Monday, June 23, 2014

Social Support and Bipolar Disorder

The following is an excerpt from the book, Preventing Bipolar Relapse (New Harbinger, 2014)

Several studies have shown that social support from friends and family is important to preventing bipolar disorder. Studies seem to be biased towards the impact of social support on depression, probably because people with mania are less likely to seek help. The onset of symptoms can be accompanied by social behaviors such as irritability, anxiety and anger that impact social relationships and negative social relationships can exacerbate or trigger mood changes creating a downward spiral. Some studies of the link between social support and bipolar disorder is discussed below to demonstrate the evidence for making a case for seeking and maintaining a social support network that will improve your overall mental health and prevent and reduce the impact of symptoms of both mania and depression.

A study of social support and social strain (Eidelman et al, 2012) compared people living with bipolar disorder and people without a mental illness (control group) for 28 days using journals. The bipolar disorder group had lower measures of social support and more social strain that the control group. Manic and depressive symptoms in the bipolar disorder group were increased the more social strain they experienced. Social support was also associated with more stable sleep in people living with bipolar disorder.

Another study of social support and mood symptoms (Pratchett, 2010) among high-functioning people living with bipolar disorder showed that lower levels of perceived social social support was related to more severe symptoms of lower mood and higher mood, and to persistence of these symptoms 6 months later, regardless of age, marital status, income or gender.

Unsupportive social networks have also been found to increase the likelihood of medication non-adherence (Sajatovic et al., 2011). A study of unipolar and bipolar disorders found differences in the functioning of social networks between the two groups but found that stabilizing supportive relationships should be a goal of psychotherapy because both groups had minimal social networks and relied on one primary person for all their social support (Poradowska-Trosz, Dudek, Rogoz and Zieba, 2009).

Self-esteem has also been shown to be a mediating factor through which social support is expressed. This means that people with higher self-esteem are more likely to seek out social support and to have more friends. It also means that people with higher self-esteem are more open to the social support that a strong network of friends provide.

For adolescents with bipolar disorder it appears that family relationships are important to onset and continuation of symptoms (Sullivan et al, 2012). Family conflict, adaptability and lack of cohesion are predictors of adolescent mood symptoms. The authors suggest that family conflict be a focus of psychosocial intervention in early onset bipolar disorder.

Eidelman, Polina, Anda Gershon, Katherine Kaplan, Eleanor McGlinchey, and Allison G Harvey, "Social support and social strain in inter-episode bipolar disorder." Bipolar Disorders 14 (2012): 628-640.
Poradowska-Trzos, Magdalena, Dominika Dudek, Monika Rogoż, and Andrzej Zięba, "The comparison of social networks of patients with unipolar and bipolar affective disorder." Archives Of Psychiatry & Psychotherapy 11 (2009): 43-50. 
Pratchett, Laura.  "Social support in bipolar disorder: The relationship between social support and mood symptoms." US: ProQuest Information & Learning, 2010.
Sajatovic, M., M. Valenstein and F. Blow, “Treatment adherence with antipsychotic medications in bipolar disorder”, Bipolar Disorders 8 (2006): 232 – 241.
Sullivan, A. E., C. M. Judd, D. A. Axelson, and D. J. Miklowitz, “Family functioning and the course of adolescent bipolar disorder”, Behavior Therapy, 43 (2012): 837-847.