, Chiang K S, Lanza di Scalea T, O'Hara S, Carberry K, Strakowski S M, Suarez J, Teisberg E, Wallace S, Almeida J R C
机构信息
Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
出版信息
Int J Bipolar Disord. 2023 Apr 20;11(1):13. doi: 10.1186/s40345-023-00293-9.
BACKGROUND
When assessing the value of an intervention in bipolar disorder, researchers and clinicians often focus on metrics that quantify improvements to core diagnostic symptoms (e.g., mania). Providers often overlook or misunderstand the impact of treatment on life quality and function. We wanted to better characterize the shared experiences and obstacles of bipolar disorder within the United States from the patient's perspective.
METHODS
We recruited 24 individuals diagnosed with bipolar disorder and six caretakers supporting someone with the condition. Participants were involved in treatment or support services for bipolar disorder in central Texas. As part of this qualitative study, participants discussed their everyday successes and obstacles related to living with bipolar disorder during personalized, open-ended interviews. Audio files were transcribed, and Nvivo software processed an initial thematic analysis. We then categorized themes into bipolar disorder-related obstacles that limit the patient's capability (i.e., function), comfort (i.e., relief from suffering) and calm (i.e., life disruption) (Liu et al., FebClin Orthop 475:315-317, 2017; Teisberg et al., MayAcad Med 95:682-685, 2020). We then discuss themes and suggest practical strategies that might improve the value of care for patients and their families.
RESULTS
Issues regarding capability included the struggle to maintain identity, disruptions to meaningful employment, relationship loss and the unpredictable nature of bipolar disorder. Comfort related themes included the personal perception of diagnosis, social stigma and medication issues. Calm themes included managing dismissive doctors, finding the right psychotherapist and navigating financial burdens.
CONCLUSIONS
Qualitative data from patients with bipolar disorder helps identify gaps in care or practical limitations to treatment. When we listen to these individuals, it is clear that treatments must also address the unmet psychosocial impacts of the condition to improve patient care, capability and calm.
背景
在评估双相情感障碍干预措施的价值时，研究人员和临床医生通常关注量化核心诊断症状（如躁狂）改善情况的指标。医疗服务提供者往往忽视或误解治疗对生活质量和功能的影响。我们希望从患者角度更好地描述美国双相情感障碍患者的共同经历和障碍。
方法
我们招募了24名被诊断为双相情感障碍的个体以及6名照顾双相情感障碍患者的看护者。参与者均参与了得克萨斯州中部针对双相情感障碍的治疗或支持服务。作为这项定性研究的一部分，参与者在个性化的开放式访谈中讨论了他们在日常生活中与双相情感障碍共处的成功经历和障碍。音频文件被转录，Nvivo软件进行了初步的主题分析。然后，我们将主题分类为与双相情感障碍相关的障碍，这些障碍限制了患者的能力（即功能）、舒适度（即减轻痛苦）和平静感（即生活干扰）（Liu等人，《FebClin Orthop》475:315 - 317，2017年；Teisberg等人，《MayAcad Med》95:682 - 685，2020年）。然后，我们讨论这些主题，并提出可能提高患者及其家庭护理价值的实用策略。
结果
与能力相关的问题包括难以维持身份认同、有意义的工作受到干扰、人际关系丧失以及双相情感障碍的不可预测性。与舒适度相关的主题包括对诊断的个人认知、社会污名和药物问题。与平静感相关的主题包括应对轻视患者的医生、找到合适的心理治疗师以及应对经济负担。
结论
双相情感障碍患者的定性数据有助于识别护理方面的差距或治疗的实际限制。当我们倾听这些个体的声音时，很明显治疗还必须解决该疾病未得到满足的心理社会影响，以改善患者护理、能力和平静感。
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